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Sample records for respiratory hospital admissions

  1. Effects of diurnal temperature range on cardiovascular and respiratory hospital admissions in Korea.

    PubMed

    Lim, Youn-Hee; Hong, Yun-Chul; Kim, Ho

    2012-02-15

    The effects of heat and cold waves have been studied as risk factors for cardiovascular and respiratory diseases. However, few studies have examined the effect of diurnal temperature changes on health. We hypothesized that the diurnal temperature range (DTR) may affect the rate of hospital admissions for cardiovascular- and respiratory-related diseases, and therefore investigated the risk of hospital admissions of cardiovascular (stroke, myocardial infarction, ischemic heart disease, cardiac failure, cardiac disease, and arrhythmia) and respiratory (asthma, chronic obstructive pulmonary disease, and pneumonia) diseases attributable to DTR in four metropolitan areas in Korea during 2003-2006. The area-combined effects of DTR on some cardiovascular and respiratory diseases were significantly increased by an increment of DTR. In particular, the effects on cardiac failure and asthma were significant with the percentage change of hospital admissions per 1 °C increment of DTR at 3.0% (95% CI, 1.4-4.6) and 1.1% (95% CI, 0.1-2.0), respectively, among 9 diseases. For those 75 years and older, the DTR effect on asthma admissions was greater than in those aged under 75 years. These results support the hypothesis of a positive association between DTR and cardiovascular and respiratory hospital admission. PMID:22281041

  2. Air pollution and hospital admissions for respiratory conditions in Rome, Italy.

    PubMed

    Fusco, D; Forastiere, F; Michelozzi, P; Spadea, T; Ostro, B; Arcà, M; Perucci, C A

    2001-06-01

    Most of the evidence regarding the association between particulate air pollution and emergency room visits or hospital admissions for respiratory conditions and asthma comes from the USA. European time-series analyses have suggested that gaseous air pollutants are important determinants of acute hospitalization for respiratory conditions, at least as important as particulate mass. The association between daily mean levels of suspended particles and gaseous pollutants (sulphur dioxide, nitrogen dioxide, carbon monoxide, ozone) was examined. The daily emergency hospital admissions for respiratory conditions in the metropolitan area of Rome during 1995-1997 were also recorded. Daily counts of hospital admissions for total respiratory conditions (43 admissions day(-1)), acute respiratory infections including pneumonia (18 day(-1)), chronic obstructive pulmonary disease (COPD) (13 day(-1)), and asthma (4.5 day(-1)) among residents of all ages and among children (0-14 yrs) were analysed. The generalized additive models included spline smooth functions of the day of study, mean temperature, mean humidity, influenza epidemics, and indicator variables for day of the week and holidays. Total respiratory admissions were significantly associated with same-day level of NO2 (2.5% increase per interquartile range (IQR) change, 22.3 microg x m(-3)) and CO (2.8% increase per IQR, 1.5 mg x m(-3)). No effect was found for particulate matter and SO2, whereas O3 was associated with admissions only among children (lag 1, 5.5% increase per IQR, 23.9 microg x m3). The effect of NO2 was stronger on acute respiratory infections (lag 0, 4.0% increase) and on asthma among children (lag 1, 10.7% increase). The admissions for all ages for asthma and COPD were associated only with same-day level of CO (5.5% and 4.3% increase, respectively). Multipollutant models confirmed the role of CO on all respiratory admissions, including asthma and COPD, and that of NO2 on acute respiratory infections

  3. Qualitative critical incident study of patients’ experiences leading to emergency hospital admission with advanced respiratory illness

    PubMed Central

    Karasouli, Eleni; Munday, Daniel; Bailey, Cara; Staniszewska, Sophie; Hewison, Alistair; Griffiths, Frances

    2016-01-01

    Objectives The high volume of emergency admissions to hospital is a challenge for health systems internationally. Patients with lung cancer and chronic obstructive pulmonary disease (COPD) are frequently admitted to hospital as emergency cases. While the frequency of emergency admission has been investigated, few studies report patient experiences, particularly in relation to the decision-making process prior to emergency admission. We sought to explore patient and carer experiences and those of their healthcare professionals in the period leading up to emergency admission to hospital. Setting 3 UK hospitals located in different urban and rural settings. Design Qualitative critical incident study. Participants 24 patients with advanced lung cancer and 15 with advanced COPD admitted to hospital as emergencies, 20 of their carers and 50 of the health professionals involved in the patients’ care. Results The analysis of patient, carer and professionals’ interviews revealed a detailed picture of the complex processes involved leading to emergency admission to hospital. 3 phases were apparent in this period: self-management of deteriorating symptoms, negotiated decision-making and letting go. These were dynamic processes, characterised by an often rapidly changing clinical condition, uncertainty and anxiety. Patients considered their options drawing on experience, current and earlier advice. Patients tried to avoid admission, reluctantly accepting it, albeit often with a sense of relief, as anxiety increased with worsening symptoms. Conclusions Patients with advanced respiratory illness, and their carers, try to avoid emergency admission, and use logical and complex decision-making before reluctantly accepting it. Clinicians and policy-makers need to understand this complex process when considering how to reduce emergency hospital admissions rather than focusing on identifying and labelling admissions as ‘inappropriate’. PMID:26916687

  4. Respiratory hospital admissions associated with PM10 pollution in Utah, Salt Lake, and Cache Valleys

    SciTech Connect

    Pope CA, I.I.I. )

    1991-03-01

    This study assessed the association between respiratory hospital admissions and PM10 pollution in Utah, Salt Lake, and Cache valleys during April 1985 through March 1989. Utah and Salt Lake valleys had high levels of PM10 pollution that violated both the annual and 24-h standards issued by the Environmental Protection Agency (EPA). Much lower PM10 levels occurred in the Cache Valley. Utah Valley experienced the intermittent operation of its primary source of PM10 pollution: an integrated steel mill. Bronchitis and asthma admissions for preschool-age children were approximately twice as frequent in Utah Valley when the steel mill was operating versus when it was not. Similar differences were not observed in Salt Lake or Cache valleys. Even though Cache Valley had higher smoking rates and lower temperatures in winter than did Utah Valley, per capita bronchitis and asthma admissions for all ages were approximately twice as high in Utah Valley. During the period when the steel mill was closed, differences in per capita admissions between Utah and Cache valleys narrowed considerably. Regression analysis also demonstrated a statistical association between respiratory hospital admissions and PM10 pollution. The results suggest that PM10 pollution plays a role in the incidence and severity of respiratory disease.

  5. Proximity to coke works and hospital admissions for respiratory and cardiovascular disease in England and Wales

    PubMed Central

    Aylin, P; Bottle, A; Wakefield, J; Jarup, L; Elliott, P

    2001-01-01

    BACKGROUND—The incidence of hospital admissions for respiratory and cardiovascular diseases in areas close to operating coke works in England and Wales was investigated.
METHODS—A small area study using distance from source as a proxy for exposure was undertaken in subjects aged 65 or over and children under 5 years within 7.5 km of four coke works (1991 estimated populations 87 760 and 43 932, respectively). The main outcome measures were emergency hospital admissions in 1992/3-1994/5 with a primary diagnosis of coronary heart disease (ICD 410-414), stroke (ICD 431-438), all respiratory diseases (ICD 460-519), chronic obstructive pulmonary disease (ICD 491-492), and asthma (ICD 493) in those aged 65 or over, and all respiratory and asthma admissions in children under 5 years of age.
RESULTS—At age 65 or over the combined estimate of relative risk with proximity to coke works (per km) ranged from 0.99 (95% CI 0.90to 1.09) for chronic obstructive pulmonary disease to 1.03 (95% CI 0.94 to 1.13) for asthma. For children under 5 years the combined estimate of risk was 1.08 (95% CI 0.98 to 1.20) for all respiratory disease and 1.07 (95% CI 0.98 to 1.18) for asthma. There was evidence of significant heterogeneity in risk estimates between coke work groups, especially in children under 5 years (p<0.001 and p=0.004 for respiratory disease and asthma, respectively). For the Teesside coke works in North East England the relative risk with proximity (per km) was 1.09 (95% CI 1.06 to 1.12) for respiratory disease and 1.09 (95% CI 1.04 to 1.15) for asthma.
CONCLUSIONS—No evidence overall was found for an association between hospital admissions and living near operational coke works in England and Wales. Trends of a higher risk of hospital admission for respiratory disease and asthma among children with proximity to the Teesside plant require further investigation.

 PMID:11182017

  6. Ambient biomass smoke and cardio-respiratory hospital admissions in Darwin, Australia

    PubMed Central

    Johnston, Fay H; Bailie, Ross S; Pilotto, Louis S; Hanigan, Ivan C

    2007-01-01

    Background Increasing severe vegetation fires worldwide has been attributed to both global environmental change and land management practices. However there is little evidence concerning the population health effects of outdoor air pollution derived from biomass fires. Frequent seasonal bushfires near Darwin, Australia provide an opportunity to examine this issue. We examined the relationship between atmospheric particle loadings <10 microns in diameter (PM10), and emergency hospital admissions for cardio-respiratory conditions over the three fire seasons of 2000, 2004 and 2005. In addition we examined the differential impacts on Indigenous Australians, a high risk population subgroup. Methods We conducted a case-crossover analysis of emergency hospital admissions with principal ICD10 diagnosis codes J00–J99 and I00–I99. Conditional logistic regression models were used to calculate odds ratios for admission with 10 μg/m3 rises in PM10. These were adjusted for weekly influenza rates, same day mean temperature and humidity, the mean temperature and humidity of the previous three days, days with rainfall > 5 mm, public holidays and holiday periods. Results PM10 ranged from 6.4 – 70.0 μg/m3 (mean 19.1). 2466 admissions were examined of which 23% were for Indigenous people. There was a positive relationship between PM10 and admissions for all respiratory conditions (OR 1.08 95%CI 0.98–1.18) with a larger magnitude in the Indigenous subpopulation (OR1.17 95% CI 0.98–1.40). While there was no relationship between PM10 and cardiovascular admissions overall, there was a positive association with ischaemic heart disease in Indigenous people, greatest at a lag of 3 days (OR 1.71 95%CI 1.14–2.55). Conclusion PM10 derived from vegetation fires was predominantly associated with respiratory rather than cardiovascular admissions. This outcome is consistent with the few available studies of ambient biomass smoke pollution. Indigenous people appear to be at higher risk

  7. Pneumonia and influenza, and respiratory and circulatory hospital admissions in Belgium: a retrospective database study

    PubMed Central

    2014-01-01

    Background Influenza infections can lead to viral pneumonia, upper respiratory tract infection or facilitate co-infection by other pathogens. Influenza is associated with the exacerbation of chronic conditions like diabetes and cardiovascular disease and consequently, these result in acute hospitalizations. This study estimated the number, proportions and costs from a payer perspective of hospital admissions related to severe acute respiratory infections. Methods We analyzed retrospectively, a database of all acute inpatient stays from a non-random sample of eleven hospitals using the Belgian Minimal Hospital Summary Data. Codes from the International Classification of Diseases, Ninth Revision, Clinical Modification was used to identify and diagnose cases of pneumonia and influenza (PI), respiratory and circulatory (RC), and the related complications. Results During 2002–2007, we estimated relative hospital admission rates of 1.69% (20960/1237517) and 21.79% (269634/1237517) due to primary PI and RC, respectively. The highest numbers of hospital admissions with primary diagnosis as PI were reported for the elderly patient group (n = 10184) followed by for children below five years of age (n = 3451). Of the total primary PI and RC hospital admissions, 56.14% (11768/20960) and 63.48% (171172/269634) of cases had at least one possible influenza-related complication with the highest incidence of complications reported for the elderly patient group. Overall mortality rate in patients with PI and RC were 9.25% (1938/20960) and 5.51% (14859/269634), respectively. Average lengths of hospital stay for PI was 11.6 ± 12.3 days whereas for RC it was 9.1 ± 12.7 days. Annual average costs were 20.2 and 274.6 million Euros for PI and RC hospitalizations. Average cost per hospitalization for PI and RC were 5779 and 6111 Euros (2007), respectively. These costs increased with the presence of complications (PI: 7159, RC: 7549 Euros). Conclusion The clinical and

  8. The relationship of respiratory and cardiovascular hospital admissions to the southern California wildfires of 2003

    PubMed Central

    Delfino, R J; Brummel, S; Wu, J; Stern, H; Ostro, B; Lipsett, M; Winer, A; Street, D H; Zhang, L; Tjoa, T; Gillen, D L

    2014-01-01

    Objective There is limited information on the public health impact of wildfires. The relationship of cardiorespiratory hospital admissions (n = 40 856) to wildfire-related particulate matter (PM2.5) during catastrophic wildfires in southern California in October 2003 was evaluated. Methods Zip code level PM2.5 concentrations were estimated using spatial interpolations from measured PM2.5, light extinction, meteorological conditions, and smoke information from MODIS satellite images at 250 m resolution. Generalised estimating equations for Poisson data were used to assess the relationship between daily admissions and PM2.5, adjusted for weather, fungal spores (associated with asthma), weekend, zip code-level population and sociodemographics. Results Associations of 2-day average PM2.5 with respiratory admissions were stronger during than before or after the fires. Average increases of 70 μg/m3 PM2.5 during heavy smoke conditions compared with PM2.5 in the pre-wildfire period were associated with 34% increases in asthma admissions. The strongest wildfire-related PM2.5 associations were for people ages 65– 99 years (10.1% increase per 10 μg/m3 PM2.5, 95% CI 3.0% to 17.8%) and ages 0–4 years (8.3%, 95% CI 2.2% to 14.9%) followed by ages 20–64 years (4.1%, 95% CI 20.5% to 9.0%). There were no PM2.5–asthma associations in children ages 5–18 years, although their admission rates significantly increased after the fires. Per 10 μg/m3 wildfire-related PM2.5, acute bronchitis admissions across all ages increased by 9.6% (95% CI 1.8% to 17.9%), chronic obstructive pulmonary disease admissions for ages 20–64 years by 6.9% (95% CI 0.9% to 13.1%), and pneumonia admissions for ages 5–18 years by 6.4% (95% CI 21.0% to 14.2%). Acute bronchitis and pneumonia admissions also increased after the fires. There was limited evidence of a small impact of wildfire-related PM2.5 on cardiovascular admissions. Conclusions Wildfire-related PM2.5 led to increased respiratory

  9. The effect of coarse ambient particulate matter on first, second, and overall hospital admissions for respiratory disease among the elderly

    SciTech Connect

    Yue Chen; Qiuying Yang; Daniel Krewski; Richard T. Burnett; Yuanli Shi; Kimberlyn M. McGrail

    2005-11-01

    The objective of this article is to examine differences in the effect of ambient particulate matter on first, second, and overall hospital admissions for respiratory disease among the elderly. 8989 adults 65 yr of age or older living in the greater Vancouver area who were admitted to hospital for any acute respiratory disease (ICD-9 codes 460-519) between June 1, 1995, and March 31, 1999 were studied. Time-series analysis was used to evaluate the association between respiratory admissions and daily measures of particulate matter (PM{sub 10}, PM{sub 2.5}, and PM{sub 10-2.5} in urban air, after adjustment for gaseous copollutants (CO, O{sub 3}, NO{sub 2}, and SO{sub 2}) and meteorological variables. Repeated admissions for respiratory disease were common among the elderly. Approximately 30% of the subjects were readmitted to hospital after the first admission; 9% had more than 2 admissions for respiratory disease during the 4-yr study period. PM{sub 10-2.5} was significantly associated with the second and overall admissions for respiratory disease, but not with the first admission. The adjusted relative risks for an increment of 4.2 {mu} g/m{sup 3} in-day average PM{sub 10-2.5} concentrations were 1.03 for the first admission, 1.22 for the second admission, and 1.06 for overall admissions. There was no significant association between PM{sub 2.5} and hospital admissions for respiratory disease among the elderly. The data suggest that (1) people with a history of respiratory admissions are at a higher risk of respiratory disease in relation to particulate air pollution in urban areas, (2) analyses based on overall rather than repeated hospital admissions lead to lower estimates of the risk of respiratory disease associated with particulate air pollution, and (3) PM{sub 10-2.5} has a larger effect on respiratory admissions than PM{sub 2.5}.

  10. Extreme weather and air pollution effects on cardiovascular and respiratory hospital admissions in Cyprus.

    PubMed

    Tsangari, H; Paschalidou, A K; Kassomenos, A P; Vardoulakis, S; Heaviside, C; Georgiou, K E; Yamasaki, E N

    2016-01-15

    In many regions of the world, climatic change is associated with increased extreme temperatures, which can have severe effects on mortality and morbidity. In this study, we examine the effect of extreme weather on hospital admissions in Cyprus, for inland and coastal areas, through the use of synoptic weather classifications (air mass types). In addition, the effect of particulate air pollution (PM10) on morbidity is examined. Our results show that two air mass types, namely (a) warm, rainy days with increased levels of water vapour in the atmosphere and (b) cold, cloudy days with increased levels of precipitation, were associated with increased morbidity in the form of hospital admissions. This was true both for cardiovascular and respiratory conditions, for all age groups, but particularly for the elderly, aged over 65. Particulate air pollution was also associated with increased morbidity in Cyprus, where the effect was more pronounced for cardiovascular diseases. PMID:26519584

  11. Air pollution and hospital admissions for respiratory diseases in Lanzhou, China.

    PubMed

    Tao, Yan; Mi, Shengquan; Zhou, Shuhong; Wang, Shigong; Xie, Xiaoyun

    2014-02-01

    Lanzhou is among the most seriously air-polluted cities in China as a whole, due to its unique topography, climate, industrial structure and so on. We studied the relationship between different air pollution and respiratory hospitalizations from 2001 to 2005, the total of respiratory hospital admissions were 28,057. The data were analyzed using Poisson regression models after controlling for the long time trend for air pollutants, the "day of week" effect and confounding meteorological factors. Three air pollutants (PM10, SO2, NO2) had a lag effect, the lag was 3-5 days for PM10, 1-3 days for SO2 and 1-4 days for NO2. The relative risks were calculated for increases in the inter-quartile range of the pollutants (139 μg/m(3) in PM10, 61 μg/m(3) in SO2 and 31 μg/m(3) in NO2). Results showed that there were significant associations between air pollutants and respiratory hospital admissions, and stronger effects were observed for females and aged ≥65 yrs in Lanzhou. PMID:24286694

  12. Coarse Particulate Air Pollution Associated with Increased Risk of Hospital Admissions for Respiratory Diseases in a Tropical City, Kaohsiung, Taiwan.

    PubMed

    Cheng, Meng-Hsuan; Chiu, Hui-Fen; Yang, Chun-Yuh

    2015-10-01

    This study was undertaken to determine whether there was an association between coarse particles (PM₂.₅-₁₀) levels and frequency of hospital admissions for respiratory diseases (RD) in Kaohsiung, Taiwan. Hospital admissions for RD including chronic obstructive pulmonary disease (COPD), asthma, and pneumonia, and ambient air pollution data levels for Kaohsiung were obtained for the period from 2006 to 2010. The relative risk of hospital admissions for RD was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single pollutant model (without adjustment for other pollutants), increased rate of admissions for RD were significantly associated with higher coarse PM levels only on cool days (<25 °C), with a 10 µg/m³ elevation in PM₂.₅-₁₀ concentrations associated with a 3% (95% CI = 1%-5%) rise in COPD admissions, 4% (95% CI = 1%-7%) increase in asthma admissions, and 3% (95% CI = 2%-4%) rise in pneumonia admissions. No significant associations were found between coarse particle levels and the number of hospital admissions for RD on warm days. In the two-pollutant models, PM₂.₅-₁₀ levels remained significantly correlated with higher rate of RD admissions even controlling for sulfur dioxide, nitrogen dioxide, carbon monoxide, or ozone on cool days. This study provides evidence that higher levels of PM₂.₅-₁₀ enhance the risk of hospital admissions for RD on cool days. PMID:26501308

  13. Winter circulation weather types and hospital admissions for respiratory diseases in Galicia, Spain.

    PubMed

    Royé, D; Taboada, J J; Martí, A; Lorenzo, M N

    2016-04-01

    The link between various pathologies and atmospheric conditions has been a constant topic of study over recent decades in many places across the world; knowing more about it enables us to pre-empt the worsening of certain diseases, thereby optimizing medical resources. This study looked specifically at the connections in winter between respiratory diseases and types of atmospheric weather conditions (Circulation Weather Types, CWT) in Galicia, a region in the north-western corner of the Iberian Peninsula. To do this, the study used hospital admission data associated with these pathologies as well as an automatic classification of weather types. The main result obtained was that weather types giving rise to an increase in admissions due to these diseases are those associated with cold, dry weather, such as those in the east and south-east, or anticyclonic types. A second peak was associated with humid, hotter weather, generally linked to south-west weather types. In the future, this result may help to forecast the increase in respiratory pathologies in the region some days in advance. PMID:26307637

  14. Winter circulation weather types and hospital admissions for respiratory diseases in Galicia, Spain

    NASA Astrophysics Data System (ADS)

    Royé, D.; Taboada, J. J.; Martí, A.; Lorenzo, M. N.

    2016-04-01

    The link between various pathologies and atmospheric conditions has been a constant topic of study over recent decades in many places across the world; knowing more about it enables us to pre-empt the worsening of certain diseases, thereby optimizing medical resources. This study looked specifically at the connections in winter between respiratory diseases and types of atmospheric weather conditions (Circulation Weather Types, CWT) in Galicia, a region in the north-western corner of the Iberian Peninsula. To do this, the study used hospital admission data associated with these pathologies as well as an automatic classification of weather types. The main result obtained was that weather types giving rise to an increase in admissions due to these diseases are those associated with cold, dry weather, such as those in the east and south-east, or anticyclonic types. A second peak was associated with humid, hotter weather, generally linked to south-west weather types. In the future, this result may help to forecast the increase in respiratory pathologies in the region some days in advance.

  15. Coarse Particulate Air Pollution Associated with Increased Risk of Hospital Admissions for Respiratory Diseases in a Tropical City, Kaohsiung, Taiwan

    PubMed Central

    Cheng, Meng-Hsuan; Chiu, Hui-Fen; Yang, Chun-Yuh

    2015-01-01

    This study was undertaken to determine whether there was an association between coarse particles (PM2.5–10) levels and frequency of hospital admissions for respiratory diseases (RD) in Kaohsiung, Taiwan. Hospital admissions for RD including chronic obstructive pulmonary disease (COPD), asthma, and pneumonia, and ambient air pollution data levels for Kaohsiung were obtained for the period from 2006 to 2010. The relative risk of hospital admissions for RD was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single pollutant model (without adjustment for other pollutants), increased rate of admissions for RD were significantly associated with higher coarse PM levels only on cool days (<25 °C), with a 10 µg/m3 elevation in PM2.5–10 concentrations associated with a 3% (95% CI = 1%–5%) rise in COPD admissions, 4% (95% CI = 1%–7%) increase in asthma admissions, and 3% (95% CI = 2%–4%) rise in pneumonia admissions. No significant associations were found between coarse particle levels and the number of hospital admissions for RD on warm days. In the two-pollutant models, PM2.5–10 levels remained significantly correlated with higher rate of RD admissions even controlling for sulfur dioxide, nitrogen dioxide, carbon monoxide, or ozone on cool days. This study provides evidence that higher levels of PM2.5–10 enhance the risk of hospital admissions for RD on cool days. PMID:26501308

  16. Hospital admission rates for asthma and respiratory disease in the West Midlands: their relationship to air pollution levels.

    PubMed Central

    Walters, S.; Phupinyokul, M.; Ayres, J.

    1995-01-01

    BACKGROUND--A study was undertaken to determine the relationship between hospital admissions for asthma and all respiratory conditions in electoral wards in the West Midlands and ambient levels of smoke, sulphur dioxide, and nitrogen dioxide, and to establish whether the relationship is independent of social deprivation and ethnicity, and is different for young children and older individuals. METHODS--Data on hospital admissions for acute respiratory conditions were obtained by electoral ward from the West Midlands Regional Health Authority Information Department Körner inpatient data including asthma (ICD 493) and all acute respiratory disease (466, 480-486, 490-496) for the period April 1988 to March 1990. The population for each electoral ward, percentage of ward population that was from non-white ethnic groups, and Townsend deprivation score were all calculated from 1991 census information. Data on smoke and sulphur dioxide (SO2) levels were obtained for 24 wards in Birmingham, Coventry, Wolverhampton, Dudley, Stafford, and Burton-on-Trent, and on nitrogen dioxide (NO2) levels from 39 wards in the same local authority areas. All were background urban sites and most participated in the Warren Spring national quality control programme for SO2 and smoke monitoring. Indirect age-sex standardised hospitalisation rates (SHR) for all respiratory conditions and asthma were calculated using the 1991 rates for the West Midlands RHA as the standard. Multivariate regression models were used to assess the relationship between individual pollutants and the SHR. The Townsend score and percentage of the population from non-white ethnic groups were included in all models to adjust for ethnicity and socioeconomic deprivation. RESULTS--The SHR for asthma varied almost fourfold across the region, and all respiratory SHR showed more than three fold variation. Bivariate regression revealed both Townsend score and percentage of non-white individuals to be associated with SHR for

  17. CHILDHOOD RESPIRATORY SYMPTOMS, HOSPITAL ADMISSIONS, AND LONG-TERM EXPOSURE TO AIRBORNE PARTICULATE MATTER

    EPA Science Inventory

    The effects of long-term exposure to air pollution on respiratory symptoms and respiratory hospitalization (for asthma, bronchitis or pneumonia) were assessed in a cross-sectional study of children (ages 7--11 years, N=667) living in a moderately industrialized city in Central Sl...

  18. Association between exposure to particulate matter and hospital admissions for respiratory disease in children

    PubMed Central

    Cesar, Ana Cristina Gobbo; Nascimento, Luiz Fernando C; de Carvalho, João Andrade

    2013-01-01

    The aim of this study was to estimate the association between exposure to particulate matter less than 2.5 microns in diameter and hospitalization for respiratory disease. It was an ecological time series study with daily indicators of hospitalization for respiratory diseases in children up to 10 years old, living in Piracicaba, SP, Southeastern Brazil, between August 1, 2011 and July 31, 2012. A generalized additive Poisson regression model was used. The relative risks were RR = 1.008; 95%CI 1.001;1.016 for lag 1 and RR = 1.009; 95%CI 1.001;1.017 for lag 3. The increment of 10 μg/m3in particulate matter less than 2.5 microns in diameter implies increase in relative risk of between 7.9 and 8.6 percentage points. In conclusion, exposure to particulate matter less than 2.5 microns in diameter was associated with hospitalization for respiratory disease in children. PMID:24626559

  19. Fine Particulate Matter Pollution and Hospital Admissions for Respiratory Diseases in Beijing, China.

    PubMed

    Xiong, Qiulin; Zhao, Wenji; Gong, Zhaoning; Zhao, Wenhui; Tang, Tao

    2015-09-01

    Fine particulate matter has become the premier air pollutant of Beijing in recent years, enormously impacting the environmental quality of the city and the health of the residents. Fine particles with aerodynamic diameters of 0~0.3 μm, 0.3~0.5 μm, and 0.5~1.0 μm, from the yeasr 2007 to 2012, were monitored, and the hospital data about respiratory diseases during the same period was gathered and calculated. Then the correlation between respiratory health and fine particles was studied by spatial analysis and grey correlation analysis. The results showed that the aerial fine particulate matter pollution was mainly distributed in the Zizhuyuan sub-district office. There was a certain association between respiratory health and fine particles. Outpatients with respiratory system disease in this study area were mostly located in the southeastern regions (Balizhuang sub-district office, Ganjiakou sub-district office, Wanshoulu sub-district office, and Yongdinglu sub-district office) and east-central regions (Zizhuyuan sub-district office and Shuangyushu sub-district office) of the study area. Correspondingly, PM₁ (particulate matter with aerodynamic diameter smaller than 1.0 um) concentrations in these regions were higher than those in any other regions. Grey correlation analysis results showed that the correlation degree of the fine particle concentration with the number of outpatients is high, and the smaller fine particles had more obvious effects on respiratory system disease than larger particles. PMID:26402691

  20. Fine Particulate Matter Pollution and Hospital Admissions for Respiratory Diseases in Beijing, China

    PubMed Central

    Xiong, Qiulin; Zhao, Wenji; Gong, Zhaoning; Zhao, Wenhui; Tang, Tao

    2015-01-01

    Fine particulate matter has become the premier air pollutant of Beijing in recent years, enormously impacting the environmental quality of the city and the health of the residents. Fine particles with aerodynamic diameters of 0~0.3 μm, 0.3~0.5 μm, and 0.5~1.0 μm, from the yeasr 2007 to 2012, were monitored, and the hospital data about respiratory diseases during the same period was gathered and calculated. Then the correlation between respiratory health and fine particles was studied by spatial analysis and grey correlation analysis. The results showed that the aerial fine particulate matter pollution was mainly distributed in the Zizhuyuan sub-district office. There was a certain association between respiratory health and fine particles. Outpatients with respiratory system disease in this study area were mostly located in the southeastern regions (Balizhuang sub-district office, Ganjiakou sub-district office, Wanshoulu sub-district office, and Yongdinglu sub-district office) and east-central regions (Zizhuyuan sub-district office and Shuangyushu sub-district office) of the study area. Correspondingly, PM1 (particulate matter with aerodynamic diameter smaller than 1.0 um) concentrations in these regions were higher than those in any other regions. Grey correlation analysis results showed that the correlation degree of the fine particle concentration with the number of outpatients is high, and the smaller fine particles had more obvious effects on respiratory system disease than larger particles. PMID:26402691

  1. A multi-year study of air pollution and respiratory hospital admissions in three New York State metropolitan areas: results for 1988 and 1989 summers

    SciTech Connect

    Thurston, G.D.; Ito, K.; Kinney, P.L.; Lippmann, M. )

    1992-10-01

    As part of a multi-year study of air pollution and respiratory hospital admissions in the Buffalo, Albany, and New York City, New York, metropolitan areas, filter samples were collected daily at suburban air monitoring sites and analyzed for their content of particulate phase aerosol strong acidity (i.e., hydrogen ion, H+) and sulfate (SO4 =). In addition, daily hospital admissions for respiratory causes, other community air pollutant measurements (e.g., ozone, O3), and meteorological data (e.g., temperature) were also obtained for these metropolitan areas. The summer months (June-August) were selected for analysis because that is when the highest H+ (and O3) are usually experienced at these sites, and because these months are rarely complicated by other major influences (e.g., high pollen counts). Thus, any pollution-admissions relationships were expected to be most clearly discernible in this season. Prior to the health effects analysis, the summer admissions and environmental data were first detrended to eliminate long-wave autocorrelations, and day-of-week effects were removed via regression. Cross-correlations of the filtered 1988 and 1989 admissions and environmental data revealed strong associations between elevated summer haze pollution (i.e., H+, SO4 =, and O3) and increased total respiratory and asthma admissions on the same day and/or on subsequent days in Buffalo and New York City, especially during the summer of 1988 (when pollution levels were more extreme). Regression analyses indicated that the pollution-admissions associations remained significant (p < 0.05) even after the simultaneous inclusion of lagged daily maximum temperature. Mean effects calculations for these cities indicated that summertime haze can play a significant role in the occurrence of respiratory admissions in that season: accounting for an average 6 to 24% of 1988 Buffalo and NYC asthma admissions. O3 consistently had the highest mean effects estimates.

  2. Differential Effects of Temperature Extremes on Hospital Admission Rates for Respiratory Disease between Indigenous and Non-Indigenous Australians in the Northern Territory.

    PubMed

    Green, Donna; Bambrick, Hilary; Tait, Peter; Goldie, James; Schultz, Rosalie; Webb, Leanne; Alexander, Lisa; Pitman, Andrew

    2015-12-01

    The health gap between Indigenous and non-Indigenous Australians may be exacerbated by climate change if temperature extremes have disproportionate adverse effects on Indigenous people. To explore this issue, we analysed the effect of temperature extremes on hospital admissions for respiratory diseases, stratified by age, Indigenous status and sex, for people living in two different climates zones in the Northern Territory during the period 1993-2011. We examined admissions for both acute and chronic respiratory diagnoses, controlling for day of the week and seasonality variables. Our analysis showed that: (1) overall, Indigenous hospital admission rates far exceeded non-Indigenous admission rates for acute and chronic diagnoses, and Top End climate zone admission rates exceeded Central Australia climate zone admission rates; (2) extreme cold and hot temperatures were associated with inconsistent changes in admission rates for acute respiratory disease in Indigenous and non-Indigenous children and older adults; and (3) no response to cold or hot temperature extremes was found for chronic respiratory diagnoses. These findings support our two hypotheses, that extreme hot and cold temperatures have a different effect on hospitalisations for respiratory disease between Indigenous and non-Indigenous people, and that these health risks vary between the different climate zones. We did not, however, find that there were differing responses to temperature extremes in the two populations, suggesting that any increased vulnerability to climate change in the Indigenous population of the Northern Territory arises from an increased underlying risk to respiratory disease and an already greater existing health burden. PMID:26633456

  3. Differential Effects of Temperature Extremes on Hospital Admission Rates for Respiratory Disease between Indigenous and Non-Indigenous Australians in the Northern Territory

    PubMed Central

    Green, Donna; Bambrick, Hilary; Tait, Peter; Goldie, James; Schultz, Rosalie; Webb, Leanne; Alexander, Lisa; Pitman, Andrew

    2015-01-01

    The health gap between Indigenous and non-Indigenous Australians may be exacerbated by climate change if temperature extremes have disproportionate adverse effects on Indigenous people. To explore this issue, we analysed the effect of temperature extremes on hospital admissions for respiratory diseases, stratified by age, Indigenous status and sex, for people living in two different climates zones in the Northern Territory during the period 1993–2011. We examined admissions for both acute and chronic respiratory diagnoses, controlling for day of the week and seasonality variables. Our analysis showed that: (1) overall, Indigenous hospital admission rates far exceeded non-Indigenous admission rates for acute and chronic diagnoses, and Top End climate zone admission rates exceeded Central Australia climate zone admission rates; (2) extreme cold and hot temperatures were associated with inconsistent changes in admission rates for acute respiratory disease in Indigenous and non-Indigenous children and older adults; and (3) no response to cold or hot temperature extremes was found for chronic respiratory diagnoses. These findings support our two hypotheses, that extreme hot and cold temperatures have a different effect on hospitalisations for respiratory disease between Indigenous and non-Indigenous people, and that these health risks vary between the different climate zones. We did not, however, find that there were differing responses to temperature extremes in the two populations, suggesting that any increased vulnerability to climate change in the Indigenous population of the Northern Territory arises from an increased underlying risk to respiratory disease and an already greater existing health burden. PMID:26633456

  4. Short-term relationships between emergency hospital admissions for respiratory and cardiovascular diseases and fine particulate air pollution in Beirut, Lebanon.

    PubMed

    Nakhlé, Myriam Mrad; Farah, Wehbeh; Ziadé, Nelly; Abboud, Maher; Salameh, Dominique; Annesi-Maesano, Isabella

    2015-04-01

    High levels of major outdoor air pollutants have been documented in Lebanon, but their health effects remain unknown. The Beirut Air Pollution and Health Effects study aimed to determine the relationship between short-term variations in ambient concentrations of particulate matter (PM10 and PM2.5) and emergency hospital admissions in the city of Beirut, and whether susceptible groups are more greatly affected. An autoregressive Poisson model was used to evaluate the association between daily concentrations of particulate matter and respiratory and cardiovascular emergency hospital admissions after controlling for confounders. All variables were measured during 1 year from January 2012 to December 2012. Relative risks of admissions for respiratory and cardiovascular diseases were calculated for an increase in 10 μg.m(-3) of pollutant concentrations. Total respiratory admissions were significantly associated with the levels of PM10 (1.012 [95% CI 1.004-1.02]) per 10 μg.m(-3) rise in daily mean pollutant concentration for PM10 and 1.016 [95% CI 1.000-1.032] for PM2.5 on the same day. With regard to susceptible groups, total respiratory admissions were associated with PM2.5 and PM10 within the same day in children (relative risk (RR), 1.013 and 1.014; 95% confidence interval, 0.985-1.042 and 1.000-1.029 for PM2.5 and PM10, respectively). Moreover, a nearly significant association was found between particles and total circulatory admissions for adults and elderly groups in the same day. These results are similar to other international studies. Therefore, air pollution control is expected to reduce the number of admissions of these diseases in Lebanon. PMID:25792024

  5. The impact of 9/11 on the association of ambient air pollution with daily respiratory hospital admissions in a Canada-US border city, Windsor, Ontario.

    PubMed

    Luginaah, Isaac; Fung, Karen Y; Gorey, Kevin M; Khan, Shahedul

    2006-08-01

    The 11 September 2001 (9/11) terrorist attacks in the United States resulted in long lines of trucks at the border crossing in Windsor, Ontario. Public concern about the potential impact of these trucks spewing toxic pollutants into the air drew attention to the need to investigate the impact of 9/11 on the daily levels of air pollutants and respiratory hospitalization. In this study, significant increases in respiratory admissions were found one month and 6 months post-9/11. Mean daily respiratory admission was also significantly higher than the same period one year earlier and one year later. SO(2) and CO concentration levels were found to be generally higher after 9/11 than one year before and immediately before. Relative risk estimates of respiratory hospitalization after 9/11 showed that SO(2) (RR̂ = 1.15 for two-day, RR̂ = 1.18 for three-day, and RR̂ = 1.21 for five-day averages), NO(2) (RR̂ = 1.10 for current day), and COH (RR̂ = 1.09 for current day, RR̂ = 1.10 for two-day average) had the most significant effects after 9/11. These results suggest the need for more stringent regulatory efforts in air quality in the region in response to the changing transportation dynamics at this Canada-US border crossing. PMID:21234298

  6. Meta-analysis of the association between short-term exposure to ambient ozone and respiratory hospital admissions

    NASA Astrophysics Data System (ADS)

    Ji, Meng; Cohan, Daniel S.; Bell, Michelle L.

    2011-04-01

    Ozone is associated with health impacts including respiratory outcomes; however, results differ across studies. Meta-analysis is an increasingly important approach to synthesizing evidence across studies. We conducted meta-analysis of short-term ozone exposure and respiratory hospitalizations to evaluate variation across studies and explore some of the challenges in meta-analysis. We identified 136 estimates from 96 studies and investigated how estimates differed by age, ozone metric, season, lag, region, disease category, and hospitalization type. Overall results indicate associations between ozone and various kinds of respiratory hospitalizations; however, study characteristics affected risk estimates. Estimates were similar, but higher, for the elderly compared to all ages and for previous day exposure compared to same day exposure. Comparison across studies was hindered by variation in definitions of disease categories, as some (e.g., asthma) were identified through >= 3 different sets of ICD codes. Although not all analyses exhibited evidence of publication bias, adjustment for publication bias generally lowered overall estimates. Emergency hospitalizations for total respiratory disease increased by 4.47% (95% interval: 2.48, 6.50%) per 10 ppb 24 h ozone among the elderly without adjustment for publication bias and 2.97% (1.05, 4.94%) with adjustment. Comparison of multi-city study results and meta-analysis based on single-city studies further suggested publication bias.

  7. Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis

    PubMed Central

    Nair, Harish; Simões, Eric AF; Rudan, Igor; Gessner, Bradford D; Azziz-Baumgartner, Eduardo; Zhang, Jian Shayne F; Feikin, Daniel R; Mackenzie, Grant A; Moiïsi, Jennifer C; Roca, Anna; Baggett, Henry C; Zaman, Syed MA; Singleton, Rosalyn J; Lucero, Marilla G; Chandran, Aruna; Gentile, Angela; Cohen, Cheryl; Krishnan, Anand; Bhutta, Zulfiqar A; Arguedas, Adriano; Clara, Alexey Wilfrido; Andrade, Ana Lucia; Ope, Maurice; Ruvinsky, Raúl Oscar; Hortal, María; McCracken, John P; Madhi, Shabir A; Bruce, Nigel; Qazi, Shamim A; Morris, Saul S; El Arifeen, Shams; Weber, Martin W; Scott, J Anthony G; Brooks, W Abdullah; Breiman, Robert F; Campbell, Harry

    2013-01-01

    Summary Background The annual number of hospital admissions and in-hospital deaths due to severe acute lower respiratory infections (ALRI) in young children worldwide is unknown. We aimed to estimate the incidence of admissions and deaths for such infections in children younger than 5 years in 2010. Methods We estimated the incidence of admissions for severe and very severe ALRI in children younger than 5 years, stratified by age and region, with data from a systematic review of studies published between Jan 1, 1990, and March 31, 2012, and from 28 unpublished population-based studies. We applied these incidence estimates to population estimates for 2010, to calculate the global and regional burden in children admitted with severe ALRI in that year. We estimated in-hospital mortality due to severe and very severe ALRI by combining incidence estimates with case fatality ratios from hospital-based studies. Findings We identified 89 eligible studies and estimated that in 2010, 11·9 million (95% CI 10·3–13·9 million) episodes of severe and 3·0 million (2·1–4·2 million) episodes of very severe ALRI resulted in hospital admissions in young children worldwide. Incidence was higher in boys than in girls, the sex disparity being greatest in South Asian studies. On the basis of data from 37 hospital studies reporting case fatality ratios for severe ALRI, we estimated that roughly 265 000 (95% CI 160 000–450 000) in-hospital deaths took place in young children, with 99% of these deaths in developing countries. Therefore, the data suggest that although 62% of children with severe ALRI are treated in hospitals, 81% of deaths happen outside hospitals. Interpretation Severe ALRI is a substantial burden on health services worldwide and a major cause of hospital referral and admission in young children. Improved hospital access and reduced inequities, such as those related to sex and rural status, could substantially decrease mortality related to such infection

  8. Associations of short-term exposure to traffic-related air pollution with cardiovascular and respiratory hospital admissions in London, UK

    PubMed Central

    Samoli, Evangelia; Atkinson, Richard W; Analitis, Antonis; Fuller, Gary W; Green, David C; Mudway, Ian; Anderson, H Ross; Kelly, Frank J

    2016-01-01

    Objectives There is evidence of adverse associations between short-term exposure to traffic-related pollution and health, but little is known about the relative contribution of the various sources and particulate constituents. Methods For each day for 2011–2012 in London, UK over 100 air pollutant metrics were assembled using monitors, modelling and chemical analyses. We selected a priori metrics indicative of traffic sources: general traffic, petrol exhaust, diesel exhaust and non-exhaust (mineral dust, brake and tyre wear). Using Poisson regression models, controlling for time-varying confounders, we derived effect estimates for cardiovascular and respiratory hospital admissions at prespecified lags and evaluated the sensitivity of estimates to multipollutant modelling and effect modification by season. Results For single day exposure, we found consistent associations between adult (15–64 years) cardiovascular and paediatric (0–14 years) respiratory admissions with elemental and black carbon (EC/BC), ranging from 0.56% to 1.65% increase per IQR change, and to a lesser degree with carbon monoxide (CO) and aluminium (Al). The average of past 7 days EC/BC exposure was associated with elderly (65+ years) cardiovascular admissions. Indicated associations were higher during the warm period of the year. Although effect estimates were sensitive to the adjustment for other pollutants they remained consistent in direction, indicating independence of associations from different sources, especially between diesel and petrol engines, as well as mineral dust. Conclusions Our results suggest that exhaust related pollutants are associated with increased numbers of adult cardiovascular and paediatric respiratory hospitalisations. More extensive monitoring in urban centres is required to further elucidate the associations. PMID:26884048

  9. Statistical Analysis Aiming at Predicting Respiratory Tract Disease Hospital Admissions from Environmental Variables in the City of São Paulo

    PubMed Central

    de Sousa Zanotti Stagliorio Coêlho, Micheline; Luiz Teixeira Gonçalves, Fabio; do Rosário Dias de Oliveira Latorre, Maria

    2010-01-01

    This study is aimed at creating a stochastic model, named Brazilian Climate and Health Model (BCHM), through Poisson regression, in order to predict the occurrence of hospital respiratory admissions (for children under thirteen years of age) as a function of air pollutants, meteorological variables, and thermal comfort indices (effective temperatures, ET). The data used in this study were obtained from the city of São Paulo, Brazil, between 1997 and 2000. The respiratory tract diseases were divided into three categories: URI (Upper Respiratory tract diseases), LRI (Lower Respiratory tract diseases), and IP (Influenza and Pneumonia). The overall results of URI, LRI, and IP show clear correlation with SO2 and CO, PM10 and O3, and PM10, respectively, and the ETw4 (Effective Temperature) for all the three disease groups. It is extremely important to warn the government of the most populated city in Brazil about the outcome of this study, providing it with valuable information in order to help it better manage its resources on behalf of the whole population of the city of Sao Paulo, especially those with low incomes. PMID:20706674

  10. Effect of photochemical smog associated with synoptic weather patterns on cardiovascular and respiratory hospital admissions in metropolitan Taipei.

    PubMed

    Lai, Li-Wei

    2012-01-01

    This study focuses on the relationship between photochemical smog (PS) (hourly ozone conc. >100 ppb), PS-related diseases, and the synoptic weather patterns during 2005-2009 in metropolitan Taipei. The results show that compared to respiratory ailments (ICD code 460-519) and asthma (ICD code 493), cardiovascular ailments (ICD code 390-459) were more clearly influenced by PS events. On the PS event day, the number of admissions of babies, children, and adults increased by 0.04 [95% CI 0.01-0.06], 0.03 [95% CI 0.00-0.07], and 1.12 [95% CI 0.36-1.89] (P < 0.05), respectively. The investigation showed that more than 70% of the PS events were associated primarily with the peripheral circulation of typhoons, Pacific pressure, and discrete Pacific pressure. PS events are a threat to public health. To avoid the ill effects of air pollution, residents should be informed about the daily weather patterns and air quality. PMID:22098558

  11. Effects of short-term exposure to air pollution on hospital admissions of young children for acute lower respiratory infections in Ho Chi Minh City, Vietnam.

    PubMed

    Le, Truong Giang; Ngo, Long; Mehta, Sumi; Do, Van Dzung; Thach, T Q; Vu, Xuan Dan; Nguyen, Dinh Tuan; Cohen, Aaron

    2012-06-01

    There is emerging evidence, largely from studies in Europe and North America, that economic deprivation increases the magnitude of morbidity and mortality related to air pollution. Two major reasons why this may be true are that the poor experience higher levels of exposure to air pollution, and they are more vulnerable to its effects--in other words, due to poorer nutrition, less access to medical care, and other factors, they experience more health impact per unit of exposure. The relations among health, air pollution, and poverty are likely to have important implications for public health and social policy, especially in areas such as the developing countries of Asia where air pollution levels are high and many live in poverty. The aims of this study were to estimate the effect of exposure to air pollution on hospital admissions of young children for acute lower respiratory infection (ALRI*) and to explore whether such effects differed between poor children and other children. ALRI, which comprises pneumonia and bronchiolitis, is the largest single cause of mortality among young children worldwide and is responsible for a substantial burden of disease among young children in developing countries. To the best of our knowledge, this is the first study of the health effects of air pollution in Ho Chi Minh City (HCMC), Vietnam. For these reasons, the results of this study have the potential to make an important contribution to the growing literature on the health effects of air pollution in Asia. The study focused on the short-term effects of daily average exposure to air pollutants on hospital admissions of children less than 5 years of age for ALRI, defined as pneumonia or bronchiolitis, in HCMC during 2003, 2004, and 2005. Admissions data were obtained from computerized records of Children's Hospital 1 and Children's Hospital 2 (CH1 and CH2) in HCMC. Nearly all children hospitalized for respiratory illnesses in the city are admitted to one of these two pediatric

  12. Antibiotic treatment interruption of suspected lower respiratory tract infections based on a single procalcitonin measurement at hospital admission--a randomized trial.

    PubMed

    Kristoffersen, K B; Søgaard, O S; Wejse, C; Black, F T; Greve, T; Tarp, B; Storgaard, M; Sodemann, M

    2009-05-01

    Recent studies have suggested that procalcitonin (PCT) is a safe marker for the discrimination between bacterial and viral infection, and that PCT-guided treatment may lead to substantial reductions in antibiotic use. The present objective was to evaluate the effect of a single PCT measurement on antibiotic use in suspected lower respiratory tract infections (LRTIs) in a Danish hospital setting. In a randomized, controlled intervention study, 223 adult patients admitted to the hospital because of suspicion of LRTI were included with 210 patients available for analysis. Patients were randomized to either PCT-guided treatment or standard treatment. Antibiotic treatment duration in the PCT group was based on the serum PCT value at admission. The cut-off point for recommending antibiotic treatment was PCT > or =0.25 microg/L. Physicians could overrule treatment guidelines. The mean duration of hospital stay was 5.9 days in the PCT group vs. 6.7 days in the control group (p 0.22). The mean duration of antibiotic treatment during hospitalization in the PCT group was 5.1 days on average, as compared to 6.8 days in the control group (p 0.007). In a subgroup analysis of chronic obstructive pulmonary disease patients, the mean length of stay was reduced from 7.1 days in the control group to 4.8 days in the PCT group (p 0.009). It was concluded that the determination of a single PCT value at admission in patients with suspected LRTIs can lead to a reduction in the duration of antibiotic treatment by 25% without compromising outcome. No effect on the length of hospital stay was found. PMID:19416298

  13. Respiratory rate and pulse oximetry derived information as predictors of hospital admission in young children in Bangladesh: a prospective observational study

    PubMed Central

    Garde, Ainara; Zhou, Guohai; Raihana, Shahreen; Dunsmuir, Dustin; Karlen, Walter; Dekhordi, Parastoo; Huda, Tanvir; Arifeen, Shams El; Larson, Charles; Kissoon, Niranjan; Dumont, Guy A; Ansermino, J Mark

    2016-01-01

    Objective Hypoxaemia is a strong predictor of mortality in children. Early detection of deteriorating condition is vital to timely intervention. We hypothesise that measures of pulse oximetry dynamics may identify children requiring hospitalisation. Our aim was to develop a predictive tool using only objective data derived from pulse oximetry and observed respiratory rate to identify children at increased risk of hospital admission. Setting Tertiary-level hospital emergency department in Bangladesh. Participants Children under 5 years (n=3374) presenting at the facility (October 2012–April 2013) without documented chronic diseases were recruited. 1-minute segments of pulse oximetry (photoplethysmogram (PPG), blood oxygen saturation (SpO2) and heart rate (HR)) and respiratory rate were collected with a mobile app. Primary outcome The need for hospitalisation based on expert physician review and follow-up. Methods Pulse rate variability (PRV) using pulse peak intervals of the PPG signal and features extracted from the SpO2 signal, all derived from pulse oximetry recordings, were studied. A univariate age-adjusted logistic regression was applied to evaluate differences between admitted and non-admitted children. A multivariate logistic regression model was developed using a stepwise selection of predictors and was internally validated using bootstrapping. Results Children admitted to hospital showed significantly (p<0.01) decreased PRV and higher SpO2 variability compared to non-admitted children. The strongest predictors of hospitalisation were reduced PRV-power in the low frequency band (OR associated with a 0.01 unit increase, 0.93; 95% CI 0.89 to 0.98), greater time spent below an SpO2 of 98% and 94% (OR associated with 10 s increase, 1.4; 95% CI 1.3 to 1.4 and 1.5; 95% CI 1.4 to 1.6, respectively), high respiratory rate, high HR, low SpO2, young age and male sex. These variables provided a bootstrap-corrected AUC of the receiver operating characteristic

  14. Appropriateness of hospital admissions in general hospitals in Egypt.

    PubMed

    Al-Tehewy, M; Shehad, E; Al Gaafary, M; Al-Houssiny, M; Nabih, D; Salem, B

    2009-01-01

    We measured the rate of inappropriate admissions, and associated factors, in 3 general hospitals in Egypt. A total of 1191 admissions were reviewed using the Appropriateness Evaluation Protocol for adult patients and the Pediatric Appropriateness Evaluation Protocol for paediatric patients. Inappropriate admissions were 66.3% and 78.9% of admissions in the surgery departments of 2 hospitals compared with 1.9% in the 3rd hospital that followed a specific admission protocol for elective surgery. The paediatrics department had the lowest rates of inappropriate admissions in all hospitals (0%, 1.0% and 1.9%). On logistic regression analysis, the route of admission was the only factor significantly associated with inappropriate admissions in the departments of surgery, obstetrics/gynaecology and internal medicine. PMID:20214126

  15. Association between atmospheric pollutants and hospital admissions in Lisbon.

    PubMed

    Cruz, A M J; Sarmento, S; Almeida, S M; Silva, A V; Alves, C; Freitas, M C; Wolterbeek, H

    2015-04-01

    Ambient air pollution is recognised as one of the potential environmental risk factors causing health hazards to the exposed population, demonstrated in numerous previous studies. Several longitudinal, ecological and epidemiological studies have shown associations between outdoor levels of outdoor atmospheric pollutants and adverse health effects, especially associated with respiratory and cardiovascular hospital admissions. The aim of this work is to assess the influence of atmospheric pollutants over the hospital admissions in Lisbon, by Ordinary Least Squares Linear Regression. The pollutants (CO, NO, NO2, SO2, O3, PM10 and PM2.5) were obtained from 13 monitoring stations of the Portuguese Environmental Agency, which provide hourly observations. Hospital admission data were collected from the Central Administration of the Health System and were compiled by age: <15, 15-64, >64 years old. The study period was 2006-2008. Results showed significant positive associations between the following: (1) the pollutants CO, NO, NO2, SO2, PM10 and PM2.5 and circulatory diseases for ages between 15 and 64 years (0.5% hospital admissions (HA) increase with 10 μg m(-3) NO increase) and above 64 years (1.0% stroke admission increase with 10 μg m(-3) NO2 increase); (2) the pollutants CO, NO, NO2, SO2, PM10 and PM2.5 and respiratory diseases for ages below 15 years (up to 1.9% HA increase with 10 μg m(-3) pollutant increase); and (3) the pollutants NO, NO2 and SO2 and respiratory diseases for ages above 64 years (1.3% HA increase with 10 μg m(-3) CO increase). PMID:25471710

  16. Association between air pollution and hospital admission: Case study at three monitoring stations in Malaysia

    NASA Astrophysics Data System (ADS)

    Zahari, Marina; Zin@Ibrahim, Wan Zawiah Wan; Ismail, Noriszura; Ni, Tan Hui

    2014-06-01

    The relationships between the exposure of pollutants towards hospitalized admission and mortality have been identified in several studies on Asian cities such as Taipei, Bangkok and Tokyo. In Malaysia, evidence on the health risks associated with exposure to pollutants is limited. In this study, daily time-series data were analysed to estimate risks of cardiovascular and respiratory hospitalized admissions associated with particulate matter ≤ 10 μm (PM10), carbon monoxide (CO), nitrogen dioxide, sulphur dioxide, and ozone concentrations in Klang Valley during 2004-2009. Daily counts of hospital admissions for cardiovascular and respiratory outcomes were obtained from eleven hospitals while pollutants data were taken from several air quality monitoring stations located nearest to the hospitals. These data were fitted with Generalised Additive Poisson regression models. Additionally, temperature, humidity, and time data were also included to allow for potential effect of weather and time-varying influences on hospital admissions. CO showed the most significant (P < 0.05) relationship to cardiovascular admissions. An increment of 1 ppm in CO predicted an increase of 4% to 20% in cardiovascular admissions. Respiratory admissions were associated with PM10, which had about 1% increase in risk of admission per 10 ug/m3 increment in PM10. Exposure to CO and PM10 increases the risk of hospitalization for cardiovascular and respiratory illnesses in Klang Valley, Malaysia.

  17. Association between ozone and respiratory admissions among children and the elderly in Vancouver, Canada.

    PubMed

    Yang, Qiuying; Chen, Yue; Shi, Yuanli; Burnett, Richard T; McGrail, Kimberly M; Krewski, Daniel

    2003-11-01

    In this study, we examine the impact of ozone on daily respiratory admissions in both young children and the elderly in greater Vancouver, British Columbia. Study subjects included children less than 3 yr of age and adults 65 yr of age or over living in greater Vancouver who had acute hospital admissions for any respiratory diseases (ICD-9 codes 460-519) during the 13-yr period 1986-1998. Bidirectional case-crossover analysis was used to investigate associations between ambient ozone and respiratory hospitalizations after adjustment for other pollutants, including carbon monoxide, nitrogen dioxide, sulfur dioxide, and coefficient of haze. Potential effect modification by socioeconomic status as measured by household income was also examined. Respiratory admissions were associated with ozone levels 2, 3, 4, and 5 days prior to admission in both children and the elderly, with the strongest association observed at a lag of 4 days. Odds ratios for hospital admission of 1.22 (95% CI: 1.15-1.30) for children and 1.13 (1.09-1.18) for the elderly, respectively, were found, based on an increment in exposure corresponding to the interquartile range for ozone. Adjusting for other pollutants did not attenuate the ozone effect on respiratory admissions. Nor did socioeconomic status appear to modify the association between ozone and respiratory admissions in either children or the elderly. We concluded that ambient ozone is positively associated with respiratory hospital admission among young children and the elderly in Vancouver, British Columbia. These associations persisted after adjustment for both copollutant exposures and socioeconomic status. PMID:14569494

  18. Respiratory and cardiovascular hospitalizations after the World Trade Center disaster.

    PubMed

    Lin, Shao; Gomez, Marta I; Gensburg, Lenore; Liu, Wei; Hwang, Syni-An

    2010-01-01

    The objective of this study was to determine whether there were increases in respiratory and cardiovascular hospital admissions among residents of lower Manhattan after the destruction of the World Trade Center. The authors used hospital admission records from 1991 to 2001 with a diagnosis of respiratory, cardiovascular, or cerebrovascular illness and a residential address in lower Manhattan or Queens. The authors assessed the change in admissions by comparing lower Manhattan to Queens (the control area) and before and after 9/11 admissions in lower Manhattan. They found the following significant increases in hospital admissions: for respiratory illnesses during the weeks of 9/11/01 and 10/16/01; asthma during the week of 9/11/01; cardiovascular during the weeks of 9/18/01 and 10/9/01; cerebrovascular during the weeks of 9/11/01, 9/18/01, 10/2/01, and 10/9/01. There was an immediate increase in respiratory admissions after the disaster and a delayed increase in cardiovascular and cerebrovascular admissions. PMID:20146998

  19. The effects of the 2009 dust storm on emergency admissions to a hospital in Brisbane, Australia

    NASA Astrophysics Data System (ADS)

    Barnett, Adrian G.; Fraser, John F.; Munck, Lynette

    2012-07-01

    In September 2009 an enormous dust storm swept across eastern Australia. Dust is potentially hazardous to health as it interferes with breathing, and previous dust storms have been linked to increased risks of asthma and even death. We examined whether the 2009 Australian dust storm changed the volume or characteristics of emergency admissions to hospital. We used an observational study design, using time series analyses to examine changes in the number of admissions, and case-only analyses to examine changes in the characteristics of admissions. The admission data were from the Prince Charles Hospital, Brisbane, between 1 January 2009 and 31 October 2009. There was a 39% increase in emergency admissions associated with the storm (95% confidence interval: 5, 81%), which lasted for just 1 day. The health effects of the storm could not be detected using particulate matter levels. We found no significant change in the characteristics of admissions during the storm; specifically, there was no increase in respiratory admissions. The dust storm had a short-lived impact on emergency hospital admissions. This may be because the public took effective avoidance measures, or because the dust was simply not toxic, being composed mainly of soil. Emergency departments should be prepared for a short-term increase in admissions during dust storms.

  20. Heat, Heat Waves, and Hospital Admissions among the Elderly in the United States, 1992–2006

    PubMed Central

    Zanobetti, Antonella; Schwartz, Joel D.; Wellenius, Gregory A.; O’Neill, Marie S.

    2014-01-01

    Background: Heat-wave frequency, intensity, and duration are increasing with global climate change. The association between heat and mortality in the elderly is well documented, but less is known regarding associations with hospital admissions. Objectives: Our goal was to determine associations between moderate and extreme heat, heat waves, and hospital admissions for nonaccidental causes among Medicare beneficiaries ≥ 65 years of age in 114 cities across five U.S. climate zones. Methods: We used Medicare inpatient billing records and city-specific data on temperature, humidity, and ozone from 1992 through 2006 in a time-stratified case-crossover design to estimate the association between hospitalization and moderate [90th percentile of apparent temperature (AT)] and extreme (99th percentile of AT) heat and heat waves (AT above the 95th percentile over 2–8 days). In sensitivity analyses, we additionally considered confounding by ozone and holidays, different temperature metrics, and alternate models of the exposure–response relationship. Results: Associations between moderate heat and hospital admissions were minimal, but extreme heat was associated with a 3% (95% CI: 2%, 4%) increase in all-cause hospital admissions over the subsequent 8 days. In cause-specific analyses, extreme heat was associated with increased hospitalizations for renal (15%; 95% CI: 9%, 21%) and respiratory (4%; 95% CI: 2%, 7%) diseases, but not for cardiovascular diseases. An added heat-wave effect was observed for renal and respiratory admissions. Conclusion: Extreme heat is associated with increased hospital admissions, particularly for renal causes, among the elderly in the United States. Citation: Gronlund CJ, Zanobetti A, Schwartz JD, Wellenius GA, O’Neill MS. 2014. Heat, heat waves, and hospital admissions among the elderly in the United States, 1992–2006. Environ Health Perspect 122:1187–1192; http://dx.doi.org/10.1289/ehp.1206132 PMID:24905551

  1. The Effects of Air Pollution on Cardiovascular and Respiratory Causes of Emergency Admission

    PubMed Central

    Shahi, Ali Mohammad; Omraninava, Ali; Goli, Mitra; Soheilarezoomand, Hamid Reza; Mirzaei, Nader

    2014-01-01

    Introduction: Today, air pollution is one of the critical problems in metropolitans and necessary preparations are needed for confronting this crisis. The present study was based on the goal of determining the relationship of air pollutant levels with the rate of emergency admissions for respiratory and cardiovascular patients. Methods: In the present retrospective cross-sectional study, all respiratory and cardiovascular patients, referred to emergency department during 2012, were assessed. The meteorological and air pollution data were collected. Information regarding the numbers and dates (month, day) of admission for respiratory and cardiovascular diseases was achieved from the hospital's electronic registration system. The relation of air pollution and respiratory and cardiovascular admissions were analyzed by generalize additive model (GAM). Results: 5922 patients were assessed which included 4048 (68.36%) cardiovascular and 1874 (31.64%) respiratory. Carbon monoxide (CO) level was an independent risk factor of cardiovascular disease on the same day (RR=1.49; 95% CI: 1.25- 1.77; P<0.001), the day before (RR=1.22; 95% CI: 1.02- 1.45; P=0.03), and the last two days (RR=1.3; 95% CI: 1.09- 1.54; P<0.001). The same process was repeated for ozone (O3). In addition, the O3 level on the same day (RR=1.49; 95% CI: 1.25- 1.77; P<0.001), the day before (RR=1.22; 95% CI: 1.02- 1.45; P=0.03), the last two days (RR=1.3; 95% CI: 1.09- 1.54; P<0.001), and the last week (RR=1.004; 95% CI: 1.0007-1.008; P=0.02) were independent risk factors of respiratory admissions. The increased level of particulate matter less than 2.5 micrometers in diameter (PM2.5) like O3 led to growth in the admissions to emergency department. Conclusion: The findings of the present study suggested that rising levels of CO and O3 during two days leads to a significant increase in cardiovascular admission on the third day. Furthermore, increase in O3, PM2.5, nitrogen dioxide (NO2), and CO levels causes a

  2. Assessment and prediction of short term hospital admissions: the case of Athens, Greece

    NASA Astrophysics Data System (ADS)

    Kassomenos, P.; Papaloukas, C.; Petrakis, M.; Karakitsios, S.

    The contribution of air pollution on hospital admissions due to respiratory and heart diseases is a major issue in the health-environmental perspective. In the present study, an attempt was made to run down the relationships between air pollution levels and meteorological indexes, and corresponding hospital admissions in Athens, Greece. The available data referred to a period of eight years (1992-2000) including the daily number of hospital admissions due to respiratory and heart diseases, hourly mean concentrations of CO, NO 2, SO 2, O 3 and particulates in several monitoring stations, as well as, meteorological data (temperature, relative humidity, wind speed/direction). The relations among the above data were studied through widely used statistical techniques (multivariate stepwise analyses) and Artificial Neural Networks (ANNs). Both techniques revealed that elevated particulate concentrations are the dominant parameter related to hospital admissions (an increase of 10 μg m -3 leads to an increase of 10.2% in the number of admissions), followed by O 3 and the rest of the pollutants (CO, NO 2 and SO 2). Meteorological parameters also play a decisive role in the formation of air pollutant levels affecting public health. Consequently, increased/decreased daily hospital admissions are related to specific types of meteorological conditions that favor/do not favor the accumulation of pollutants in an urban complex. In general, the role of meteorological factors seems to be underestimated by stepwise analyses, while ANNs attribute to them a more important role. Comparison of the two models revealed that ANN adaptation in complicate environmental issues presents improved modeling results compared to a regression technique. Furthermore, the ANN technique provides a reliable model for the prediction of the daily hospital admissions based on air quality data and meteorological indices, undoubtedly useful for regulatory purposes.

  3. [Compulsory admission to hospital in Tunisia: a necessary evolution].

    PubMed

    Ellouze, Faten; Lahmar, Aymen; Beji, Rami; Dridi, Anis; Fadhel M'rad, Mohamed

    2015-01-01

    The evolution of the legislation governing compulsory admission to hospital in Tunisia is interesting for two reasons. The country's 2011 revolution notably brought about major changes to the legislative framework, from constitutional through to ordinary laws. At the same time, the current trend for globalisation is also affecting legislation: international laws, treaties and UN charters are imposed on the laws of individual countries. This article looks at how Tunisian law governing compulsory admission to hospital has had to evolve. PMID:26143219

  4. Hospital admissions before the age of 2 years in Western Australia.

    PubMed Central

    Read, A W; Gibbins, J; Stanley, F J; Morich, P

    1994-01-01

    A linked data file of birth records and hospital admissions was used to investigate inpatient hospital morbidity before 2 years of age for all non-Aboriginal and Aboriginal children born in Western Australia in 1986. Of the non-Aboriginal children, 31.8% were admitted to hospital at least once before the age of 2 years, with an overall admission rate of 526/1000 live births; the corresponding figures for Aboriginal children were 68.7% and 2797. The mean number of days in hospital for each non-Aboriginal child admitted was 7.4, and 26.5 for Aboriginal children. Of the total cohort, 21% of non-Aboriginal and 20% of Aboriginal children were admitted only once, and 4% of non-Aboriginal and 36% of Aboriginal children were admitted at least three times; 23% of non-Aboriginal and 24% of Aboriginal children were admitted for only one major disease category, and 1% of non-Aboriginal and 16% of Aboriginal children were in at least four categories. The highest admission rates and highest percentages of the cohort admitted were for gastrointestinal and respiratory diseases and social admissions. These results illustrate the importance for both descriptive and analytical research of relating admissions to hospital for the total population to the individual child, and of using clinically relevant disease classifications. PMID:8135564

  5. The impact of heat, cold, and heat waves on hospital admissions in eight cities in Korea

    NASA Astrophysics Data System (ADS)

    Son, Ji-Young; Bell, Michelle L.; Lee, Jong-Tae

    2014-01-01

    Although the impact of temperature on mortality is well documented, relatively fewer studies have evaluated the associations of temperature with morbidity outcomes such as hospital admissions, and most studies were conducted in North America or Europe. We evaluated weather and hospital admissions including specific causes (allergic disease, asthma, selected respiratory disease, and cardiovascular disease) in eight major cities in Korea from 2003 to 2008. We also explored potential effect modification by individual characteristics such as sex and age. We used hierarchical modeling to first estimate city-specific associations between heat, cold, or heat waves and hospitalizations, and then estimated overall effects. Stratified analyses were performed by cause of hospitalization, sex, and age (0-14, 15-64, 65-74, and ≥75 years). Cardiovascular hospitalizations were significantly associated with high temperature, whereas hospitalizations for allergic disease, asthma, and selected respiratory disease were significantly associated with low temperature. The overall heat effect for cardiovascular hospitalization was a 4.5 % (95 % confidence interval 0.7, 8.5 %) increase in risk comparing hospitalizations at 25 to 15 °C. For cold effect, the overall increase in risk of hospitalizations comparing 2 with 15 °C was 50.5 (13.7, 99.2 %), 43.6 (8.9, 89.5 %), and 53.6 % (9.8, 114.9 %) for allergic disease, asthma, and selected respiratory disease, respectively. We did not find statistically significant effects of heat waves compared with nonheat wave days. Our results suggest susceptible populations such as women and younger persons. Our findings provide suggestive evidence that both high and low ambient temperatures are associated with the risk of hospital admissions, particularly in women or younger person, in Korea.

  6. Environmental exposures to Florida red tides: Effects on emergency room respiratory diagnoses admissions

    PubMed Central

    Kirkpatrick, Barbara; Fleming, Lora E.; Backer, Lorraine C.; Bean, Judy A.; Tamer, Robert; Kirkpatrick, Gary; Kane, Terrance; Wanner, Adam; Dalpra, Dana; Reich, Andrew; Baden, Daniel G.

    2010-01-01

    Human exposure to Florida red tides formed by Karenia brevis, occurs from eating contaminated shellfish and inhaling aerosolized brevetoxins. Recent studies have documented acute symptom changes and pulmonary function responses after inhalation of the toxic aerosols, particularly among asthmatics. These findings suggest that there are increases in medical care facility visits for respiratory complaints and for exacerbations of underlying respiratory diseases associated with the occurrence of Florida red tides. This study examined whether the presence of a Florida red tide affected the rates of admission with a respiratory diagnosis to a hospital emergency room in Sarasota, FL. The rate of respiratory diagnoses admissions were compared for a 3-month time period when there was an onshore red tide in 2001 (red tide period) and during the same 3-month period in 2002 when no red tide bloom occurred (non-red tide period). There was no significant increase in the total number of respiratory admissions between the two time periods. However, there was a 19% increase in the rate of pneumonia cases diagnosed during the red tide period compared with the non-red tide period. We categorized home residence zip codes as coastal (within 1.6 km from the shore) or inland (>1.6 km from shore). Compared with the non-red tide period, the coastal residents had a significantly higher (54%) rate of respiratory diagnoses admissions than during the red tide period. We then divided the diagnoses into subcategories (i.e. pneumonia, bronchitis, asthma, and upper airway disease). When compared with the non-red tide period, the coastal zip codes had increases in the rates of admission of each of the subcategories during the red tide period (i.e. 31, 56, 44, and 64%, respectively). This increase was not observed seen in the inland zip codes. These results suggest that the healthcare community has a significant burden from patients, particularly those who live along the coast, needing emergency

  7. Chemical Properties of Air Pollutants and Cause-Specific Hospital Admissions among the Elderly in Atlanta, Georgia

    PubMed Central

    Zanobetti, Antonella; Schwartz, Joel; Coull, Brent A.

    2011-01-01

    Background: Health risks differ by fine particle (aerodynamic diameter ≤ 2.5 μm) component, although with substantial variability. Traditional methods to assess component-specific risks are limited, suggesting the need for alternative methods. Objectives: We examined whether the odds of daily hospital admissions differ by pollutant chemical properties. Methods: We categorized pollutants by chemical properties and examined their impacts on the odds of daily hospital admissions among Medicare recipients > 64 years of age in counties in Atlanta, Georgia, for 1998–2006. We analyzed data in two stages. In the first stage we applied a case-crossover analysis to simultaneously estimate effects of 65 pollutants measured in the Aerosol Research and Inhalation Epidemiology Study on cause-specific hospital admissions, controlling for temperature and ozone. In the second stage, we regressed pollutant-specific slopes from the first stage on pollutant properties. We calculated uncertainty estimates using a bootstrap procedure. We repeated the two-stage analyses using coefficients from first-stage models that included single pollutants plus ozone and meteorological variables only. We based our primary analyses on exposures on day of admission. Results: We found that 24-hr transition metals and alkanes were associated with increased odds [0.26%; 95% confidence interval (CI), 0.02–0.48; and 0.37%; 95% CI, 0.04–0.72, respectively] of hospital admissions for cardiovascular disease (CVD). Transition metals were significantly associated with increased hospital admissions for ischemic heart disease, congestive heart failure, and atrial fibrillation. Increased respiratory-related hospital admissions were significantly associated with alkanes. Aromatics and microcrystalline oxides were significantly associated with decreased CVD- and respiratory-related hospital admissions. Conclusions: The two-stage approach showed transition metals to be consistently associated with increased

  8. Temporal association between hospital admissions for asthma in Birmingham and ambient levels of sulphur dioxide and smoke.

    PubMed Central

    Walters, S.; Griffiths, R. K.; Ayres, J. G.

    1994-01-01

    BACKGROUND--A study was performed to determine whether daily and weekly variations in the levels of smoke and sulphur dioxide (SO2) in Birmingham are related to hospital admissions for asthma and acute respiratory diseases. METHODS--Daily numbers of hospital admissions for asthma (ICD code 493) and acute respiratory conditions (ICD 466, 480-486, 490-496) for residents of Birmingham between 1988 and 1990 were obtained from West Midlands RHA Körner inpatient data. Average daily levels of sulphur dioxide and smoke were obtained from Birmingham City Council for the same period, together with daily meteorological summaries from the Department of Geography, University of Birmingham. With the exception of one day, all air pollution measurements remained within current EC guide levels. Data were divided into seasons and the relation between hospital admissions and pollutant levels were explored by stepwise least squares regression models. Meteorological variables (temperature, pressure, humidity) were entered into the model if they showed significant association with hospital admissions during the season in question. Analysis was undertaken for daily (same day and lagged by two days) and weekly pollutant levels. Admissions were lagged behind pollution levels to allow for delayed effects of pollutants. RESULTS--The mean daily level of smoke was 12.7 micrograms/m3 and of SO2 was 39.1 micrograms/m3, with maxima of 188.3 micrograms/m3 and 126.3 micrograms/m3, respectively. Significant associations were found between hospital admissions for respiratory disease lagged by two days, and smoke and SO2 levels during winter. Associations between admissions for asthma and smoke and SO2 levels were significant at the 5% level. These were independent of temperature, pressure, and humidity. Stepwise regression including both pollutants showed that smoke, but not SO2, was a significant independent predictor of hospital admissions for both asthma and all respiratory conditions. During

  9. Seasonality of hospital admissions for mental disorders in Hanoi, Vietnam

    PubMed Central

    Trang, Phan Minh; Rocklöv, Joacim; Giang, Kim Bao; Nilsson, Maria

    2016-01-01

    Background Some studies have shown a relationship between seasonality in weather patterns and depressive and behavioural disorders, especially in temperate climate regions. However, there is a lack of studies describing the seasonal patterns of hospital admissions for a variety of mental disorders in tropical and subtropical nations. The aim of this study has been to examine the relationship between seasons and daily hospital admissions for mental disorders in Hanoi, Vietnam. Designs A 5-year database (2008–2012) compiled by Hanoi Mental Hospital covering mental disorder admissions diagnosed by the International Classification of Diseases 10 was analysed. A negative binominal regression model was applied to estimate the associations between seasonality and daily hospital admissions for mental disorders, for all causes and for specific diagnoses. Results The summer season indicated the highest relative risk (RR=1.24, confidence interval (CI)=1.1–1.39) of hospital admission for mental disorders, with a peak in these cases in June (RR=1.46, CI=1.19–1.7). Compared to other demographic groups, males and the elderly (aged over 60 years) were more sensitive to seasonal risk changes. In the summer season, the RR of hospital visits among men increased by 26% (RR=1.26, CI=1.12–1.41) and among the elderly by 23% (RR=1.23, CI=1.03–1.48). Furthermore, when temperatures including minimum, mean, and maximum increased 1°C, the number of cases for mental disorders increased by 1.7%, 2%, and 2.1%, respectively. Conclusion The study results showed a correlation between hospital admission for mental disorders and season. PMID:27566716

  10. Trends in hospital admissions for obstructive lung disease from 2000 to 2010 in Portugal.

    PubMed

    Vieira, Rafael; Fonseca, João Almeida; Lopes, Fernando; Freitas, Alberto

    2016-07-01

    The burden of hospitalisations for obstructive lung diseases (OLD) has not been sufficiently studied. We aimed to characterise the hospitalisations for OLD from 2000 to 2010 in all Portuguese public hospitals. We analysed hospital discharges with a diagnosis of OLD regarding the patients' gender, age, residence and comorbidities. Of the 120 399 hospital admissions with a principal diagnosis of OLD, COPD (ICD-9-CM 491.x, 492.x, 496) was responsible for 81%. The change in patients discharged with OLD as a principal diagnosis was only 1% from 2000 to 2010 and did not change for COPD. Hospital admissions and deaths for COPD and other OLD increased with age and were more common in men than women. In-hospital mortality for COPD decreased 34.1% from 2000 to 2010, while the median length of stay was fairly constant at 8 days. Respiratory failure, insufficiency and/or arrest, and pneumonia, are the principal diagnoses often associated with COPD. When both pneumonia and COPD were diagnosed there was an increasing trend to classify pneumonia as the principal diagnosis (64.4%-72.9%), a sign that may lead to underestimation of COPD hospitalisations. In summary, a considerable decrease in in-hospital COPD mortality was observed while hospital admissions and the length of stay did not change substantially. These results suggest that better healthcare or other factors may be counteracting the expected increase of the burden of COPD. PMID:27296823

  11. Daily weather variables and affective disorder admissions to psychiatric hospitals.

    PubMed

    McWilliams, Stephen; Kinsella, Anthony; O'Callaghan, Eadbhard

    2014-12-01

    Numerous studies have reported that admission rates in patients with affective disorders are subject to seasonal variation. Notwithstanding, there has been limited evaluation of the degree to which changeable daily meteorological patterns influence affective disorder admission rates. A handful of small studies have alluded to a potential link between psychiatric admission rates and meteorological variables such as environmental temperature (heat waves in particular), wind direction and sunshine. We used the Kruskal-Wallis test, ARIMA and time-series regression analyses to examine whether daily meteorological variables--namely wind speed and direction, barometric pressure, rainfall, hours of sunshine, sunlight radiation and temperature--influence admission rates for mania and depression across 12 regions in Ireland over a 31-year period. Although we found some very weak but interesting trends for barometric pressure in relation to mania admissions, daily meteorological patterns did not appear to affect hospital admissions overall for mania or depression. Our results do not support the small number of papers to date that suggest a link between daily meteorological variables and affective disorder admissions. Further study is needed. PMID:24599495

  12. Daily weather variables and affective disorder admissions to psychiatric hospitals

    NASA Astrophysics Data System (ADS)

    McWilliams, Stephen; Kinsella, Anthony; O'Callaghan, Eadbhard

    2014-12-01

    Numerous studies have reported that admission rates in patients with affective disorders are subject to seasonal variation. Notwithstanding, there has been limited evaluation of the degree to which changeable daily meteorological patterns influence affective disorder admission rates. A handful of small studies have alluded to a potential link between psychiatric admission rates and meteorological variables such as environmental temperature (heat waves in particular), wind direction and sunshine. We used the Kruskal-Wallis test, ARIMA and time-series regression analyses to examine whether daily meteorological variables—namely wind speed and direction, barometric pressure, rainfall, hours of sunshine, sunlight radiation and temperature—influence admission rates for mania and depression across 12 regions in Ireland over a 31-year period. Although we found some very weak but interesting trends for barometric pressure in relation to mania admissions, daily meteorological patterns did not appear to affect hospital admissions overall for mania or depression. Our results do not support the small number of papers to date that suggest a link between daily meteorological variables and affective disorder admissions. Further study is needed.

  13. The admissions process in two state psychiatric hospitals.

    PubMed

    Solomon, P

    1981-06-01

    In this study, a conceptual model of the factors influencing the admissions process was tested in two state psychiatric hospitals. The factors included in the model fell into four categories: characteristics of patients, characteristics of admitting personnel, system factors, and patient assessment. The attitudes of individuals accompanying an applicant were found to be most important. Patients referred by police, courts, family, friends, or agency personnel were more likely to be admitted than self-referrals. Pathological behaviors that had a significant impact on the admissions process were those that indicated the presence of mental disorder or danger to self or others. The availability of alternatives to hospitalization was not found to be significant, a finding that suggests that admitting personnel, particularly psychiatrists, should be educated about community alternatives if spiraling rates of psychiatric admission are to be reduced. PMID:7262846

  14. A Study of Hospital Admission Rules During Pediatric Residency Training.

    ERIC Educational Resources Information Center

    Ferguson, Jane; Alpert, Joel J.

    1980-01-01

    A survey of U.S. pediatric training programs to determine the role of rules in the hospital admission of pediatric patients is reported. The results support the hypothesis that rules are a widely used teaching tool. The rules relate to such factors as fevers, age, specific diseases, administrative concerns, head traumas, and poisonings. (JMD)

  15. Atmospheric pollutants and hospital admissions due to pneumonia in children

    PubMed Central

    Negrisoli, Juliana; Nascimento, Luiz Fernando C.

    2013-01-01

    OBJECTIVE: To analyze the relationship between exposure to air pollutants and hospitalizations due to pneumonia in children of Sorocaba, São Paulo, Brazil. METHODS: Time series ecological study, from 2007 to 2008. Daily data were obtained from the State Environmental Agency for Pollution Control for particulate matter, nitric oxide, nitrogen dioxide, ozone, besides air temperature and relative humidity. The data concerning pneumonia admissions were collected in the public health system of Sorocaba. Correlations between the variables of interest using Pearson cofficient were calculated. Models with lags from zero to five days after exposure to pollutants were performed to analyze the association between the exposure to environmental pollutants and hospital admissions. The analysis used the generalized linear model of Poisson regression, being significant p<0.05. RESULTS: There were 1,825 admissions for pneumonia, with a daily mean of 2.5±2.1. There was a strong correlation between pollutants and hospital admissions, except for ozone. Regarding the Poisson regression analysis with the multi-pollutant model, only nitrogen dioxide was statistically significant in the same day (relative risk - RR=1.016), as well as particulate matter with a lag of four days (RR=1.009) after exposure to pollutants. CONCLUSIONS: There was an acute effect of exposure to nitrogen dioxide and a later effect of exposure to particulate matter on children hospitalizations for pneumonia in Sorocaba. PMID:24473956

  16. Hospital admissions as a function of temperature, other weather phenomena and pollution levels in an urban setting in China

    PubMed Central

    Goggins, William B; Yue, Janice SK; Lee, Poyi

    2013-01-01

    Abstract Objective To explore the relationship between weather phenomena and pollution levels and daily hospital admissions (as an approximation to morbidity patterns) in Hong Kong Special Administrative Region (SAR), China, in 1998–2009. Methods Generalized additive models and lag models were constructed with data from official sources on hospital admissions and on mean daily temperature, mean daily wind speed, mean relative humidity, daily total global solar radiation, total daily rainfall and daily pollution levels. Findings During the hot season, admissions increased by 4.5% for every increase of 1 °C above 29 °C; during the cold season, admissions increased by 1.4% for every decrease of 1 °C within the 8.2–26.9 °C range. In subgroup analyses, admissions for respiratory and infectious diseases increased during extreme heat and cold, but cardiovascular disease admissions increased only during cold temperatures. For every increase of 1 °C above 29 °C, admissions for unintentional injuries increased by 1.9%. During the cold season, for every decrease of 1 °C within the 8.2–26.9 °C range, admissions for cardiovascular diseases and intentional injuries rose by 2.1% and 2.4%, respectively. Admission patterns were not sensitive to sex. Admissions for respiratory diseases rose during hot and cold temperatures among children but only during cold temperatures among the elderly. In people aged 75 years or older, admissions for infectious diseases rose during both temperature extremes. Conclusion In Hong Kong SAR, hospitalizations rise during extreme temperatures. Public health interventions should be developed to protect children, the elderly and other vulnerable groups from excessive heat and cold. PMID:23940405

  17. Reducing hospital admissions from nursing homes: a systematic review

    PubMed Central

    2014-01-01

    Background The geriatric nursing home population is vulnerable to acute and deteriorating illness due to advanced age, multiple chronic illnesses and high levels of dependency. Although the detriments of hospitalising the frail and old are widely recognised, hospital admissions from nursing homes remain common. Little is known about what alternatives exist to prevent and reduce hospital admissions from this setting. The objective of this study, therefore, is to summarise the effects of interventions to reduce acute hospitalisations from nursing homes. Methods A systematic literature search was performed in Cochrane Library, PubMed, MEDLINE, EMBASE and ISI Web of Science in April 2013. Studies were eligible if they had a geriatric nursing home study population and were evaluating any type of intervention aiming at reducing acute hospital admission. Systematic reviews, randomised controlled trials, quasi randomised controlled trials, controlled before-after studies and interrupted time series were eligible study designs. The process of selecting studies, assessing them, extracting data and grading the total evidence was done by two researchers individually, with any disagreement solved by a third. We made use of meta-analyses from included systematic reviews, the remaining synthesis is descriptive. Based on the type of intervention, the included studies were categorised in: 1) Interventions to structure and standardise clinical practice, 2) Geriatric specialist services and 3) Influenza vaccination. Results Five systematic reviews and five primary studies were included, evaluating a total of 11 different interventions. Fewer hospital admissions were found in four out of seven evaluations of structuring and standardising clinical practice; in both evaluations of geriatric specialist services, and in influenza vaccination of residents. The quality of the evidence for all comparisons was of low or very low quality, using the GRADE approach. Conclusions Overall, eleven

  18. Heatwaves and Hospital Admissions for Mental Disorders in Northern Vietnam

    PubMed Central

    Trang, Phan Minh; Rocklöv, Joacim; Giang, Kim Bao; Kullgren, Gunnar; Nilsson, Maria

    2016-01-01

    Studies in high-income countries have shown an association between heatwaves and hospital admissions for mental disorders. It is unknown whether such associations exist in subtropical nations like Vietnam. The study aim was to investigate whether hospital admissions for mental disorders may be triggered, or exacerbated, by heat exposure and heatwaves, in a low- and middle-income country, Vietnam. For this, we used data from the Hanoi Mental Hospital over five years (2008–2012) to estimate the effect of heatwaves on admissions for mental disorders. A zero-inflated negative binomial regression model accounting for seasonality, time trend, days of week, and mean humidity was used to analyse the relationship. Heatwave events were mainly studied as periods of three or seven consecutive days above the threshold of 35°C daily maximum temperature (90th percentile). The study result showed heatwaves increased the risk for admission in the whole group of mental disorders (F00-79) for more persistent heatwaves of at least 3 days when compared with non-heatwave periods. The relative risks were estimated at 1.04 (0.95–1.13), 1.15 (1.005–1.31), and 1.36 (1–1.90) for a one-, three- and seven-day heatwave, respectively. Admissions for mental disorders increased among men, residents in rural communities, and the elderly population during heatwaves. The groups of organic mental disorders, including symptomatic illnesses (F0-9) and mental retardation (F70-79), had increased admissions during heatwaves. The findings are novel in their focus on heatwave impact on mental diseases in a population habituating in a subtropical low- and middle-income country characterized by rapid epidemiological transitions and environmental changes. PMID:27195473

  19. Heatwaves and Hospital Admissions for Mental Disorders in Northern Vietnam.

    PubMed

    Trang, Phan Minh; Rocklöv, Joacim; Giang, Kim Bao; Kullgren, Gunnar; Nilsson, Maria

    2016-01-01

    Studies in high-income countries have shown an association between heatwaves and hospital admissions for mental disorders. It is unknown whether such associations exist in subtropical nations like Vietnam. The study aim was to investigate whether hospital admissions for mental disorders may be triggered, or exacerbated, by heat exposure and heatwaves, in a low- and middle-income country, Vietnam. For this, we used data from the Hanoi Mental Hospital over five years (2008-2012) to estimate the effect of heatwaves on admissions for mental disorders. A zero-inflated negative binomial regression model accounting for seasonality, time trend, days of week, and mean humidity was used to analyse the relationship. Heatwave events were mainly studied as periods of three or seven consecutive days above the threshold of 35°C daily maximum temperature (90th percentile). The study result showed heatwaves increased the risk for admission in the whole group of mental disorders (F00-79) for more persistent heatwaves of at least 3 days when compared with non-heatwave periods. The relative risks were estimated at 1.04 (0.95-1.13), 1.15 (1.005-1.31), and 1.36 (1-1.90) for a one-, three- and seven-day heatwave, respectively. Admissions for mental disorders increased among men, residents in rural communities, and the elderly population during heatwaves. The groups of organic mental disorders, including symptomatic illnesses (F0-9) and mental retardation (F70-79), had increased admissions during heatwaves. The findings are novel in their focus on heatwave impact on mental diseases in a population habituating in a subtropical low- and middle-income country characterized by rapid epidemiological transitions and environmental changes. PMID:27195473

  20. [The appropriateness of hospital admissions: reflections for a global approach].

    PubMed

    Pasini, E; Scherillo, M; Ramponi, C

    2000-05-01

    In accordance with a recent definition, appropriateness of medical care is a diagnostic-therapeutic intervention with a correct use of resources and competency, and a procedure that satisfies the request of patients. This definition considers not only the risk/benefit relationship but also the interaction between costs and benefits. In this light, the concept of appropriateness needs a global approach. The identification of the Mission and Vision of the structure, the use of medical guidelines, the distribution of documents which inform patients on the procedures carried out in the hospital and the modalities of access to the structure, the implementation of procedures which define hospital admission and finally the random check of medical records could represent important steps to implement a quality system aimed at guaranteeing the appropriateness of hospital admissions in accordance with the international standards for total quality management ISO 9000. PMID:10834130

  1. Long-term exposure to traffic pollution and hospital admissions in London.

    PubMed

    Halonen, Jaana I; Blangiardo, Marta; Toledano, Mireille B; Fecht, Daniela; Gulliver, John; Anderson, H Ross; Beevers, Sean D; Dajnak, David; Kelly, Frank J; Tonne, Cathryn

    2016-01-01

    Evidence on the effects of long-term exposure to traffic pollution on health is inconsistent. In Greater London we examined associations between traffic pollution and emergency hospital admissions for cardio-respiratory diseases by applying linear and piecewise linear Poisson regression models in a small-area analysis. For both models the results for children and adults were close to unity. In the elderly, linear models found negative associations whereas piecewise models found non-linear associations characterized by positive risks in the lowest and negative risks in the highest exposure category. An increased risk was observed among those living in areas with the highest socioeconomic deprivation. Estimates were not affected by adjustment for traffic noise. The lack of convincing positive linear associations between primary traffic pollution and hospital admissions agrees with a number of other reports, but may reflect residual confounding. The relatively greater vulnerability of the most deprived populations has important implications for public health. PMID:26476693

  2. Increasing malaria hospital admissions in Uganda between 1999 and 2009

    PubMed Central

    2011-01-01

    Background Some areas of Africa are witnessing a malaria transition, in part due to escalated international donor support and intervention coverage. Areas where declining malaria rates have been observed are largely characterized by relatively low baseline transmission intensity and rapid scaling of interventions. Less well described are changing patterns of malaria burden in areas of high parasite transmission and slower increases in control and treatment access. Methods Uganda is a country predominantly characterized by intense, perennial malaria transmission. Monthly pediatric admission data from five Ugandan hospitals and their catchments have been assembled retrospectively across 11 years from January 1999 to December 2009. Malaria admission rates adjusted for changes in population density within defined catchment areas were computed across three time periods that correspond to periods where intervention coverage data exist and different treatment and prevention policies were operational. Time series models were developed adjusting for variations in rainfall and hospital use to examine changes in malaria hospitalization over 132 months. The temporal changes in factors that might explain changes in disease incidence were qualitatively examined sequentially for each hospital setting and compared between hospital settings Results In four out of five sites there was a significant increase in malaria admission rates. Results from time series models indicate a significant month-to-month increase in the mean malaria admission rates at four hospitals (trend P < 0.001). At all hospitals malaria admissions had increased from 1999 by 47% to 350%. Observed changes in intervention coverage within the catchments of each hospital showed a change in insecticide-treated net coverage from <1% in 2000 to 33% by 2009 but accompanied by increases in access to nationally recommended drugs at only two of the five hospital areas studied. Conclusions The declining malaria disease

  3. Impacts of hot and cold temperature extremes on hospital admissions for cardiovascular diseases

    NASA Astrophysics Data System (ADS)

    Davídkovová, H.; Kyselý, J.; Kříž, B.

    2010-09-01

    Elevated mortality associated with high ambient temperatures in summer represents one of the main impacts of weather extremes on human society. Increases in mortality during heat waves were examined in many European countries; much less is known about the effects of heat waves on morbidity, measured for example by the number of hospital admissions. Relatively less understood is also cold-related mortality and morbidity in winter, when the relationships between weather and human health are more complex, less direct, and confounded by other factors such as epidemics of influenza/acute respiratory infections. The present study examines links between hot and cold temperature extremes and daily hospital admissions for cardiovascular diseases in the population of the Czech Republic over 1994-2007. We make use of a recently completed database of all admissions for cardiovascular diseases to hospitals in the area of the Czech Republic since 1994, with a detailed classification of diseases and detailed information concerning each patient (in total 1,467,675 hospital admissions over 1994-2007). The main goals of the study are (i) to identify excess/deficit morbidity during and after periods of heat waves in summer and cold spells in winter, (ii) to compare the links for individual diseases (e.g. acute myocardial infarction, I21; angina pectoris, I20; cerebral infarction, I63; brain ischemia, I64) and to identify those diagnoses that are most closely linked to weather, (iii) to identify population groups most vulnerable to temperature extremes, and (iv) to compare the links to temperature extremes for morbidity and mortality. Periods when morbidity data were affected by epidemics of influenza and acute respiratory infections in winter were excluded from the analysis.

  4. Hospital admission avoidance through the introduction of a virtual ward.

    PubMed

    Jones, Joanne; Carroll, Andrea

    2014-07-01

    The ageing British population is placing increased demands on the delivery of care in mainstream health-care institutions. While people are living longer, a significant percentage is also living with one or more long-term conditions. These issues, alongside continuing financial austerity measures, require a radical improvement in the care of patients away from hospitals. The Wyre Forest Clinical Commissioning Group introduced a virtual ward model for two main purposes: to save on spiralling costs of hospital admissions, and, secondly, to ensure the preferred wishes of most patients to be cared for and even die at home were achieved. This commentary describes how the virtual ward model was implemented and the impact of preventing unplanned emergency admissions to hospitals. The setting up of enhanced care services and virtual wards in one county is discussed, aiming to highlight success points and potential pitfalls to avoid. The results from the implementation of the virtual ward model show a significant reduction in emergency and avoidable patient admissions to hospital. The success of virtual wards is dependent on integrated working between different health-care disciplines. PMID:25039341

  5. Air pollution and daily hospital admissions in metropolitan Los Angeles.

    PubMed Central

    Linn, W S; Szlachcic, Y; Gong, H; Kinney, P L; Berhane, K T

    2000-01-01

    We used daily time-series analysis to evaluate associations between ambient carbon monoxide, nitrogen dioxide, particulate matter [less than and equal to] 10 microm in aerodynamic diameter (PM(10)), or ozone concentrations, and hospital admissions for cardiopulmonary illnesses in metropolitan Los Angeles during 1992-1995. We performed Poisson regressions for the entire patient population and for subgroups defined by season, region, or personal characteristics, allowing for effects of temporal variation, weather, and autocorrelation. CO showed the most consistently significant (p<0.05) relationships to cardiovascular admissions. A wintertime 25th-75th percentile increase in CO (1.1-2.2 ppm) predicted an increase of 4% in cardiovascular admissions. NO(2), and, to a lesser extent, PM(10) tracked CO and showed similar associations with cardiovascular disease, but O(3) was negatively or nonsignificantly associated. No significant demographic differences were found, although increased cardiovascular effects were suggested in diabetics, in whites and blacks (relative to Hispanics and Asians), and in persons older than 65 years of age. Pulmonary disease admissions associated more with NO(2) and PM(10) than with CO. Pulmonary effects were generally smaller than cardiovascular effects and were more sensitive to the choice of model. We conclude that in Los Angeles, atmospheric stagnation with high primary (CO/NO(2)/PM(10)) pollution, most common in autumn/winter, increases the risk of hospitalization for cardiopulmonary illness. Summer photochemical pollution (high O(3)) apparently presents less risk. Images Figure 1 Figure 2 PMID:10811569

  6. [Big data, Roemer's law and avoidable hospital admissions].

    PubMed

    van der Horst, H E

    2016-01-01

    From an analysis of data from 23 European countries to determine the impact of primary care on avoidable hospital admissions for uncontrolled diabetes it appeared that, contrary to expectation, countries with strong primary care did not have a lower rate of avoidable hospital admission. It is clear that Roemer's law, 'a bed built is a bed filled,' still applies. However, the validity of this sort of analysis can be questioned, as these data are highly aggregated, and registration quality differs between countries. It is also questionable if these datasets can be considered as 'big data' as there are relatively small numbers per country. Big data analyses are useful for discerning patterns and formulating hypotheses, but not for proving causality. An unwanted side effect of this kind of analysis might be that policymakers use these not so valid results to underpin their policy to their advantage. PMID:27484429

  7. Duration of Hospital Admission and the Need for Empirical Antipseudomonal Therapy

    PubMed Central

    Elligsen, M.; Walker, S. A. N.; Simor, A.

    2012-01-01

    To reduce selective pressure for antimicrobial resistance, empirical use of antipseudomonal antibiotics is often reserved for patients with late-onset hospital-acquired infections. We examined the likelihood of isolating Pseudomonas aeruginosa as a function of time from hospital admission. We conducted a retrospective cohort study of all positive bacterial cultures in a tertiary-care hospital between March 2010 and November 2011. The primary outcome was the proportion of positive cultures yielding P. aeruginosa. Multivariable logistic regression was employed to assess the impact of time from admission on the likelihood of isolating P. aeruginosa, after adjusting for other important risk factors. A total of 7,668 positive cultures were obtained from 4,108 unique patients during the study interval, including 633 (8.3%) yielding P. aeruginosa. The probability of isolating P. aeruginosa increased linearly from 79/2,044 (3.9%) positive cultures obtained on admission to 153/664 (23%) in the 10th week of admission or beyond. The unadjusted odds ratio was 1.002/day (95% confidence interval [CI], 1.0016 to 1.0028; P < 0.0001); the adjusted odds ratio (aOR) was 1.0007/day (95% CI, 1.0001 to 1.0013; P = 0.02). Other important predictors of P. aeruginosa isolation included respiratory specimen type (aOR, 13.8; 95% CI, 9.1 to 21.1), recent hospital admission (aOR,1.8; 95% CI, 1.4 to 2.3), prior P. aeruginosa isolation during current admission (aOR, 4.9; 95% CI, 3.7 to 6.4), and prior antipseudomonal (aOR, 1.9; 95% CI, 1.4 to 2.5) or nonantipseudomonal (aOR, 1.8; 95% CI, 1.4 to 2.4) antibiotic exposure. It was determined that as time from admission increases, there is a linear increase in the likelihood of P. aeruginosa isolation. Any guidelines which distinguish early from late hospital-acquired infection must consider the implications of time point selection on the likelihood of inadequate P. aeruginosa empirical coverage. PMID:22675131

  8. Emergency re-admissions to hospital due to adverse drug reactions within 1 year of the index admission

    PubMed Central

    Davies, Emma C; Green, Christopher F; Mottram, David R; Rowe, Philip H; Pirmohamed, Munir

    2010-01-01

    AIM The proportion of re-admissions to hospital caused by ADRs is poorly documented in the UK. The aim of this study was to evaluate the impact of ADRs on re-admission to hospital after a period as an inpatient. METHODS One thousand patients consecutively admitted to 12 wards were included. All subsequent admissions for this cohort within 1 year of discharge from the index admission were retrospectively reviewed. RESULTS Of the 1000 patients included, 403 (40.3%, 95% CI 39.1, 45.4%) were re-admitted within 1 year. Complete data were available for 290 (70.2%) re-admitted patients, with an ADR contributing to admission in 60 (20.8%, 95% CI 16.4, 25.6%) patients. Presence of an ADR in the index admission did not predict for an ADR-related re-admission (10.5% vs. 7.2%, P = 0.25), or re-admission overall (47.2% vs. 41.2%, P = 0.15). The implicated drug was commenced in the index admission in 33/148 (22.3%) instances, with 37/148 (25%) commenced elsewhere since the index admission. Increasing age and an index admission in a medical ward were associated with a higher incidence of re-admission ADR. The most frequent causative drugs were anti-platelets and loop diuretics, with bleeding and renal impairment the most frequent ADRs. Over half (52/91, 57.1%) of the ADRs were judged to be definitely or possibly avoidable. CONCLUSIONS One fifth of patients re-admitted to hospital within 1 year of discharge from their index admission are re-admitted due to an ADR. Our data highlight drug and patient groups where interventions are needed to reduce the incidence of ADRs leading to re-admission. PMID:21039769

  9. PARTICULATE MATTER AND RESPIRATORY ADMISSIONS AMONG U.S. VETERANS IN DENVER

    EPA Science Inventory

    Previous studies have found that ambient particulate matter levels were associated with respiratory admissions as a principal diagnosis. We examined this association among 17,933 admissions to the Denver VA Medical Center over a six-year period (1994-1999) after restricting to m...

  10. Expiratory flow limitation relates to symptoms during COPD exacerbations requiring hospital admission

    PubMed Central

    Jetmalani, Kanika; Timmins, Sophie; Brown, Nathan J; Diba, Chantale; Berend, Norbert; Salome, Cheryl M; Wen, Fu-Qiang; Chen, Peng; King, Gregory G; Farah, Claude S

    2015-01-01

    Background Expiratory flow limitation (EFL) is seen in some patients presenting with a COPD exacerbation; however, it is unclear how EFL relates to the clinical features of the exacerbation. We hypothesized that EFL when present contributes to symptoms and duration of recovery during a COPD exacerbation. Our aim was to compare changes in EFL with symptoms in subjects with and without flow-limited breathing admitted for a COPD exacerbation. Subjects and methods A total of 29 subjects with COPD were recruited within 48 hours of admission to West China Hospital for an acute exacerbation. Daily measurements of post-bronchodilator spirometry, resistance, and reactance using the forced oscillation technique and symptom (Borg) scores until discharge were made. Flow-limited breathing was defined as the difference between inspiratory and expiratory respiratory system reactance (EFL index) greater than 2.8 cmH2O·s·L−1. The physiological predictors of symptoms during recovery were determined by mixed-effect analysis. Results Nine subjects (31%) had flow-limited breathing on admission despite similar spirometry compared to subjects without flow-limited breathing. Spirometry and resistance measures did not change between enrolment and discharge. EFL index values improved in subjects with flow-limited breathing on admission, with resolution in four patients. In subjects with flow-limited breathing on admission, symptoms were related to inspiratory resistance and EFL index values. In subjects without flow-limited breathing, symptoms related to forced expiratory volume in 1 second/forced vital capacity. In the whole cohort, EFL index values at admission was related to duration of stay (Rs=0.4, P=0.03). Conclusion The presence of flow-limited breathing as well as abnormal respiratory system mechanics contribute independently to symptoms during COPD exacerbations. PMID:25999709

  11. Possible adverse drug events leading to hospital admission in a Brazilian teaching hospital

    PubMed Central

    Varallo, Fabiana Rossi; Capucho, Helaine Carneiro; da Silva Planeta, Cleópatra; de Carvalho Mastroianni, Patrícia

    2014-01-01

    OBJECTIVES: Drug safety problems can lead to hospital admission. In Brazil, the prevalence of hospitalization due to adverse drug events is unknown. This study aims to estimate the prevalence of hospitalization due to adverse drug events and to identify the drugs, the adverse drug events, and the risk factors associated with hospital admissions. METHOD: A cross-sectional study was performed in the internal medicine ward of a teaching hospital in São Paulo State, Brazil, from August to December 2008. All patients aged ≥18 years with a length of stay ≥24 hours were interviewed about the drugs used prior to hospital admission and their symptoms/complaints/causes of hospitalization. RESULTS: In total, 248 patients were considered eligible. The prevalence of hospitalization due to potential adverse drug events in the ward was 46.4%. Overprescribed drugs and those indicated for prophylactic treatments were frequently associated with possible adverse drug events. Frequently reported symptoms were breathlessness (15.2%), fatigue (12.3%), and chest pain (9.0%). Polypharmacy was a risk factor for the occurrence of possible adverse drug events. CONCLUSION: Possible adverse drug events led to hospitalization in a high-complexity hospital, mainly in polymedicated patients. The clinical outcomes of adverse drug events are nonspecific, which delays treatment, hinders causality analysis, and contributes to the underreporting of cases. PMID:24626940

  12. Apparent Temperature and Cause-Specific Emergency Hospital Admissions in Greater Copenhagen, Denmark

    PubMed Central

    Wichmann, Janine; Andersen, Zorana; Ketzel, Matthias; Ellermann, Thomas; Loft, Steffen

    2011-01-01

    One of the key climate change factors, temperature, has potentially grave implications for human health. We report the first attempt to investigate the association between the daily 3-hour maximum apparent temperature (Tappmax) and respiratory (RD), cardiovascular (CVD), and cerebrovascular (CBD) emergency hospital admissions in Copenhagen, controlling for air pollution. The study period covered 1 January 2002−31 December 2006, stratified in warm and cold periods. A case-crossover design was applied. Susceptibility (effect modification) by age, sex, and socio-economic status was investigated. For an IQR (8°C) increase in the 5-day cumulative average of Tappmax, a 7% (95% CI: 1%, 13%) increase in the RD admission rate was observed in the warm period whereas an inverse association was found with CVD (−8%, 95% CI: −13%, −4%), and none with CBD. There was no association between the 5-day cumulative average of Tappmax during the cold period and any of the cause-specific admissions, except in some susceptible groups: a negative association for RD in the oldest age group and a positive association for CVD in men and the second highest SES group. In conclusion, an increase in Tappmax is associated with a slight increase in RD and decrease in CVD admissions during the warmer months. PMID:21829550

  13. The effect of primary organic particles on emergency hospital admissions among the elderly in 3 US cities

    PubMed Central

    2013-01-01

    Background Fine particle (PM2.5) pollution related to combustion sources has been linked to a variety of adverse health outcomes. Although poorly understood, it is possible that organic carbon (OC) species, particularly those from combustion-related sources, may be partially responsible for the observed toxicity of PM2.5. The toxicity of the OC species may be related to their chemical structures; however, few studies have examined the association of OC species with health impacts. Methods We categorized 58 primary organic compounds by their chemical properties into 5 groups: n-alkanes, hopanes, cyclohexanes, PAHs and isoalkanes. We examined their impacts on the rate of daily emergency hospital admissions among Medicare recipients in Atlanta, GA and Birmingham, AL (2006–2009), and Dallas, TX (2006–2007). We analyzed data in two stages; we applied a case-crossover analysis to simultaneously estimate effects of individual OC species on cause-specific hospital admissions. In the second stage we estimated the OC chemical group-specific effects, using a multivariate weighted regression. Results Exposures to cyclohexanes of six days and longer were significantly and consistently associated with increased rate of hospital admissions for CVD (3.40%, 95%CI = (0.64, 6.24%) for 7-d exposure). Similar increases were found for hospitalizations for ischemic heart disease and myocardial infarction. For respiratory related hospital admissions, associations with OC groups were less consistent, although exposure to iso-/anteiso-alkanes was associated with increased respiratory-related hospitalizations. Conclusions Results suggest that week-long exposures to traffic-related, primary organic species are associated with increased rate of total and cause-specific CVD emergency hospital admissions. Associations were significant for cyclohexanes, but not hopanes, suggesting that chemical properties likely play an important role in primary OC toxicity. PMID:23981468

  14. Contribution of ED admissions to inpatient hospital revenue.

    PubMed

    Sacchetti, Alfred; Harris, Russell H; Warden, Todd; Roth, Sandra

    2002-01-01

    Emergency department (ED) practices are traditionally profiled in terms of their patient encounters. Such evaluations reflect a preponderance of outpatient visits while crediting income from admitted patients to traditional hospital-based services. This study evaluates the contribution of ED admissions to inpatient hospital revenue. The study was set at an urban tertiary care community hospital with university affiliation. Information referable to ED patients was collected from the hospital's Universal Billing Code (UB-92)-based patient information warehouse. Data fields referable to hospital charges, insurance type, and disposition were used for analysis of a 1-year period from September 1, 1998 to August 31, 1999. Statistical analysis was through chi square and ANOVA. During the study period 33,174 patients were treated in the ED with 6,671 (20%) admitted to inpatient services. Total hospital charges for all ED patients during this time were $107 million dollars with $9.1 million (8.5%) generated from discharged patients and $98.0 million (91.5%) from admitted ED patients (P <.001). Mean charges for individual discharged patients were $344.10 whereas for individual admitted patients mean charges were $14,692.28. (P <.001) Medicaid and self pay represented 55.4% of the insurance coverage for discharged ED patients whereas these same insurance classes accounted for only 16.3% of admitted patients. (P <.001) Medicare visits accounted for 12.7% of discharged ED patients but 60.7% of admitted patients (P <.001). Total hospital gross revenue for inpatient services for the study period was $288 million of which 34% was contributed from admitted ED patients. ED services represent a major source of inpatient hospital revenue. The recognition of the ED's potential in this area may be lost if income from patients admitted through the ED is credited to traditional hospital-based services. PMID:11781909

  15. Bacteremia in Children Hospitalized with Respiratory Syncytial Virus Infection

    PubMed Central

    Pardo-Seco, Jacobo; Gómez-Carballa, Alberto; Martinón-Torres, Nazareth; Martinón-Sánchez, José María; Justicia-Grande, Antonio; Rivero-Calle, Irene; Pinnock, Elli; Salas, Antonio; Fink, Colin

    2016-01-01

    Background The risk of bacteremia is considered low in children with acute bronchiolitis. However the rate of occult bacteremia in infants with RSV infection is not well established. The aim was to determine the actual rate and predictive factors of bacteremia in children admitted to hospital due to confirmed RSV acute respiratory illness (ARI), using both conventional culture and molecular techniques. Methods A prospective multicenter study (GENDRES-network) was conducted between 2011–2013 in children under the age of two admitted to hospital because of an ARI. Among those RSV-positive, bacterial presence in blood was assessed using PCR for Meningococcus, Streptococcus pneumoniae, Haemophilus influenzae, Streptococcus pyogenes, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus, in addition to conventional cultures. Results 66 children with positive RSV respiratory illness were included. In 10.6% patients, bacterial presence was detected: H. influenzae (n = 4) and S. pneumoniae (n = 2). In those patients with bacteremia, there was a previous suspicion of bacterial superinfection and had received empirical antibiotic treatment 6 out of 7 (85.7%) patients. There were significant differences in terms of severity between children with positive bacterial PCR and those with negative results: PICU admission (100% vs. 50%, P-value = 0.015); respiratory support necessity (100% vs. 18.6%, P-value < 0.001); Wood-Downes score (mean = 8.7 vs. 4.8 points, P-value < 0.001); GENVIP scale (mean = 17 vs. 10.1, P-value < 0.001); and length of hospitalization (mean = 12.1 vs. 7.5 days, P-value = 0.007). Conclusion Bacteremia is not frequent in infants hospitalized with RSV respiratory infection, however, it should be considered in the most severe cases. PMID:26872131

  16. Risk Factors for Inpatient Hospital Admission in Pediatric Burn Patients

    PubMed Central

    Puckett, Yana

    2016-01-01

    Purpose Our objective was to determine the risk factors for inpatient admission of pediatric burn patients. Materials & methods This cross-sectional study uses data from the Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP KID) for the years of 2003, 2006, 2009, and 2012 to estimate the risk factors for inpatient admission for pediatric patients who sustained a burn injury. Patients who sustained a burn between the ages of 1 and 18 years were included. Results A total of 43,453 patients met inclusion criteria. Of those, 42.3% were Caucasian, 20.1% were African American, and 19.3% were Hispanic. Males comprised 63.5% of the studied population. The month of July was associated with a 31.8% increased chance (p=.011) of being admitted to hospital for a pediatric burn. It was found that patients being admitted had a 32.2% increased chance (p=.002) of a fluid and electrolyte abnormality and a 61.0% increased chance (p=.027) of drug abuse.  Conclusions Pediatric burn patients are more likely to be admitted to the hospital having a fluid and electrolyte abnormality, having a drug abuse status, and/or during the month of July. PMID:27335714

  17. Medical causes of admissions to hospital among adults in Africa: a systematic review

    PubMed Central

    Etyang, Anthony O.; Scott, John Anthony Gerard

    2013-01-01

    Background Despite the publication of several studies on the subject, there is significant uncertainty regarding the burden of disease among adults in sub-Saharan Africa (sSA). Objectives To describe the breadth of available data regarding causes of admission to hospital, to systematically analyze the methodological quality of these studies, and to provide recommendations for future research. Design We performed a systematic online and hand-based search for articles describing patterns of medical illnesses in patients admitted to hospitals in sSA between 1950 and 2010. Diseases were grouped into bodily systems using International Classification of Disease (ICD) guidelines. We compared the proportions of admissions and deaths by diagnostic category using χ2. Results Thirty articles, describing 86,307 admissions and 9,695 deaths, met the inclusion criteria. The leading causes of admission were infectious and parasitic diseases (19.8%, 95% confidence interval [CI] 19.6–20.1), respiratory (16.2%, 95% CI 16.0–16.5) and circulatory (11.3%, 95% CI 11.1–11.5) illnesses. The leading causes of death were infectious and parasitic (17.1%, 95% CI 16.4–17.9), circulatory (16%, 95% CI 15.3–16.8) and digestive (16.2%, 95% CI 15.4–16.9). Circulatory diseases increased from 3.9% of all admissions in 1950–59 to 19.9% in 2000–2010 (RR 5.1, 95% CI 4.5–5.8, test for trend p<0.00005). The most prevalent methodological deficiencies, present in two-thirds of studies, were failures to use standardized case definitions and ICD guidelines for classifying illnesses. Conclusions Cardiovascular and infectious diseases are currently the leading causes of admissions and in-hospital deaths in sSA. Methodological deficiencies have limited the usefulness of previous studies in defining national patterns of disease in adults. As African countries pass through demographic and health transition, they need to significantly invest in clinical research capacity to provide an accurate

  18. Hospital Admissions for Stroke among the Very Old in the USA

    PubMed Central

    Tabereaux, Paul B.; Brass, Lawrence M.; Concato, John; Bravata, Dawn M.

    2008-01-01

    Background We sought to describe the proportion of acute ischemic stroke admissions for very old patients (≥85 years), compare the characteristics of very old versus younger patients and identify factors among very old patients associated with adverse outcomes. Methods The 2000 Healthcare Cost and Utilization Project data included acute ischemic stroke hospitalizations for patients ≥45 years. The combined outcome was in-hospital mortality or discharge to a long-term care facility. Results Among 15,020 stroke hospitalizations, 20.4% were for very old patients. The outcome rate was higher in hospitalizations for very old patients (2,176/3,058, 71.2%; versus 5,748/11,962, 48%; p < 0.0001). More hospitalizations for very old patients were for women (73.5 versus 55.1%; p < 0.0001), fewer for Blacks (6.1 versus 12.3%; p < 0.0001) and fewer at teaching hospitals (30.4 versus 36.2%; p < 0.0001). Among very old patients, factors that were independently associated with the outcome included: age [years; adjusted OR = 1.02 (95% CI = 1.000–1.05)], female gender [1.4 (1.18–1.68)], atrial fibrillation [1.37 (1.15–1.63)], acute myocardial infarction [1.68 (1.20–2.35)], respiratory failure [3.59 (1.60–8.05)] and teaching hospital admission [0.82 (0.69–0.98)]. Similar results were observed in the hospitalizations for younger patients. The adjusted OR for the outcome displayed geographic disparities in both age groups, but the pattern of the geographic variation was not similar between the two age groups. Conclusions The very old constitute a substantial proportion of stroke hospitalizations. Hospitalizations for very old patients are more likely to end in death or discharge to a long-term care facility than hospitalizations for younger patients. The pattern of geographic disparity in poststroke adverse outcomes differs between younger and very old patients. PMID:18645263

  19. Air pollution and risk of respiratory and cardiovascular hospitalizations in the most populous city in Vietnam.

    PubMed

    Phung, Dung; Hien, To Thi; Linh, Ho Nhut; Luong, Ly M T; Morawska, Lidia; Chu, Cordia; Binh, Nguyen Duy; Thai, Phong K

    2016-07-01

    Air pollution has become an alarming issue in Vietnam recently; however, there was only one study so far on the effects of ambient air pollution on population health. Our study aimed to investigate the short-term effects of air pollutants including PM10, NO2, SO2, and O3 on respiratory and cardiovascular hospitalizations in Ho Chi Minh City (HCMC), the largest city in Vietnam. Data on hospitalization from the two largest hospitals in HCMC and daily records of PM10, NO2, SO2, O3 and meteorological data were collected from February 2004 to December 2007. A time-series regression analysis with distributed lag model was applied for data analysis. Changes in levels of NO2 and PM10 were strongly associated with hospital admissions for both respiratory and cardiovascular diseases (CVD); whereas levels of SO2 were only moderately associated with respiratory and CVD hospital admissions and O3 concentration was not associated with any of them. For a 10μg/m(3) increase of each air pollutant, the risk of respiratory admissions increased from 0.7% to 8% while the risk of CVD admissions increased from 0.5% to 4%. Females were found to be more sensitive than males to exposure to air pollutants in regard to respiratory diseases. In regard to CVD, females (RR, 1.04, 95% CI, 1.01-1.07) had a slightly higher risk of admissions than males (RR, 1.03, 95% CI, 1-1.06) to exposure to NO2. In contrast, males (RR, 1.007, 95%CI, 1-1.01) had a higher risk of admission than females (RR, 1.004, 95%CI, 1.001-1.007) to exposure to PM10. People in the age group of 5-65year-olds had a slightly higher risk of admissions caused by air pollutants than the elderly (65+years old) except for a significant effect of PM10 on the risk of cardiovascular admissions was found for the elderly only. PMID:27016680

  20. Day hospital versus admission for acute psychiatric disorders

    PubMed Central

    Marshall, Max; Crowther, Ruth; Sledge, William Hurt; Rathbone, John; Soares-Weiser, Karla

    2014-01-01

    Background Inpatient treatment is an expensive way of caring for people with acute psychiatric disorders. It has been proposed that many of those currently treated as inpatients could be cared for in acute psychiatric day hospitals. Objectives To assess the effects of day hospital versus inpatient care for people with acute psychiatric disorders. Search methods We searched the Cochrane Schizophrenia Group Trials Register (June 2010) which is based on regular searches of MEDLINE, EMBASE, CINAHL and PsycINFO. We approached trialists to identify unpublished studies. Selection criteria Randomised controlled trials of day hospital versus inpatient care, for people with acute psychiatric disorders. Studies were ineligible if a majority of participants were under 18 or over 65, or had a primary diagnosis of substance abuse or organic brain disorder. Data collection and analysis Two review authors independently extracted and cross-checked data. We calculated risk ratios (RR) and 95% confidence intervals (CI) for dichotomous data. We calculated weighted or standardised means for continuous data. Day hospital trials tend to present similar outcomes in slightly different formats, making it difficult to synthesise data. We therefore sought individual patient data so that we could re-analyse outcomes in a common format. Main results Ten trials (involving 2685 people) met the inclusion criteria. We obtained individual patient data for four trials (involving 646 people). We found no difference in the number lost to follow-up by one year between day hospital care and inpatient care (5 RCTs, n = 1694, RR 0.94 CI 0.82 to 1.08). There is moderate evidence that the duration of index admission is longer for patients in day hospital care than inpatient care (4 RCTs, n = 1582, WMD 27.47 CI 3.96 to 50.98). There is very low evidence that the duration of day patient care (adjusted days/month) is longer for patients in day hospital care than inpatient care (3 RCTs, n = 265, WMD 2.34 days

  1. Did a ban on diesel-fuel reduce emergency respiratory admissions for children?

    PubMed

    El-Zein, Abbas; Nuwayhid, Iman; El-Fadel, Mutasem; Mroueh, Salman

    2007-10-01

    This paper assesses whether a ban on diesel-powered motor vehicles in Lebanon has reduced emergency respiratory admissions for children less than 17 years of age in Beirut. Monthly admissions for total respiratory complaints, asthma, bronchitis, pneumonia, and upper respiratory tract infections, from October to February, were compared before and after the ban, using Poisson regression models and adjusting for rainfall, humidity and temperature. Analyses were repeated excluding the flu months of January and February. A test of significance of p < or = 0.05 was used. Air pollution is not systematically monitored in Lebanon and no ambient particulate concentration data were available. A significant drop in admissions for respiratory symptoms (p < or = 0.05) and upper respiratory tract infection (p < or = 0.001) from 1 year pre-ban to 1 year post-ban has been recorded. When flu months are excluded, a significant drop (p < or = 0.001) in admissions for all studied categories, except pneumonia, is observed. The effect of the ban however was negligible in the second year. When 2 year pre-ban versus 2 year post-ban are considered excluding flu months, statistically non-significant reductions are recorded for asthma and upper respiratory tract infection (p < or = 0.1). The study hence suggests an impact of the diesel ban on respiratory health only during the first year after the ban. This finding is weakened by the absence of supporting evidence from air quality monitoring and speciation of particulate matter, which are lacking in Lebanon and most developing countries. PMID:17659765

  2. Delay in hospital admission of patients with cerebral vein and dural sinus thrombosis.

    PubMed

    Ferro, José M; Lopes, M G; Rosas, M J; Fontes, J

    2005-01-01

    Factors influencing early hospital admission have been described for several stroke types but not for cerebral vein and dural sinus thrombosis (CVT). CVT is more difficult to diagnose than arterial stroke; delay in hospital admission may postpone CVT treatment. The purposes of this study were: (1) to describe the delay between the onset of symptoms and hospital admission of patients with CVT, and (2) to identify the variables that influence that delay. We registered the interval (days) between the onset of symptoms and hospital admission in 91 consecutive patients admitted to 20 Portuguese hospitals between June 1995 and June 1998. We also studied the impact of admission delay on treatments (prescription of anticoagulants and the number of days elapsed between the onset of symptoms and start of anticoagulation and admission). Median admission delay was 4 days. Twenty-two (25%) patients were admitted within 24 h. Two thirds of the patients were admitted within 7 days and 75% within 13 days. In multiple logistic regression analysis, admission within 24 h was positively associated with mental status disorder (delirium or abulia; OR = 4.59; 95% CI = 1.41-14.89) and negatively associated with headache (OR = 0.03; 95% CI = 0.00-0.32). Presentation as isolated intracranial hypertension was associated with admission delay of more than 4 days (OR = 2.63; 95% CI = 0.97-7.14). Papilloedema was associated with an admission delay of more than 13 days (OR = 4.69; 95% CI = 1.61-13.61). There was no association between admission delay and the proportion of anticoagulated patients. The interval between onset of symptoms and start of anticoagulation was shorter in patients admitted earlier (p = 0.0001, for either admission within 24 h, 4 or 13 days). There is a considerable delay until the clinical picture associated with CVT is recognised as justifying hospital admission, especially when patients present with symptoms identical to isolated intracranial hypertension syndrome. PMID

  3. Predictors and Outcomes of Infection-Related Hospital Admissions of Heart Failure Patients

    PubMed Central

    Korenfeld, Roman; Fuchs, Shmuel

    2013-01-01

    Background Infections are one of the most common causes for hospitalization of patients with heart failure (HF). Yet, little is known regarding the prevalence and predictors of different types of acute infections as well as their impact on outcome among this growing population. Methods and Results We identified all patients aged 50 or older with a major diagnosis of HF and at least one echocardiography examination who had been hospitalized over a 10-year period (January 2000 and December 2009). Infection-associated admissions were identified according to discharge diagnoses. Among 9,335 HF patients, 3530 (38%) were hospitalized at least once due to infections. The most frequent diagnoses were respiratory infection (52.6%) and sepsis/bacteremia (23.6%) followed by urinary (15.7%) and skin and soft tissue infections (7.8%). Hospitalizations due to infections compared to other indications were associated with increased 30-day mortality (13% vs. 8%, p<0.0001). These higher mortality rates were predominately related to respiratory infections (OR 1.28 [95% CI 1.09, 1.5]) and sepsis\\bacteremia (OR 3.13 [95% CI 2.6, 3.7]). Important predictors for these serious infections included female gender, chronic obstructive pulmonary disease, past myocardial infarction and echocardiography-defined significant right (RV) but not left ventricular dysfunction. Conclusions Major infection-related hospitalizations are frequent among patients with HF and are associated with increased mortality rates. Elderly female patients with multiple comorbidities and those with severe RV dysfunction are at higher risk for these infections. PMID:24009684

  4. Comparing Exposure Metrics for the Effects of Fine Particulate Matter on Emergency Hospital Admissions

    PubMed Central

    Mannshardt, Elizabeth; Sucic, Katarina; Jiao, Wan; Dominici, Francesca; Frey, H. Christopher; Reich, Brian; Fuentes, Montserrat

    2013-01-01

    A crucial step in an epidemiological study of the effects of air pollution is to accurately quantify exposure of the population. In this paper, we investigate the sensitivity of the health effects estimates associated with short-term exposure to fine particulate matter with respect to three potential metrics for daily exposure: ambient monitor data, estimated values from a deterministic atmospheric chemistry model, and stochastic daily average human exposure simulation output. Each of these metrics has strengths and weaknesses when estimating the association between daily changes in ambient exposure to fine particulate matter and daily emergency hospital admissions. Monitor data is readily available, but is incomplete over space and time. The atmospheric chemistry model output is spatially and temporally complete, but may be less accurate than monitor data. The stochastic human exposure estimates account for human activity patterns and variability in pollutant concentration across microenvironments, but requires extensive input information and computation time. To compare these metrics, we consider a case study of the association between fine particulate matter and emergency hospital admissions for respiratory cases for the Medicare population across three counties in New York. Of particular interest is to quantify the impact and/or benefit to using the stochastic human exposure output to measure ambient exposure to fine particulate matter. Results indicate that the stochastic human exposure simulation output indicates approximately the same increase in relative risk associated with emergency admissions as using a chemistry model or monitoring data as exposure metrics. However, the stochastic human exposure simulation output and the atmospheric chemistry model both bring additional information which helps to reduce the uncertainly in our estimated risk. PMID:23942393

  5. Charges for hospital admissions attributable to health disparities for African-American patients, 1998-2002.

    PubMed Central

    Chumney, Elinor C. G.; Mauldin, Patrick D.; Simpson, Kit N.

    2006-01-01

    OBJECTIVE: Racial disparities exist across most major disease categories, which result in a disproportionately large number of hospital admissions for many conditions. Estimates for the financial impact of the racial admission differences for the State of South Carolina are assessed. METHODS: South Carolina hospital discharge data for 1998-2002 was used for the analysis. The database includes all-payer billing data for inpatient hospital admissions as received on the UB-92 billing file for the covered episode. Charges were inflation adjusted to 2002 constant dollars. RESULTS: For 1998-2002, there were an estimated dollar 1.6 billion in total charges for hospital admissions in South Carolina that were attributed to higher age-adjusted admission rates for African-American patients. In addition, African Americans had consistently higher hospital admission rates for disease categories that are often associated with a failure to obtain ambulatory and preventive care. CONCLUSION: This simple analysis reveals that age-adjusted hospital admission rates for African Americans in South Carolina are higher than for Caucasians, and the gap appears to be widening over time. Given the magnitude of the financial implication, interventions with even a small impact on the conditions underlying the racial disparities in hospital admissions are likely to be cost effective. PMID:16749643

  6. The Effect of a Smoking Ban on Hospitalization Rates for Cardiovascular and Respiratory Conditions in Prince Edward Island, Canada

    PubMed Central

    Gaudreau, Katherine; Sanford, Carolyn J.; Cheverie, Connie; McClure, Carol

    2013-01-01

    Background This is the first study to have examined the effect of smoking bans on hospitalizations in the Atlantic Canadian socio-economic, cultural and climatic context. On June 1, 2003 Prince Edward Island (PEI) enacted a province-wide smoking ban in public places and workplaces. Changes in hospital admission rates for cardiovascular (acute myocardial infarction, angina, and stroke) and respiratory (chronic obstructive pulmonary disease and asthma) conditions were examined before and after the smoking ban. Methods Crude annual and monthly admission rates for the above conditions were calculated from April 1, 1995 to December 31, 2008 in all PEI acute care hospitals. Autoregressive Integrated Moving Average time series models were used to test for changes in mean and trend of monthly admission rates for study conditions, control conditions and a control province after the comprehensive smoking ban. Age- and sex-based analyses were completed. Results The mean rate of acute myocardial infarctions was reduced by 5.92 cases per 100,000 person-months (P = 0.04) immediately after the smoking ban. The trend of monthly angina admissions in men was reduced by −0.44 cases per 100,000 person-months (P = 0.01) in the 67 months after the smoking ban. All other cardiovascular and respiratory admission changes were non-significant. Conclusions A comprehensive smoking ban in PEI reduced the overall mean number of acute myocardial infarction admissions and the trend of angina hospital admissions. PMID:23520450

  7. Association between annual river flood pulse and paediatric hospital admissions in the Mekong Delta area.

    PubMed

    Phung, Dung; Huang, Cunrui; Rutherford, Shannon; Chu, Cordia; Wang, Xiaoming; Nguyen, Minh

    2014-11-01

    The Mekong Delta is the most vulnerable region to extreme climate and hydrological conditions however the association between these conditions and children's health has been little studied. We examine the association between annual river flood pulse and paediatric hospital admissions in a Vietnam Mekong Delta city. Daily paediatric hospital admissions (PHA) were collected from the City Paediatric Hospital, and daily river water level (RWL) and meteorological data were retrieved from the Southern Regional Hydro-Meteorological Centre from 2008 to 2011. We evaluated the association between annual river flood pulse (>=90th percentile of RWL) and PHA using the Poisson distributed lag model, controlling for temperature, relative humidity, day of week, seasonal and long-term trends. The seasonal pattern of PHA was examined using harmonic and polynomial regression models. The cumulative risk ratios estimated for a 15-day period following an extreme RWL was 1.26 (95%CI, 1.2-1.38) for all age groups, 1.27 (95%CI, 1.23-1.30) for under five-years and 1.15 (95%CI, 1.07-1.20) for school-aged children, 1.24 (95%CI, 1.21-1.27) for all-causes, 1.18 (95%CI, 1.12-1.21) for communicable infection, 1.66 (95%CI, 1.57-1.74) for respiratory infection and 1.06 (95%CI, 1.01-1.1) for other diseases. The peak PHA risk is in the September-October period corresponding to the highest RWL, and the PHA-RWL association was modified by temperature. An increase in PHA is significantly associated with annual river flood, and the pattern of PHA is seasonally correspondent to the RWL. These findings combined with projected changes in climate conditions suggest important implications of climate change for human health in the Mekong Delta region. PMID:25282279

  8. Community -and hospital laboratory-based surveillance for respiratory viruses.

    PubMed

    Zachariah, Philip; Whittier, Susan; Reed, Carrie; LaRussa, Philip; Larson, Elaine L; Vargas, Celibell Y; Saiman, Lisa; Stockwell, Melissa S

    2016-09-01

    Traditional surveillance for respiratory viruses relies on symptom detection and laboratory detection during medically attended encounters for acute respiratory infection/influenza-like illness (ARI/ILI). Ecological momentary reporting using text messages is a novel method for surveillance. This study compares respiratory viral activity detected through longitudinal community-based surveillance using text message responses for sample acquisition and testing to respiratory viral activity obtained from hospital laboratory data from the same community. We demonstrate a significant correlation between community- and hospital laboratory-based surveillance for most respiratory viruses, although the relative proportions of viruses detected in the community and hospital differed significantly. PMID:26987664

  9. Effect of tele health care on exacerbations and hospital admissions in patients with chronic obstructive pulmonary disease: a randomized clinical trial

    PubMed Central

    Ringbæk, Thomas; Green, Allan; Laursen, Lars Christian; Frausing, Ejvind; Brøndum, Eva; Ulrik, Charlotte Suppli

    2015-01-01

    Background and objective Tele monitoring (TM) of patients with chronic obstructive pulmonary disease (COPD) has gained much interest, but studies have produced conflicting results. Our aim was to investigate the effect of TM with the option of video consultations on exacerbations and hospital admissions in patients with severe COPD. Materials and methods Patients with severe COPD at high risk of exacerbations were eligible for the study. Of 560 eligible patients identified, 279 (50%) declined to participate. The remaining patients were equally randomized to either TM (n=141) or usual care (n=140) for the 6-month study period. TM comprised recording of symptoms, saturation, spirometry, and weekly video consultations. Algorithms generated alerts if readings breached thresholds. Both groups received standard care. The primary outcome was number of hospital admissions for exacerbation of COPD during the study period. Results Most of the enrolled patients had severe COPD (forced expiratory volume in 1 second <50%pred in 86% and ≥hospital admission for COPD in the year prior to enrollment in 45%, respectively, of the patients). No difference in drop-out rate and mortality was found between the groups. With regard to the primary outcome, no significant difference was found in hospital admissions for COPD between the groups (P=0.74), and likewise, no difference was found in time to first admission or all-cause hospital admissions. Compared with the control group, TM group patients had more moderate exacerbations (ie, treated with antibiotics/corticosteroid, but not requiring hospital admission; P<0.001), whereas the control group had more visits to outpatient clinics (P<0.001). Conclusion Our study of patients with severe COPD showed that TM including video consultations as add-on to standard care did not reduce hospital admissions for exacerbated COPD, but TM may be an alternative to visits at respiratory outpatient clinics. Further studies are needed to establish the

  10. Respiratory Viral Testing and Influenza Antiviral Prescriptions During Hospitalization for Acute Respiratory Illnesses

    PubMed Central

    Rolfes, Melissa A.; Yousey-Hindes, Kimberly M.; Meek, James I.; Fry, Alicia M.; Chaves, Sandra S.

    2016-01-01

    We examined respiratory viral testing and influenza antiviral prescriptions at a US tertiary care hospital. During the 2010–11 to 2012–13 influenza seasons, antiviral prescriptions among acute respiratory illness (ARI) hospitalizations were associated with viral testing (rate ratio = 15.0), and empiric prescriptions were rare (<1% of ARI hospitalizations). PMID:26885545

  11. Impact of rotavirus disease in Spain: an estimate of hospital admissions due to rotavirus.

    PubMed

    Visser, L E; Cano Portero, R; Gay, N J; Martínez Navarro, J F

    1999-01-01

    The epidemiology of rotavirus infection in Spain was investigated using information from existing surveillance systems. Reports from laboratories and data on hospital admissions were used to estimate the number of hospital admissions due to rotavirus infection. Between January 1989 and December 1995 there were 8265 reports of rotavirus identification in the Sistema de Información Microbiológica, a voluntary national laboratory surveillance system. Where age was reported, 89.2% were in children under 5 y old. This represents 21.8% of all pathogens identified in faecal specimens in children of this age group. Between January and December 1994 there were 5639 admissions coded as "infectious intestinal disease" and 8225 as "non-infective gastroenteritis" in children under 5 y of age in the Conjunto Mínimo Básico de Datos, an obligatory hospital admissions surveillance system which covers 83% of public hospitals. Using regression analysis of admission data and laboratory reports it was estimated that rotavirus infection accounted for 3519 (25.3%) of the hospital admissions. We estimate that 4239 admissions attributable to rotavirus occurred in children under 5 y of age in Spain in 1994, a rate of 2.5/1000 population in this age group. These estimates are lower than those published for other countries, where the burden of disease is considered high enough to warrant a national vaccination programme. A cost-effectiveness study with Spanish information is essential before embarking on a national vaccination programme. PMID:10088916

  12. The association between depressive symptoms in the community, non-psychiatric hospital admission and hospital outcomes: A systematic review

    PubMed Central

    Prina, A. Matthew; Cosco, Theodore D.; Dening, Tom; Beekman, Aartjan; Brayne, Carol; Huisman, Martijn

    2015-01-01

    Objectives This paper aims to systematically review observational studies that have analysed whether depressive symptoms in the community are associated with higher general hospital admissions, longer hospital stays and increased risk of re-admission. Methods We identified prospective studies that looked at depressive symptoms in the community as a risk factor for non-psychiatric general hospital admissions, length of stay or risk of re-admission. The search was carried out on MEDLINE, PsycINFO, Cochrane Library Database, and followed up with contact with authors and scanning of reference lists. Results Eleven studies fulfilled our inclusion and exclusion criteria, and all were deemed to be of moderate to high quality. Meta-analysis of seven studies with relevant data suggested that depressive symptoms may be a predictor of subsequent admission to a general hospital in unadjusted analyses (RR = 1.36, 95% CI: 1.28–1.44), but findings after adjustment for confounding variables were inconsistent. The narrative synthesis also reported depressive symptoms to be independently associated with longer length of stay, and higher re-admission risk. Conclusions Depressive symptoms are associated with a higher risk of hospitalisation, longer length of stay and a higher re-admission risk. Some of these associations may be mediated by other factors, and should be explored in more details. PMID:25466985

  13. Clinical outcomes and mortality associated with weekend admission to psychiatric hospital

    PubMed Central

    Patel, Rashmi; Chesney, Edward; Cullen, Alexis E.; Tulloch, Alex D.; Broadbent, Matthew; Stewart, Robert; McGuire, Philip

    2016-01-01

    Background Studies indicate that risk of mortality is higher for patients admitted to acute hospitals at the weekend. However, less is known about clinical outcomes among patients admitted to psychiatric hospitals. Aims To investigate whether weekend admission to a psychiatric hospital is associated with worse clinical outcomes. Method Data were obtained from 45 264 consecutive psychiatric hospital admissions. The association of weekend admission with in-patient mortality, duration of hospital admission and risk of readmission was investigated using multivariable regression analyses. Secondary analyses were performed to investigate the distribution of admissions, discharges, in-patient mortality, episodes of seclusion and violent incidents on different days of the week. Results There were 7303 weekend admissions (16.1%). Patients who were aged between 26 and 35 years, female or from a minority ethnic group were more likely to be admitted at the weekend. Patients admitted at the weekend were more likely to present via acute hospital services, other psychiatric hospitals and the criminal justice system than to be admitted directly from their own home. Weekend admission was associated with a shorter duration of admission (B coefficient −21.1 days, 95% CI −24.6 to −17.6, P<0.001) and an increased risk of readmission in the 12 months following index admission (incidence rate ratio 1.13, 95% CI 1.08 to 1.18, P<0.001), but in-patient mortality (odds ratio (OR) = 0.79, 95% CI 0.51 to 1.23, P = 0.30) was not greater than for weekday admission. Fewer episodes of seclusion occurred at the weekend but there was no significant variation in deaths during hospital admission or violent incidents on different days of the week. Conclusions Being admitted at the weekend was not associated with an increased risk of in-patient mortality. However, patients admitted at the weekend had shorter admissions and were more likely to be readmitted, suggesting that they may represent a

  14. Impact of childhood trauma on risk of relapse requiring psychiatric hospital admission for psychosis.

    PubMed

    Petros, N; Foglia, E; Klamerus, E; Beards, S; Murray, R M; Bhattacharyya, S

    2016-08-01

    Relapse in psychosis typically necessitates admission to hospital placing a significant financial burden on the health service. Exposure to childhood trauma is associated with an increased risk of psychosis, however, the extent to which this influences relapse is unclear. This report summarises current research investigating the influence of childhood trauma on relapse requiring psychiatric hospital admission for psychosis. Seven studies were included; two revealed a positive association between childhood trauma and relapse admission, two studies found a negative relationship and three found no significant difference. Inconsistent current evidence suggests a need for further research in this area. PMID:27151070

  15. Caregivers' perceptions of coercion in psychiatric hospital admission.

    PubMed

    Ranieri, Veronica; Madigan, Kevin; Roche, Eric; Bainbridge, Emma; McGuinness, David; Tierney, Kevin; Feeney, Larkin; Hallahan, Brian; McDonald, Colm; O'Donoghue, Brian

    2015-08-30

    While knowledge on service users' perspective on their admissions to psychiatric wards has improved substantially in the last decade, there is a paucity of knowledge of the perspectives of caregivers. This study aimed to determine caregiver's perception of the levels of perceived coercion, perceived pressures and procedural justice experienced by service users during their admission to acute psychiatric in-patient units. The perspective of caregivers were then compared to the perspectives of their related service users, who had been admitted to five psychiatric units in Ireland. Caregivers were interviewed using an adapted version of the MacArthur admission experience interview. Sixty-six caregivers participated in this study and the majority were parents. Seventy one percent of service users were admitted involuntarily and nearly half had a diagnosis of schizophrenia or schizoaffective disorder. Caregivers of involuntarily admitted individuals perceived the service users' admission as less coercive than reported by the service users. Caregivers also perceived a higher level of procedural justice in comparison to the level reported by service users. Reducing the disparity of perceptions between caregivers and service users could result in caregivers having a greater understanding of the admission process and why some service users may be reluctant to be admitted. PMID:26163727

  16. Concordance of effects of medical interventions on hospital admission and readmission rates with effects on mortality

    PubMed Central

    Hemkens, Lars G.; Contopoulos-Ioannidis, Despina G.; Ioannidis, John P.A.

    2013-01-01

    Background: Many clinical trials examine a composite outcome of admission to hospital and death, or infer a relationship between hospital admission and survival benefit. This assumes concordance of the outcomes “hospital admission” and “death.” However, whether the effects of a treatment on hospital admissions and readmissions correlate to its effect on serious outcomes such as death is unknown. We aimed to assess the correlation and concordance of effects of medical interventions on admission rates and mortality. Methods: We searched the Cochrane Database of Systematic Reviews from its inception to January 2012 (issue 1, 2012) for systematic reviews of treatment comparisons that included meta-analyses for both admission and mortality outcomes. For each meta-analysis, we synthesized treatment effects on admissions and death, from respective randomized trials reporting those outcomes, using random-effects models. We then measured the concordance of directions of effect sizes and the correlation of summary estimates for the 2 outcomes. Results: We identified 61 meta-analyses including 398 trials reporting mortality and 182 trials reporting admission rates; 125 trials reported both outcomes. In 27.9% of comparisons, the point estimates of treatment effects for the 2 outcomes were in opposite directions; in 8.2% of trials, the 95% confidence intervals did not overlap. We found no significant correlation between effect sizes for admission and death (Pearson r = 0.07, p = 0.6). Our results were similar when we limited our analysis to trials reporting both outcomes. Interpretation: In this metaepidemiological study, admission and mortality outcomes did not correlate, and discordances occurred in about one-third of the treatment comparisons included in our analyses. Both outcomes convey useful information and should be reported separately, but extrapolating the benefits of admission to survival is unreliable and should be avoided. PMID:24144601

  17. Mold sensitization is common amongst patients with severe asthma requiring multiple hospital admissions

    PubMed Central

    O'Driscoll, B Ronan; Hopkinson, Linda C; Denning, David W

    2005-01-01

    Background Multiple studies have linked fungal exposure to asthma, but the link to severe asthma is controversial. We studied the relationship between asthma severity and immediate type hypersensitivity to mold (fungal) and non-mold allergens in 181 asthmatic subjects. Methods We recruited asthma patients aged 16 to 60 years at a University hospital and a nearby General Practice. Patients were categorized according to the lifetime number of hospital admissions for asthma (82 never admitted, 53 one admission, 46 multiple admissions). All subjects had allergy skin prick tests performed for 5 mold allergens (Aspergillus, Alternaria, Cladosporium, Penicillium and Candida) and 4 other common inhalant allergens (D. pteronyssinus, Grass Pollen, Cat and Dog). Results Skin reactivity to all allergens was commonest in the group with multiple admissions. This trend was strongest for mold allergens and dog allergen and weakest for D. pteronyssinus. 76% of patients with multiple admissions had at least one positive mold skin test compared with 16%-19% of other asthma patients; (Chi squared p < 0.0001). Multiple mold reactions were also much commoner in the group with multiple admissions (50% V 5% and 6%; p < 0.0001). The number of asthma admissions was related to the number and size of positive mold skin allergy tests (Spearman Correlation Coefficient r = 0.60, p < 0.0001) and less strongly correlated to the number and size of non-mold allergy tests (r = 0.34, p = 0.0005). Hospital admissions for asthma patients aged 16–40 were commonest during the mold spore season (July to October) whereas admissions of patients aged above 40 peaked in November-February (Chi Squared, p < 0.02). Conclusion These findings support previous suggestions that mold sensitization may be associated with severe asthma attacks requiring hospital admission. PMID:15720706

  18. Temporal dynamics of emergency department and hospital admissions of pediatric asthmatics

    NASA Technical Reports Server (NTRS)

    Kimes, Daniel; Levine, Elissa; Timmins, Sidey; Weiss, Sheila R.; Bollinger, Mary E.; Blaisdell, Carol

    2004-01-01

    Asthma is a chronic disease that can result in exacerbations leading to urgent care in emergency departments (EDs) and hospitals. We examined seasonal and temporal trends in pediatric asthma ED (1997-1999) and hospital (1986-1999) admission data so as to identify periods of increased risk of urgent care by age group, gender, and race. All pediatric ED and hospital admission data for Maryland residents occurring within the state of Maryland were evaluated. Distinct peaks in pediatric ED and hospital asthma admissions occurred each year during the winter-spring and autumn seasons. Although the number and timing of these peaks were consistent across age and racial groups, the magnitude of the peaks differed by age and race. The same number, timing, and relative magnitude of the major peaks in asthma admissions occurred statewide, implying that the variables affecting these seasonal patterns of acute asthma exacerbations occur statewide. Similar gross seasonal trends are observed worldwide. Although several environmental, infectious, and psychosocial factors have been linked with increases in asthma exacerbations among children, thus far they have not explained these seasonal patterns of admissions. The striking temporal patterns of pediatric asthma admissions within Maryland, as described here, provide valuable information in the search for causes.

  19. Affective disorders, hospital admissions, and seasonal variation of mania in a subtropical area, southern hemisphere.

    PubMed

    Kerr-Corrêa, F; Souza, L B; Calil, H M

    1998-01-01

    Hospital admissions (n = 15,450) to a state psychiatric hospital in Botucatu, São Paulo State, Brazil, over a 10-year period (1982-1991) were reviewed. 157 (1%) patients received a probable diagnosis of affective disorder according to DSM-III-R criteria. Among them, 46% had been diagnosed by the staff psychiatrists, and their diagnoses were sustained by the researchers, whereas 54% were diagnosed only by one of the researchers (F.K.C.). These last patients had previously received a diagnosis of paranoid schizophrenia or unspecified psychosis (ICD-9). Most of the patients with affective disorders were bipolar: 72 and 8%, respectively, presented manic and depressive episodes. Thus, only 20% received a diagnosis of major depression. A seasonal pattern in hospital admission was observed only for mania in women, their episodes occurring more often (p < 0.02) in spring and summer. No significant seasonal pattern in hospital admission for depression was found. PMID:9730786

  20. Determinants of hospital admission among HIV-positive people in British Columbia

    PubMed Central

    Weber, A E; Yip, B; O'Shaughnessy, M V; Montaner, J S; Hogg, R S

    2000-01-01

    BACKGROUND: This study was initiated to evaluate the demographic and clinical determinants of admission to hospital among HIV-positive men and women receiving antiretroviral therapy in British Columbia. METHODS: The analysis was restricted to participants enrolled in the HIV/AIDS Drug Treatment Program between September 1992 and March 1997 who had completed an annual participant survey, had a viral load determination and had signed a consent form allowing electronic access to their inpatient hospital records. A record linkage was conducted with the BC Ministry of Health to obtain all records of hospital admissions from April 1991 to March 1997. Statistical analyses were carried out using parametric and nonparametric methods and multivariate logistic analyses. RESULTS: The study sample comprised 947 participants (859 men, 88 women). Of these, 165 (17%) were admitted to hospital during the study period from May 1, 1996, to Mar. 31, 1997. The median number of admissions was 1 (interquartile range [IQR] 1-2 admissions), and the median length of stay per admission was 3 days (IQR 1-8 days). Admission to hospital was associated with being unemployed (82% of those admitted v. 58% of those not admitted), being an injection drug user (24% v. 17%), reporting a fair or poor health status (46% v. 29%) and having a physician experienced in the management of HIV/AIDS (31% v. 24%). Examination of clinical determinants demonstrated that hospital admission was associated with a previous admission (72% v. 46%), a high viral load (median 74,000 v. 14,000 HIV-1 RNA copies/mL), a low CD4 count (median 0.16 v. 0.27 x 10(9)/L) and an AIDS diagnosis (44% v. 24%). Multivariate logistic regression analysis revealed that being admitted to hospital was independently associated with being unemployed (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.66-4.20), having been previously admitted to hospital (OR 2.30, 95% CI 1.53-3.46), having a high viral load at baseline (OR 1.45, 95% CI 1

  1. The impact of primary care organization on avoidable hospital admissions for diabetes in 23 countries

    PubMed Central

    Van Loenen, Tessa; Faber, Marjan J.; Westert, Gert P.; Van den Berg, Michael J.

    2016-01-01

    Objective Diabetes is a so-called ambulatory care sensitive condition. It is assumed that by appropriate and timely primary care, hospital admissions for complications of such conditions can be avoided. This study examines whether differences between countries in diabetes-related hospitalization rates can be attributed to differences in the organization of primary care in these countries. Design Data on characteristics of primary care systems were obtained from the QUALICOPC study that includes surveys held among general practitioners and their patients in 34 countries. Data on avoidable hospitalizations were obtained from the OECD Health Care Quality Indicator project. Negative binomial regressions were carried out to investigate the association between characteristics of primary care and diabetes-related hospitalizations. Setting A total of 23 countries. Subjects General practitioners and patients. Main outcome measures Diabetes-related avoidable hospitalizations. Results Continuity of care was associated with lower rates of diabetes-related hospitalization. Broader task profiles for general practitioners and more medical equipment in general practice were associated with higher rates of admissions for uncontrolled diabetes. Countries where patients perceive better access to care had higher rates of hospital admissions for long-term diabetes complications. There was no association between disease management programmes and rates of diabetes-related hospitalization. Hospital bed supply was strongly associated with admission rates for uncontrolled diabetes and long-term complications. Conclusions Countries with elements of strong primary care do not necessarily have lower rates of diabetes-related hospitalizations. Hospital bed supply appeared to be a very important factor in this relationship. Apparently, it takes more than strong primary care to avoid hospitalizations. Key pointsCountries with elements of strong primary care do not necessarily have lower rates of

  2. Religious coping and hospital admissions among adults with sickle cell disease

    PubMed Central

    Bediako, Shawn M.; Lattimer, Lakshmi; Haywood, Carlton; Ratanawongsa, Neda; Lanzkron, Sophie; Beach, Mary Catherine

    2011-01-01

    Although a well-established literature implicates religiosity as a central element of the African American experience, little is known about how individuals from this group utilize religion to cope with specific health-related stressors. The present study examined the relation between religious coping and hospital admissions among a cohort of 95 adults with sickle cell disease—a genetic blood disorder that, in the United States, primarily affects people of African ancestry. Multiple regression analyses indicated that positive religious coping uniquely accounted for variance in hospital admissions after adjusting for other demographic and diagnostic variables. Specifically, greater endorsement of positive religious coping was associated with significantly fewer hospital admissions (β = −.29, P<.05). These results indicate a need for further investigation of the roles that religion and spirituality play in adjustment to sickle cell disease and their influence on health care utilization patterns and health outcomes. PMID:20812027

  3. The role of rhinovirus in children hospitalized for acute respiratory disease, Santa Fe, Argentina.

    PubMed

    Rudi, Juan Manuel; Molina, Fabiana; Díaz, Rocío; Bonet, Virginia; Ortellao, Lucila; Cantarutti, Diego; Gómez, Alejandra; Pierini, Judith; Cociglio, Raquel; Kusznierz, Gabriela

    2015-12-01

    Human rhinoviruses (HRVs) were historically considered upper airway pathogens. However, they have recently been proven to cause infections in the lower respiratory tract, resulting in hospitalization of children with pneumonia, bronchiolitis, and chronic pulmonary obstruction. In this report, HRV frequency and seasonality are described together with patient clinical-epidemiological aspects. From a total of 452 surveyed samples, the HRV nucleic acids was detected in 172 (38.1%) and found in every month of the study year. 60% of inpatients with acute respiratory infection (ARI) associated with HRV were under 6 months of age and 31% had a clinical history, being preterm birth and recurrent wheezing the prevailing conditions. The most frequent discharge diagnoses were pneumonia (35.2%), bronchiolitis (32.4%), and bronchitis (12.4%). Fifteen point nine percent of patients required admission into intensive care units. The results obtained in this study demonstrated the association between HRV and children hospitalizations caused by ARI. PMID:25983014

  4. From hospital admission to independent living: is prediction possible?

    PubMed

    Lipskaya-Velikovsky, Lena; Kotler, Moshe; Easterbrook, Adam; Jarus, Tal

    2015-04-30

    An integral component of recovery from mental illness is being able to engage in everyday activities. This ability is often restricted among people with schizophrenia. Although functional deficits are addressed during hospitalization, the ability to predict daily functioning based on information gathered during hospitalization has not been well established. This study examines whether measurements completed during hospitalization can be useful for predicting independent living within the community. Inpatients with schizophrenia (N=104) were enrolled in the study and assessed for cognitive functioning, functional capacity and symptoms. They were approached again 6 months after discharge to evaluate their functioning with respect to everyday life Instrumental Activities of Daily Living (IADL) and Activities of Daily Living (ADL). Functional capacity during hospitalization predicted 26.8% of ADL functioning and 38.8% of IADL functioning. ADL was best predicted by the severity of negative symptoms, cognitive functioning, and the number of hospitalizations (51.2%), while IADL was best predicted by functional capacity, cognition, and number of hospitalizations (60.1%). This study provides evidence that evaluations during hospitalization can be effective, and demonstrates the advantage of a holistic approach in predicting daily functioning. When a holistic approach is not practical, a functional capacity measurement may serve as an effective predictor. PMID:25747682

  5. Substance use treatment barriers for patients with frequent hospital admissions.

    PubMed

    Raven, Maria C; Carrier, Emily R; Lee, Joshua; Billings, John C; Marr, Mollie; Gourevitch, Marc N

    2010-01-01

    Substance use (SU) disorders adversely impact health status and contribute to inappropriate health services use. This qualitative study sought to determine SU-related factors contributing to repeated hospitalizations and to identify opportunities for preventive interventions. Fifty Medicaid-insured inpatients identified by a validated statistical algorithm as being at high-risk for frequent hospitalizations were interviewed at an urban public hospital. Patient drug/alcohol history, experiences with medical, psychiatric and addiction treatment, and social factors contributing to readmission were evaluated. Three themes related to SU and frequent hospitalizations emerged: (a) barriers during hospitalization to planning long-term treatment and follow-up, (b) use of the hospital as a temporary solution to housing/family problems, and (c) unsuccessful SU aftercare following discharge. These data indicate that homelessness, brief lengths of stay complicating discharge planning, patient ambivalence regarding long-term treatment, and inadequate detox-to-rehab transfer resources compromise substance-using patients' likelihood of avoiding repeat hospitalization. Intervention targets included supportive housing, detox-to-rehab transportation, and postdischarge patient support. PMID:19540700

  6. Air pollution and hospital admissions for asthma in a tropical city: Kaohsiung, Taiwan

    SciTech Connect

    Shang-Shyue Tsai; Meng-Hsuan Cheng; Hui-Fen Chiu; Trong-Neng Wu; Chun-Yuh Yang

    2006-07-15

    This study was undertaken to determine whether there is an association between air pollutants levels and hospital admissions for asthma in Kaohsiung, Taiwan. Hospital admissions for asthma and ambient air pollution data for Kaohsiung were obtained for the period from 1996 through 2003. The relative risk of hospital admission was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. In the single-pollutant models, on warm days ({>=}25{sup o}C) statistically significant positive associations were found in all pollutants except sulfur dioxide. On cool days ({<=} 25{sup o}C) all pollutants were significantly associated with asthma admissions. For the two pollutant models, CO and O{sub 3} were significant in combination with each of the other four pollutants on warm days. On cool days NO{sub 2} remained statistically significant in all the two-pollutant models. This study provides evidence that higher levels of ambient pollutants increase the risk of hospital admissions for asthma.

  7. Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data

    PubMed Central

    Cowling, Thomas E; Harris, Matthew; Watt, Hilary; Soljak, Michael; Richards, Emma; Gunning, Elinor; Bottle, Alex; Macinko, James; Majeed, Azeem

    2016-01-01

    Background The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes. Objective To determine whether primary care access is associated with the route of emergency admission—via a GP versus via an A and E department. Methods Retrospective analysis of national administrative data from English hospitals for 2011–2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access—the percentage of patients able to get a general practice appointment on their last attempt—was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics. Results The analysis included 2 322 112 emergency admissions (81.9% via an A and E department). With a 5 unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful. This equates to 139 673 fewer GP admissions (456 232 vs 316 559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England. Conclusions Among hospital inpatients admitted as an emergency, patients

  8. Childhood Malaria Admission Rates to Four Hospitals in Malawi between 2000 and 2010

    PubMed Central

    Okiro, Emelda A.; Kazembe, Lawrence N.; Kabaria, Caroline W.; Ligomeka, Jeffrey; Noor, Abdisalan M.; Ali, Doreen; Snow, Robert W.

    2013-01-01

    Introduction The last few years have witnessed rapid scaling-up of key malaria interventions in several African countries following increases in development assistance. However, there is only limited country-specific information on the health impact of expanded coverage of these interventions. Methods Paediatric admission data were assembled from 4 hospitals in Malawi reflecting different malaria ecologies. Trends in monthly clinical malaria admissions between January 2000 and December 2010 were analysed using time-series models controlling for covariates related to climate and service use to establish whether changes in admissions can be related to expanded coverage of interventions aimed at reducing malaria infection. Results In 3 of 4 sites there was an increase in clinical malaria admission rates. Results from time series models indicate a significant month-to-month increase in the mean clinical malaria admission rates at two hospitals (trend P<0.05). At these hospitals clinical malaria admissions had increased from 2000 by 41% to 100%. Comparison of changes in malaria risk and ITN coverage appear to correspond to a lack of disease declines over the period. Changes in intervention coverage within hospital catchments showed minimal increases in ITN coverage from <6% across all sites in 2000 to maximum of 33% at one hospital site by 2010. Additionally, malaria transmission intensity remained unchanged between 2000–2010 across all sites. Discussion Despite modest increases in coverage of measures to reduce infection there has been minimal changes in paediatric clinical malaria cases in four hospitals in Malawi. Studies across Africa are increasingly showing a mixed set of impact results and it is important to assemble more data from more sites to understand the wider implications of malaria funding investment. We also caution that impact surveillance should continue in areas where intervention coverage is increasing with time, for example Malawi, as decline may

  9. Paediatric admissions to the British military hospital at Camp Bastion, Afghanistan

    PubMed Central

    Arul, GS; Reynolds, J; DiRusso, S; Scott, A; Bree, S; Templeton, P; Midwinter, MJ

    2012-01-01

    INTRODUCTION International humanitarian law requires emergency medical support for both military personnel and civilians, including children. Here we present a detailed review of paediatric admissions with the pattern of injury and the resources they consume. METHODS All paediatric admissions to the hospital at Camp Bastion between 1 January and 29 April 2011 were analysed prospectively. Data collected included time and date of admission, patient age and weight, mechanism of injury, extent of wounding, treatment, length of hospital stay and discharge destination. RESULTS Eighty-five children (65 boys and 17 girls, median age: 8 years, median weight: 20kg) were admitted. In 63% of cases the indication for admission was battle related trauma and in 31% non-battle trauma. Of the blast injuries, 51% were due to improvised explosive devices. Non-battle emergencies were mainly due to domestic burns (46%) and road traffic accidents (29%). The most affected anatomical area was the extremities (44% of injuries). Over 30% of patients had critical injuries. Operative intervention was required in 74% of cases. The median time to theatre for all patients was 52 minutes; 3 patients with critical injuries went straight to theatre in a median of 7 minutes. A blood transfusion was required in 27 patients; 6 patients needed a massive transfusion. Computed tomography was performed on 62% of all trauma admissions and 40% of patients went to the intensive care unit. The mean length of stay was 2 days (range: 1–26 days) and there were 7 deaths. CONCLUSIONS Paediatric admissions make up a small but significant part of admissions to the hospital at Camp Bastion. The proportion of serious injuries is very high in comparison with admissions to a UK paediatric emergency department. The concentration of major injuries means that lessons learnt in terms of teamwork, the speed of transfer to theatre and massive transfusion protocols could be applied to UK paediatric practice. PMID:22524930

  10. Preventing hospitalizations for respiratory syncytial virus infection

    PubMed Central

    Robinson, Joan L; Le Saux, Nicole

    2015-01-01

    Respiratory syncytial virus infection is the leading cause of lower respiratory tract infections in young children. Palivizumab has minimal impact on RSV hospitilization rates as it is only practical to offer it to the highest risk groups. The present statement reviews the published literature and provides updated recommendations regarding palivizumab use in children in Canada. PMID:26435673

  11. Admission to psychiatric hospital in the early and late postpartum periods: Scottish national linkage study

    PubMed Central

    Langan Martin, Julie; McLean, Gary; Cantwell, Roch; Smith, Daniel J

    2016-01-01

    Objective To describe weekly admission rates for affective and non-affective psychosis, major depression and other psychiatric disorders in the early and late postpartum periods. To assess the impact of socioeconomic status, age and parity on admission rates. Methods Scottish maternity records were linked to psychiatric hospital admissions. 3290 pregnancy-related psychiatric admissions were assessed. Weekly admission rates were calculated for the pregnancy period, early postpartum period (6 weeks after birth) and late postpartum period (up to 2 years after birth), and compared with pre-pregnancy rates (up to 2 years before pregnancy). Admission rates were generated by calculating the total number of admissions for each time period divided by the number of weeks in the period. Incidence rate ratios (IRRs) were generated for each time period, using deprivation, age, parity and record of previous psychiatric hospital care-adjusted Poisson regression models. Results Women from more deprived social quintiles accounted for the largest proportion of admissions across all time periods. Compared with pre-pregnancy period, admission rates fell during pregnancy, increased markedly during the early postpartum period, and remained elevated for 2 years after childbirth. Within the most affluent quintile, admission IRRs were higher in the early postpartum period (IRR=1.29, 95% CI 1.02 to 1.59) than in the late postpartum period (IRR=0.87, 95% CI 0.74 to 0.98). For the late postpartum period, there was a positive association between higher maternal age and admission IRRs (ages 20–35 years, IRR=1.35, 95% CI 1.16 to 1.54 and age>40 years IRR=1.72, 95% CI 1.41 to 2.09). Conclusions Rates of psychiatric admission fell during pregnancy and increased in the early postpartum period (particularly during the first 2 weeks after birth), and remained elevated above baseline during the 2-year late postpartum period. An understanding of how social deprivation, age and parity

  12. Influences on hospital admission for asthma in south Asian and white adults: qualitative interview study

    PubMed Central

    Griffiths, Chris; Kaur, Gurmit; Gantley, Madeleine; Feder, Gene; Hillier, Sheila; Goddard, Jill; Packe, Geoff

    2001-01-01

    Objective To explore reasons for increased risk of hospital admission among south Asian patients with asthma. Design Qualitative interview study using modified critical incident technique and framework analysis. Setting Newham, east London, a deprived area with a large mixed south Asian population. Participants 58 south Asian and white adults with asthma (49 admitted to hospital with asthma, 9 not admitted); 17 general practitioners; 5 accident and emergency doctors; 2 out of hours general practitioners; 1 asthma specialist nurse. Main outcome measures Patients' and health professionals' views on influences on admission, events leading to admission, general practices' organisation and asthma strategies, doctor-patient relationship, and cultural attitudes to asthma. Results South Asian and white patients admitted to hospital coped differently with asthma. South Asians described less confidence in controlling their asthma, were unfamiliar with the concept of preventive medication, and often expressed less confidence in their general practitioner. South Asians managed asthma exacerbations with family advocacy, without systematic changes in prophylaxis, and without systemic corticosteroids. Patients describing difficulty accessing primary care during asthma exacerbations were registered with practices with weak strategies for asthma care and were often south Asian. Patients with easy access described care suggesting partnerships with their general practitioner, had better confidence to control asthma, and were registered with practices with well developed asthma strategies that included policies for avoiding hospital admission. Conclusions The different ways of coping with asthma exacerbations and accessing care may partly explain the increased risk of hospital admission in south Asian patients. Interventions that increase confidence to control asthma, confidence in the general practitioner, understanding of preventive treatment, and use of systemic corticosteroids in

  13. Pediatric hospital admissions from influenza A (H1N1) in Brazil: effects of the 2010 vaccination campaign.

    PubMed

    Marcos, Ana Carolina Cavalcanti; Pelissoni, Fernanda D'Angelo Monteiro; Cunegundes, Kelly Simone Almeida; Abramczyk, Marcelo Luiz; Bellei, Nancy Cristina Junqueira; Sanches, Nivea Aparecida Pissaia; Moraes-Pinto, Maria Isabel de

    2012-10-01

    lIn 2009, the influenza A (H1N1) virus spread rapidly around the world, causing the first pandemic of the 21st Century. In 2010, there was a vaccination campaign against this new virus subtype to reduce the morbidity and mortality of the disease in some countries, including Brazil. Herein, we describe the clinical and epidemiological characteristics of patients under 19 years of age who were hospitalized with confirmed influenza A (H1N1) infection in 2009 and 2010. We retrospectively reviewed files from the pediatric patients who were admitted to a university hospital with real-time polymerase chain reaction (RT-PCR) confirmed influenza A (H1N1) infection in 2009 and 2010. There were 37 hospitalized patients with influenza A (H1N1) in 2009 and 2 in 2010. In 2009, many of the hospitalized children had an underlying chronic disease and a lower median age than those not hospitalized. Of the hospitalized patients, 78% had a chronic disease, primarily pneumopathy (48%). The main signs and symptoms of influenza were fever (97%), cough (76%), and dyspnea (59%). Complications occurred in 81% of the patients. The median length of hospitalization was five days; 27% of the patients required intensive care, and two died. In 2010, two patients were hospitalized with influenza A (H1N1): one infant with adenovirus co-infection who had received one previous H1N1 vaccine dose and presented with respiratory sequelae and a 2-month-old infant who had a hospital-acquired infection. An impressive reduction in hospital admissions was observed in 2010 when the vaccination campaign took place in Brazil. PMID:23070350

  14. Increased hospital admissions associated with extreme-heat exposure in King County, Washington, 1990-2010

    PubMed Central

    Isaksen, Tania Busch; Yost, Michael G.; Hom, Elizabeth K.; Ren, You; Lyons, Hilary; Fenske, Richard A.

    2016-01-01

    Increased morbidity and mortality have been associated with extreme heat events, particularly in temperate climates. Few epidemiologic studies have considered the impact of extreme heat events on hospitalization rates in the Pacific Northwest region. This study quantifies the historical (May to September 1990-2010) heat-morbidity relationship in the most populous Pacific Northwest County -King County, Washington. A relative risk (RR) analysis was used to explore the association between heat and all non-traumatic hospitalizations on 99th percentile heat days, while a time series analysis using a piece-wise linear model approximation was used to estimate the effect that heat’s intensity has on hospitalizations, adjusted for temporal trends and day of the week. A non-statistically significant 2% [95% CI: 1.02 (0.98, 1.05)] increase in hospitalization risk, on a heat day versus a non-heat day, was noted for all-ages, all non-traumatic causes. When considering the effect heat intensity has on admissions, we found a statistically significant 1.59% (95% CI: 0.9%, 2.29%) increase in admissions per degree increase in humidex above 37.4 °C. Admissions stratified by cause and age produced statistically significant results with both relative risk and time series analyses for nephritis and nephrotic syndromes, acute renal failure and natural heat exposure hospitalizations. This study demonstrates that heat, expressed as humidex, is associated with increased hospital admissions. When stratified by age and cause of admission, the non-elderly (less than 85) age groups experience significant risk for: nephritis and nephrotic syndromes, acute renal failure, natural heat exposure, COPD and asthma hospitalizations. PMID:25719287

  15. Hospital Admissions, Transfers and Costs of Guillain-Barré Syndrome

    PubMed Central

    van Leeuwen, Nikki; Lingsma, Hester F.; Vanrolleghem, Ann M.; Sturkenboom, Miriam C. J. M.; van Doorn, Pieter A.; Steyerberg, Ewout W.; Jacobs, Bart C.

    2016-01-01

    Background Guillain-Barré syndrome (GBS) has a highly variable clinical course, leading to frequent transfers within and between hospitals and high associated costs. We defined the current admissions, transfers and costs in relation to disease severity of GBS. Methods Dutch neurologists were requested to report patients diagnosed with GBS between November 2009 and November 2010. Information regarding clinical course and transfers was obtained via neurologists and general practitioners. Results 87 GBS patients were included with maximal GBS disability score of 1 or 2 (28%), 3 or 4 (53%), 5 (18%) and 6 (1%). Four mildly affected GBS patients were not hospital admitted. Of the 83 hospitalized patients 68 (82%) were initially admitted at a neurology department, 4 (5%) at an ICU, 4 (5%) at pediatrics, 4 (5%) at pediatrics neurology and 3 (4%) at internal medicine. Median hospital stay was 17 days (IQR 11–26 days, absolute range 1–133 days). Transfers between departments or hospitals occurred in 33 (40%) patients and 25 (30%) were transferred 2 times or more. From a cost-effectiveness perspective 21 (25%) of the admissions was suboptimal. Median costs for hospital admission of GBS patients were 15,060 Euro (IQR 11,226–23,683). Maximal GBS disability score was significantly correlated with total length of stay, number of transfers, ICU admission and costs. Conclusions Hospital admissions for GBS patients are highly heterogeneous, with frequent transfers and higher costs for those with more severe disease. Future research should aim to develop prediction models to early identify the most cost-effective allocation in individual patients. PMID:26859880

  16. Diabetes mellitus in Addis Ababa, Ethiopia: admissions, complications and outcomes in a large referral hospital

    PubMed Central

    Harries, A. D.; Ade, S.; Tayler-Smith, K.; Ali, E.; Firdu, N.; Yifter, H.

    2015-01-01

    Setting: The Black Lion Referral Hospital, Addis Ababa, Ethiopia. Objective: To document indications for admission, complications and outcomes of patients with diabetes mellitus (DM) admitted between 2010 and 2013. Design: A descriptive retrospective study using medical files. Results: Of 8048 admissions, 523 (6.5%) had DM; of these, 418 medical records were retrieved: 301 (72%) patients had type 2 and 104 (28%) type 1 disease, with male sex (62%) and older age (median age 60 years) being features of type 2 disease. Main admission diagnoses for type 2 disease were diabetic foot ulcer (39%) and cardiovascular disease (21%); for type 1 disease, it was diabetic ketoacidosis (62%). Hypertension, neuropathy, nephropathy, retinopathy and diabetic foot accounted for 85% of the 756 existing complications. Overall in-patient mortality was 21%. Of the 89 deaths, 77 occurred among patients with type 2 disease; the main indications for admission were diabetic foot ulcer/gangrene and cardiovascular disease. Conclusion: DM, especially type 2 DM, is an important cause of admission to Ethiopia’s largest referral hospital. Many patients had already developed disease-related complications at admission, and mortality was high. There is a need to improve awareness about and care for DM in Ethiopia. PMID:26400605

  17. Equestrian injuries: a five year review of hospital admissions in British Columbia, Canada

    PubMed Central

    Sorli, J.

    2000-01-01

    Aim—To determine the demographics of hospital admissions and mortality associated with equestrian activities in the 33 000 riders in British Columbia (BC). Method—Analysis of admission data from the Ministry of Health for the years 1991–96, review of information obtained from the Office of the Chief Coroner, and comparison of data from Canadian Hospitals Injury Reporting and Prevention Program. Results—The mean number of admissions per year was 390. Head injury was the most common cause of admission to hospital (20%) in BC. Females most often required admission (62%). Teenagers and children have a higher incidence of head injuries than the general population. The injury rate was 0.49/1000 hours of riding. There were three deaths per year, 1/10 000 riders; 60% were caused by head injury and females predominated. Conclusion—Head injuries and other serious injuries occur with equestrian activities and it is important for doctors, instructors, and parents to promote the use of appropriate safety equipment, including helmets, especially for children. PMID:10728545

  18. Factors Associated with Inpatient Hospital (Re)admissions in Medicare Beneficiaries in Need of Food Assistance.

    PubMed

    Sattler, Elisabeth Lilian Pia; Lee, Jung Sun; Young, Henry N

    2015-01-01

    Little is known about pathways underlying inpatient hospital (re)admissions in older adults unable to meet basic needs. This study examined the factors associated with (re)admissions in a sample of low-income older Medicare beneficiaries in need of food assistance in Georgia in 2008 (N = 892, mean age 75.4 ± 8.8 years, 30.3% Black, 68.5% female). About 35.3% of the sample experienced 1 + hospital (re)admissions. (Re)admissions were significantly more likely in individuals who requested Older Americans Act Nutrition Program Home Delivered Meals services (OR 2.3; 95% CI 1.4, 3.8), had more outpatient emergency room visits (1 visit: OR 2.1; 95% CI 1.4, 3.1; 2+ visits: OR 3.6; 95% CI 2.4, 5.4), and experienced greater multimorbidity (OR 1.6; 95% CI 1.4, 3.1). Support for home and community-based services may be critical in reducing potentially avoidable inpatient hospital (re)admissions. PMID:26106990

  19. Clinical Audit of COPD Patients Requiring Hospital Admissions in Spain: AUDIPOC Study

    PubMed Central

    Pozo-Rodríguez, Francisco; López-Campos, Jose Luis; Álvarez-Martínez, Carlos J.; Castro-Acosta, Ady; Agüero, Ramón; Hueto, Javier; Hernández-Hernández, Jesús; Barrón, Manuel; Abraira, Victor; Forte, Anabel; Sanchez Nieto, Juan Miguel; Lopez-Gabaldón, Encarnación; Cosío, Borja G.; Agustí, Alvar

    2012-01-01

    Backgrounds AUDIPOC is a nationwide clinical audit that describes the characteristics, interventions and outcomes of patients admitted to Spanish hospitals because of an exacerbation of chronic obstructive pulmonary disease (ECOPD), assessing the compliance of these parameters with current international guidelines. The present study describes hospital resources, hospital factors related to case recruitment variability, patients’ characteristics, and adherence to guidelines. Methodology/Principal Findings An organisational database was completed by all participant hospitals recording resources and organisation. Over an 8-week period 11,564 consecutive ECOPD admissions to 129 Spanish hospitals covering 70% of the Spanish population were prospectively identified. At hospital discharge, 5,178 patients (45% of eligible) were finally included, and thus constituted the audited population. Audited patients were reassessed 90 days after admission for survival and readmission rates. A wide variability was observed in relation to most variables, hospital adherence to guidelines, and readmissions and death. Median inpatient mortality was 5% (across-hospital range 0–35%). Among discharged patients, 37% required readmission (0–62%) and 6.5% died (0–35%). The overall mortality rate was 11.6% (0–50%). Hospital size and complexity and aspects related to hospital COPD awareness were significantly associated with case recruitment. Clinical management most often complied with diagnosis and treatment recommendations but rarely (<50%) addressed guidance on healthy life-styles. Conclusions/Significance The AUDIPOC study highlights the large across-hospital variability in resources and organization of hospitals, patient characteristics, process of care, and outcomes. The study also identifies resources and organizational characteristics associated with the admission of COPD cases, as well as aspects of daily clinical care amenable to improvement. PMID:22911875

  20. Hazards of Hospitalization: Residence Prior to Admission Predicts Outcomes

    ERIC Educational Resources Information Center

    Friedman, Susan M.; Mendelson, Daniel A.; Bingham, Karilee W.; McCann, Robert M.

    2008-01-01

    Purpose: Previous studies investigating adverse outcomes of hospitalized elders have focused on community-dwelling patients. Given the rapid growth of populations living in other settings, such as assisted living facilities, it is important to understand whether these patients are at higher risk of experiencing specific adverse outcomes during…

  1. The Impact of Profitability of Hospital Admissions on Mortality

    PubMed Central

    Lindrooth, Richard C; Konetzka, R Tamara; Navathe, Amol S; Zhu, Jingsan; Chen, Wei; Volpp, Kevin

    2013-01-01

    Background Fiscal constraints faced by Medicare are leading to policies designed to reduce expenditures. Evidence of the effect of reduced reimbursement on the mortality of Medicare patients discharged from all major hospital service lines is limited. Methods We modeled risk-adjusted 30-day mortality of patients discharged from 21 hospital service lines as a function of service line profitability, service line time trends, and hospital service line and year-fixed effects. We simulated the effect of alternative revenue-neutral reimbursement policies on mortality. Our sample included all Medicare discharges from PPS-eligible hospitals (1997, 2001, and 2005). Results The results reveal a statistically significant inverse relationship between changes in profitability and mortality. A $0.19 average reduction in profit per $1.00 of costs led to a 0.010–0.020 percentage-point increase in mortality rates (p < .001). Mortality in newly unprofitable service lines is significantly more sensitive to reduced payment generosity than in service lines that remain profitable. Policy simulations that target service line inequities in payment generosity result in lower mortality rates, roughly 700–13,000 fewer deaths nationally. Conclusions The policy simulations raise questions about the trade-offs implicit in universal reductions in reimbursement. The effect of reduced payment generosity on mortality could be mitigated by targeting highly profitable services only for lower reimbursement. PMID:23346946

  2. Viral etiology of acute lower respiratory tract infections in hospitalized young children in a children's referral hospital in Iran.

    PubMed

    Pourakbari, Babak; Mahmoudi, Shima; Movahedi, Zahra; Halimi, Shahnaz; Momeni, Shervin; Hosseinpour-Sadeghi, Reihaneh; Mamishi, Setareh

    2014-01-01

    Viruses are considered major causes of acute respiratory tract infections among children under 5 years old. In this study we investigated the prevalence of three respiratory viruses--respiratory syncytial virus (RSV), influenza virus (INF) and adenovirus (ADV)--among hospitalized children with acute viral lower respiratory tract infections (LRTIs). Nasopharyngeal aspirates were collected from children under five who had been hospitalized for LRTIs. The clinical data, including demographic data (age and sex), vital symptoms and signs at admission, duration of fever, duration of hospitalization, chest X-ray findings and outcome were considered. All inpatient specimens were tested by reverse transcriptase-polymerase chain reaction (RT-PCR) for RSV and the INF-A, INF-B and parainfluenza viruses and by polymerase chain reaction (PCR) for ADV. Out of those from 232 patients, 58 (25%) specimens were positive for either RSV, INF or ADV. The most predominant pathogens were RSV (40 cases, 17.2%), followed by INF (10 cases, 4%; including 8 type A and 2 type B) and ADV (8 cases, 3.4%). A total of 32 (55.1%) viral cases were identified in the spring, followed by 19 (32.7%) in the autumn and 7 (12%) in the winter. There was no significant correlation between clinical symptoms and the individual virus detected. In our study, RSV and INF were the two most common causes of LRTIs. These data are helpful for guiding the development of further vaccines as well as the use of antiviral drugs. Further studies will be needed to investigate other respiratory viruses such as parainfluenza, human metapneumovirus and rhinovirus. PMID:25818953

  3. Causes and incidence of 30 day hospital re-admissions after primary TKJR

    PubMed Central

    Mortimer, John; van Dalen, John

    2016-01-01

    Objective: 30 day re-admission of patients following TKJR is estimated between 0.9-9.9%. It’s a cause of significant cost to the healthcare system and marks significant patient morbidity. Aim: The aim of this study is to describe the causes and incidence of patient re-admission to hospital within 30 days of a primary total knee joint replacement between 2009-2015 in a single centre. Methods: In a retrospective cohort study, computerized records were used to evaluated the causes and incidence of patient re-admission within 30 days of discharge following primary TKJR. Results: The total 30 day Re-admission rate was 5.0%. Medical causes for re-admission accounted for 29% of re-admissions. 34% were attributed to non-specific pain/swelling. Infection was attributed to 26%. 29% of patients presented with wound problems, either infective or non-infective. The total incidence of re-operation at 30 days was 0.77%. Conclusions: Our rate of re-admission is consistent with previous studies in the literature. Many patients were found to have no specific cause for re-admission. This suggests it may be possible to further reduce re-admission rates with improved patient education and management of common post-operative symptoms such as pain and swelling. Infection remains a common complication; fortunately the majority superficial infections are successfully treated with antibiotics and few requiring a washout operation. Medical complications account for almost a third showing the importance of good management of patient medical co-morbidities and risk factors.

  4. Evaluating Psychiatric Hospital Admission Decisions for Children in Foster Care: An Optimal Classification Tree Analysis

    ERIC Educational Resources Information Center

    Snowden, Jessica A.; Leon, Scott C.; Bryant, Fred B.; Lyons, John S.

    2007-01-01

    This study explored clinical and nonclinical predictors of inpatient hospital admission decisions across a sample of children in foster care over 4 years (N = 13,245). Forty-eight percent of participants were female and the mean age was 13.4 (SD = 3.5 years). Optimal data analysis (Yarnold & Soltysik, 2005) was used to construct a nonlinear…

  5. Non-Invasive Continuous Respiratory Monitoring on General Hospital Wards: A Systematic Review

    PubMed Central

    van Loon, Kim; van Zaane, Bas; Bosch, Els J.; Kalkman, Cor J.; Peelen, Linda M.

    2015-01-01

    Background Failure to recognize acute deterioration in hospitalized patients may contribute to cardiopulmonary arrest, unscheduled intensive care unit admission and increased mortality. Purpose In this systematic review we aimed to determine whether continuous non-invasive respiratory monitoring improves early diagnosis of patient deterioration and reduces critical incidents on hospital wards. Data Sources Studies were retrieved from Medline, Embase, CINAHL, and the Cochrane library, searched from 1970 till October 25, 2014. Study Selection Electronic databases were searched using keywords and corresponding synonyms ‘ward’, ‘continuous’, ‘monitoring’ and ‘respiration’. Pediatric, fetal and animal studies were excluded. Data Extraction Since no validated tool is currently available for diagnostic or intervention studies with continuous monitoring, methodological quality was assessed with a modified tool based on modified STARD, CONSORT, and TREND statements. Data Synthesis Six intervention and five diagnostic studies were included, evaluating the use of eight different devices for continuous respiratory monitoring. Quantitative data synthesis was not possible because intervention, study design and outcomes differed considerably between studies. Outcomes estimates for the intervention studies ranged from RR 0.14 (0.03, 0.64) for cardiopulmonary resuscitation to RR 1.00 (0.41, 2.35) for unplanned ICU admission after introduction of continuous respiratory monitoring, Limitations The methodological quality of most studies was moderate, e.g. ‘before-after’ designs, incomplete reporting of primary outcomes, and incomplete clinical implementation of the monitoring system. Conclusions Based on the findings of this systematic review, implementation of routine continuous non-invasive respiratory monitoring on general hospital wards cannot yet be advocated as results are inconclusive, and methodological quality of the studies needs improvement. Future

  6. Present and Future Human Thermal Bioclimatic Conditions and Impacts on Respiratory Admissions in Crete Island, Greece

    NASA Astrophysics Data System (ADS)

    Bleta, Anastasia; Nastos, Panagiotis

    2015-04-01

    The objective of this study is to assess and quantify the association between present and future human thermal bioclimatic conditions and daily counts of respiratory problems in Heraklion city, Crete Island, Greece. The bioclimatic conditions were analyzed in terms of the Physiologically Equivalent Temperature (PET) and Universal Thermal Climate Index (UTCI), which are two of the most popular human thermal indices based on the human energy balance. The PET and UTCI analysis was performed by the application of the bioclimate model, "RayMan", which is well-suited to calculate radiation fluxes and human biometeorological indices. Future changes in meteorological parameters such as air temperature, relative humidity, wind speed and cloudiness (used as input variables in the estimation of PET and UTCI) were derived by the simulations of the regional atmospheric climate model KNMI under SRES A1B, for the near (2021-2050) and far (2071-2100) future with respect to the reference period 1961-1990. Generalized linear models (GLM) with Poisson distribution were applied to the time series of daily numbers of outpatients (total, males and females) with respiratory problems against present and future bioclimatic changes, after controlling for possible confounders and adjustment for season and trends. The interpretation of the results of this analysis suggests a significant association between cold weather and increased respiratory admissions. For the near future, the projected increase of 1.6oC in PET may result in reducing the incidence of respiratory problemsby almost 3% against 7.5% in the far future, when PET is projected to increase by 4oC.

  7. Effect of particulate matter air pollution on hospital admissions and medical visits for lung and heart disease in two southeast Idaho cities.

    PubMed

    Ulirsch, Gregory V; Ball, Louise M; Kaye, Wendy; Shy, Carl M; Lee, Carolyn V; Crawford-Brown, Douglas; Symons, Michael; Holloway, Tracey

    2007-08-01

    Few, if any, published time series studies have evaluated the effects of particulate matter air exposures by combining hospital admissions with medical visit data for smaller populations. We investigated the relationship between daily particulate matter (<10 microm in aerometric diameter or PM10) exposures with admissions and medical visits (emergency room, urgent care, and family practice) for respiratory and cardiovascular disease in Pocatello and Chubbuck, Idaho (population about 60,000), from November 1994 through March 2000. Within generalized linear models, time, weather, influenza, and day-of-week effects were controlled. In single-pollutant models, respiratory disease admissions and visits increased (7.1-15.4% per 50 microg/m3 PM10) for each age group analyzed, with the highest increases in two groups, children and especially the elderly. Statistical analyses suggest that the results probably did not occur by chance. Sensitivity analyses did not provide strong evidence that the respiratory disease effect estimates were sensitive to reasonable changes in the final degrees of freedom choice for time and weather effects. No strong evidence of confounding by NO2 and SO2 was found from results of multi-pollutant models. Ozone and carbon monoxide data were not available to include multi-pollutant models, but evidence suggests that they were not a problem. Unexpectedly, evidence of an association between PM10 with cardiovascular disease was not found, possibly due to the lifestyles of the mostly Mormon study population. Successful time series analyses can be performed on smaller populations if diverse, centralized databases are available. Hospitals that offer urgent or other primary care services may be a rich source of data for researchers. Using data that potentially represented a wide-range of disease severity, the findings provide evidence that evaluating only hospital admissions or emergency room visit effects may underestimate the overall morbidity due to

  8. An investigation of factors associated with psychiatric hospital admission despite the presence of crisis resolution teams

    PubMed Central

    Cotton, Mary-Anne; Johnson, Sonia; Bindman, Jonathan; Sandor, Andrew; White, Ian R; Thornicroft, Graham; Nolan, Fiona; Pilling, Stephen; Hoult, John; McKenzie, Nigel; Bebbington, Paul

    2007-01-01

    Background Crisis resolution teams (CRTs) provide a community alternative to psychiatric hospital admission for patients presenting in crisis. Little is known about the characteristics of patients admitted despite the availability of such teams. Methods Data were drawn from three investigations of the outcomes of CRTs in inner London. A literature review was used to identify candidate explanatory variables that may be associated with admission despite the availability of intensive home treatment. The main outcome variable was admission to hospital within 8 weeks of the initial crisis. Associations between this outcome and the candidate explanatory variables were tested using first univariate and then multivariate analysis. Results Patients who were uncooperative with initial assessment (OR 10.25 95% CI-4.20–24.97), at risk of self-neglect (OR 2.93 1.42–6.05), had a history of compulsory admission (OR 2.64 1.07–6.55), assessed outside usual office hours (OR 2.34 1.11–4.94) and/or were assessed in hospital casualty departments (OR 3.12 1.55–6.26), were more likely to be admitted. Other than age, no socio-demographic features or diagnostic variables were significantly associated with risk of admission. Conclusion With the introduction of CRTs, inpatient wards face a significant challenge, as patients who cooperate little with treatment, neglect themselves, or have previously been compulsorily detained are especially likely to be admitted. The increased risk of admission associated with casualty department assessment may be remediable. PMID:17910756

  9. Emergency department utilization, hospital admissions, and physician visits among elderly African American persons.

    PubMed

    Bazargan, M; Bazargan, S; Baker, R S

    1998-02-01

    This study uses a theoretical model of health services utilization to examine (a) emergency department utilization, (b) hospital admissions, and (c) office-based physician visits among a sample of 998 low-income elderly African American persons. Poisson Regression analysis was used to estimate the parameters specified in the Andersen behavioral model. Some of the more interesting results include the following: (a) a greater frequency of emergency room visits among respondents with a lower level of accessibility to physician services, (b) a lack of a significant relationship between some chronic illnesses such as diabetes and heart problems and the frequency of office-based physician visits, (c) a greater number of hospital admissions among insured persons, and (d) a significant impact of the health locus of control indexes on all three types of health care utilization. The results of this study challenge the assumption that hospital and emergency use are the results of nondiscretionary behavior. PMID:9499651

  10. Physician impact on hospital admission and on mortality rates in the Medicare population.

    PubMed Central

    Krakauer, H; Jacoby, I; Millman, M; Lukomnik, J E

    1996-01-01

    OBJECTIVE. We assess the effect of variations in the supply and specialty distribution of physicians on admission rates for ambulatory care-sensitive conditions (ACS) and for all causes, and on mortality rates among Medicare beneficiaries of various health care service areas (HCSA). DATA SOURCES. For the Medicare beneficiaries, sources were the Health Care Financing Administration's 1992 enrollment and impatient (Part A) files for a 5 percent sample of that population; for the overall populations and for the medical resources of the HCSAs, the Area Resource File. STUDY DESIGN. This observational, cross-sectional study employed multiple linear regression to assess the influence of population characteristics and of the supply of physicians on hospital admissions, and Poisson regression in the analysis of the factors that affect mortality. PRINCIPAL FINDINGS. Physician supply levels vary nearly fourfold or more when comparing the top and bottom deciles of the HCSAs, Medicare admissions for ACS conditions vary about threefold, and admission rates for all causes and mortality rates vary about 1.5-fold. Physician supply levels and distributions have very little influence on ACS admission rates, and even less on the admissions for all causes and on mortality, except in HCSAs with very low physician supply levels (one-fourth the national average or less). However, these HCSAs account for only about 1 percent of the U.S. population. CONCLUSIONS. Physician supply levels and the proportions of specialists and generalists have negligible effects on health status as measured by mortality rates and by rates of admission for all causes and for conditions presumed to be sensitive to the adequacy of ambulatory care. Reductions in admissions for such conditions are not likely to be achieved through broadening of insurance to levels that exist under Medicare, nor through increases in the supply of physicians, nor, conversely, through a reduction in any presumed oversupply of

  11. Associations between Extreme Precipitation and Gastrointestinal-Related Hospital Admissions in Chennai, India

    PubMed Central

    O’Neill, Marie S.; Li, Shi; Mukherjee, Bhramar; Hu, Howard; Ghosh, Santu; Balakrishnan, Kalpana

    2013-01-01

    Background: Understanding the potential links between extreme weather events and human health in India is important in the context of vulnerability and adaptation to climate change. Research exploring such linkages in India is sparse. Objectives: We evaluated the association between extreme precipitation and gastrointestinal (GI) illness-related hospital admissions in Chennai, India, from 2004 to 2007. Methods: Daily hospital admissions were extracted from two government hospitals in Chennai, India, and meteorological data were retrieved from the Chennai International Airport. We evaluated the association between extreme precipitation (≥ 90th percentile) and hospital admissions using generalized additive models. Both single-day and distributed lag models were explored over a 15-day period, controlling for apparent temperature, day of week, and long-term time trends. We used a stratified analysis to explore the association across age and season. Results: Extreme precipitation was consistently associated with GI-related hospital admissions. The cumulative summary of risk ratios estimated for a 15-day period corresponding to an extreme event (relative to no precipitation) was 1.60 (95% CI: 1.29, 1.98) among all ages, 2.72 (95% CI: 1.25, 5.92) among the young (≤ 5 years of age), and 1.62 (95% CI: 0.97, 2.70) among the old (≥ 65 years of age). The association was stronger during the pre-monsoon season (March–May), with a cumulative risk ratio of 6.50 (95% CI: 2.22, 19.04) for all ages combined compared with other seasons. Conclusions: Hospital admissions related to GI illness were positively associated with extreme precipitation in Chennai, India, with positive cumulative risk ratios for a 15-day period following an extreme event in all age groups. Projected changes in precipitation and extreme weather events suggest that climate change will have important implications for human health in India, where health disparities already exist. Citation: Bush KF, O

  12. Hospitalization risk factors for children's lower respiratory tract infection: A population-based, cross-sectional study in Mongolia.

    PubMed

    Dagvadorj, Amarjargal; Ota, Erika; Shahrook, Sadequa; Baljinnyam Olkhanud, Purevdorj; Takehara, Kenji; Hikita, Naoko; Bavuusuren, Bayasgalantai; Mori, Rintaro; Nakayama, Takeo

    2016-01-01

    This study aimed to assess the potential risk factors for lower respiratory tract infection (LRTI)-related hospital admissions in Mongolian children. A population-based cross-sectional study was conducted in rural Mongolia in 2013, and 1,013 mother-child pairs were included. Of the participating children, 38.9% were admitted to hospital with LRTIs. Home smoking, low birthweight, being a male child, exclusive breastfeeding and healthcare-seeking behaviour showed substantial association with LRTI-related hospital admissions. Number of cigarettes smoked by family members showed a dose-response relationship and increased hospital admissions. Strategies to prevent second-hand-smoke exposure from adult smokers, especially inside the home, are crucial to preventing LRTI-related hospital admissions for children in Mongolia. Improving rates of exclusive breastfeeding and increasing birthweight have great potential to decrease the likelihood of children acquiring a LRTI. Educational initiatives are also necessary for women who are less likely to seek out care for their children's symptoms. PMID:27090182

  13. Trends in hospital admission rates for whooping cough in England across five decades: database studies

    PubMed Central

    Hoang, Uy; Goldacre, Michael J

    2014-01-01

    Objectives Our aim was to report on trends in hospitalisation rates for pertussis in England from the 1960s to 2011; and to provide context for the recent unexpected activity of Bordetella pertussis in the UK. Design A retrospective analysis of English national Hospital Episode Statistics (HES, 1968–2011) and the Oxford Record Linkage Study (ORLS, 1963–2011) for people admitted to hospital with whooping cough. Setting England and the Oxford Record Linkage Study area. Main outcome measures Age- and gender-specific hospital admission rates, and summary age- and sex-standardised rates, for people aged under 25 years per 100,000 population in each age group. Results Admission rates declined from the 1960s to the early 1970s. For example, the standardised rates were 12.8 (95% confidence interval 11.2–14.5) per 100,000 in England in 1968 and 4.0 (3.0–4.9) per 100,000 in 1973. They then increased to reach 45.0 (41.4–48.6) per 100,000 in 1978 and 47.4 (43.7–51.1) in 1982. From the late 1980s, admission rates continued to decline, falling to between 1 and 4 per 100,000 in each of the years between 2003 and 2011. While the trend in hospital admissions closely followed that in notifications, the annual ratio between these two measures was not consistent ranging from 1.07 (95% confidence interval 1.00–1.14) to 4.03 (3.79–4.27) notifications per admission over the last 10 years. Conclusions Epidemics of whooping cough in the late 1970s and early 1980s were associated with a significant rise in hospital admission rates. Current admission rates are low, by historical comparison. Vaccine programmes must continue to be fully implemented in order to improve control of pertussis activity. PMID:24526463

  14. The Impact of Admission Diagnosis on Recurrent or Frequent Hospitalizations in 3 Dementia Subtypes

    PubMed Central

    Chang, Chiung-Chih; Lin, Pin-Hsuan; Chang, Ya-Ting; Chen, Nai-Ching; Huang, Chi-Wei; Lui, Chun-Chung; Huang, Shu-Hua; Chang, Yen-Hsiang; Lee, Chen-Chang; Lai, Wei-An

    2015-01-01

    Abstract Increasing numbers of patients with different types of dementia have resulted in the increasing medical care loads. It is not known whether explanatory factors for recurrent or prolong hospitalization were driven by the subtypes of dementia. We analyzed 203 dementia patients aged >65-year-old with a clinical diagnosis of Alzheimer disease (AD), vascular dementia (VaD), or Parkinsonism-related dementia (PRD). With a 4-year follow-up period, logistic regression analyses were used to identify predictors of dementia diagnosis, cerebrovascular risk factors, chronic systemic diseases, and the etiology for admission for recurrent (>4 times/4 years) or prolonged hospitalization stay (>14 days per hospitalization). There were 48 AD, 96 VaD, and 59 PRD patients that completed the 4-year study. The average length of hospital stay was significant, the shortest in AD and the longest in PRD (P = 0.01), whereas the frequency of hospitalization was not different among 3 dementia subtypes. Although delirium is the most common etiology for admission in the patients, diabetes mellitus (Odds ratio, OR = 2.79, P = 0.02), pneumonia (OR = 11.21, P < 0.001), and fall-related hip fracture (OR = 4.762, P = 0.029) were significantly associated with prolong hospitalization. Patients with coronary artery disease (OR = 9.87, P = 0.02), pneumonia (OR = 84.48, P < 0.001), urinary tract infection (OR = 55.09, P < 0.001), and fall-related fracture (OR = 141.7, P < 0.001) predict recurrent hospitalization. Dementia subtypes did not influence directly on the hospitalization courses. The etiologies for admission carried higher clinical significance, compared with the coexisted systemic diseases. PMID:26579820

  15. Associations of PM2.5 Constituents and Sources with Hospital Admissions: Analysis of Four Counties in Connecticut and Massachusetts (USA) for Persons ≥ 65 Years of Age

    PubMed Central

    Ebisu, Keita; Leaderer, Brian P.; Gent, Janneane F.; Lee, Hyung Joo; Koutrakis, Petros; Wang, Yun; Dominici, Francesca; Peng, Roger D.

    2013-01-01

    Background: Epidemiological studies have demonstrated associations between short-term exposure to PM2.5 and hospital admissions. The chemical composition of particles varies across locations and time periods. Identifying the most harmful constituents and sources is an important health and regulatory concern. Objectives: We examined pollutant sources for associations with risk of hospital admissions for cardiovascular and respiratory causes. Methods: We obtained PM2.5 filter samples for four counties in Connecticut and Massachusetts and analyzed them for PM2.5 elements. Source apportionment was used to estimate daily PM2.5 contributions from sources (traffic, road dust, oil combustion, and sea salt as well as a regional source representing coal combustion and other sources). Associations between daily PM2.5 constituents and sources and risk of cardiovascular and respiratory hospitalizations for the Medicare population (> 333,000 persons ≥ 65 years of age) were estimated with time-series analyses (August 2000–February 2004). Results: PM2.5 total mass and PM2.5 road dust contribution were associated with cardiovascular hospitalizations, as were the PM2.5 constituents calcium, black carbon, vanadium, and zinc. For respiratory hospitalizations, associations were observed with PM2.5 road dust, and sea salt as well as aluminum, calcium, chlorine, black carbon, nickel, silicon, titanium, and vanadium. Effect estimates were generally robust to adjustment by co-pollutants of other constituents. An interquartile range increase in same-day PM2.5 road dust (1.71 μg/m3) was associated with a 2.11% (95% CI: 1.09, 3.15%) and 3.47% (95% CI: 2.03, 4.94%) increase in cardiovascular and respiratory admissions, respectively. Conclusions: Our results suggest some particle sources and constituents are more harmful than others and that in this Connecticut/Massachusetts region the most harmful particles include black carbon, calcium, and road dust PM2.5. Citation: Bell ML, Ebisu K

  16. Comparison of emergency department and hospital admissions data for air pollution time-series studies

    PubMed Central

    2012-01-01

    Background Emergency department (ED) visit and hospital admissions (HA) data have been an indispensible resource for assessing acute morbidity impacts of air pollution. ED visits and HAs are types of health care visits with similarities, but also potentially important differences. Little previous information is available regarding the impact of health care visit type on observed acute air pollution-health associations from studies conducted for the same location, time period, outcome definitions and model specifications. Methods As part of a broader study of air pollution and health in St. Louis, individual-level ED and HA data were obtained for a 6.5 year period for acute care hospitals in the eight Missouri counties of the St. Louis metropolitan area. Patient demographic characteristics and diagnostic code distributions were compared for four visit types including ED visits, HAs, HAs that came through the ED, and non-elective HAs. Time-series analyses of the relationship between daily ambient ozone and PM2.5 and selected cardiorespiratory outcomes were conducted for each visit type. Results Our results indicate that, compared with ED patients, HA patients tended to be older, had evidence of greater severity for some outcomes, and had a different mix of specific outcomes. Consideration of ‘HA through ED’ appeared to more effectively select acute visits than consideration of ‘non-elective HA’. While outcomes with the strongest observed temporal associations with air pollutants tended to show strong associations for all visit types, we found some differences in observed associations for ED visits and HAs. For example, risk ratios for the respiratory disease-ozone association were 1.020 for ED visits and 1.004 for ‘HA through ED’; risk ratios for the asthma/wheeze-ozone association were 1.069 for ED visits and 1.106 for ‘HA through ED’. Several factors (e.g. age) were identified that may be responsible, in part, for the differences in observed

  17. Respiratory Syncytial Virus Coinfections With Rhinovirus and Human Bocavirus in Hospitalized Children

    PubMed Central

    Calvo, Cristina; García-García, María Luz; Pozo, Francisco; Paula, Gallardo; Molinero, Mar; Calderón, Ana; González-Esguevillas, Mónica; Casas, Inmaculada

    2015-01-01

    Abstract It is not clearly established if coinfections are more severe than single viral respiratory infections. The aim of the study was to study and to compare simple infections and viral coinfections of respiratory syncytial virus (RSV) in hospitalized children. From September 2005 to August 2013, a prospective study was conducted on children younger than 14 years of age, admitted with respiratory infection to the Pediatric Department of the Severo Ochoa Hospital, in Spain. Specimens of nasopharyngeal aspirate were taken for virological study by using polymerase chain reaction, and clinical data were recorded. Simple RSV infections were selected and compared with double infections of RSV with rhinovirus (RV) or with human bocavirus (HBoV). In this study, 2993 episodes corresponding to 2525 children were analyzed. At least 1 virus was detected in 77% (2312) of the episodes. Single infections (599 RSV, 513 RV, and 81 HBoV) were compared with 120 RSV-RV and 60 RSV-HBoV double infections. The RSV-RV coinfections had fever (63% vs 43%; P < 0.001) and hypoxia (70% vs 43%; P < 0.001) more often than RV infections. Hypoxia was similar between single or dual infections (71%). Bronchiolitis was more frequent in the RSV simple group (P < 0.001). Pediatric intensive care unit admission was more common in RSV simple or RSV-RV groups than in the RV monoinfection (P = 0.042). Hospitalization was longer for both RSV simple group and RSV-HBoV coinfection, lasting about 1 day (4.7 vs 3.8 days; P < 0.001) longer than in simple HBoV infections. There were no differences in PICU admission. RSV single group was of a younger age than the other groups. Coinfections between RSV-RV and RSV-HBoV are frequent. Overall viral coinfections do not present greater severity, but have mixed clinical features. PMID:26496310

  18. Trauma admissions to the Intensive care unit at a reference hospital in Northwestern Tanzania

    PubMed Central

    2011-01-01

    Background Major trauma has been reported to be a major cause of hospitalization and intensive care utilization worldwide and consumes a significant amount of the health care budget. The aim of this study was to describe the characteristics and treatment outcome of major trauma patients admitted into our ICU and to identify predictors of outcome. Methods Between January 2008 and December 2010, a descriptive prospective study of all trauma admissions to a multidisciplinary intensive care unit (ICU) of Bugando Medical Centre in Northwestern Tanzania was conducted. Results A total of 312 cases of major trauma were admitted in the ICU, representing 37.1% of the total ICU admissions. Males outnumbered females by a ratio of 5.5:1. Their median age was 27 years. Trauma admissions were almost exclusively emergencies (95.2%) and came mainly from the Accident and Emergency (60.6%) and Operating room (23.4%). Road traffic crash (RTC) was the most common cause of injuries affecting 70.8% of patients. Two hundred fourteen patients (68.6%) required surgical intervention. The overall ICU length of stay (LOS) for all trauma patients ranged from 1 to 59 days (median = 8 days). The median ICU length of hospital stay (LOS) for survivors and non-survivors were 8 and 5 days respectively. (P = 0.002). Mortality rate was 32.7%. Mortality rate of trauma patients was significantly higher than that of all ICU admissions (32.7% vs. 18.8%, P = 0.0012). According to multivariate logistic regression analysis, multiple injuries, severe head injuries and burns were responsible for a longer mean ICU stay (P < 0.001) whereas admission Glasgow Coma Score < 9, systolic blood pressure < 90 mmHg, injury severity core >16, prolonged duration of loss of consciousness, delayed ICU admission (0.028), the need for ventilatory support and finding of space occupying lesion on computed tomography scan significantly influenced mortality (P < 0.001). Conclusion Trauma resulting from road traffic crashes is a

  19. Incidence and Risk Factors for Neonatal Tetanus in Admissions to Kilifi County Hospital, Kenya

    PubMed Central

    Ibinda, Fredrick; Bauni, Evasius; Kariuki, Symon M.; Fegan, Greg; Lewa, Joy; Mwikamba, Monica; Boga, Mwanamvua; Odhiambo, Rachael; Mwagandi, Kiponda; Seale, Anna C.; Berkley, James A.; Dorfman, Jeffrey R.; Newton, Charles R. J. C.

    2015-01-01

    Background Neonatal Tetanus (NT) is a preventable cause of mortality and neurological sequelae that occurs at higher incidence in resource-poor countries, presumably because of low maternal immunisation rates and unhygienic cord care practices. We aimed to determine changes in the incidence of NT, characterize and investigate the associated risk factors and mortality in a prospective cohort study including all admissions over a 15-year period at a County hospital on the Kenyan coast, a region with relatively high historical NT rates within Kenya. Methods We assessed all neonatal admissions to Kilifi County Hospital in Kenya (1999–2013) and identified cases of NT (standard clinical case definition) admitted during this time. Poisson regression was used to examine change in incidence of NT using accurate denominator data from an area of active demographic surveillance. Logistic regression was used to investigate the risk factors for NT and factors associated with mortality in NT amongst neonatal admissions. A subset of sera from mothers (n = 61) and neonates (n = 47) were tested for anti-tetanus antibodies. Results There were 191 NT admissions, of whom 187 (98%) were home deliveries. Incidence of NT declined significantly (Incidence Rate Ratio: 0.85 (95% Confidence interval 0.81–0.89), P<0.001) but the case fatality (62%) did not change over the study period (P = 0.536). Younger infant age at admission (P = 0.001) was the only independent predictor of mortality. Compared to neonatal hospital admittee controls, the proportion of home births was higher among the cases. Sera tested for antitetanus antibodies showed most mothers (50/61, 82%) had undetectable levels of antitetanus antibodies, and most (8/9, 89%) mothers with detectable antibodies had a neonate without protective levels. Conclusions Incidence of NT in Kilifi County has significantly reduced, with reductions following immunisation campaigns. Our results suggest immunisation efforts are effective if

  20. Trends in Hospital Admission and Surgical Procedures Following ED visits for Diverticulitis

    PubMed Central

    Greenwood-Ericksen, Margaret B.; Havens, Joaquim M.; Ma, Jiemin; Weissman, Joel S.; Schuur, Jeremiah D.

    2016-01-01

    , while ED admission rates and surgical rates declined, with comorbidity, sociodemographic factors predicting hospitalization. Future work should focus on determining if these differences reflect increased disease prevalence, increased diagnosis, or changes in management. PMID:27429691

  1. Adverse drug reactions related to hospital admission in Slovak elderly patients.

    PubMed

    Wawruch, Martin; Zikavska, Martina; Wsolova, Ladislava; Kuzelova, Magdalena; Kahayova, Katarina; Strateny, Kamil; Kristova, Viera

    2009-01-01

    The aims of the present study were: to evaluate the prevalence of adverse drug reactions (ADRs) leading to hospitalization in elderly patients; to analyze the drugs which have been identified as having causal relationship with ADRs and to identify risk factors which predispose the patient to such ADRs. The study has been performed in 600 patients aged> or =65 years, hospitalized in a general hospital between 1 December 2003 and 31 March 2005. The ADRs recorded in patient's documentation as one of the reasons for hospital admission were evaluated. ADRs leading to hospital admission were recorded in 47 (7.8%) patients. ADRs in 43 patients represented A-type ADRs which are preventable. The most frequent ADRs were cardiovascular disorders. According to the results of multivariate analysis ischemic heart disease (odds ratio (OR)=4.50; 95% confidence interval (CI)=1.36-14.88), depression (OR, 2.49; 95% CI, 1.08-5.77) and heart failure (OR, 2.08; 95% CI, 1.13-3.81) were the most important patient-related characteristics predicting ADRs leading to hospitalization. The majority of ADRs in elderly patients could be avoided. Regular re-evaluation of the medication as well as taking into account the specific features of elderly patients represent the most important tools for ADR prevention. PMID:18313773

  2. Respiratory rate estimation during triage of children in hospitals.

    PubMed

    Shah, Syed Ahmar; Fleming, Susannah; Thompson, Matthew; Tarassenko, Lionel

    2015-01-01

    Accurate assessment of a child's health is critical for appropriate allocation of medical resources and timely delivery of healthcare in Emergency Departments. The accurate measurement of vital signs is a key step in the determination of the severity of illness and respiratory rate is currently the most difficult vital sign to measure accurately. Several previous studies have attempted to extract respiratory rate from photoplethysmogram (PPG) recordings. However, the majority have been conducted in controlled settings using PPG recordings from healthy subjects. In many studies, manual selection of clean sections of PPG recordings was undertaken before assessing the accuracy of the signal processing algorithms developed. Such selection procedures are not appropriate in clinical settings. A major limitation of AR modelling, previously applied to respiratory rate estimation, is an appropriate selection of model order. This study developed a novel algorithm that automatically estimates respiratory rate from a median spectrum constructed applying multiple AR models to processed PPG segments acquired with pulse oximetry using a finger probe. Good-quality sections were identified using a dynamic template-matching technique to assess PPG signal quality. The algorithm was validated on 205 children presenting to the Emergency Department at the John Radcliffe Hospital, Oxford, UK, with reference respiratory rates up to 50 breaths per minute estimated by paediatric nurses. At the time of writing, the authors are not aware of any other study that has validated respiratory rate estimation using data collected from over 200 children in hospitals during routine triage. PMID:26548638

  3. European hospital adherence to GOLD recommendations for chronic obstructive pulmonary disease (COPD) exacerbation admissions.

    PubMed

    Roberts, C Michael; Lopez-Campos, Jose Luis; Pozo-Rodriguez, Francisco; Hartl, Sylvia

    2013-12-01

    Understanding how European care of chronic obstructive pulmonary disease (COPD) admissions vary against guideline standards provides an opportunity to target appropriate quality improvement interventions. In 2010-2011 an audit of care against the 2010 'Global initiative for chronic Obstructive Lung Disease' (GOLD) standards was performed in 16 018 patients from 384 hospitals in 13 countries. Clinicians prospectively identified consecutive COPD admissions over a period of 8 weeks, recording clinical care measures on a web-based data tool. Data were analysed comparing adherence to 10 key management recommendations. Adherence varied between hospitals and across countries. The lack of available spirometry results and variable use of oxygen and non-invasive ventilation (NIV) are high impact areas identified for improvement. PMID:23729193

  4. Declining Statewide Trends in Motor Vehicle Crashes and Injury-Related Hospital Admissions

    PubMed Central

    Dischinger, Patricia C.; Ryb, Gabriel E.; Kufera, Joseph A.; Ho, Shiu M.

    2013-01-01

    Numbers of crashes, rates of police-reported injury severity, and hospital admission rates were calculated for the ten year period between 2001 and 2010 in Maryland. Comparisons were made for two 5-year periods of 2001–2005 and 2006–2010. Crash characteristics remained similar for the two five-year periods, but there was a significant increase in occupant age. Declines in police-reported injury severity were noted for each of four age groups: 16–29, 30–54, 55–64, and 65+, with smaller declines among older occupants. In addition, there were significant declines in hospital admissions, comparing the two time periods. Although reductions in crashes may be attributable to various roadway, behavioral, and other safety improvement efforts, reductions in hospital admission rates most likely reflect major improvements in crashworthiness implemented during the past decade. For those admitted to hospitals, significant increases in injury severity were noted between the first and second time periods. There was an association between age and ISS, a measure of total bodily injury, with the highest ISS scores noted for the youngest and oldest groups (16–29 and 55+, respectively). In addition, there was a significant increase in the mean age over time, from 39 in 2001 to 43 in 2010, p<.001. In general, the incidence and severity of injuries increased for all body regions. There was also a significant increase in hospital mortality, although length of hospital stay remained the same. Given these trends, increased efforts need to focus on both injury prevention and treatment for the increasing population of older, sometimes frail, vehicle occupants. PMID:24406962

  5. Declining statewide trends in motor vehicle crashes and injury-related hospital admissions.

    PubMed

    Dischinger, Patricia C; Ryb, Gabriel E; Kufera, Joseph A; Ho, Shiu M

    2013-01-01

    Numbers of crashes, rates of police-reported injury severity, and hospital admission rates were calculated for the ten year period between 2001 and 2010 in Maryland. Comparisons were made for two 5-year periods of 2001-2005 and 2006-2010. Crash characteristics remained similar for the two five-year periods, but there was a significant increase in occupant age. Declines in police-reported injury severity were noted for each of four age groups: 16-29, 30-54, 55-64, and 65+, with smaller declines among older occupants. In addition, there were significant declines in hospital admissions, comparing the two time periods. Although reductions in crashes may be attributable to various roadway, behavioral, and other safety improvement efforts, reductions in hospital admission rates most likely reflect major improvements in crashworthiness implemented during the past decade. For those admitted to hospitals, significant increases in injury severity were noted between the first and second time periods. There was an association between age and ISS, a measure of total bodily injury, with the highest ISS scores noted for the youngest and oldest groups (16-29 and 55+, respectively). In addition, there was a significant increase in the mean age over time, from 39 in 2001 to 43 in 2010, p<.001. In general, the incidence and severity of injuries increased for all body regions. There was also a significant increase in hospital mortality, although length of hospital stay remained the same. Given these trends, increased efforts need to focus on both injury prevention and treatment for the increasing population of older, sometimes frail, vehicle occupants. PMID:24406962

  6. Social Welfare Centers Protect Outpatients with Mood Disorders from Risk of Hospital Admission

    PubMed Central

    Han, Kyu-Tae; Jang, Suk Yong; Park, Sohee; Cho, Kyung Hee; Yoo, Ki-Bong; Choi, Young; Park, Eun-Cheol

    2016-01-01

    Background South Korea faces difficulties in the management of mental disorders, and those difficulties are expected to gradually worsen. Therefore, we analyzed the relationship between social welfare centers and hospital admission after outpatient treatment for mood disorders. Methods We used data from the National Health Insurance Service National Sample Cohort 2002–2013, which included all medical claims filed for the 50,160 patients who were newly diagnosed with a mood disorder among the 1,025,340 individuals in a nationally representative sample. We performed a logistic regression analysis using generalized estimating equation (GEE) models to examine the relationship between social welfare centers and hospital admission after outpatient treatment for mood disorders (ICD-10: F3). Results There was a 3.9% admission rate among a total of 99,533 person-years. Outpatients who lived in regions with more social welfare centers were less likely to be admitted to a hospital (per increase of five social welfare centers per 100,000 people; OR: 0.958; 95% CI: 0.919–0.999). Social welfare centers had an especially strong protective effect on patients with relatively mild mood disorders and those who were vulnerable to medical expenditures. Conclusions Considering the protective role of social welfare centers in managing patients with mood disorders, health-policy makers need to consider strategies for activating mental healthcare. PMID:26745728

  7. Vulnerabilities to Temperature Effects on Acute Myocardial Infarction Hospital Admissions in South Korea

    PubMed Central

    Kwon, Bo Yeon; Lee, Eunil; Lee, Suji; Heo, Seulkee; Jo, Kyunghee; Kim, Jinsun; Park, Man Sik

    2015-01-01

    Most previous studies have focused on the association between acute myocardial function (AMI) and temperature by gender and age. Recently, however, concern has also arisen about those most susceptible to the effects of temperature according to socioeconomic status (SES). The objective of this study was to determine the effect of heat and cold on hospital admissions for AMI by subpopulations (gender, age, living area, and individual SES) in South Korea. The Korea National Health Insurance (KNHI) database was used to examine the effect of heat and cold on hospital admissions for AMI during 2004–2012. We analyzed the increase in AMI hospital admissions both above and below a threshold temperature using Poisson generalized additive models (GAMs) for hot, cold, and warm weather. The Medicaid group, the lowest SES group, had a significantly higher RR of 1.37 (95% CI: 1.07–1.76) for heat and 1.11 (95% CI: 1.04–1.20) for cold among subgroups, while also showing distinctly higher risk curves than NHI for both hot and cold weather. In additions, females, older age group, and those living in urban areas had higher risks from hot and cold temperatures than males, younger age group, and those living in rural areas. PMID:26580643

  8. Vulnerabilities to Temperature Effects on Acute Myocardial Infarction Hospital Admissions in South Korea.

    PubMed

    Kwon, Bo Yeon; Lee, Eunil; Lee, Suji; Heo, Seulkee; Jo, Kyunghee; Kim, Jinsun; Park, Man Sik

    2015-11-01

    Most previous studies have focused on the association between acute myocardial function (AMI) and temperature by gender and age. Recently, however, concern has also arisen about those most susceptible to the effects of temperature according to socioeconomic status (SES). The objective of this study was to determine the effect of heat and cold on hospital admissions for AMI by subpopulations (gender, age, living area, and individual SES) in South Korea. The Korea National Health Insurance (KNHI) database was used to examine the effect of heat and cold on hospital admissions for AMI during 2004-2012. We analyzed the increase in AMI hospital admissions both above and below a threshold temperature using Poisson generalized additive models (GAMs) for hot, cold, and warm weather. The Medicaid group, the lowest SES group, had a significantly higher RR of 1.37 (95% CI: 1.07-1.76) for heat and 1.11 (95% CI: 1.04-1.20) for cold among subgroups, while also showing distinctly higher risk curves than NHI for both hot and cold weather. In additions, females, older age group, and those living in urban areas had higher risks from hot and cold temperatures than males, younger age group, and those living in rural areas. PMID:26580643

  9. Ambient Coarse Particulate Matter and Hospital Admissions in the Medicare Cohort Air Pollution Study, 1999–2010

    PubMed Central

    Powell, Helen; Krall, Jenna R.; Wang, Yun; Bell, Michelle L.

    2015-01-01

    Background In recent years a number of studies have examined the short-term association between coarse particulate matter (PM10–2.5) and mortality and morbidity outcomes. These studies, however, have produced inconsistent conclusions. Objectives We estimated both the national- and regional-level associations between PM10–2.5 and emergency hospitalizations for both cardiovascular and respiratory disease among Medicare enrollees ≥ 65 years of age during the 12-year period 1999 through 2010. Methods Using air pollution data obtained from the U.S. Environmental Protection Agency air quality monitoring network and daily emergency hospitalizations for 110 large urban U.S. counties assembled from the Medicare Cohort Air Pollution Study (MCAPS), we estimated the association between short-term exposure to PM10–2.5 and hospitalizations using a two-stage Bayesian hierarchical model and Poisson log-linear regression models. Results A 10-μg/m3 increase in PM10–2.5 was associated with a significant increase in same-day cardiovascular hospitalizations [0.69%; 95% posterior interval (PI): 0.45, 0.92]. After adjusting for PM2.5, this association remained significant (0.63%; 95% PI: 0.38, 0.88). A 10-μg/m3 increase in PM10–2.5 was not associated with a significant increase in respiratory-related hospitalizations. Conclusions We found statistically significant evidence that daily variation in PM10–2.5 is associated with emergency hospitalizations for cardiovascular diseases among Medicare enrollees ≥ 65 years of age. This association was robust to adjustment for concentrations of PM2.5. Citation Powell H, Krall JR, Wang Y, Bell ML, Peng RD. 2015. Ambient coarse particulate matter and hospital admissions in the Medicare Cohort Air Pollution Study, 1999–2010. Environ Health Perspect 123:1152–1158; http://dx.doi.org/10.1289/ehp.1408720 PMID:25872223

  10. Respiratory morbidity in hospitalized Bedouins residing near an industrial park.

    PubMed

    Kordysh, Ella; Karakis, Isabella; Belmaker, Ilana; Vardi, Hilel; Bolotin, Arkady; Sarov, Batia

    2005-01-01

    The residents' concern about exposure to a chemical industrial park (IP), which includes the national toxic industrial waste site, prompted the authors to initiate this ecological study on the association between residing near the IP and being hospitalized for respiratory ailments in the local Bedouin population. The population was stratified by sex, age, and locality type (permanent settlements and traditional tribal settlements). The distance and wind direction from the IP were used as exposure indicators. Hospitalization data were obtained from the regional medical center. Increased hospitalization rates for chronic obstructive pulmonary disease and all respiratory diseases were found to be associated with residential proximity to the IP. Attributable risk for chronic obstructive pulmonary disease was 34.2% in male members of the traditional tribal settlements and 49.3% in female members of the permanent settlements. PMID:17153087

  11. Monitoring Child Abuse and Neglect at a Population Level: Patterns of Hospital Admissions for Maltreatment and Assault

    ERIC Educational Resources Information Center

    O'Donnell, Melissa; Nassar, Natasha; Leonard, Helen; Mathews, Richard; Patterson, Yvonne; Stanley, Fiona

    2010-01-01

    Objectives: To investigate the prevalence, trends, and characteristics of maltreatment and assault related hospital admissions and deaths among children; and identify common injuries and conditions associated with these admissions using routinely collected morbidity and mortality data. Methods: A retrospective cohort study of all children aged…

  12. Hospital admissions for acute myocardial infarction before and after implementation of a comprehensive smoke-free policy in Uruguay

    PubMed Central

    Sebrié, Ernesto Marcelo; Sandoya, Edgardo; Hyland, Andrew; Bianco, Eduardo; Glantz, Stanton A; Cummings, K Michael

    2012-01-01

    Background Stimulated by the WHO Framework Convention on Tobacco Control, many countries in Latin America adopted comprehensive smoke-free policies. In March 2006, Uruguay became the first Latin American country to adopt 100% smoke-free national legislation, which ended smoking in all indoor public places and workplaces, including restaurants and bars. The objective of this study was to evaluate trends in hospital admissions for cardiovascular disease 2 years before and 2 years after the policy was implemented in Uruguay. Methods Reports of hospital admissions for acute myocardial infarction (AMI) (International Classification of Disease-10 I21) from 37 hospitals (79% of all hospital admissions in the country), representing the period 2 years before and 2 years after the adoption of a nationwide smoke-free policy in Uruguay (between 1 March 2004 and 29 February 2008), were reviewed. A time series analysis was undertaken to compare the average monthly number of events of hospital admission for AMI before and after the smoke-free law. Results A total of 7949 hospital admissions for AMI were identified during the 4-year study period. Two years after the smoke-free policy was enacted, hospital admissions for AMI fell by 22%. The same pattern and roughly the same magnitude of reduction in AMI admissions were observed for patients seen in public and private hospitals, men, women and people aged 40–65 years and older than 65 years. Conclusions The national smoke-free policy implemented in Uruguay in 2006 was associated with a significant reduction in hospital admissions for AMI. PMID:22337557

  13. Medicaid patients at high risk for frequent hospital admission: real-time identification and remediable risks.

    PubMed

    Raven, Maria C; Billings, John C; Goldfrank, Lewis R; Manheimer, Eric D; Gourevitch, Marc N

    2009-03-01

    Patients with frequent hospitalizations generate a disproportionate share of hospital visits and costs. Accurate determination of patients who might benefit from interventions is challenging: most patients with frequent admissions in 1 year would not continue to have them in the next. Our objective was to employ a validated regression algorithm to case-find Medicaid patients at high-risk for hospitalization in the next 12 months and identify intervention-amenable characteristics to reduce hospitalization risk. We obtained encounter data for 36,457 Medicaid patients with any visit to an urban public hospital from 2001 to 2006 and generated an algorithm-based score for hospitalization risk in the subsequent 12 months for each patient (0 = lowest, 100 = highest). To determine medical and social contributors to the current admission, we conducted in-depth interviews with high-risk hospitalized patients (scores >50) and analyzed associated Medicaid claims data. An algorithm-based risk score >50 was attained in 2,618 (7.2%) patients. The algorithm's positive predictive value was equal to 0.67. During the study period, 139 high-risk patients were admitted: 60 met inclusion criteria and 50 were interviewed. Fifty-six percent cited the Emergency Department as their usual source of care or had none. Sixty-eight percent had >1 chronic medical conditions, and 42% were admitted for conditions related to substance use. Sixty percent were homeless or precariously housed. Mean Medicaid expenditures for the interviewed patients were $39,188 and $84,040 per patient for the years immediately prior to and following study participation, respectively. Findings including high rates of substance use, homelessness, social isolation, and lack of a medical home will inform the design of interventions to improve community-based care and reduce hospitalizations and associated costs. PMID:19082899

  14. A qualitative examination of inappropriate hospital admissions and lengths of stay

    PubMed Central

    Hammond, Christina L; Pinnington, Lorraine L; Phillips, Margaret F

    2009-01-01

    Background Research has shown that a number of patients, with a variety of diagnoses, are admitted to hospital when it is not essential and can remain in hospital unnecessarily. To date, research in this area has been primarily quantitative. The purpose of this study was to explore the perceived causes of inappropriate or prolonged lengths of stay and focuses on a specific population (i.e., patients with long term neurological conditions). We also wanted to identify interventions which might avoid admission or expedite discharge as periods of hospitalisation pose particular risks for this group. Methods Two focus groups were conducted with a convenience sample of eight primary and secondary care clinicians working in the Derbyshire area. Data were analysed using a thematic content approach. Results The participants identified a number of key causes of inappropriate admissions and lengths of stay, including: the limited capacity of health and social care resources; poor communication between primary and secondary care clinicians and the cautiousness of clinicians who manage patients in community settings. The participants also suggested a number of strategies that may prevent inappropriate admissions or reduce length of stay (LoS), including: the introduction of new sub-acute care facilities; the introduction of auxiliary nurses to support specialist nursing staff and patient held summaries of specialist consultations. Conclusion Clinicians in both the secondary and primary care sectors acknowledged that some admissions were unnecessary and some patients remain in hospital for a prolonged period. These events were attributed to problems with the current capacity or structuring of services. It was noted, for example, that there is a shortage of appropriate therapeutic services and that the distribution of beds between community and sub-acute care should be reviewed. PMID:19265547

  15. Payment Reform Pilot In Beijing Hospitals Reduced Expenditures And Out-Of-Pocket Payments Per Admission.

    PubMed

    Jian, Weiyan; Lu, Ming; Chan, Kit Yee; Poon, Adrienne N; Han, Wei; Hu, Mu; Yip, Winnie

    2015-10-01

    In 2009 China announced plans to reform provider payment methods at public hospitals by moving from fee-for-service (FFS) to prospective and aggregated payment methods that included the use of diagnosis-related groups (DRGs) to control health expenditures. In October 2011 health policy makers selected six Beijing hospitals to pioneer the first DRG payment system in China. We used hospital discharge data from the six pilot hospitals and eight other hospitals, which continued to use FFS and served as controls, from the period 2010-12 to evaluate the pilot's impact on cost containment through a difference-in-differences methods design. Our study found that DRG payment led to reductions of 6.2 percent and 10.5 percent, respectively, in health expenditures and out-of-pocket payments by patients per hospital admission. We did not find evidence of any increase in hospital readmission rates or cost shifting from cases eligible for DRG payment to ineligible cases. However, hospitals continued to use FFS payments for patients who were older and had more complications than other patients, which reduced the effectiveness of payment reform. Continuous evidence-based monitoring and evaluation linked with adequate management systems are necessary to enable China and other low- and middle-income countries to broadly implement DRGs and refine payment systems. PMID:26438752

  16. Aerosol Optical Depth As a Measure of Particulate Exposure Using Imputed Censored Data, and Relationship with Childhood Asthma Hospital Admissions for 2004 in Athens, Greece

    PubMed Central

    Higgs, Gary; Sterling, David A; Aryal, Subhash; Vemulapalli, Abhilash; Priftis, Kostas N; Sifakis, Nicolas I

    2015-01-01

    An understanding of human health implications from atmosphere exposure is a priority in both the geographic and the public health domains. The unique properties of geographic tools for remote sensing of the atmosphere offer a distinct ability to characterize and model aerosols in the urban atmosphere for evaluation of impacts on health. Asthma, as a manifestation of upper respiratory disease prevalence, is a good example of the potential interface of geographic and public health interests. The current study focused on Athens, Greece during the year of 2004 and (1) demonstrates a systemized process for aligning data obtained from satellite aerosol optical depth (AOD) with geographic location and time, (2) evaluates the ability to apply imputation methods to censored data, and (3) explores whether AOD data can be used satisfactorily to investigate the association between AOD and health impacts using an example of hospital admission for childhood asthma. This work demonstrates the ability to apply remote sensing data in the evaluation of health outcomes, that the alignment process for remote sensing data is readily feasible, and that missing data can be imputed with a sufficient degree of reliability to develop complete datasets. Individual variables demonstrated small but significant effect levels on hospital admission of children for AOD, nitrogen oxides (NOx), relative humidity (rH), temperature, smoke, and inversely for ozone. However, when applying a multivari-able model, an association with asthma hospital admissions and air quality could not be demonstrated. This work is promising and will be expanded to include additional years. PMID:25987842

  17. Aerosol optical depth as a measure of particulate exposure using imputed censored data, and relationship with childhood asthma hospital admissions for 2004 in athens, Greece.

    PubMed

    Higgs, Gary; Sterling, David A; Aryal, Subhash; Vemulapalli, Abhilash; Priftis, Kostas N; Sifakis, Nicolas I

    2015-01-01

    An understanding of human health implications from atmosphere exposure is a priority in both the geographic and the public health domains. The unique properties of geographic tools for remote sensing of the atmosphere offer a distinct ability to characterize and model aerosols in the urban atmosphere for evaluation of impacts on health. Asthma, as a manifestation of upper respiratory disease prevalence, is a good example of the potential interface of geographic and public health interests. The current study focused on Athens, Greece during the year of 2004 and (1) demonstrates a systemized process for aligning data obtained from satellite aerosol optical depth (AOD) with geographic location and time, (2) evaluates the ability to apply imputation methods to censored data, and (3) explores whether AOD data can be used satisfactorily to investigate the association between AOD and health impacts using an example of hospital admission for childhood asthma. This work demonstrates the ability to apply remote sensing data in the evaluation of health outcomes, that the alignment process for remote sensing data is readily feasible, and that missing data can be imputed with a sufficient degree of reliability to develop complete datasets. Individual variables demonstrated small but significant effect levels on hospital admission of children for AOD, nitrogen oxides (NOx), relative humidity (rH), temperature, smoke, and inversely for ozone. However, when applying a multivari-able model, an association with asthma hospital admissions and air quality could not be demonstrated. This work is promising and will be expanded to include additional years. PMID:25987842

  18. Albuterol Use in Children Hospitalized with Human Metapneumovirus Respiratory Infection

    PubMed Central

    Rasmussen, Lindsey K.

    2016-01-01

    Introduction. Human metapneumovirus (HMPV) is a paramyxovirus from the same subfamily as respiratory syncytial virus (RSV) and causes similar acute lower respiratory tract infection. Albuterol in the setting of acute RSV infection is controversial and has not yet been studied in HMPV. We sought to determine the frequency of albuterol use in HMPV infection and the association between albuterol administration and patient outcomes. Methods. We conducted a retrospective cohort study identifying all patients hospitalized in a tertiary care children's hospital with laboratory-confirmed HMPV infection between January 2010 and December 2010. Results. There were 207 patients included in the study; 57% had a chronic medical condition. The median hospital length of stay was 3 days. Only 31% of patients in the study had a documented wheezing history, while 69% of patients received at least one albuterol treatment. There was no difference in length of stay between patients who received albuterol and those who did not. Conclusion. There is a high frequency of albuterol use in children hospitalized with HMPV infection. As with RSV, evidence may not support routine use of bronchodilators in patients with acute HMPV respiratory infection. Research involving additional patient outcomes and illness severity indicators would be useful in future studies. PMID:26925109

  19. Increased Plasma Levels of Heparin-Binding Protein on Admission to Intensive Care Are Associated with Respiratory and Circulatory Failure

    PubMed Central

    Tydén, Jonas; Herwald, Heiko; Sjöberg, Folke; Johansson, Joakim

    2016-01-01

    Purpose Heparin-binding protein (HBP) is released by granulocytes and has been shown to increase vascular permeability in experimental investigations. Increased vascular permeability in the lungs can lead to fluid accumulation in alveoli and respiratory failure. A generalized increase in vascular permeability leads to loss of circulating blood volume and circulatory failure. We hypothesized that plasma concentrations of HBP on admission to the intensive care unit (ICU) would be associated with decreased oxygenation or circulatory failure. Methods This is a prospective, observational study in a mixed 8-bed ICU. We investigated concentrations of HBP in plasma at admission to the ICU from 278 patients. Simplified acute physiology score (SAPS) 3 was recorded on admission. Sequential organ failure assessment (SOFA) scores were recorded daily for three days. Results Median SAPS 3 was 58.8 (48–70) and 30-day mortality 64/278 (23%). There was an association between high plasma concentrations of HBP on admission with decreased oxygenation (p<0.001) as well as with circulatory failure (p<0.001), after 48–72 hours in the ICU. There was an association between concentrations of HBP on admission and 30-day mortality (p = 0.002). ROC curves showed areas under the curve of 0,62 for decreased oxygenation, 0,65 for circulatory failure and 0,64 for mortality. Conclusions A high concentration of HBP in plasma on admission to the ICU is associated with respiratory and circulatory failure later during the ICU care period. It is also associated with increased 30-day mortality. Despite being an interesting biomarker for the composite ICU population it´s predictive value at the individual patient level is low. PMID:27007333

  20. Inpatient Readmissions and Emergency Department Visits within 30 Days of a Hospital Admission

    PubMed Central

    Brennan, Jesse J.; Chan, Theodore C.; Killeen, James P.; Castillo, Edward M.

    2015-01-01

    Introduction Inpatient hospital readmissions have become a focus for healthcare reform and cost-containment efforts. Initiatives targeting unanticipated readmissions have included care coordination for specific high readmission diseases and patients and health coaching during the post-discharge transition period. However, little research has focused on emergency department (ED) visits following an inpatient admission. The objective of this study was to assess 30-day ED utilization and all-cause readmissions following a hospital admission. Methods This was a retrospective study using inpatient and ED utilization data from two hospitals with a shared patient population in 2011. We assessed the 30-day ED visit rate and 30-day readmission rate and compared patient characteristics among individuals with 30-day inpatient readmissions, 30-day ED discharges, and no 30-day visits. Results There were 13,449 patients who met the criteria of an index visit. Overall, 2,453 (18.2%) patients had an ED visit within 30 days of an inpatient stay. However, only 55.6% (n=1,363) of these patients were admitted at one of these 30-day visits, resulting in a 30-day all-cause readmission rate of 10.1%. Conclusion Approximately one in five patients presented to the ED within 30 days of an inpatient hospitalization and over half of these patients were readmitted. Readmission measures that incorporate ED visits following an inpatient stay might better inform interventions to reduce avoidable readmissions. PMID:26759647

  1. Population-based characteristics of fatal and hospital admissions for poisoning in Fiji: TRIP Project-11.

    PubMed

    Peiris-John, Roshini; Kafoa, Berlin; Wainiqolo, Iris; Reddy, Ravi Krishnan; McCaig, Eddie; Ameratunga, Shanthi N

    2013-10-01

    This study investigated the incidence and characteristics of poisoning fatalities and hospital admissions among indigenous Fijians and Indians in Viti Levu, Fiji. Individuals with a mechanism of injury classified as poisoning were identified using the Fiji injury surveillance in hospitals system, a population-based registry established for 12 months in Viti Levu, and analysed using population-based denominators. The mean annual rates of fatalities and hospitalisations were 2.3 and 26.0 per 100 000, respectively. Over two-thirds of poisonings occurred among people of Indian ethnicity. Most intentional poisoning admissions occurred among women (58.3%) and in 15-29-year-old individuals (73.8%). Unintentional poisoning admission rates were highest among Indian boys aged 0-14 years. While over 75% of events occurred at home, the substances involved were not systematically identified. The findings indicate the need for a strategy that addresses the differing contexts across age group, gender and ethnicity, and a lead agency responsible for implementing and monitoring its effectiveness. PMID:23353079

  2. Epidemiology of Orthopaedic Trauma Admissions Over One Year in a District General Hospital in England

    PubMed Central

    Taylor, A; Young, A

    2015-01-01

    Introduction : Admission to district general hospitals in England has undergone change in recent years due to both an aging population and the reconfiguration of the major trauma network throughout the United Kingdom. Methods : We utilised a retrospective cohort study to analyse the epidemiology over a 12-month period at a district general hospital. Data was collected and divided into groups: upper limb, lower limb, vertebral disc disease, vertebral fracture, cellulitis without bone involvement and deep infection including metalwork. Results : 2817 patients were admitted over the 12-month period. There were 893 upper limb fractures, 1511 lower limb fractures, 126 vertebral disc disease, 55 vertebral fractures, 108 cellulitis without bone involvement and 124 deep infections with 19 admissions not specified due to coding. AN average of 242 patients were admitted each month with the majority admitted during the summer months. Conclusion : Although fractures make up the majority of the reason for which a person is admitted, there are also many other injuries/morbidities, which may necessitate admission. There is an increasing incidence of elderly osteoporotic fractures in females, which is balancing out the previously more common fractures seen in younger adults and adolescents. PMID:26069514

  3. Hospital Preparations for Viral Hemorrhagic Fever Patients and Experience Gained from Admission of an Ebola Patient

    PubMed Central

    Minderhoud, A.L.C. (Ben); Wind, Jelte D.D.; Leenen, Luke P.H.; Hoepelman, Andy I.M.; Ellerbroek, Pauline M.

    2016-01-01

    The Major Incident Hospital of the University Medical Centre of Utrecht has a longstanding history of preparing for the management of highly pathogenic and infectious organisms. An assessment of the hospital’s preparations for an outbreak of viral hemorrhagic fever and its experience during admission of a patient with Ebola virus disease showed that the use of the buddy system, frequent training, and information sessions for staff and their relatives greatly increased the sense of safety and motivation among staff. Differing procedures among ambulance services limited the number of services used for transporting patients. Waste management was the greatest concern, and destruction of waste had to be outsourced. The admission of an Ebola patient proceeded without incident but led to considerable demands on staff. The maximum time allowed for wearing personal protective equipment was 45 minutes to ensure safety, and an additional 20 minutes was needed for recovery. PMID:26812146

  4. Rising United States Hospital Admissions for Acute Bacterial Skin and Skin Structure Infections: Recent Trends and Economic Impact

    PubMed Central

    Kaye, Keith S.; Patel, Dipen A.; Stephens, Jennifer M.; Khachatryan, Alexandra; Patel, Ayush; Johnson, Kenneth

    2015-01-01

    Background The number of ambulatory patients seeking treatment for skin and skin structure infections (SSSI) are increasing. The objective of this study is to determine recent trends in hospital admissions and healthcare resource utilization and identify covariates associated with hospital costs and mortality for hospitalized adult patients with a primary SSSI diagnosis in the United States. Methods We performed a retrospective cross-sectional analysis (years 2005–2011) of data from the US Healthcare Cost and Utilization Project National Inpatient Sample. Recent trends, patient characteristics, and healthcare resource utilization for patients hospitalized with a primary SSSI diagnosis were evaluated. Descriptive and bivariate analyses were conducted to assess patient and hospital characteristics. Results A total of 1.8% of hospital admissions for the years 2005 through 2011 were for adult patients with a SSSI primary diagnosis. SSSI-related hospital admissions significantly changed during the study period (P < .001 for trend) ranging from 1.6% (in 2005) to 2.0% (in 2011). Mean hospital length of stay (LOS) decreased from 5.4 days in the year 2005 to 5.0 days in the year 2011 (overall change, P < .001) with no change in hospital costs. Patients with postoperative wound infections had the longest hospital stays (adjusted mean, 5.81 days; 95% confidence interval (CI), 5.80–5.83) and highest total costs (adjusted mean, $9388; 95% CI, $9366-$9410). Year of hospital admission was strongly associated with mortality; infection type, all patient refined diagnosis related group severity of illness level, and LOS were strongly associated with hospital costs. Conclusions Hospital admissions for adult patients in the United States with a SSSI primary diagnosis continue to increase. Decreasing hospital inpatient LOS and mortality rate may be due to improved early treatment. Future research should focus on identifying alternative treatment processes for patients with SSSI

  5. Complications Requiring Hospital Admission and Causes of In-Hospital Death over Time in Alcoholic and Nonalcoholic Cirrhosis Patients

    PubMed Central

    Kim, Hee Yeon; Kim, Chang Wook; Choi, Jong Young; Lee, Chang Don; Lee, Sae Hwan; Kim, Moon Young; Jang, Byoung Kuk; Woo, Hyun Young

    2016-01-01

    Background/Aims Data on the epidemiology of alcoholic cirrhosis, especially in Asian countries, are limited. We compared the temporal evolution of patterns of alcoholic and nonalcoholic cirrhosis over the last decade. Methods We retrospectively examined the inpatient datasets of five referral centers during 2002 and 2011. The study included patients who were admitted due to specific complications of liver cirrhosis. We compared the causes of hospital admissions and in-hospital deaths between patients with alcoholic and nonalcoholic cirrhosis. Results Among the included 2,799 hospitalizations (2,165 patients), 1,496 (1,143 patients) were from 2002, and 1,303 (1,022 patients) were from 2011. Over time, there was a reduction in the rate of hepatic encephalopathy (HE) as a cause of hospitalization and an increase in the rate of hepatocellular carcinoma. Deaths that were attributable to HE or spontaneous bacterial peritonitis (SBP) significantly decreased, whereas those due to hepatorenal syndrome (HRS) significantly increased over time in patients with alcoholic cirrhosis. However, in patients with nonalcoholic cirrhosis, hepatic failure and HRS remained the principal causes of in-hospital death during both time periods. Conclusions The major causes of in-hospital deaths have evolved from acute cirrhotic complications, including HE or SBP to HRS in alcoholic cirrhosis, whereas those have remained unchanged in nonalcoholic cirrhosis during the last decade. PMID:26087788

  6. Respiratory viruses in children hospitalized for acute lower respiratory tract infection in Ghana

    PubMed Central

    2012-01-01

    Background Acute respiratory tract infections are one of the major causes of morbidity and mortality among young children in developing countries. Information on the viral aetiology of acute respiratory infections in developing countries is very limited. The study was done to identify viruses associated with acute lower respiratory tract infection among children less than 5 years. Method Nasopharyngeal samples and blood cultures were collected from children less than 5 years who have been hospitalized for acute lower respiratory tract infection. Viruses and bacteria were identified using Reverse Transcriptase Real-Time Polymerase Chain Reaction and conventional biochemical techniques. Results Out of 128 patients recruited, 33(25.88%%, 95%CI: 18.5% to 34.2%) were positive for one or more viruses. Respiratory Syncytial Virus (RSV) was detected in 18(14.1%, 95%CI: 8.5% to 21.3%) patients followed by Adenoviruses (AdV) in 13(10.2%, 95%CI: 5.5% to 16.7%), Parainfluenza (PIV type: 1, 2, 3) in 4(3.1%, 95%CI: 0.9% to 7.8%) and influenza B viruses in 1(0.8%, 95%CI: 0.0 to 4.3). Concomitant viral and bacterial co-infection occurred in two patients. There were no detectable significant differences in the clinical signs, symptoms and severity for the various pathogens isolated. A total of 61.1% (22/36) of positive viruses were detected during the rainy season and Respiratory Syncytial Virus was the most predominant. Conclusion The study has demonstrated an important burden of respiratory viruses as major causes of childhood acute respiratory infection in a tertiary health institution in Ghana. The data addresses a need for more studies on viral associated respiratory tract infection. PMID:22490115

  7. A Nationwide Analysis of Outcomes of Weekend Admissions for Intracerebral Hemorrhage Shows Disparities Based on Hospital Teaching Status

    PubMed Central

    Patel, Achint A.; Benjo, Alexandre; Pathak, Ambarish; Kar, Jitesh; Jani, Vishal B.; Annapureddy, Narender; Agarwal, Shiv Kumar; Sabharwal, Manpreet S.; Simoes, Priya K.; Konstantinidis, Ioannis; Yacoub, Rabi; Javed, Fahad; El Hayek, Georges; Menon, Madhav C.; Nadkarni, Girish N.

    2015-01-01

    Background and Purpose: With the “weekend effect” being well described, the Brain Attack Coalition released a set of “best practice” guidelines in 2005, with the goal to uniformly provide standard of care to patients with stroke. We attempted to define a “weekend effect” in outcomes among patients with intracranial hemorrhage (ICH) over the last decade, utilizing the Nationwide Inpatient Sample (NIS) data. We also attempted to analyze the trend of such an effect. Materials and Methods: We determined the association of ICH weekend admissions with hospital outcomes including mortality, adverse discharge, length of stay, and cost compared to weekday admissions using multivariable logistic regression. We extracted our study cohort from the NIS, the largest all-payer data set in the United States. Results: Of 485 329 ICH admissions from 2002 to 2011, 27.5% were weekend admissions. Overall, weekend admissions were associated with 11% higher odds of in-hospital mortality. When analyzed in 3-year groups, excess mortality of weekend admissions showed temporal decline. There was higher mortality with weekend admissions in nonteaching hospitals persisted (odds ratios 1.16, 1.13, and 1.09, respectively, for 3-year subgroups). Patients admitted during weekends were also 9% more likely to have an adverse discharge (odds ratio 1.09; 95% confidence interval: 1.07-1.11; P < .001) with no variation by hospital status. There was no effect of a weekend admission on either length of stay or cost of care. Conclusion: Nontraumatic ICH admissions on weekends have higher in-hospital mortality and adverse discharge. This demonstrates need for in-depth review for elucidating this discrepancy and stricter adherence to standard-of-care guidelines to ensure uniform care. PMID:27053981

  8. Health conditions in a cohort of New Zealand Vietnam veterans: hospital admissions between 1988 and 2009

    PubMed Central

    Cox, Brian; Broughton, John; Tong, Darryl

    2015-01-01

    Objectives To inform the provision of support to veterans by analysing hospital discharge data, thereby identifying which conditions show an excess risk, require specific management strategies and deserve further investigation. Setting Tertiary level care, including all public and private New Zealand hospitals. Participants All New Zealand Vietnam veterans with service between 1964 and 1972. Primary outcome measures Standardised hospitalisation ratios (SHRs) were calculated based on the number of first observed hospital admissions for a condition, those expected being based on New Zealand national hospitalisation rates. Results The SHR for all causes of hospitalisation was 1.18, 95% CI 1.15 to 1.21, with modest increases for the major common causes, cardio and cerebrovascular disease. Admission rates for chronic renal failure and chronic obstructive pulmonary disease were highest in the 2006–2009 time period. The highest statistically significant hospitalisation risk was for alcohol-related mental disorder, SHR 1.91, 99% CI 1.39 to 2.43. Conclusions Chronic renal failure has limited attribution to veteran service but along with chronic obstructive pulmonary disease has the potential to have high costs both to the individual and the health system. We suggest that routine surveillance of veterans by way of a ‘flag’ in national and primary care databases would facilitate the recognition of service-related conditions and the appropriate provision of healthcare. PMID:26656012

  9. Characterization of hospital and community-acquired respiratory syncytial virus in children with severe lower respiratory tract infections in Ho Chi Minh City, Vietnam, 2010

    PubMed Central

    Tuan, Tran Anh; Thanh, Tran Tan; Hai, Nguyen thi Thanh; Tinh, Le Binh Bao; Kim, Le thi Ngoc; Do, Lien Anh Ha; Chinh B'Krong, Nguyen thi Thuy; Tham, Nguyen thi; Hang, Vu thi Ty; Merson, Laura; Farrar, Jeremy; Thuong, Tang Chi; de Jong, Menno D; Schultsz, Constance; van Doorn, H Rogier

    2015-01-01

    Background Human respiratory syncytial virus (RSV) is an important community and nosocomial pathogen in developed countries but data regarding the importance of RSV in developing countries are relatively scarce. Methods During a 1-year surveillance study in 2010, we took serial samples from children admitted to the Emergency Unit of the Respiratory Ward of Children's Hospital 1 in Ho Chi Minh City, Vietnam. RSV was detected within 72 hours of admission to the ward in 26% (376/1439; RSV A: n = 320; RSV B: n = 54; and RSV A and B: n = 2). Among those negative in the first 72 hours after admission, 6·6% (25/377) acquired nosocomial RSV infection during hospitalization (RSV A: n = 22; and RSV B: n = 3). Results Children with nosocomial RSV infection were younger (P = 0·001) and had a longer duration of hospitalization (P < 0·001). The rate of incomplete recovery among children with nosocomial RSV infection was significantly higher than among those without (P < 0·001). Phylogenetic analysis of partial G gene sequences obtained from 79% (316/401) of positive specimens revealed the co-circulation of multiple genotypes with RSV A NA1 being predominant (A NA1: n = 275; A GA5: n = 5; B BA3: n = 3; B BA9: n = 26; and B BA10: n = 7). The RSV A GA5 and RSV B BA3 genotypes have not been reported from Vietnam, previously. Conclusion Besides emphasizing the importance of RSV as a cause of respiratory infection leading to hospitalization in young children and as a nosocomial pathogen, data from this study extend our knowledge on the genetic diversity of RSV circulating in Vietnam. PMID:25702707

  10. New strategies to identify patients harbouring antibiotic-resistant bacteria at hospital admission.

    PubMed

    Tacconelli, E

    2006-02-01

    Nosocomial infections caused by antibiotic-resistant bacteria are associated with high morbidity and mortality worldwide. Most prevention strategies focus on cross-transmission, but the endemic state inside the hospital is also maintained through the influx of patients colonised or infected with antibiotic-resistant bacteria, balanced by the efflux of colonised patients following discharge. Epidemiological research has demonstrated that eradication can be achieved by preventing the influx of resistant bacteria. The presence of a central venous catheter and a history of methicillin-resistant Staphylococcus aureus (MRSA) infection or colonisation are associated significantly with methicillin-resistant staphylococcal bacteraemia at admission. Previous antibiotic therapy and transfer from long-term care facilities or nursing homes are associated with bacteraemia caused by methicillin-resistant coagulase-negative staphylococci, while skin ulcer and cellulites are independent risk-factors for MRSA bacteraemia. A scoring system using point values has been developed and validated to identify patients positive for vancomycin-resistant enterococci at admission. Six variables were identified: age > 60 years (2 points); hospitalisation in the previous year (3); use of two or more antibiotics during the previous 30 days (3); transfer from another hospital or long-term care facility (3); a requirement for chronic haemodialysis (2); and a previous history of MRSA infection (4). With a point score cut-off of > or = 10, the specificity of this prediction rule is 98%. Knowledge of variables identifying patients at high risk for being colonised or infected with antibiotic-resistant bacteria may assist clinicians in targeting preventive measures and streamlining the use of vancomycin. Current studies are analysing risk-factors for harbouring multiresistant Gram-negative bacteria at hospital admission. PMID:16441446

  11. No Evidence of Purported Lunar Effect on Hospital Admission Rates or Birth Rates

    PubMed Central

    Margot, Jean-Luc

    2015-01-01

    Background Studies indicate that a fraction of nursing professionals believe in a “lunar effect”—a purported correlation between the phases of the Earth’s moon and human affairs, such as birth rates, blood loss, or fertility. Purpose This article addresses some of the methodological errors and cognitive biases that can explain the human tendency of perceiving a lunar effect where there is none. Approach This article reviews basic standards of evidence and, using an example from the published literature, illustrates how disregarding these standards can lead to erroneous conclusions. Findings Román, Soriano, Fuentes, Gálvez, and Fernández (2004) suggested that the number of hospital admissions related to gastrointestinal bleeding was somehow influenced by the phases of the Earth’s moon. Specifically, the authors claimed that the rate of hospital admissions to their bleeding unit is higher during the full moon than at other times. Their report contains a number of methodological and statistical flaws that invalidate their conclusions. Reanalysis of their data with proper procedures shows no evidence that the full moon influences the rate of hospital admissions, a result that is consistent with numerous peer-reviewed studies and meta-analyses. A review of the literature shows that birth rates are also uncorrelated to lunar phases. Conclusions Data collection and analysis shortcomings, as well as powerful cognitive biases, can lead to erroneous conclusions about the purported lunar effect on human affairs. Adherence to basic standards of evidence can help assess the validity of questionable beliefs. PMID:25756232

  12. Hospital Admission Rates for a Racially Diverse Low-Income Cohort of Patients With Diabetes: The Urban Diabetes Study

    PubMed Central

    Robbins, Jessica M.; Webb, David A.

    2006-01-01

    Objective. We sought to determine the frequency and costs of hospitalization and to assess possible racial/ethnic disparities in a large cohort of low-income patients with diabetes who had received primary care at municipal health clinics. Methods. Administrative data from Philadelphia Health Care Centers were linked with discharge data from Pennsylvania hospitals for March 1993 through December 2001. We tested differences in hospitalization rates and mean hospital charges by age, gender, and race/ethnicity. Results. A total of 18 800 patients with diabetes experienced 30 528 hospital admissions, for a hospitalization rate of 0.35 per person-year. Rates rose with age and with the interaction of male gender and age. Rates for non-Hispanic Whites were higher than those for African Americans, whereas those for Hispanics, Asian Americans, and “others” were lower. Patients who were hospitalized at least 5 times made up 10.5% of the study population and accounted for 64% of hospital admissions and hospital charges in this cohort. Conclusions. Hospitalization rates for this low-income cohort with access to primary care and pharmacy services were comparable to those of other diabetic patient populations, suggesting that reducing financial barriers to care may have benefited these patients. A subgroup of patients with multiple hospitalizations accounted for the majority of hospital admissions. PMID:16735627

  13. High Prevalence of Respiratory Muscle Weakness in Hospitalized Acute Heart Failure Elderly Patients

    PubMed Central

    Verissimo, Pedro; Timenetsky, Karina T.; Casalaspo, Thaisa Juliana André; Gonçalves, Louise Helena Rodrigues; Yang, Angela Shu Yun; Eid, Raquel Caserta

    2015-01-01

    Introduction Respiratory Muscle Weakness (RMW) has been defined when the maximum inspiratory pressure (MIP) is lower than 70% of the predictive value. The prevalence of RMW in chronic heart failure patients is 30 to 50%. So far there are no studies on the prevalence of RMW in acute heart failure (AHF) patients. Objectives Evaluate the prevalence of RMW in patients admitted because of AHF and the condition of respiratory muscle strength on discharge from the hospital. Methods Sixty-three patients had their MIP measured on two occasions: at the beginning of the hospital stay, after they had reached respiratory, hemodynamic and clinical stability and before discharge from the hospital. The apparatus and technique to measure MIP were adapted because of age-related limitations of the patients. Data on cardiac ejection fraction, ECG, brain natriuretic peptide (BNP) levels and on the use of noninvasive ventilation (NIV) were collected. Results The mean age of the 63 patients under study was 75 years. On admission the mean ejection fraction was 33% (95% CI: 31–35) and the BNP hormone median value was 726.5 pg/ml (range: 217 to 2283 pg/ml); 65% of the patients used NIV. The median value of MIP measured after clinical stabilization was -52.7 cmH2O (range: -20 to -120 cmH2O); 76% of the patients had MIP values below 70% of the predictive value. On discharge, after a median hospital stay of 11 days, the median MIP was -53.5 cmH2O (range:-20 to -150 cmH2O); 71% of the patients maintained their MIP values below 70% of the predictive value. The differences found were not statistically significant. Conclusion Elderly patients admitted with AHF may present a high prevalence of RMW on admission; this condition may be maintained at similar levels on discharge in a large percentage of these patients, even after clinical stabilization of the heart condition. PMID:25671566

  14. Minimum Alcohol Prices and Outlet Densities in British Columbia, Canada: Estimated Impacts on Alcohol-Attributable Hospital Admissions

    PubMed Central

    Zhao, Jinhui; Martin, Gina; Macdonald, Scott; Vallance, Kate; Treno, Andrew; Ponicki, William; Tu, Andrew; Buxton, Jane

    2013-01-01

    Objectives. We investigated whether periodic increases in minimum alcohol prices were associated with reduced alcohol-attributable hospital admissions in British Columbia. Methods. The longitudinal panel study (2002–2009) incorporated minimum alcohol prices, density of alcohol outlets, and age- and gender-standardized rates of acute, chronic, and 100% alcohol-attributable admissions. We applied mixed-method regression models to data from 89 geographic areas of British Columbia across 32 time periods, adjusting for spatial and temporal autocorrelation, moving average effects, season, and a range of economic and social variables. Results. A 10% increase in the average minimum price of all alcoholic beverages was associated with an 8.95% decrease in acute alcohol-attributable admissions and a 9.22% reduction in chronic alcohol-attributable admissions 2 years later. A Can$ 0.10 increase in average minimum price would prevent 166 acute admissions in the 1st year and 275 chronic admissions 2 years later. We also estimated significant, though smaller, adverse impacts of increased private liquor store density on hospital admission rates for all types of alcohol-attributable admissions. Conclusions. Significant health benefits were observed when minimum alcohol prices in British Columbia were increased. By contrast, adverse health outcomes were associated with an expansion of private liquor stores. PMID:23597383

  15. Association between antipsychotic/antidepressant drug treatments and hospital admissions in schizophrenia assessed using a mental health case register

    PubMed Central

    Cardinal, Rudolf N; Savulich, George; Mann, Louisa M; Fernández-Egea, Emilio

    2015-01-01

    Background: The impact of psychotropic drug choice upon admissions for schizophrenia is not well understood. Aims: To examine the association between antipsychotic/antidepressant use and time in hospital for patients with schizophrenia. Methods: We conducted an observational study, using 8 years’ admission records and electronically generated drug histories from an institution providing secondary mental health care in Cambridgeshire, UK, covering the period 2005–2012 inclusive. Patients with a coded ICD-10 diagnosis of schizophrenia were selected. The primary outcome measure was the time spent as an inpatient in a psychiatric unit. Antipsychotic and antidepressant drugs used by at least 5% of patients overall were examined for associations with admissions. Periods before and after drug commencement were compared for patients having pre-drug admissions, in mirror-image analyses correcting for overall admission rates. Drug use in one 6-month calendar period was used to predict admissions in the next period, across all patients, in a regression analysis accounting for the effects of all other drugs studied and for time. Results: In mirror-image analyses, sulpiride, aripiprazole, clozapine, and olanzapine were associated with fewer subsequent admission days. In regression analyses, sulpiride, mirtazapine, venlafaxine, and clozapine–aripiprazole and clozapine–amisulpride combinations were associated with fewer subsequent admission days. Conclusions: Use of these drugs was associated with fewer days in hospital. Causation is not implied and these findings require confirmation by randomized controlled trials. PMID:27336041

  16. Respiratory Syncytial Virus Hospitalizations in Healthy Preterm Infants

    PubMed Central

    Margulis, Andrea V.; Samuel, Miny; Lohr, Kathleen N.

    2016-01-01

    Background: Studies have explored the risk for and impact of respiratory syncytial virus (RSV) infection requiring hospitalization among healthy preterm infants born at 29–35 weeks of gestational age not given RSV immunoprophylaxis. We performed a systematic review and qualitative synthesis of these studies. Methods: Two experienced reviewers used prespecified inclusion/exclusion criteria to screen titles/abstracts and full-text studies using MEDLINE, Embase, BIOSIS and Cochrane Library (January 1, 1985, to November 6, 2014). We abstracted data on risk factors for RSV hospitalization, incidence and short- and long-term outcomes of RSV hospitalization. Using standard procedures, we assessed study risk of bias and graded strength of evidence (SOE). Results: We identified 4754 records and reviewed 27. Important risk factors for RSV hospitalization included young age during the RSV season, having school-age siblings and day-care attendance, with odds ratios >2.5 in at least one study (high SOE). Incidence rates for RSV hospitalizations ranged from 2.3% to 10% (low SOE). Length of hospital stays ranged from 3.8 to 6.1 days (low SOE). Recurrent wheezing rates ranged from 20.7% to 42.8% 1 to 2 years after RSV hospitalization (low SOE). Conclusions: Young chronological age and some environmental risk factors are important clinical indicators of an increased risk of RSV hospitalization in healthy preterm infants 32 to 35 weeks of gestational age. SOE was low for estimates of incidence of RSV hospitalizations, in-hospital resource use and recurrent wheezing in this population. Studies were inconsistent in study characteristics, including weeks of gestational age, age during RSV season and control for confounding factors. PMID:27093166

  17. Seasonality of Admissions for Mania: Results From a General Hospital Psychiatric Unit in Pondicherry, India

    PubMed Central

    Sarkar, Siddharth

    2015-01-01

    Introduction: Bipolar disorder is affected by variables that modulate circadian rhythm, including seasonal variations. There is evidence of a seasonal pattern of admissions of mania in various geographical settings, though its timing varies by region and climate. Variables such as age and gender have been shown to affect seasonality in some studies. Methodology: Data on monthly admission patterns for mania at a general hospital psychiatry unit in Pondicherry, India, were collected for 4 years (2010–2013) and analyzed for seasonality and seasonal peaks. The effects of age and gender were analyzed separately. Results: There was overall evidence of a seasonal pattern of admissions for mania (P < .01, Friedman test for seasonality), with a peak beginning during the rainy season and ending before summer (P < .0.1, Ratchet circular scan test). Male sex (P < .005, Ratchet circular scan test) and age > 25 years (P < .005, Ratchet circular scan test) were specifically associated with this seasonal peak. Discussion: The effect of seasons on mania is complex and is modulated by a variety of variables. Our study is consistent with earlier research findings: a greater degree of seasonality for mania in men. It is possible that climatic and individual variables interact to determine seasonal patterns in bipolar disorder in a given setting. PMID:26644962

  18. Air pollution from biomass burning and asthma hospital admissions in a sugar cane plantation area in Brazil

    PubMed Central

    Arbex, Marcos Abdo; Martins, Lourdes Conceição; de Oliveira, Regiani Carvalho; Pereira, Luiz Alberto Amador; Arbex, Flávio Ferlin; Cançado, José Eduardo Delfini; Saldiva, Paulo Hilário Nascimento; Braga, Alfésio Luís Ferreira

    2007-01-01

    Objective To evaluate the association between the total suspended particles (TSPs) generated from preharvest sugar cane burning and hospital admission due to asthma (asthma hospital admissions) in the city of Araraquara. Design An ecological time‐series study. Total daily records of asthma hospital admissions (ICD 10th J15) were obtained from one of the main hospitals in Araraquara, São Paulo State, Brazil, from 23 March 2003 to 27 July 2004. The daily concentration of TSP (μg/m3) was obtained using Handi‐vol equipment (Energética, Brazil) placed in downtown Araraquara. The local airport provided the daily mean figures of temperature and humidity. The daily number of asthma hospital admissions was considered as the dependent variable in Poisson's regression models and the daily concentration of TSP was considered the independent variable. The generalised linear model with natural cubic spline was adopted to control for long‐time trend. Linear terms were used for weather variables. Results TSP had an acute effect on asthma admissions, starting 1 day after TSP concentrations increased and remaining almost unchanged for the next four days. A 10 μg/m3 increase in the 5‐day moving average (lag1–5) of TSP concentrations was associated with an increase of 11.6% (95% CI 5.4 to 17.7) in asthma hospital admissions. Conclusion Increases in TSP concentrations were definitely associated with asthma hospital admissions in Araraquara and, despite using sugar cane alcohol to reduce air pollution from automotive sources in large Brazilian urban centres, the cities where sugar cane is harvested pay a high toll in terms of public health. PMID:17435205

  19. A Preliminary Assessment of the Role of Ambient Nitric Oxide Exposure in Hospitalization with Respiratory Syncytial Virus Bronchiolitis

    PubMed Central

    Mohammed, Nuredin I.; Everard, Mark L.; Ayres, Jon G.; Barker, Nicola J.; Litchfield, Ian J.

    2016-01-01

    Some in vitro studies have indicated a possible link between respiratory syncytial virus (RSV) infection and exposure to Nitric Oxide (NO). However, these studies used much higher NO concentrations than normally found in the ambient environment. This preliminary study explored whether an association was present with short-term exposure to NO in the environment. RSV-related admission data between November 2011 and February 2012 were obtained from Sheffield Children’s Hospital. The dates of admission were linked to contemporaneous ambient NO derived from sentinel air monitors. The case-crossover design was used to study the relationship between daily RSV admissions and NO, controlling for temperature and relative humidity. We found little evidence of association between daily RSV admission rates and exposure to ambient NO at different lags or average exposure across several lags. The findings should, however, be viewed with caution due to the low number of events observed during the time frame. It is possible that the apparent lack of association may be accounted for by the timing of the seasonal RSV epidemic in relation to peaks in NO concentrations. A larger study incorporating a wider range of RSV and NO peaks would determine whether said peaks enhanced the number of RSV hospitalizations in children. PMID:27294948

  20. The potential economic value of screening hospital admissions for Clostridium difficile.

    PubMed

    Bartsch, S M; Curry, S R; Harrison, L H; Lee, B Y

    2012-11-01

    Asymptomatic Clostridium difficile carriage has a prevalence reported as high as 51-85 %; with up to 84 % of incident hospital-acquired infections linked to carriers. Accurately identifying carriers may limit the spread of Clostridium difficile. Since new technology adoption depends heavily on its economic value, we developed an analytic simulation model to determine the cost-effectiveness screening hospital admissions for Clostridium difficile from the hospital and third party payer perspectives. Isolation precautions were applied to patients testing positive, preventing transmission. Sensitivity analyses varied Clostridium difficile colonization rate, infection probability among secondary cases, contact isolation compliance, and screening cost. Screening was cost-effective (i.e., incremental cost-effectiveness ratio [ICER] ≤ $50,000/QALY) for every scenario tested; all ICER values were ≤ $256/QALY. Screening was economically dominant (i.e., saved costs and provided health benefits) with a ≥10.3 % colonization rate and ≥5.88 % infection probability when contact isolation compliance was ≥25 % (hospital perspective). Under some conditions screening led to cost savings per case averted (range, $53-272). Clostridium difficile screening, coupled with isolation precautions, may be a cost-effective intervention to hospitals and third party payers, based on prevalence. Limiting Clostridium difficile transmission can reduce the number of infections, thereby reducing its economic burden to the healthcare system. PMID:22752150

  1. Residential exposure to aircraft noise and hospital admissions for cardiovascular diseases: multi-airport retrospective study

    PubMed Central

    Correia, Andrew W; Peters, Junenette L; Levy, Jonathan I; Melly, Steven

    2013-01-01

    Objective To investigate whether exposure to aircraft noise increases the risk of hospitalization for cardiovascular diseases in older people (≥65 years) residing near airports. Design Multi-airport retrospective study of approximately 6 million older people residing near airports in the United States. We superimposed contours of aircraft noise levels (in decibels, dB) for 89 airports for 2009 provided by the US Federal Aviation Administration on census block resolution population data to construct two exposure metrics applicable to zip code resolution health insurance data: population weighted noise within each zip code, and 90th centile of noise among populated census blocks within each zip code. Setting 2218 zip codes surrounding 89 airports in the contiguous states. Participants 6 027 363 people eligible to participate in the national medical insurance (Medicare) program (aged ≥65 years) residing near airports in 2009. Main outcome measures Percentage increase in the hospitalization admission rate for cardiovascular disease associated with a 10 dB increase in aircraft noise, for each airport and on average across airports adjusted by individual level characteristics (age, sex, race), zip code level socioeconomic status and demographics, zip code level air pollution (fine particulate matter and ozone), and roadway density. Results Averaged across all airports and using the 90th centile noise exposure metric, a zip code with 10 dB higher noise exposure had a 3.5% higher (95% confidence interval 0.2% to 7.0%) cardiovascular hospital admission rate, after controlling for covariates. Conclusions Despite limitations related to potential misclassification of exposure, we found a statistically significant association between exposure to aircraft noise and risk of hospitalization for cardiovascular diseases among older people living near airports. PMID:24103538

  2. Improving quality of care and reducing unnecessary hospital admissions: a literature review.

    PubMed

    Means, Tracy

    2016-06-01

    As the UK population lives to older ages, with more complex health and social care needs, there comes a time when going to live in a care home might be essential for a frail, older person. Residents and their families expect high-quality care in return for the costs of their placements, but often find this is not the case ( Help the Aged, 2006 ). In order to improve quality in care homes, the Lincolnshire Community Health Services NHS Trust are piloting a care home support team. The new service aims to provide education and training to an unpredictable workforce, with the addition of regular ward rounds in care homes to ensure more proactive care for residents, in order to reduce unnecessary hospital admissions and improve the quality of care offered. This article looks at the literature relating to education and training for staff in care homes to support this service. It also aims to use the reviewed articles to identify specific training and education needed to improve quality of care for residents and reduce avoidable hospital admissions. PMID:27270196

  3. Factors affecting hospital admission and length of stay of poisoned patients in the north east of England.

    PubMed

    Thomas, S H; Lewis, S; Bevan, L; Bhattacharyya, S; Bramble, M G; Chew, K; Connolly, J; Dorani, B; Han, K H; Horner, J E; Rodgers, A; Sen, B; Tesfayohannes, B; Wynne, H; Bateman, D N

    1996-11-01

    1. Poisoning is a common reason for presentation to hospital and hospital admission but there is no agreed policy for managing these patients. This study examined the management of patients presenting with poisoning and the factors affecting the probability of hospital admission and prolonged stay. 2. Data on all cases of poisoning presenting to six Accident and Emergency departments in the North East of England over 12 weeks in 1994 was collected prospectively from A&E notes. Length of stay and outcome were recorded from hospital computer records. 3. Overall, 73% of patients were admitted to a medical ward. Probability of admission was not independently affected by age or gender but was increased in those with intentional poisoning (Odds Ratio (OR) 3.3 [95% CI 1.8, 6.1]), a history of self harm (OR 1.7, [1.0, 2.9]) or potentially hazardous poisoning (OR 3.7 [2.1, 6.6]). There were significant variations between hospitals (50-80%) which could not be attributed to case mix. 4. Prolonged stay (> 2 nights) was more common in patients over 65 years (OR 6.8 [2.9, 16.1]), those with intentional poisoning (OR 2.7 [1.1, 6.6]) and those with potentially hazardous poisoning (OR 2.6 [1.4, 4.9]). Mean hospital stay was 1.5 days and varied significantly between hospitals from 0.8 to 2.1 days and this was independent of case mix. 5. There are appreciable variations in the management of poisoning between hospitals which are not explained by patient characteristics. Savings would occur if rates of admission and duration of stay were reduced by those hospitals where admission is more frequent or hospital stay is longer. However, the impact of this on long term morbidity is unknown. PMID:8938488

  4. Neonatal respiratory distress in Omdurman Maternity Hospital, Sudan

    PubMed Central

    Hamed, Selma MA; Nasr, Abdelhaleem

    2014-01-01

    Neonatal respiratory distress (NRD) is a common neonatal problem, which is responsible for high morbidity and mortality. There are few published studies in developing countries addressing neonatal respiratory distress. There is no previously published study in Sudan on this problem. The objective of the study is to determine the frequency, different causes, immediate outcome. It was a prospective, descriptive, cross sectional hospital-based study which was carried out in neonatal intensive care unit (NICU) of Omdurman Maternity Hospital, between February-March 2013. The study enrolled all Sudanese newborns from 0-28 days including normal, low and high birth weight of different gestational ages admitted to the neonatal intensive care unit and diagnosed as neonatal respiratory distress. The frequency of NRD was calculated, the causes and immediate outcome were determined. Results showed that the frequency rate of NRD was (4.83%) among the total number of hospital (2071) live births during the period of the study. The commonest causes were transient tachypnoea of the newborn (TTN) in 28% of cases, sepsis in 24% of cases and hyaline membrane disease (HMD) in 15% of cases. The outcome of NRD was: cure in 56% of cases, death in 36% of cases, and patients discharged with complications in 8% of cases. In conclusion, the study confirmed the importance of NRD with a frequency rate of 4.83%, morbidity of 8% and mortality of 36% of cases. The causes and immediate outcome were determined and discussed. Some recommendations were suggested in order to reduce its frequency, morbidity and mortality. PMID:27493392

  5. Association between dust weather and number of admissions for patients with respiratory diseases in spring in Lanzhou.

    PubMed

    Tao, Yan; An, Xingqin; Sun, Zhaobin; Hou, Qing; Wang, Yu

    2012-04-15

    Controlling the confounding factors on respiratory hospitalizations such as long-term trend, meteorological factor, atmospheric pollution, and calendar effect, the research is designed to study the effect of sand-dust weather on respiratory diseases from 2001 to 2005 in Lanzhou City on the basis of the semi-parametric generalized additive model (GAM). The results indicate that there is an association between sand-dust weather and the increase in respiratory hospitalizations, and with lagging effect. There are gender and age differences in the effect of sand-dust weather on health, on male severer than on female (RR value being 1.148 for male, while 1.144 for female without statistical significance), and much greater on the aged ≥ 65 years than on < 65 years (RR value being 1.266 for ≥ 65 yr, and 1.119 for < 65 yr). PMID:22386996

  6. The Pattern of Pediatric Respiratory Illnesses Admitted in Ebonyi State University Teaching Hospital South-East Nigeria

    PubMed Central

    Ezeonu, CT; Uneke, CJ; Ojukwu, JO; Anyanwu, OU; Okike, CO; Ezeanosike, OB; Agumadu, HU

    2015-01-01

    Background: Reports from the developed nations reveal respiratory tract infections as the leading cause of childhood hospital admissions. Children may be admitted for a variety of respiratory illnesses. Data on the spectrum of pediatric respiratory illnesses admitted in the hospital is scarce. Aim: To determine the pattern of pediatrics respiratory illness admissions, seasonal frequency, underlying risk factors and outcome. Subjects and Methods: A retrospective assessment of respiratory cases admitted in the pediatric ward from 2005 to 2010 was conducted using case notes. Parameters considered included month of presentation, age, sex, immunization and nutritional status, tools of diagnosis and patient outcome. Results were analyzed using the Statistical Package for the Social Sciences with the level of significance P ≤ 0.05. Results: Of the 239 cases admitted, there were more males than females (1.4:1). The commonest case was Bronchopneumonia, 71.6% (171/239 out of which 161 were uncomplicated, 5 had effusions and 6 were associated with measles). Other cases were Pulmonary Tuberculosis, 10.9% (26/239), Lobar pneumonia 8.8% (21/239), Bronchiolitis, 5% (12/239), Aspiration pneumonitis 2.1% (5/239) and Bronchial asthma, 0.8% (2/239). Mortality was 7.5% (18/239) mostly from Bronchopneumonia amongst the 1–5 years old. Mortality was significantly associated with malnutrition (P < 0.001) and poor immunization status (P < 0.01). Conclusion: Bronchopneumonia was found to be the commonest illness with significant mortality and peak occurrence in the rainy season. More emphasis must be laid on anticipatory guidance and prevention by encouraging the immunization, good nutrition and increased attention on children even after 1 year of age. PMID:25745580

  7. Association of ambient air pollution with respiratory hospitalization in a government-designated "area of concern": the case of Windsor, Ontario.

    PubMed

    Luginaah, Isaac N; Fung, Karen Y; Gorey, Kevin M; Webster, Greg; Wills, Chris

    2005-03-01

    This study is part of a larger research program to examine the relationship between ambient air quality and health in Windsor, Ontario, Canada. We assessed the association between air pollution and daily respiratory hospitalization for different age and sex groups from 1995 to 2000. The pollutants included were nitrogen dioxide, sulfur dioxide, carbon monoxide, ozone, particulate matter 10 microm in diameter (PM10), coefficient of haze (COH), and total reduced sulfur (TRS). We calculated relative risk (RR) estimates using both time-series and case-crossover methods after controlling for appropriate confounders (temperature, humidity, and change in barometric pressure). The results of both analyses were consistent. We found associations between NO2, SO2, CO, COH, or PM10 and daily hospital admission of respiratory diseases especially among females. For females 0-14 years of age, there was 1-day delayed effect of NO2 (RR = 1.19, case-crossover method), a current-day SO2 (RR = 1.11, time series), and current-day and 1- and 2-day delayed effects for CO by case crossover (RR = 1.15, 1.19, 1.22, respectively). Time-series analysis showed that 1-day delayed effect of PM10 on respiratory admissions of adult males (15-64 years of age), with an RR of 1.18. COH had significant effects on female respiratory hospitalization, especially for 2-day delayed effects on adult females, with RRs of 1.15 and 1.29 using time-series and case-crossover analysis, respectively. There were no significant associations between O3 and TRS with respiratory admissions. These findings provide policy makers with current risks estimates of respiratory hospitalization as a result of poor ambient air quality in a government designated "area of concern." PMID:15743717

  8. Pattern of respiratory diseases in children presenting to the paediatric emergency unit of the University of Nigeria Teaching Hospital, Enugu: a case series report

    PubMed Central

    2014-01-01

    Background Respiratory diseases are one of the causes of childhood morbidity and mortality as well as hospitalization globally. The patterns of different respiratory illnesses in several parts of the world have been reported but there are few on the combined burden of the diseases. Determination of the burden of respiratory diseases as a group will help ascertain their collective impact on the health systems in order to develop intervention measures. Methods Data from case notes of children with respiratory diseases admitted to the University of Nigeria Teaching Hospital Enugu, Nigeria over a six year period were extracted. Age, gender, admission rates, types of respiratory illness, duration of admission, season of presentation and outcome were analysed. Descriptive and inferential (Chi square) statistics were used to describe the various disease types and ascertain association of the disease outcome, seasonal pattern with the types of diseases. Results Of the total of 8974 children admissions, 2214 (24.7%) were due to respiratory diseases. The mean age of all the children with respiratory diseases was 3.3 years (SD 3.9). Communicable diseases were the common cause of admission cases throughout the seasons, p < 0.001. The highest admission rates were for pneumonia, (34.0%), acute bronchial asthma, (27.7%) and rhinosinusitis (14.6%) p < 0.001. The frequency of respiratory disease decreases with age and children less than five years of age and of low socio-economic status were commonly affected, p = 0.01. The median duration of hospital stay was two days [range 1 to 8 days], children less than five years old and those of low socio-economic status, spent more than four days (p = 0.01 and p < 0.001 respectively). The all-cause mortality was 0.5% (11/2214) of which 81.8% (9/11) was due to pneumonia. Conclusions Respiratory diseases constitute a significant burden of childhood illnesses in our centre. Efforts are required to reduce the impact as part of the

  9. Mortality and Incidence of Hospital Admissions for Stroke among Brazilians Aged 15 to 49 Years between 2008 and 2012

    PubMed Central

    Adami, Fernando; Figueiredo, Francisco Winter dos Santos; Paiva, Laércio da Silva; de Sá, Thiago Hérick; Santos, Edige Felipe de Sousa; Martins, Bruno Luis; Valenti, Vitor Engrácia; de Abreu, Luiz Carlos

    2016-01-01

    Introduction The objective was to analyze rates of stroke-related mortality and incidence of hospital admissions in Brazilians aged 15 to 49 years according to region and age group between 2008 and 2012. Methods Secondary analysis was performed in 2014 using data from the Hospital and Mortality Information Systems and the Brazilian Institute of Geography and Statistics. Stroke was defined by ICD, 10th revision (I60–I64). Crude and standardized mortality (WHO reference) and incidence of hospital admissions per 100,000 inhabitants, stratified by region and age group, were estimated. Absolute and relative frequencies; and linear regression were also used. The software used was Stata 11.0. Results There were 35,005 deaths and 131,344 hospital admissions for stroke in Brazilians aged 15–49 years old between 2008 and 2012. Mortality decreased from 7.54 (95% CI 7.53; 7.54) in 2008 to 6.32 (95% CI 6.31; 6.32) in 2012 (β = -0.27, p = 0.013, r2 = 0.90). During the same time, incidence of hospital admissions stabilized: 24.67 (95% CI 24.66; 24.67) in 2008 and 25.11 (95% CI 25.10; 25.11) in 2012 (β = 0.09, p = 0.692, r2 = 0.05). There was a reduction in mortality in all Brazilian regions and in the age group between 30 and 49 years. Incidence of hospitalizations decreased in the South, but no significant decrease was observed in any age group. Conclusion We observed a decrease in stroke-related mortality, particularly in individuals over 30 years old, and stability of the incidence of hospitalizations; and also regional variation in stroke-related hospital admission incidence and mortality among Brazilian young adults. PMID:27332892

  10. Oral Polio Vaccination and Hospital Admissions With Non-Polio Infections in Denmark: Nationwide Retrospective Cohort Study

    PubMed Central

    Sørup, Signe; Stensballe, Lone G.; Krause, Tyra G.; Aaby, Peter; Benn, Christine S.; Ravn, Henrik

    2016-01-01

    Background. Live vaccines may have nonspecific beneficial effects on morbidity and mortality. This study examines whether children who had the live-attenuated oral polio vaccine (OPV) as the most recent vaccine had a different rate of admissions for infectious diseases than children with inactivated diphtheria-tetanus-pertussis-polio-Haemophilus influenzae type b vaccine (DTaP-IPV-Hib) or live measles-mumps-rubella vaccine (MMR) as their most recent vaccine. Methods. A nationwide, register-based, retrospective cohort study of 137 403 Danish children born 1997–1999, who had received 3 doses of DTaP-IPV-Hib, were observed from 24 months (first OPV dose) to 36 months of age. Results. Oral polio vaccine was associated with a lower rate of admissions with any type of non-polio infection compared with DTaP-IPV-Hib as most recent vaccine (adjusted incidence rate ratio [IRR], 0.85; 95% confidence interval [CI], .77–.95). The association was separately significant for admissions with lower respiratory infections (adjusted IRR, 0.73; 95% CI, .61–.87). The admission rates did not differ for OPV versus MMR. Conclusions. Like MMR, OPV was associated with fewer admissions for lower respiratory infections than having DTaP-IPV-Hib as the most recent vaccination. Because OPV is now being phased-out globally, further studies of the potential beneficial nonspecific effects of OPV are warranted. PMID:26885538

  11. Oral Polio Vaccination and Hospital Admissions With Non-Polio Infections in Denmark: Nationwide Retrospective Cohort Study.

    PubMed

    Sørup, Signe; Stensballe, Lone G; Krause, Tyra G; Aaby, Peter; Benn, Christine S; Ravn, Henrik

    2016-01-01

    Background.  Live vaccines may have nonspecific beneficial effects on morbidity and mortality. This study examines whether children who had the live-attenuated oral polio vaccine (OPV) as the most recent vaccine had a different rate of admissions for infectious diseases than children with inactivated diphtheria-tetanus-pertussis-polio-Haemophilus influenzae type b vaccine (DTaP-IPV-Hib) or live measles-mumps-rubella vaccine (MMR) as their most recent vaccine. Methods.  A nationwide, register-based, retrospective cohort study of 137 403 Danish children born 1997-1999, who had received 3 doses of DTaP-IPV-Hib, were observed from 24 months (first OPV dose) to 36 months of age. Results.  Oral polio vaccine was associated with a lower rate of admissions with any type of non-polio infection compared with DTaP-IPV-Hib as most recent vaccine (adjusted incidence rate ratio [IRR], 0.85; 95% confidence interval [CI], .77-.95). The association was separately significant for admissions with lower respiratory infections (adjusted IRR, 0.73; 95% CI, .61-.87). The admission rates did not differ for OPV versus MMR. Conclusions.  Like MMR, OPV was associated with fewer admissions for lower respiratory infections than having DTaP-IPV-Hib as the most recent vaccination. Because OPV is now being phased-out globally, further studies of the potential beneficial nonspecific effects of OPV are warranted. PMID:26885538

  12. Respiratory Viruses Associated Hospitalization among Children Aged <5 Years in Bangladesh: 2010-2014

    PubMed Central

    Homaira, Nusrat; Luby, Stephen P.; Hossain, Kamal; Islam, Kariul; Ahmed, Makhdum; Rahman, Mustafizur; Rahman, Ziaur; Paul, Repon C.; Bhuiyan, Mejbah Uddin; Brooks, W. Abdullah; Sohel, Badrul Munir; Banik, Kajal Chandra; Widdowson, Marc-Alain; Willby, Melisa; Rahman, Mahmudur; Bresee, Joseph; Ramirez, Katharine-Sturm; Azziz-Baumgartner, Eduardo

    2016-01-01

    Background We combined hospital-based surveillance and health utilization survey data to estimate the incidence of respiratory viral infections associated hospitalization among children aged < 5 years in Bangladesh. Methods Surveillance physicians collected respiratory specimens from children aged <5 years hospitalized with respiratory illness and residing in the primary hospital catchment areas. We tested respiratory specimens for respiratory syncytial virus, parainfluenza viruses, human metapneumovirus, influenza, adenovirus and rhinoviruses using rRT-PCR. During 2013, we conducted a health utilization survey in the primary catchment areas of the hospitals to determine the proportion of all hospitalizations for respiratory illness among children aged <5 years at the surveillance hospitals during the preceding 12 months. We estimated the respiratory virus-specific incidence of hospitalization by dividing the estimated number of hospitalized children with a laboratory confirmed infection with a respiratory virus by the population aged <5 years of the catchment areas and adjusted for the proportion of children who were hospitalized at the surveillance hospitals. Results We estimated that the annual incidence per 1000 children (95% CI) of all cause associated respiratory hospitalization was 11.5 (10–12). The incidences per 1000 children (95% CI) per year for respiratory syncytial virus, parainfluenza, adenovirus, human metapneumovirus and influenza infections were 3(2–3), 0.5(0.4–0.8), 0.4 (0.3–0.6), 0.4 (0.3–0.6), and 0.4 (0.3–0.6) respectively. The incidences per 1000 children (95%CI) of rhinovirus-associated infections among hospitalized children were 5 (3–7), 2 (1–3), 1 (0.6–2), and 3 (2–4) in 2010, 2011, 2012 and 2013, respectively. Conclusion Our data suggest that respiratory viruses are associated with a substantial burden of hospitalization in children aged <5 years in Bangladesh. PMID:26840782

  13. Ethnic variations in compulsory detention and hospital admission for psychosis across four UK Early Intervention Services.

    PubMed

    Mann, Farhana; Fisher, Helen L; Major, Barnaby; Lawrence, Jo; Tapfumaneyi, Andrew; Joyce, John; Hinton, Mark F; Johnson, Sonia

    2014-09-01

    BackgroundSubstantial ethnic variations have been found in incidence, pathways to care and outcomes in psychosis. It is unknown whether these remain as marked in the presence of specialist Early Intervention Services (EIS) for psychosis. We present the first UK study exploring ethnic differences in compulsory detention and hospitalization rates for EIS patients. We investigated whether the excess rates of compulsory admission for people from Black groups have persisted following nationwide introduction of EIS. We also explored variations in compulsory admission for other ethnic groups, and differences by gender and diagnosis.MethodsFour inner-city London EIS teams gathered data from first-presentation psychosis patients between 2004¿2009 using the MiData audit tool. Clinical, sociodemographic and pathways to care data were recorded regarding adult patients from eight different ethnic groups at entry to EIS and one year later.ResultsBlack African EIS service users had odds of being detained and of being hospitalised three times greater than White British patients, even after adjustment for confounders. This was most marked in Black African women (seven to eight times greater odds than White British women). A post-hoc analysis showed that pathways to care and help-seeking behaviour partially explained these differences.ConclusionThese findings suggest EIS input in its current form has little impact on higher admission and detention rates in certain Black and minority groups. There is a need to tackle these differences and engage patients earlier, focusing on the needs of men and women from the most persistently affected groups. PMID:25214411

  14. Respiratory syncytial virus: its transmission in the hospital environment.

    PubMed

    Hall, C B

    1982-01-01

    Respiratory syncytial virus (RSV) over the past two decades has been recognized as the most important cause of lower respiratory tract disease in infants and young children. Recently, it has also been identified as a major nosocomial hazard on pediatric wards. The potential for RSV to spread on such wards is underlined by several singular characteristics of RSV. It arrives in yearly epidemics and is highly contagious in all age groups. Immunity is of short duration, allowing repeated infections to occur. Thus, during an epidemic 20--40 percent of infants admitted for other conditions may acquire nosocomial RSV infection, as well as 50 percent of the ward personnel. The usual infection control procedures for respiratory illnesses have had limited success in controlling the spread of RSV. This may be due in part to the modes of transmission of RSV. Inoculation occurs mainly through the eye and nose, rather than the mouth. This may be via large-particle aerosols or droplets, requiring close contact. The virus, however, does not seem capable of traversing distances by small-particle aerosols. Nevertheless, it is able to remain infectious on various environmental surfaces, suggesting fomites as a source of spread. Indeed, inoculation after touching such contaminated surfaces can occur, and may be a major second means of spread, in hospitals as well as in families. PMID:6758370

  15. Medicare Home Visit Program Associated With Fewer Hospital And Nursing Home Admissions, Increased Office Visits.

    PubMed

    Mattke, Soeren; Han, Dan; Wilks, Asa; Sloss, Elizabeth

    2015-12-01

    Clinical home visit programs for Medicare beneficiaries are a promising approach to supporting aging in place and avoiding high-cost institutional care. Such programs combine a comprehensive geriatric assessment by a clinician during a home visit with referrals to community providers and health plan resources to address uncovered issues. We evaluated UnitedHealth Group's HouseCalls program, which has been offered to Medicare Advantage plan members in Arkansas, Georgia, Missouri, South Carolina, and Texas since January 2008. We found that, compared to non-HouseCalls Medicare Advantage plan members and fee-for-service beneficiaries, HouseCalls participants had reductions in admissions to hospitals (1 percent and 14 percent, respectively) and lower risk of nursing home admission (0.67 percent and 1.3 percent, respectively). In addition, participants' numbers of office visits--chiefly to specialists--increased 2-6 percent (depending on the comparison group). The program's effects on emergency department use were mixed. These results indicate that a thorough home-based clinical assessment of a member's health and home environment combined with referral services can support aging in place, promote physician office visits, and preempt costly institutional care. PMID:26643635

  16. Analysis of the Spatial Variation of Hospitalization Admissions for Hypertension Disease in Shenzhen, China

    PubMed Central

    Wang, Zhensheng; Du, Qingyun; Liang, Shi; Nie, Ke; Lin, De-nan; Chen, Yan; Li, Jia-jia

    2014-01-01

    In China, awareness about hypertension, the treatment rate and the control rate are low compared to developed countries, even though China’s aging population has grown, especially in those areas with a high degree of urbanization. However, limited epidemiological studies have attempted to describe the spatial variation of the geo-referenced data on hypertension disease over an urban area of China. In this study, we applied hierarchical Bayesian models to explore the spatial heterogeneity of the relative risk for hypertension admissions throughout Shenzhen in 2011. The final model specification includes an intercept and spatial components (structured and unstructured). Although the road density could be used as a covariate in modeling, it is an indirect factor on the relative risk. In addition, spatial scan statistics and spatial analysis were utilized to identify the spatial pattern and to map the clusters. The results showed that the relative risk for hospital admission for hypertension has high-value clusters in the south and southeastern Shenzhen. This study aimed to identify some specific regions with high relative risk, and this information is useful for the health administrators. Further research should address more-detailed data collection and an explanation of the spatial patterns. PMID:24394218

  17. Epidemiology of paediatric surgical admissions to a government referral hospital in the Gambia.

    PubMed Central

    Bickler, S. W.; Sanno-Duanda, B.

    2000-01-01

    INTRODUCTION: There is a paucity of published data on the type of conditions that require surgery among children in sub-Saharan Africa. Such information is necessary for assessing the impact of such conditions on child health and for setting priorities to improve paediatric surgical care. METHODS: Described in the article is a 29-month prospective study of all children aged < 15 years who were admitted to a government referral hospital in the Gambia from January 1996 to May 1998. RESULTS: A total of 1726 children were admitted with surgical problems. Surgical patients accounted for 11.3% of paediatric admissions and 34,625 total inpatient days. The most common admission diagnoses were injuries (46.9%), congenital anomalies (24.3%), and infections requiring surgery (14.5%). The diagnoses that accounted for the greatest number of inpatient days were burns (18.8%), osteomyelitis (15.4%), fractures (12.7%), soft tissue injuries (3.9%), and head injuries (3.4%). Gambian children were rarely admitted for appendicitis and never admitted for hypertrophic pyloric stenosis. The leading causes of surgical deaths were burns, congenital anomalies, and injuries other than burns. DISCUSSION: Prevention of childhood injuries and better trauma management, especially at the primary and secondary health care levels, should be the priorities for improving paediatric surgical care in sub-Saharan Africa. Surgical care of children should be considered an essential component of child health programmes in developing countries. PMID:11143193

  18. Broad respiratory virus detection in infants hospitalized for bronchiolitis by use of a multiplex RT-PCR DNA microarray system.

    PubMed

    Huguenin, Antoine; Moutte, Lauryane; Renois, Fanny; Leveque, Nicolas; Talmud, Deborah; Abely, Michel; Nguyen, Yohan; Carrat, Fabrice; Andreoletti, Laurent

    2012-06-01

    Newly available molecular tools allow a sensitive detection of a broad panel of viruses in respiratory tract specimens. In the present study, the application of a multiplex RT-PCR DNA microarray in diagnosis and epidemiological survey of viral infections in infants hospitalized for bronchiolitis was assessed. One hundred and thirty-eight nasopharyngeal aspirates collected from October 2007 to September 2008 were tested by direct immunofluorescence and viral culture, a combination of referenced RT-PCRs and the DNA microarray. One or more viruses were detected in 96, 126 and 126 of the specimens by direct immunofluorescence and viral culture, RT-PCRs and DNA microarray, respectively (70 vs. 91 vs. 91%, P < 10(-3)). The RT-PCRs and the DNA microarray yielded concordant results for 99% of specimens and identified mixed viral infections in 85 (62%). The most common associations were: human bocavirus and respiratory syncytial virus (32%), adenovirus and respiratory syncytial virus (30%), and parainfluenza virus type 3 and respiratory syncytial virus (23%). None of the bronchiolitis severity parameters including intensive care unit admission, O(2) supply, O(2) saturation percentage, O(2) length and length of stay at the hospital appeared to be significantly increased in multiple viral infections compared to single viral infections (P > 0.1). In conclusion, the use of this DNA microarray in clinical virology practice allows rapid and accurate identification of common and uncommon viral respiratory pathogens in infants hospitalized for bronchiolitis. It should improve the clinical management, the epidemiological survey, and the prevention of the nosocomial transmission of respiratory viruses in pediatric wards. PMID:22499022

  19. Quetiapine may reduce hospital admission rates in patients with mental health problems and alcohol addiction.

    PubMed

    Kong, C; Chiu, W; Davies, A; Keating, J

    2013-01-01

    A 64-year-old man presented with 40 years history of chronic alcohol excess. On average, he had six hospital admissions a year with alcohol-related problems for at least a 10-year period. In 2009, he considered reducing his alcohol intake. He was noted to have mood disturbances, was seen by a psychogeriatrician who diagnosed bipolar disorder. He tried various bipolar medications including lithium and sodium valproate which was unsuccessful. He was then started on quetiapine 600 mg a day in divided doses. Subsequently this has not only controlled the bipolar disorder but also resulted in significant reduction in alcohol intake. He now shares a bottle of wine with his wife while in the past he was consuming a bottle of scotch daily. This case illustrates the benefits of quetiapine in assisting with this man's addiction to alcohol. PMID:23925678

  20. Previous hospital admissions and disease severity predict the use of antipsychotic combination treatment in patients with schizophrenia

    PubMed Central

    2011-01-01

    Background Although not recommended in treatment guidelines, previous studies have shown a frequent use of more than one antipsychotic agent among patients with schizophrenia. The main aims of the present study were to explore the antipsychotic treatment regimen among patients with schizophrenia in a catchment area-based sample and to investigate clinical characteristics associated with antipsychotic combination treatment. Methods The study included 329 patients diagnosed with schizophrenia using antipsychotic medication. Patients were recruited from all psychiatric hospitals in Oslo. Diagnoses were obtained by use of the Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I). Additionally, Global Assessment of Functioning (GAF), Positive and Negative Syndrome Scale (PANSS) and number of hospitalisations and pharmacological treatment were assessed. Results Multiple hospital admissions, low GAF scores and high PANSS scores, were significantly associated with the prescription of combination treatment with two or more antipsychotics. The use of combination treatment increased significantly from the second hospital admission. Combination therapy was not significantly associated with age or gender. Regression models confirmed that an increasing number of hospital admission was the strongest predictor of the use of two or more antipsychotics. Conclusions Previous hospital admissions and disease severity measured by high PANSS scores and low GAF scores, predict the use of antipsychotic combination treatment in patients with schizophrenia. Future studies should further explore the use of antipsychotic drug treatment in clinical practice and partly based on such data establish more robust treatment guidelines for patients with persistently high symptom load. PMID:21812996

  1. Direct stroke unit admission of intravenous tissue plasminogen activator: safety, clinical outcome, and hospital cost savings

    PubMed Central

    Alexandrov, Anne W.; Coleman, Kisha C.; Palazzo, Paola; Shahripour, Reza Bavarsad; Alexandrov, Andrei V.

    2016-01-01

    Background: In the USA, stable intravenous tissue plasminogen activator (IV tPA) patients have traditionally been cared for in an intensive care unit (ICU). We examined the safety of using an acuity-adaptable stroke unit (SU) to manage IV tPA patients. Methods: We conducted an observational study of consecutive patients admitted to our acuity-adaptable SU over the first 3 years of operation. Safety was assessed by symptomatic intracerebral hemorrhage (sICH) rates, systemic hemorrhage (SH) rates, tPA-related deaths, and transfers from SU to ICU; cost savings and length of stay (LOS) were determined. Results: We admitted 333 IV tPA patients, of which 302 were admitted directly to the SU. A total of 31 (10%) patients had concurrent systemic hemodynamic or pulmonary compromise warranting direct ICU admission. There were no differences in admission National Institutes of Health Stroke Scale scores between SU and ICU patients (9.0 versus 9.5, respectively). Overall sICH rate was 3.3% (n = 10) and SH rate was 2.9 (n = 9), with no difference between SU and ICU patients. No tPA-related deaths occurred, and no SU patients required transfer to the ICU. Estimated hospital cost savings were US$362,400 for ‘avoided’ ICU days, and hospital LOS decreased significantly (p = 0.001) from 9.8 ± 15.6 days (median 5) in year 1, to 5.2 ± 4.8 days (median 3) by year 3. Conclusions: IV tPA patients may be safely cared for in a SU when nurses undergo extensive education to ensure clinical competence. Use of the ICU solely for monitoring may constitute significant overuse of system resources at an expense that is not associated with additional safety benefit. PMID:27366237

  2. Virological and clinical characterizations of respiratory infections in hospitalized children

    PubMed Central

    2013-01-01

    Background The purpose of this study was to determine the incidence and seasonal distribution of viral etiological agents and to compare their clinical manifestations and disease severity, including single and co infections. Methods Multiplex reverse-transcription PCR was performed for the detection of viruses in nasopharyngeal aspirat. Disease severity was grouped using a categorization index as very mild/mild, and moderate/severe. Clinical and laboratory characteristics of hospitalized children with viral respiratory tract infection were analyzed. Results Viral pathogens were detected in 103/155 (66.5%) of patients. In order of frequency, identified pathogens were respiratory syncytial virus (32.0%), adenovirus (26.2%), parainfluenza viruses type 1–4 (19.4%), rhinovirus (18.4%), influenza A and B (12.6%), human metapneumovirus (12.6%), coronavirus (2.9%), and bocavirus (0.9%). Coinfections were present in 21 samples. Most of the children had very mild (38.8%) and mild disease (37.9%). Severity of illness was not worse with coinfections. The most common discharge diagnoses were "URTI" with or without LRTI/asthma (n=58). Most viruses exhibited strong seasonal patterns. Leukocytosis (22.2%) and neutrophilia (36.6%) were most commonly detected in patients with adenovirus and rhinovirus (p<0.05). Monocytosis was the most remarkable finding in the patients (n=48, 53.3%), especially in patients with adenovirus (p<0.05). Conclusions RSV and RhV were associated with higher severity of illness in hospitalized children. RSV found to account for half of LRTI hospitalizations. In AdV and FluA and B infections, fever lasted longer than in other viruses. Coinfections were detected in 21 of the patients. The presence of coinfections was not associated with increased disease severity. PMID:23536956

  3. Clinical characteristics of respiratory syncytial virus infection in hospitalized healthy infants and young children in Qatar.

    PubMed

    Wahab, A A; Dawod, S T; Raman, H M

    2001-12-01

    To evaluate seasonal trends, clinical profile, and outcome of disease in previously healthy infants and young children hospitalized for respiratory syncytial virus (RSV) infection at Hamad Medical Corporation in the state of Qatar, we reviewed the records of 257 children admitted between 1 January 1996 and 31 December 1998. RSV epidemics occurred yearly during the winter months with peak hospitalizations occuring between November and February. Of the 257 admissions, 160 (62.3 per cent) were male and 97 (37.7 per cent) female. The mean age of all children was 5.7 months (range, 10 days to 32 months). The most common admitting diagnoses were bronchiolitis (59.9 per cent), pneumonia (17.5 per cent), bronchiolitis with pneumonia (8.9 per cent), possible sepsis (7.8 per cent), asthma (4.7 per cent) and apnea (1.2 per cent). A family history of asthma was quite common (63.8 per cent), although no statistical significant difference was noted in complication or length of stay. Treatment was supportive, the majority of the patients received oxygen therapy in 77.8 per cent of cases, bronchodilators in 85.4 per cent, and antibiotics therapy in 49.4 per cent. The median duration of hospital stay was 6 days (range, 1 to 29 days). Of the 14 (5.4 per cent) patients requiring intensive care, four (1.6 per cent) needed mechanical ventilation. No deaths were reported, but subjects aged < or = 12 months had a significantly higher oxygen requirement, intensive care unit admission, bronchodilators and antibiotics therapy than those > 12 months old. Within 1-2 years after admission with RSV infection, 63 of the 257 patients attended for recurrent episodes of wheezy chest. These results indicate that, during the season of infection, RSV is an important pathogen in infants and young children in the state of Qatar, highlighting the need for development of effective vaccines to ameliorate the impact of annual RSV epidemics in infants and young children. PMID:11827306

  4. Implementation of a Trauma Service Activation and Admission Policy for Very Elderly Trauma Patients: Impact on Hospital Efficiency and Patient Outcomes.

    PubMed

    Kalina, Michael

    2016-06-01

    Very elderly trauma patients (VETs) were routinely admitted to nonsurgical services at our institution; therefore, a trauma service activation and admission policy was implemented. Our goal was to determine policy success and impact on efficiency and outcomes. VETs, defined as trauma patients aged >89 years, admitted before and after policy implementation were reviewed. Demographics included age, gender, Injury Severity Score, Glasgow Coma Score, admission diagnosis, mechanism of injury, admission service, and comorbidities. Efficiency included intensive care unit length of stay (ICU-LOS) and hospital length of stay (H-LOS). Outcomes included complications, discharge disposition, and mortality. Statistical analysis included Chi square, Fisher's exact test, and regression analyses, significance denoted by P < 0.05. 375 VETs were investigated. Demographic analysis revealed differences in Injury Severity Score (9.4 + 5.4 vs 7.2 + 4.0, P < 0.001), coronary artery disease (2.1% vs 38.2%, P < 0.001), neurologic disease (7.4% vs 28.24%, P < 0.001), and intracranial hemorrhage (15.6% vs 6.1%, P = 0.01). The most common mechanism of injury and admission diagnosis was fall and femur fracture. VETs admitted to the trauma service increased from 28.3 per cent to 40.5 per cent, P = 0.02. Efficiency analysis revealed differences in ICU-LOS (4.0 + 4.2 days vs 0.7 + 1.3 days, P < 0.001) and H-LOS (7.3 + 4.9 days vs 6.3 + 5.5 days, P = 0.005). Outcomes analysis revealed differences in pneumonia (0.8% vs 5.3%, P = 0.01), acute respiratory distress syndrome (0% vs 2.3%, P = 0.04), discharge to skilled nursing facility (75.8% vs 57.3%, P < 0.001), but no difference in mortality. Regression analyses revealed that trauma service admission was associated with decreased ICU-LOS and H-LOS. The trauma service activation and admission policy for VETs led to improved hospital efficiency. PMID:27305879

  5. Hospitalization risk factors for children’s lower respiratory tract infection: A population-based, cross-sectional study in Mongolia

    PubMed Central

    Dagvadorj, Amarjargal; Ota, Erika; Shahrook, Sadequa; Baljinnyam Olkhanud, Purevdorj; Takehara, Kenji; Hikita, Naoko; Bavuusuren, Bayasgalantai; Mori, Rintaro; Nakayama, Takeo

    2016-01-01

    This study aimed to assess the potential risk factors for lower respiratory tract infection (LRTI)-related hospital admissions in Mongolian children. A population-based cross-sectional study was conducted in rural Mongolia in 2013, and 1,013 mother–child pairs were included. Of the participating children, 38.9% were admitted to hospital with LRTIs. Home smoking, low birthweight, being a male child, exclusive breastfeeding and healthcare-seeking behaviour showed substantial association with LRTI-related hospital admissions. Number of cigarettes smoked by family members showed a dose-response relationship and increased hospital admissions. Strategies to prevent second-hand-smoke exposure from adult smokers, especially inside the home, are crucial to preventing LRTI-related hospital admissions for children in Mongolia. Improving rates of exclusive breastfeeding and increasing birthweight have great potential to decrease the likelihood of children acquiring a LRTI. Educational initiatives are also necessary for women who are less likely to seek out care for their children’s symptoms. PMID:27090182

  6. Detection of viral and bacterial pathogens in hospitalized children with acute respiratory illnesses, Chongqing, 2009-2013.

    PubMed

    Wei, Lan; Liu, Wei; Zhang, Xiao-Ai; Liu, En-Mei; Wo, Yin; Cowling, Benjamin J; Cao, Wu-Chun

    2015-04-01

    Acute respiratory infections (ARIs) cause large disease burden each year. The codetection of viral and bacterial pathogens is quite common; however, the significance for clinical severity remains controversial. We aimed to identify viruses and bacteria in hospitalized children with ARI and the impact of mixed detections.Hospitalized children with ARI aged ≤16 were recruited from 2009 to 2013 at the Children's Hospital of Chongqing Medical University, Chongqing, China. Nasopharyngeal aspirates (NPAs) were collected for detection of common respiratory viruses by reverse transcription polymerase chain reaction (RT-PCR) or PCR. Bacteria were isolated from NPAs by routine culture methods. Detection and codetection frequencies and clinical features and severity were compared.Of the 3181 hospitalized children, 2375 (74.7%) were detected with ≥1 virus and 707 (22.2%) with ≥1 bacteria, 901 (28.3%) with ≥2 viruses, 57 (1.8%) with ≥2 bacteria, and 542 (17.0%) with both virus and bacteria. The most frequently detected were Streptococcus pneumoniae, respiratory syncytial virus, parainfluenza virus, and influenza virus. Clinical characteristics were similar among different pathogen infections for older group (≥6 years old), with some significant difference for the younger. Cases with any codetection were more likely to present with fever; those with ≥2 virus detections had higher prevalence of cough; cases with virus and bacteria codetection were more likely to have cough and sputum. No significant difference in the risk of pneumonia, severe pneumonia, and intensive care unit admission were found for any codetection than monodetection.There was a high codetection rate of common respiratory pathogens among hospitalized pediatric ARI cases, with fever as a significant predictor. Cases with codetection showed no significant difference in severity than those with single pathogens. PMID:25906103

  7. Indications to Hospital Admission and Isolation of Children With Possible or Defined Tuberculosis: Systematic Review and Proposed Recommendations for Pediatric Patients Living in Developed Countries. [Corrected].

    PubMed

    Lo Vecchio, Andrea; Bocchino, Marialuisa; Lancella, Laura; Gabiano, Clara; Garazzino, Silvia; Scotto, Riccardo; Raffaldi, Irene; Assante, Luca Rosario; Villani, Alberto; Esposito, Susanna; Guarino, Alfredo

    2015-12-01

    Tuberculosis (TB) is a re-emerging health problem in developed countries. This paper is part of large guidelines on the global management of TB in children, by a group of scientific societies. It describes the indications to hospitalization of children with suspected or diagnosed TB, the isolation measures, hospital discharge, and re-admission into the community. Using the Consensus Conference method, relevant publications in English were identified by means of a systematic review of MEDLINE and the Cochrane Database of Systematic Reviews from their inception until 31 December 2014. Available data on indications to hospitalization were mainly indirect and largely derived from observational studies. They include: (1) host-related risk factors, the main being age <12 months, immune deficiencies, and malnutrition; (2) TB-related clinical conditions that resemble those of pneumonia but also include drug-resistance; and (3) social and logistic conditions. The latter are based on opinion and depend on local conditions. Analysis of the literature showed that patients hospitalized with suspected pulmonary TB should be put in precautionary respiratory isolation regardless of their age while they await diagnosis. The general conditions for re-admission into the community are at least 14 days of effective treatment and negative microscopic tests of 3 consecutive samples in previously microscopically positive patients. This is the first paper that provides indications to hospitalization of children with TB. Most recommendations are generally applicable in all developed countries. Some might need an adaptation to local setting, epidemiological, parameters, and availability of specific health-care facilities. PMID:26683914

  8. Hospital length of stay in individuals with schizophrenia with and without cocaine-positive urine drug screens at hospital admission.

    PubMed

    Wu, Hanjing Emily; Mohite, Satyajit; Ngana, Ikenna; Burns, Wilma; Shah, Nurun; Schneider, Laurie; Schmitz, Joy M; Lane, Scott D; Okusaga, Olaoluwa O

    2015-01-01

    Despite the high prevalence of cocaine use disorder (CUD) in individuals with schizophrenia, current understanding of the effect of cocaine on psychiatric hospital length of stay (LOS) in individuals with schizophrenia is limited. We therefore retrospectively examined the medical records of 5106 hospital admissions due to exacerbation of schizophrenia. Linear regression and t-test were used to compare LOS between individuals with schizophrenia with cocaine-positive urine drug test results and those with negative test results. Individuals with schizophrenia who were also positive for cocaine had shorter LOS from both unadjusted (geometric mean LOS, 8.07 ± 1.92 vs. 11.83 ± 1.83 days; p < 0.001) and adjusted (β = 0.69; confidence interval, 0.63-0.76; p < 0.001) analyses. Our results suggest that individuals with schizophrenia who also have comorbid CUD may require shorter inpatient treatment during periods of exacerbation of symptoms. Replication of this finding has relevance in treatment planning and resource allocation for the subpopulation of individuals with schizophrenia who also have stimulant use disorders. PMID:25489749

  9. Hospitalization Incidence, Mortality, and Seasonality of Common Respiratory Viruses Over a Period of 15 Years in a Developed Subtropical City

    PubMed Central

    Chan, Paul K.S.; Tam, Wilson W.S.; Lee, Tsz Cheung; Hon, Kam Lun; Lee, Nelson; Chan, Martin C.W.; Mok, Hing Yim; Wong, Martin C.S.; Leung, Ting Fan; Lai, Raymond W.M.; Yeung, Apple C.M.; Ho, Wendy C.S.; Nelson, E. Anthony S.; Hui, David S.C.

    2015-01-01

    Abstract Information on respiratory viruses in subtropical region is limited. Incidence, mortality, and seasonality of influenza (Flu) A/B, respiratory syncytial virus (RSV), adenovirus (ADV), and parainfluenza viruses (PIV) 1/2/3 in hospitalized patients were assessed over a 15-year period (1998–2012) in Hong Kong. Male predominance and laterally transversed J-shaped distribution in age-specific incidence was observed. Incidence of Flu A, RSV, and PIV decreased sharply from infants to toddlers; whereas Flu B and ADV increased slowly. RSV conferred higher fatality than Flu, and was the second killer among hospitalized elderly. ADV and PIV were uncommon, but had the highest fatality. RSV, PIV 2/3 admissions increased over the 15 years, whereas ADV had decreased significantly. A “high season,” mainly contributed by Flu, was observed in late-winter/early-spring (February–March). The “medium season” in spring/summer (April–August) was due to Flu and RSV. The “low season” in late autumn/winter (October–December) was due to PIV and ADV. Seasonality varied between viruses, but predictable distinctive pattern for each virus existed, and temperature was the most important associating meteorological variable. Respiratory viruses exhibit strong sex- and age-predilection, and with predictable seasonality allowing strategic preparedness planning. Hospital-based surveillance is crucial for real-time assessment on severity of new variants. PMID:26579810

  10. A Study on Hospital Admissions For Eye Trauma in Kashan, Iran

    PubMed Central

    Movahedinejad, Tayebeh; Adib-Hajbaghery, Mohsen; Zahedi, Mohammad Reza

    2016-01-01

    Background Eye trauma is among the most common reasons for referral to hospital emergency departments and ophthalmologists’ offices. It also is a common cause of vision loss worldwide. However, few studies are available on the changes in the epidemiology of eye trauma in Iran in recent years. Objectives This study aimed to investigate the characteristics of hospital admissions for eye trauma in Kashan from August 2011 to February 2014. Patients and Methods A cross-sectional study was carried out on the hospital records of all patients with eye trauma who were admitted to Kashan’s Matini hospital between August 2011 and February 2014. Having an eye trauma and being hospitalized for at least one day was selected as the criteria for inclusion in the study. The data were then recorded on a checklist devised by the researcher. After entering the data into the SPSS software, descriptive statistics (i.e., percentage, frequency, mean, and standard deviation) were calculated for all variables. Chi-square, Fisher’s exact test, and Mann-Whitney U test were used to analyze the data. Results In total, 200 patients with eye trauma had been hospitalized in Matini Hospital between August 2011 and February 2014. Of these patients, 86% were males, 40% were in the age range of 20-39 years, 68% lived in urban areas, and 21% of those in employment were manual and industrial workers. Approximately 38.5% of eye traumas had occurred in the work place; 72.5% of patients had penetrating injuries and 98% of cases were injured in one eye. More injuries occurred in the cornea (25.5%) than elsewhere in the eye, and 75.5% of patients were treated surgically. Among all variables, only the type of trauma (P = 0.009) and cause of trauma (P = 0.004) were significantly related to the patients’ gender. Conclusions Eye trauma was prevalent among males, young people, urban residents, and manual and industrial workers. As the eyes play a vital role in daily life, communication, and work

  11. A tale of two cities: effects of air pollution on hospital admissions in Hong Kong and London compared.

    PubMed

    Wong, Chit-Ming; Atkinson, Richard W; Anderson, H Ross; Hedley, Anthony Johnson; Ma, Stefan; Chau, Patsy Yuen-Kwan; Lam, Tai-Hing

    2002-01-01

    The causal interpretation of reported associations between daily air pollution and daily admissions requires consideration of residual confounding, correlation between pollutants, and effect modification. If results obtained in Hong Kong and London--which differ in climate, lifestyle, and many other respects--were similar, a causal association would be supported. We used identical statistical methods for the analysis in each city. Associations between daily admissions and pollutant levels were estimated using Poisson regression. Nonparametric smoothing methods were used to model seasonality and the nonlinear dependence of admissions on temperature, humidity, and influenza admissions. For respiratory admissions (> or = 65 years of age), significant positive associations were observed with particulate matter < 10 microm in aerodynamic diameter (PM(10), nitrogen dioxide, sulfur dioxide, and ozone in both cities. These associations tended to be stronger at shorter lags in Hong Kong and at longer lags in London. Associations were stronger in the cool season in Hong Kong and in the warm season in London, periods during which levels of humidity are at their lowest in each city. For cardiac admissions (all ages) in both cities, significant positive associations were observed for PM(10), NO(2), and SO(2) with similar lag patterns. Associations tended to be stronger in the cool season. The associations with NO(2) and SO(2) were the most robust in two-pollutant models. Patterns of association for pollutants with ischemic heart disease were similar in the two cities. The associations between O(3) and cardiac admissions were negative in London but positive in Hong Kong. We conclude that air pollution has remarkably similar associations with daily cardiorespiratory admissions in both cities, in spite of considerable differences between cities in social, lifestyle, and environmental factors. The results strengthen the argument that air pollution causes detrimental short

  12. Tuberculosis in hospitalized patients: clinical characteristics of patients receiving treatment within the first 24 h after admission*

    PubMed Central

    Silva, Denise Rossato; da Silva, Larissa Pozzebon; Dalcin, Paulo de Tarso Roth

    2014-01-01

    Objective: To evaluate clinical characteristics and outcomes in patients hospitalized for tuberculosis, comparing those in whom tuberculosis treatment was started within the first 24 h after admission with those who did not. Methods: This was a retrospective cohort study involving new tuberculosis cases in patients aged ≥ 18 years who were hospitalized after seeking treatment in the emergency room. Results: We included 305 hospitalized patients, of whom 67 (22.0%) received tuberculosis treatment within the first 24 h after admission ( ≤24h group) and 238 (88.0%) did not (>24h group). Initiation of tuberculosis treatment within the first 24 h after admission was associated with being female (OR = 1.99; 95% CI: 1.06-3.74; p = 0.032) and with an AFB-positive spontaneous sputum smear (OR = 4.19; 95% CI: 1.94-9.00; p < 0.001). In the ≤24h and >24h groups, respectively, the ICU admission rate was 22.4% and 15.5% (p = 0.258); mechanical ventilation was used in 22.4% and 13.9% (p = 0.133); in-hospital mortality was 22.4% and 14.7% (p = 0.189); and a cure was achieved in 44.8% and 52.5% (p = 0.326). Conclusions: Although tuberculosis treatment was initiated promptly in a considerable proportion of the inpatients evaluated, the rates of in-hospital mortality, ICU admission, and mechanical ventilation use remained high. Strategies for the control of tuberculosis in primary care should consider that patients who seek medical attention at hospitals arrive too late and with advanced disease. It is therefore necessary to implement active surveillance measures in the community for earlier diagnosis and treatment. PMID:25029651

  13. Factors Associated with Severity and Hospital Admission of Motor-Vehicle Injury Cases in a Southern European Urban Area

    PubMed Central

    Cirera, Eva; Plasència, Antoni; Ferrando, Josep; Seguí-Gomez, Maria

    1998-01-01

    BACKGROUND The knowledge of injury severity as a result of motor-vehicle (MV) crashes is a key tool to identify and evaluate prevention activities. Hospital and emergency department (ED) records are a useful source of information to measure injury severity. OBJECTIVES To describe the main characteristics of injured people admitted to ED as a result of a MV crash, and to assess factors related to injury severity and hospital admission. METHODS Cross-sectional design. Subjects were MV injury patients admitted to seven EDs in Barcelona from January 1994 to June 1996. The data analyzed were obtained from the information routinely transmitted from the EDs to the Municipal Institute of Health, based on the processing of ED logs. Univariate and bivariate descriptive statistical analyses were performed, as well as multiple logistic regressions. RESULTS 60.7% of patients were males, 73.7% were younger than 40 years of age, while 42.2% were motorcycle and moped users and 25.2% were pedestrians. After adjusting for other variables, these three last user groups were at a higher risk of a more severe injury (OR=1.4; OR=1.5 and OR=1.7 respectively) and showed a higher likelihood of a hospital admission (OR=1.9; OR= 1.7 and OR= 2.1). Patients arriving at the hospital during night-time (OR=2.1) and in hospitals C or D (OR= 2.2 and OR= 2.3 respectively) were also at a higher risk of a hospital admission. CONCLUSIONS The study underscores that in Barcelona, pedestrians and two-wheel vehicle occupants, besides accounting for two-thirds of traffic injury cases, are also the user’s subgroups with a higher risk of a more severe injury as well as a higher chance of admission. The results also point out that decision criteria on the patient need for hospitalization may vary substantially among hospitals in the case of trauma patients.

  14. Trend study on the association between hospital admissions and the health of Dutch older adults (1995–2009)

    PubMed Central

    Galenkamp, Henrike; Deeg, Dorly J H; de Jongh, Renate T; Kardaun, Jan W P F; Huisman, Martijn

    2016-01-01

    Objectives An increase in hospital admission rates in older people may reflect improved access to healthcare, but also declining health trends in the older population. Owing to a lack of individual-level data, the latter possibility has received little attention. The current study examines associations between health status and hospitalisation rates of older adults in the Netherlands. Design Observational individual-level data linked to hospital register data. Setting Data from 1995 to 2009 from the nationally representative Longitudinal Aging Study Amsterdam were linked to the Dutch Hospital Discharge Register. Participants A total of 5681 observations of 2520 respondents across 4 measurement points (each with a follow-up of 36 months; ages 65–88 years). Outcome measures The contribution of health, demographic, psychosocial and lifestyle characteristics to time trends in hospitalisation was assessed in multivariate models. Results Between 1995 and 2009, the percentage with 1 or more overnight admissions (planned or acute) increased slightly from 38.1% to 39.7%. This was due to an increase in acute admission only (22.2–27.0%). Increased prevalences of chronic diseases, functional limitations and polypharmacy accounted for part of the observed increase in acute admissions. In addition, a more than doubled prevalence of day admissions over time was observed (12.3–28.3%), a trend that was unrelated to changes in individual characteristics. Conclusions This trend study showed a contribution of declines in population health to increases in acute hospital admissions. Since these declines did not provide a full explanation, healthcare reforms and increases in treatment possibilities in this period are likely to have contributed as well. PMID:27531734

  15. Urban air pollution and emergency room admissions for respiratory symptoms: a case-crossover study in Palermo, Italy

    PubMed Central

    2011-01-01

    Background Air pollution from vehicular traffic has been associated with respiratory diseases. In Palermo, the largest metropolitan area in Sicily, urban air pollution is mainly addressed to traffic-related pollution because of lack of industrial settlements, and the presence of a temperate climate that contribute to the limited use of domestic heating plants. This study aimed to investigate the association between traffic-related air pollution and emergency room admissions for acute respiratory symptoms. Methods From January 2004 through December 2007, air pollutant concentrations and emergency room visits were collected for a case-crossover study conducted in Palermo, Sicily. Risk estimates of short-term exposures to particulate matter and gaseous ambient pollutants including carbon monoxide, nitrogen dioxide, and sulfur dioxide were calculated by using a conditional logistic regression analysis. Results Emergency departments provided data on 48,519 visits for respiratory symptoms. Adjusted case-crossover analyses revealed stronger effects in the warm season for the most part of the pollutants considered, with a positive association for PM10 (odds ratio = 1.039, 95% confidence interval: 1.020 - 1.059), SO2 (OR = 1.068, 95% CI: 1.014 - 1.126), nitrogen dioxide (NO2: OR = 1.043, 95% CI: 1.021 - 1.065), and CO (OR = 1.128, 95% CI: 1.074 - 1.184), especially among females (according to an increase of 10 μg/m3 in PM10, NO2, SO2, and 1 mg/m3 in CO exposure). A positive association was observed either in warm or in cold season only for PM10. Conclusions Our findings suggest that, in our setting, exposure to ambient levels of air pollution is an important determinant of emergency room (ER) visits for acute respiratory symptoms, particularly during the warm season. ER admittance may be considered a good proxy to evaluate the adverse effects of air pollution on respiratory health. PMID:21489245

  16. Utilization and Expenditure of Hospital Admission in Patients with Autism Spectrum Disorder: National Health Insurance Claims Database Analysis

    ERIC Educational Resources Information Center

    Lin, Jin-Ding; Hung, Wen-Jiu; Lin, Lan-Ping; Lai, Chia-Im

    2011-01-01

    There were not many studies to provide information on health access and health utilization of people with autism spectrum disorders (ASD). The present study describes a general profile of hospital admission and the medical cost among people with ASD, and to analyze the determinants of medical cost. A retrospective study was employed to analyze…

  17. Epidemiology of Hospital Admissions with Influenza during the 2013/2014 Northern Hemisphere Influenza Season: Results from the Global Influenza Hospital Surveillance Network

    PubMed Central

    Puig-Barberà, Joan; Natividad-Sancho, Angels; Trushakova, Svetlana; Sominina, Anna; Pisareva, Maria; Ciblak, Meral A.; Badur, Selim; Yu, Hongjie; Cowling, Benjamin J.; El Guerche-Séblain, Clotilde; Mira-Iglesias, Ainara; Kisteneva, Lidiya; Stolyarov, Kirill; Yurtcu, Kubra; Feng, Luzhao; López-Labrador, Xavier; Burtseva, Elena

    2016-01-01

    Background The Global Influenza Hospital Surveillance Network was established in 2012 to obtain valid epidemiologic data on hospital admissions with influenza-like illness. Here we describe the epidemiology of admissions with influenza within the Northern Hemisphere sites during the 2013/2014 influenza season, identify risk factors for severe outcomes and complications, and assess the impact of different influenza viruses on clinically relevant outcomes in at-risk populations. Methods Eligible consecutive admissions were screened for inclusion at 19 hospitals in Russia, Turkey, China, and Spain using a prospective, active surveillance approach. Patients that fulfilled a common case definition were enrolled and epidemiological data were collected. Risk factors for hospitalization with laboratory-confirmed influenza were identified by multivariable logistic regression. Findings 5303 of 9507 consecutive admissions were included in the analysis. Of these, 1086 were influenza positive (534 A(H3N2), 362 A(H1N1), 130 B/Yamagata lineage, 3 B/Victoria lineage, 40 untyped A, and 18 untyped B). The risk of hospitalization with influenza (adjusted odds ratio [95% confidence interval]) was elevated for patients with cardiovascular disease (1.63 [1.33–2.02]), asthma (2.25 [1.67–3.03]), immunosuppression (2.25 [1.23–4.11]), renal disease (2.11 [1.48–3.01]), liver disease (1.94 [1.18–3.19], autoimmune disease (2.97 [1.58–5.59]), and pregnancy (3.84 [2.48–5.94]). Patients without comorbidities accounted for 60% of admissions with influenza. The need for intensive care or in-hospital death was not significantly different between patients with or without influenza. Influenza vaccination was associated with a lower risk of confirmed influenza (adjusted odds ratio = 0.61 [0.48–0.77]). Conclusions Influenza infection was detected among hospital admissions with and without known risk factors. Pregnancy and underlying comorbidity increased the risk of detecting influenza

  18. Trends in hospital admission rates for anorexia nervosa in Oxford (1968–2011) and England (1990–2011): database studies

    PubMed Central

    Holland, Josephine; Hall, Nick; Yeates, David GR

    2015-01-01

    Objectives To report on long-term trends in hospital admission rates for anorexia nervosa using two English datasets. Design We used data on hospital day-case and inpatient care across five decades in the Oxford Record Linkage Study (ORLS), and similar data for all England from 1990. We analysed rates of admission for anorexia nervosa in people aged 10–44 years, using hospital episodes (counting every admission) and first-recorded admissions (counting only the first record for each person). Setting Former Oxford NHS Region; and England. Participants None; anonymous statistical records were used. Results In the longstanding ORLS, the age-standardised first-recorded admission rate for women was 2.7 (95% confidence interval 1.6–3.8) per 100,000 female population aged 10–44 years in 1968–1971; 2.7 (2.1–3.3) in 1992–1996; and 6.3 (5.5–7.2) in 2007–2011. Male rates were zero in the 1960s; 0.07 (0.0–0.1) per 100,000 men in 1992–1996; and 0.4 (0.2–0.6) in 2007–2011. In England, female rates increased from 4.2 (4.0–4.4) in 1998–2001 to 6.9 (6.7–7.1) in 2007–2011; and the corresponding male rates were 0.2 (0.1–0.3) and 0.5 (0.4–0.6). Episode-based admission rates rose more than person-based rates. The highest rates by far were in girls and women aged 15–19 years. Conclusions In recent years, anorexia nervosa has become a greater burden on secondary care: not only have admission rates increased but so too have multiple admissions per person with anorexia nervosa. The increase in admission rates might reflect an increase in prevalence rates of anorexia nervosa in the general population, but other explanations, including lower clinical thresholds for admission, are possible and are discussed. PMID:26609127

  19. Simple prescribing errors and allergy documentation in medical hospital admissions in Australia and New Zealand.

    PubMed

    Barton, Lorna; Futtermenger, Judith; Gaddi, Yash; Kang, Angela; Rivers, Jon; Spriggs, David; Jenkins, Paul F; Thompson, Campbell H; Thomas, Josephine S

    2012-04-01

    This study aimed to quantify and compare the prevalence of simple prescribing errors made by clinicians in the first 24 hours of a general medical patient's hospital admission. Four public or private acute care hospitals across Australia and New Zealand each audited 200 patients' drug charts. Patient demographics, pharmacist review and pre-defined prescribing errors were recorded. At least one simple error was present on the medication charts of 672/715 patients, with a linear relationship between the number of medications prescribed and the number of errors (r = 0.571, p < 0.001). The four sites differed significantly in the prevalence of different types of simple prescribing errors. Pharmacists were more likely to review patients aged > or = 75 years (39.9% vs 26.0%; p < 0.001) and those with more than 10 drug prescriptions (39.4% vs 25.7%; p < 0.001). Patients reviewed by a pharmacist were less likely to have inadequate documentation of allergies (13.5% vs 29.4%, p < 0.001). Simple prescribing errors are common, although their nature differs from site to site. Clinical pharmacists target patients with the most complex health situations, and their involvement leads to improved documentation. PMID:22586784

  20. Length of Hospital Stay Prediction at the Admission Stage for Cardiology Patients Using Artificial Neural Network.

    PubMed

    Tsai, Pei-Fang Jennifer; Chen, Po-Chia; Chen, Yen-You; Song, Hao-Yuan; Lin, Hsiu-Mei; Lin, Fu-Man; Huang, Qiou-Pieng

    2016-01-01

    For hospitals' admission management, the ability to predict length of stay (LOS) as early as in the preadmission stage might be helpful to monitor the quality of inpatient care. This study is to develop artificial neural network (ANN) models to predict LOS for inpatients with one of the three primary diagnoses: coronary atherosclerosis (CAS), heart failure (HF), and acute myocardial infarction (AMI) in a cardiovascular unit in a Christian hospital in Taipei, Taiwan. A total of 2,377 cardiology patients discharged between October 1, 2010, and December 31, 2011, were analyzed. Using ANN or linear regression model was able to predict correctly for 88.07% to 89.95% CAS patients at the predischarge stage and for 88.31% to 91.53% at the preadmission stage. For AMI or HF patients, the accuracy ranged from 64.12% to 66.78% at the predischarge stage and 63.69% to 67.47% at the preadmission stage when a tolerance of 2 days was allowed. PMID:27195660

  1. Incidence, causes and severity of injuries in Aquitaine, France: a community-based study of hospital admissions and deaths.

    PubMed Central

    Tiret, L; Garros, B; Maurette, P; Nicaud, V; Thicoipe, M; Hatton, F; Erny, P

    1989-01-01

    This paper reports the results of a study of injuries conducted during a one-year period within a defined geographic population of 2.7 million persons (Aquitaine, France). Cases were defined as unintentional or intentional injuries, either resulting in immediate death before reaching hospital or requiring hospital admission. During the one-year period, 1,181 deaths were registered and 8,190 hospital admissions occurred during the sample periods. The three leading causes of injury were falls (40 per cent), traffic accidents (27 per cent), and poisonings (15 per cent). The overall incidence of injuries was 136 per 10,000 person years. Incidence by sex and age was assessed for the main external causes. The ratios of nonfatal to fatal cases were calculated by sex and age and by external cause. The origin of the injury was suicide in 14 per cent of cases and assault or homicide in 3 per cent. The severity of injuries, assessed using an automatic computation of the Injury Severity Score (ISS), ranged from 1 to 66 with a mean of 6.9. Substantial variations of ISS were observed according to external cause. At the 8th day following admission, 31 per cent of hospital-treated patients were still hospitalized and 0.8 per cent had died in hospital. The outcome correlated well with the ISS. PMID:2916718

  2. Association of cannabis use with hospital admission and antipsychotic treatment failure in first episode psychosis: an observational study

    PubMed Central

    Wilson, Robin; Jackson, Richard; Ball, Michael; Shetty, Hitesh; Broadbent, Matthew; Stewart, Robert; McGuire, Philip; Bhattacharyya, Sagnik

    2016-01-01

    Objective To investigate whether cannabis use is associated with increased risk of relapse, as indexed by number of hospital admissions, and whether antipsychotic treatment failure, as indexed by number of unique antipsychotics prescribed, may mediate this effect in a large data set of patients with first episode psychosis (FEP). Design Observational study with exploratory mediation analysis. Setting Anonymised electronic mental health record data from the South London and Maudsley NHS Foundation Trust. Participants 2026 people presenting to early intervention services with FEP. Exposure Cannabis use at presentation, identified using natural language processing. Main outcome measures admission to psychiatric hospital and clozapine prescription up to 5 years following presentation. Mediator Number of unique antipsychotics prescribed. Results Cannabis use was present in 46.3% of the sample at first presentation and was particularly common in patients who were 16–25, male and single. It was associated with increased frequency of hospital admission (incidence rate ratio 1.50, 95% CI 1.25 to 1.80), increased likelihood of compulsory admission (OR 1.55, 1.16 to 2.08) and greater number of days spent in hospital (β coefficient 35.1 days, 12.1 to 58.1). The number of unique antipsychotics prescribed, mediated increased frequency of hospital admission (natural indirect effect 1.09, 95% CI 1.01 to 1.18; total effect 1.50, 1.21 to 1.87), increased likelihood of compulsory admission (natural indirect effect (NIE) 1.27, 1.03 to 1.58; total effect (TE) 1.76, 0.81 to 3.84) and greater number of days spent in hospital (NIE 17.9, 2.4 to 33.4; TE 34.8, 11.6 to 58.1). Conclusions Cannabis use in patients with FEP was associated with an increased likelihood of hospital admission. This was linked to the prescription of several different antipsychotic drugs, indicating clinical judgement of antipsychotic treatment failure. Together, this suggests that cannabis use might be

  3. Outcomes and Resource Use of Sepsis-associated Stays by Presence on Admission, Severity, and Hospital Type

    PubMed Central

    Ashton, Carol M.; Kiehne, Lisa B.; Nicolas, Juan C.; Rose, Alexis L.; Shirkey, Beverly A.; Masud, Faisal; Wray, Nelda P.

    2016-01-01

    Objective: To establish a baseline for the incidence of sepsis by severity and presence on admission in acute care hospital settings before implementation of a broad sepsis screening and response initiative. Methods: A retrospective cohort study using hospital discharge abstracts of 5672 patients, aged 18 years and above, with sepsis-associated stays between February 2012 and January 2013 at an academic medical center and 5 community hospitals in Texas. Results: Sepsis was present on admission in almost 85% of cases and acquired in-hospital in the remainder. The overall inpatient death rate was 17.2%, but was higher in hospital-acquired sepsis (38.6%, medical; 29.2%, surgical) and Stages 2 (17.6%) and 3 (36.4%) compared with Stage 1 (5.9%). Patients treated at the academic medical center had a higher death rate (22.5% vs. 15.1%, P<0.001) and were more costly ($68,050±184,541 vs. $19,498±31,506, P<0.001) versus community hospitals. Conclusions: Greater emphasis is needed on public awareness of sepsis and the detection of sepsis in the prehospitalization and early hospitalization period. Hospital characteristics and case mix should be accounted for in cross-hospital comparisons of sepsis outcomes and costs. PMID:26759980

  4. Clinical Prediction Rule for Patient Outcome after In-Hospital CPR: A New Model, Using Characteristics Present at Hospital Admission, to Identify Patients Unlikely to Benefit from CPR after In-Hospital Cardiac Arrest

    PubMed Central

    Merja, Satyam; Lilien, Ryan H; Ryder, Hilary F

    2015-01-01

    BACKGROUND Physicians and patients frequently overestimate likelihood of survival after in-hospital cardiopulmonary resuscitation. Discussions and decisions around resuscitation after in-hospital cardiopulmonary arrest often take place without adequate or accurate information. METHODS We conducted a retrospective chart review of 470 instances of resuscitation after in-hospital cardiopulmonary arrest. Individuals were randomly assigned to a derivation cohort and a validation cohort. Logistic Regression and Linear Discriminant Analysis were used to perform multivariate analysis of the data. The resultant best performing rule was converted to a weighted integer tool, and thresholds of survival and nonsurvival were determined with an attempt to optimize sensitivity and specificity for survival. RESULTS A 10-feature rule, using thresholds for survival and nonsurvival, was created; the sensitivity of the rule on the validation cohort was 42.7% and specificity was 82.4%. In the Dartmouth Score (DS), the features of age (greater than 70 years of age), history of cancer, previous cardiovascular accident, and presence of coma, hypotension, abnormal PaO2, and abnormal bicarbonate were identified as the best predictors of nonsurvival. Angina, dementia, and chronic respiratory insufficiency were selected as protective features. CONCLUSIONS Utilizing information easily obtainable on admission, our clinical prediction tool, the DS, provides physicians individualized information about their patients’ probability of survival after in-hospital cardiopulmonary arrest. The DS may become a useful addition to medical expertise and clinical judgment in evaluating and communicating an individual’s probability of survival after in-hospital cardiopulmonary arrest after it is validated by other cohorts. PMID:26448686

  5. Incidence and consequence of acute kidney injury in unselected emergency admissions to a large acute UK hospital trust

    PubMed Central

    2014-01-01

    Background AKI is common among hospital in-patients and places a huge financial burden on the UK National Health Service, causing increased length of hospital stay and use of critical care services, with increased requirement for complex interventions including dialysis. This may account for up to 0.6% of the total Health Service budget. To investigate the incidence and consequences of AKI, all unselected emergency admissions to a large acute UK single centre University Teaching Hospital over two separate 7 day periods were reviewed. Methods A retrospective audit of 745 case records was undertaken (54.6% male) including laboratory data post-discharge or death, with classification of AKI by RIFLE, AKIN and AKIB criteria. Participants were included whether admitted via their general practitioners, the emergency department, or as tertiary specialty transfers. Outcome measures were presence or absence of AKI recorded using each of the three AKI criteria, length of hospital stay (LOS), admission to, and LOS in critical care, and mortality. The most severe grade of AKI only, at any time during the admission, was recorded to prevent double counting. Renal outcome was determined by requirement for renal replacement therapy (RRT), and whether those receiving RRT remained dialysis dependent or not. Results AKI incidence was 25.4% overall. With approximately one third present on admission and two thirds developing post admission. The AKI group had LOS almost three times higher than the non AKI group (10 vs 4 days). Requirement for critical care beds was 8.1% in the AKI group compared to 1.7% in non AKI group. Overall mortality was 5.5%, with the AKI group at 11.4% versus 3.3% in the non AKI group. Conclusions AKI in acute unselected hospital admissions is more common than existing literature suggests, affecting 25% of unselected admissions. In many this is relatively mild and may resolve spontaneously, but is associated with increased LOS, likelihood of admission to

  6. Respiratory hospitalizations of children living near a hazardous industrial site adjusted for prevalent dust: a case-control study.

    PubMed

    Nirel, Ronit; Maimon, Nimrod; Fireman, Elizabeth; Agami, Sarit; Eyal, Arnona; Peretz, Alon

    2015-03-01

    The Neot Hovav Industrial Park (IP), located in southern Israel, hosts 23 chemical industry facilities and the national site for treatment of hazardous waste. Yet, information about its impact on the health of local population has been mostly ecological, focused on Bedouins and did not control for possible confounding effect of prevalent dust storms. This case-control study examined whether living near the IP could lead to increased risk of pediatric hospitalization for respiratory diseases. Cases (n=3608) were residents of the Be'er Sheva sub-district aged 0-14 years who were admitted for respiratory illnesses between 2004 and 2009. These were compared to children admitted for non-respiratory conditions (n=3058). Home addresses were geocoded and the distances from the IP to the child's residence were calculated. The association between hospitalization and residential distance from the IP was examined for three age groups (0-1, 2-6, 7-14) by logistic regressions adjusting for gender, socioeconomic status, urbanity and temperature. We found that infants in the first year of life who lived within 10 km of the IP had increased risk of respiratory hospitalization when compared with those living >20 km from the IP (adjusted odds ratio, OR=2.07, 95% confidence interval, CI: 1.19-3.59). In models with both distance from the IP and particulate matter with aerodynamic diameter <10 μm (PM(10)) the estimated risk was modestly attenuated (OR=1.96, 95% CI: 1.09-3.51). Elevated risk was also observed for children 2-5 years of age but with no statistical significance (OR=1.16, 95% CI: 0.76-1.76). Our findings suggest that residential proximity to a hazardous industrial site may contribute to early life respiratory admissions, beyond that of prevailing PM(10). PMID:25547415

  7. The formation and design of the 'Acute Admission Database'- a database including a prospective, observational cohort of 6279 patients triaged in the emergency department in a larger Danish hospital

    PubMed Central

    2012-01-01

    Background Management and care of the acutely ill patient has improved over the last years due to introduction of systematic assessment and accelerated treatment protocols. We have, however, sparse knowledge of the association between patient status at admission to hospital and patient outcome. A likely explanation is the difficulty in retrieving all relevant information from one database. The objective of this article was 1) to describe the formation and design of the 'Acute Admission Database', and 2) to characterize the cohort included. Methods All adult patients triaged at the Emergency Department at Hillerød Hospital and admitted either to the observationary unit or to a general ward in-hospital were prospectively included during a period of 22 weeks. The triage system used was a Danish adaptation of the Swedish triage system, ADAPT. Data from 3 different data sources was merged using a unique identifier, the Central Personal Registry number; 1) Data from patient admission; time and date, vital signs, presenting complaint and triage category, 2) Blood sample results taken at admission, including a venous acid-base status, and 3) Outcome measures, e.g. length of stay, admission to Intensive Care Unit, and mortality within 7 and 28 days after admission. Results In primary triage, patients were categorized as red (4.4%), orange (25.2%), yellow (38.7%) and green (31.7%). Abnormal vital signs were present at admission in 25% of the patients, most often temperature (10.5%), saturation of peripheral oxygen (9.2%), Glasgow Coma Score (6.6%) and respiratory rate (4.8%). A venous acid-base status was obtained in 43% of all patients. The majority (78%) had a pH within the normal range (7.35-7.45), 15% had acidosis (pH < 7.35) and 7% had alkalosis (pH > 7.45). Median length of stay was 2 days (range 1-123). The proportion of patients admitted to Intensive Care Unit was 1.6% (95% CI 1.2-2.0), 1.8% (95% CI 1.5-2.2) died within 7 days, and 4.2% (95% CI 3.7-4.7) died within

  8. Association between air pollution and daily mortality and hospital admission due to ischaemic heart diseases in Hong Kong

    NASA Astrophysics Data System (ADS)

    Tam, Wilson Wai San; Wong, Tze Wai; Wong, Andromeda H. S.

    2015-11-01

    Ischaemic heart disease (IHD) is one of the leading causes of death worldwide. The effects of air pollution on IHD mortalities have been widely reported. Fewer studies focus on IHD morbidities and PM2.5, especially in Asia. To explore the associations between short-term exposure to air pollution and morbidities and mortalities from IHD, we conducted a time series study using a generalized additive model that regressed the daily numbers of IHD mortalities and hospital admissions on daily mean concentrations of the following air pollutants: nitrogen dioxide (NO2), particulate matter with an aerodynamic diameter less than 10 μm (PM10), particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5), ozone (O3), and sulfur dioxide (SO2). The relative risks (RR) of IHD deaths and hospital admissions per 10 μg/m3 increase in the concentration of each air pollutant were derived in single pollutant models. Multipollutant models were also constructed to estimate their RRs controlling for other pollutants. Significant RRs were observed for all five air pollutants, ranging from 1.008 to 1.032 per 10 μg/m3 increase in air pollutant concentrations for IHD mortality and from 1.006 to 1.021 per 10 μg/m3 for hospital admissions for IHD. In the multipollutant model, only NO2 remained significant for IHD mortality while SO2 and PM2.5 was significantly associated with hospital admissions. This study provides additional evidence that mortalities and hospital admissions for IHD are significantly associated with air pollution. However, we cannot attribute these health effects to a specific air pollutant, owing to high collinearity between some air pollutants.

  9. Spreading a Medical Home Redesign: Effects on Emergency Department Use and Hospital Admissions

    PubMed Central

    Reid, Robert J.; Johnson, Eric A.; Hsu, Clarissa; Ehrlich, Kelly; Coleman, Katie; Trescott, Claire; Erikson, Michael; Ross, Tyler R.; Liss, David T.; Cromp, DeAnn; Fishman, Paul A.

    2013-01-01

    PURPOSE The patient-centered medical home (PCMH) is being rapidly deployed in many settings to strengthen US primary care, improve quality, and control costs; however, evidence supporting this transformation is still lacking. We describe the Group Health experience in attempting to replicate the effects on health care use seen in a PCMH prototype clinic via a systemwide spread using Lean as the change strategy. METHODS We used an interrupted time series analysis with a patient-month unit of analysis over a 4-year period that included baseline, implementation, and stabilization periods for 412,943 patients. To account for secular trends across these periods, we compared changes in use of face-to-face primary care visits, emergency department visits, and inpatient admissions with those of a nonequivalent comparison group of patients served by community network practices. RESULTS After accounting for secular trends among network patients, patients empaneled to the PCMH clinics had 5.1% and 6.7% declines in primary care office visits in early and later stabilization years, respectively, after the implementation year. This trend was accompanied by a 123% increase in the use of secure electronic message threads and a 20% increase in telephone encounters. Declines were also seen in emergency department visits at 1 and 2 years (13.7% and 18.5%) compared with what would be expected based on secular trends in network practices. No statistically significant changes were found for hospital admissions. CONCLUSIONS The Group Health experience shows it is possible to reduce emergency department use with PCMH transformation across a diverse set of clinics using a clear change strategy (Lean) and sufficient resources and supports. PMID:23690382

  10. Seasonal Changes in Hospital Admissions for Pulmonary Embolism in Metropolitan Areas of Tokyo (from the Tokyo Cardiovascular Care Unit Network).

    PubMed

    Mizuno, Atsushi; Takeuchi, Ayano; Yamamoto, Takeshi; Tanabe, Yasuhiro; Obayashi, Toru; Takayama, Morimasa; Nagao, Ken

    2015-12-15

    Although several studies have shown the relation between temperature/atmospheric pressure and pulmonary embolism (PE), their results are inconsistent. Furthermore, diurnal temperature range (DTR) and diurnal pressure range (DPR) were not fully evaluated for their associations with hospital admissions for PE. Study subjects comprised cases of 1,148 PE treated at institutions belonging to the Tokyo Cardiovascular Care Unit Network from January 2005 to December 2012. Patient data were combined with a variety of daily local climate parameters obtained from the Japan Meteorological Agency. Every 1°C increase in the DTR at lag0 corresponded to an increased relative risk of hospital admission for PE (odds ratio [OR] 1.036, 95% confidence interval [CI] 1.003 to 1.070). In the cooler season (November to April), an increase of 1 hPa (barometric pressure) in the DPR at lag4 and lag5 was associated with an increased relative risk of hospital admission for PE (OR 1.042, 95% CI 1.007 to 1.077 and OR 0.952, 95% CI 0.914 to 0.992, respectively). An increase in the PE hospitalization rate was seen only in the cool season. Using a metropolitan database, we showed that DTR and DPR have different impacts on hospital admissions for PE. In conclusion, we found that an increase in the DTR increases the PE hospitalization rate, especially during the cooler season. The impact of DTR and DPR on PE incidence and related hospitalizations needs to be further evaluated. PMID:26602077

  11. Bordetella pertussis in infants hospitalized for acute respiratory symptoms remains a concern

    PubMed Central

    2013-01-01

    Background Preliminary results suggest that pertussis infection might be considered in infants during a seasonal respiratory syncytial virus (RSV) outbreak. Methods In order to analyze clinical features and laboratory findings in infants with pertussis hospitalized for acute respiratory symptoms during a seasonal RSV outbreak, we conducted a retrospective single-center study on 19 infants with pertussis (6 boys; median age 72 days) and 19 matched controls (RSV-bronchiolitis), hospitalized from October 2008 to April 2010. B. pertussis and RSV were detected from nasopharyngeal washes with Real Time-PCR. Results Infants with pertussis were less often breastfeed than infants with RSV bronchiolitis (63.2% vs 89.5%; p <0.06). Clinically, significantly fewer infants with pertussis than controls had more episodes of whooping cough (63.2% vs 0.0%; p < 0.001) and also less frequently fever at admission (15.8% vs 68.4%; p <0.01), apnea (52.6% vs 10.5%; p <0.006), and cyanosis (52.6% vs 10.5%; p < 0.006). Infants with pertussis had more often no abnormal chest sounds on auscultation than infants with RSV bronchiolitis (0% vs 42,1%; p < 0.005). The absolute blood lymphocyte and eosinophil counts were higher in infants with B. pertussis than in controls with bronchiolitis (23886 ± 16945 vs 10725 ± 4126 cells/mm3, p < 0.0001 and 13.653 ± 10.430 vs 4.730 ± 2.400 cells/mm3, p < 0.001). The molecular analysis of 2 B. pertussis isolates for ptxA1, ptxP3, and prn2 genes showed the presence of gene variants. Conclusions When infants are hospitalized for acute respiratory symptoms, physicians should suspect a pertussis infection, seek for specific clinical symptoms, investigate lymphocyte and eosinophil counts and thus diagnose infection early enough to allow treatment. PMID:24209790

  12. ACE Inhibitor and Angiotensin Receptor-II Antagonist Prescribing and Hospital Admissions with Acute Kidney Injury: A Longitudinal Ecological Study

    PubMed Central

    Tomlinson, Laurie A.; Abel, Gary A.; Chaudhry, Afzal N.; Tomson, Charles R.; Wilkinson, Ian B.; Roland, Martin O.; Payne, Rupert A.

    2013-01-01

    Background ACE Inhibitors (ACE-I) and Angiotensin-Receptor Antagonists (ARAs) are commonly prescribed but can cause acute kidney injury (AKI) during intercurrent illness. Rates of hospitalization with AKI are increasing. We aimed to determine whether hospital AKI admission rates are associated with increased ACE-I/ARA prescribing. Methods and Findings English NHS prescribing data for ACE-I/ARA prescriptions were matched at the level of the general practice to numbers of hospital admissions with a primary diagnosis of AKI. Numbers of prescriptions were weighted for the demographic characteristics of general practices by expressing prescribing as rates where the denominator is Age, Sex, and Temporary Resident Originated Prescribing Units (ASTRO-PUs). We performed a mixed-effect Poisson regression to model the number of admissions for AKI occurring in each practice for each of 4 years from 1/4/2007. From 2007/8-2010/11, crude AKI admission rates increased from 0.38 to 0.57 per 1000 patients (51.6% increase), and national annual ACE-I/ARA prescribing rates increased by 0.032 from 0.202 to 0.234 (15.8% increase). There was strong evidence (p<0.001) that increases in practice-level prescribing of ACE-I/ARA over the study period were associated with an increase in AKI admission rates. The increase in prescribing seen in a typical practice corresponded to an increase in admissions of approximately 5.1% (rate ratio = 1.051 for a 0.03 per ASTRO-PU increase in annual prescribing rate, 95%CI 1.047-1.055). Using the regression model we predict that 1,636 (95%CI 1,540-1,780) AKI admissions would have been avoided if prescribing rates were at the 2007/8 level, equivalent to 14.8% of the total increase in AKI admissions. Conclusion In this ecological analysis, up to 15% of the increase in AKI admissions in England over a 4-year time period is potentially attributable to increased prescribing of ACE-I and ARAs. However, these findings are limited by the lack of patient level

  13. Borderline Personality Disorder and Posttraumatic Stress Disorder at Psychiatric Discharge Predict General Hospital Admission for Self-Harm.

    PubMed

    Mellesdal, Liv; Gjestad, Rolf; Johnsen, Erik; Jørgensen, Hugo A; Oedegaard, Ketil J; Kroken, Rune A; Mehlum, Lars

    2015-12-01

    We investigated whether posttraumatic stress disorder (PTSD) was predictor of suicidal behavior even when adjusting for comorbid borderline personality disorder (BPD) and other salient risk factors. To study this, we randomly selected 308 patients admitted to a psychiatric hospital because of suicide risk. Baseline interviews were performed within the first days of the stay. Information concerning the number of self-harm admissions to general hospitals over the subsequent 6 months was retrieved through linkage with the regional hospital registers. A censored regression analysis of hospital admissions for self-harm indicated significant associations with both PTSD (β = .21, p < .001) and BPD (β = .27, p < .001). A structural model comprising two latent BPD factors, dysregulation and relationship problems, as well as PTSD and several other variables, demonstrated that PTSD was an important correlate of the number of self-harm admissions to general hospitals (B = 1.52, p < .01). Dysregulation was associated directly with self-harm (B = 0.28, p < .05), and also through PTSD. These results suggested that PTSD and related dysregulation problems could be important treatment targets for a reduction in the risk of severe self-harm in high-risk psychiatric patients. PMID:26581019

  14. Reducing variation in hospital admissions from the emergency department for low-mortality conditions may produce savings.

    PubMed

    Sabbatini, Amber K; Nallamothu, Brahmajee K; Kocher, Keith E

    2014-09-01

    The emergency department (ED) is now the primary source for hospitalizations in the United States, and admission rates for all causes differ widely between EDs. In this study we used a national sample of ED visits to examine variation in risk-standardized hospital admission rates from EDs and the relationship of this variation to inpatient mortality for the fifteen most commonly admitted medical and surgical conditions. We then estimated the impact of variation on national health expenditures under different utilization scenarios. Risk-standardized admission rates differed substantially across EDs, ranging from 1.03-fold for sepsis to 6.55-fold for chest pain between the twenty-fifth and seventy-fifth percentiles of the visits. Conditions such as chest pain, soft tissue infection, asthma, chronic obstructive pulmonary disease, and urinary tract infection were low-mortality conditions that showed the greatest variation. This suggests that some of these admissions might not be necessary, thus representing opportunities to improve efficiency and reduce health spending. Our data indicate that there may be sizeable savings to US payers if differences in ED hospitalization practices could be narrowed among a few of these high-variation, low-mortality conditions. PMID:25201672

  15. Risk of Care Home Placement following Acute Hospital Admission: Effects of a Pay-for-Performance Scheme for Dementia

    PubMed Central

    Kasteridis, Panagiotis; Goddard, Maria; Jacobs, Rowena; Santos, Rita; Rodriguez-Sanchez, Beatriz; McGonigal, Gerard

    2016-01-01

    Introduction The Quality and Outcomes Framework, or QOF, rewards primary care doctors (GPs) in the UK for providing certain types of care. Since 2006, GPs have been paid to identify patients with dementia and to conduct an annual review of their mental and physical health. During the review, the GP also assesses the carer’s support needs, including impact of caring, and ensures that services are co-ordinated across care settings. In principle, this type of care should reduce the risk of admission to long-term residential care directly from an acute hospital ward, a phenomenon considered to be indicative of poor quality care. However, this potential effect has not previously been tested. Methods Using English data from 2006/07 to 2010/11, we ran multilevel logit models to assess the impact of the QOF review on the risk of care home placement following emergency admission to acute hospital. Emergency admissions were defined for (a) people with a primary diagnosis of dementia and (b) people with dementia admitted for treatment of an ambulatory care sensitive condition. We adjusted for a wide range of potential confounding factors. Results Over the study period, 19% of individuals admitted to hospital with a primary diagnosis of dementia (N = 31,120) were discharged to a care home; of those admitted for an ambulatory care sensitive condition (N = 139,267), the corresponding figure was 14%. Risk factors for subsequent care home placement included older age, female gender, vascular dementia, incontinence, fall, hip fracture, and number of comorbidities. Better performance on the QOF review was associated with a lower risk of care home placement but only when the admission was for an ambulatory care sensitive condition. Conclusions The QOF dementia review may help to reduce the risk of long-term care home placement following acute hospital admission. PMID:27227403

  16. Trends and ethnic differences in hospital admissions and mortality for congestive heart failure in the elderly in Singapore, 1991 to 1998

    PubMed Central

    Ng, T P; Niti, M

    2003-01-01

    Objectives: To describe trends in hospital admissions and mortality from congestive heart failure in the elderly population aged 65 years and over in Singapore, 1991 to 1998. Design: Analysis of trends and population subgroup differences in rates of hospital admission and mortality for a primary diagnosis of congestive heart failure, classified as ICD-9, codes 428, 402.0, 402.11, and 402.91. Setting: The state of Singapore (multiethnic population of three million: Chinese 77%, Malay 14%, Indian 8%). Results: Congestive heart failure accounted for 4.5% of all hospital admissions and 2.5% of overall mortality in this age group. Age adjusted hospital admission rates for congestive heart failure increased by 38% (from 85.4 per 10 000 in 1991 to 110.3 per 10 000 in 1998), while mortality decreased by 20% (from 7.3 per 10 000 in 1991 to 6.1 per 10 000 in 1998). The decline in mortality was greater in women than in men. There were no sex differences in the rates of hospital admission, but there were significant ethnic differences in admissions and mortality. Thus hospital admissions for congestive heart failure were about 35% higher in both Malays and Indians than in Chinese; and mortality was 3.5 times higher in Malays, but was about the same in Indians and Chinese. Over the period studied, mortality from congestive heart failure declined in both Chinese and Indians, but rose in Malays. The increases in hospital admissions were similar in both sexes and all ethnic groups. Conclusions: An increasing rate of hospital admission accompanied by declining mortality from congestive heart failure is occurring in elderly people in this Asian multiethnic population. However, there are pronounced ethnic differences, with both Malays and Indians showing higher hospital admission rates than Chinese, and Malays showing a rising mortality as opposed to the falling mortality in the other ethnic groups. PMID:12860859

  17. Implementing hospital-based surveillance for severe acute respiratory infections caused by influenza and other respiratory pathogens in New Zealand

    PubMed Central

    Baker, Michael; McArthur, Colin; Roberts, Sally; Williamson, Deborah; Grant, Cameron; Trenholme, Adrian; Wong, Conroy; Taylor, Susan; LeComte, Lyndsay; Mackereth, Graham; Bandaranayake, Don; Wood, Tim; Bissielo, Ange; Se, Ruth; Turner, Nikki; Pierse, Nevil; Thomas, Paul; Webby, Richard; Gross, Diane; Duque, Jazmin; Thompson, Mark; Widdowson, Marc-Alain

    2014-01-01

    Background Recent experience with pandemic influenza A(H1N1)pdm09 highlighted the importance of global surveillance for severe respiratory disease to support pandemic preparedness and seasonal influenza control. Improved surveillance in the southern hemisphere is needed to provide critical data on influenza epidemiology, disease burden, circulating strains and effectiveness of influenza prevention and control measures. Hospital-based surveillance for severe acute respiratory infection (SARI) cases was established in New Zealand on 30 April 2012. The aims were to measure incidence, prevalence, risk factors, clinical spectrum and outcomes for SARI and associated influenza and other respiratory pathogen cases as well as to understand influenza contribution to patients not meeting SARI case definition. Methods/Design All inpatients with suspected respiratory infections who were admitted overnight to the study hospitals were screened daily. If a patient met the World Health Organization’s SARI case definition, a respiratory specimen was tested for influenza and other respiratory pathogens. A case report form captured demographics, history of presenting illness, co-morbidities, disease course and outcome and risk factors. These data were supplemented from electronic clinical records and other linked data sources. Discussion Hospital-based SARI surveillance has been implemented and is fully functioning in New Zealand. Active, prospective, continuous, hospital-based SARI surveillance is useful in supporting pandemic preparedness for emerging influenza A(H7N9) virus infections and seasonal influenza prevention and control. PMID:25077034

  18. Desert Dust Outbreaks in Southern Europe: Contribution to Daily PM10 Concentrations and Short-Term Associations with Mortality and Hospital Admissions

    PubMed Central

    Stafoggia, Massimo; Zauli-Sajani, Stefano; Pey, Jorge; Samoli, Evangelia; Alessandrini, Ester; Basagaña, Xavier; Cernigliaro, Achille; Chiusolo, Monica; Demaria, Moreno; Díaz, Julio; Faustini, Annunziata; Katsouyanni, Klea; Kelessis, Apostolos G.; Linares, Cristina; Marchesi, Stefano; Medina, Sylvia; Pandolfi, Paolo; Pérez, Noemí; Querol, Xavier; Randi, Giorgia; Ranzi, Andrea; Tobias, Aurelio; Forastiere, Francesco

    2015-01-01

    Background: Evidence on the association between short-term exposure to desert dust and health outcomes is controversial. Objectives: We aimed to estimate the short-term effects of particulate matter ≤ 10 μm (PM10) on mortality and hospital admissions in 13 Southern European cities, distinguishing between PM10 originating from the desert and from other sources. Methods: We identified desert dust advection days in multiple Mediterranean areas for 2001–2010 by combining modeling tools, back-trajectories, and satellite data. For each advection day, we estimated PM10 concentrations originating from desert, and computed PM10 from other sources by difference. We fitted city-specific Poisson regression models to estimate the association between PM from different sources (desert and non-desert) and daily mortality and emergency hospitalizations. Finally, we pooled city-specific results in a random-effects meta-analysis. Results: On average, 15% of days were affected by desert dust at ground level (desert PM10 > 0 μg/m3). Most episodes occurred in spring–summer, with increasing gradient of both frequency and intensity north–south and west–east of the Mediterranean basin. We found significant associations of both PM10 concentrations with mortality. Increases of 10 μg/m3 in non-desert and desert PM10 (lag 0–1 days) were associated with increases in natural mortality of 0.55% (95% CI: 0.24, 0.87%) and 0.65% (95% CI: 0.24, 1.06%), respectively. Similar associations were estimated for cardio-respiratory mortality and hospital admissions. Conclusions: PM10 originating from the desert was positively associated with mortality and hospitalizations in Southern Europe. Policy measures should aim at reducing population exposure to anthropogenic airborne particles even in areas with large contribution from desert dust advections. Citation: Stafoggia M, Zauli-Sajani S, Pey J, Samoli E, Alessandrini E, Basagaña X, Cernigliaro A, Chiusolo M, Demaria M, Díaz J, Faustini A

  19. External validation of the Hospital-patient One-year Mortality Risk (HOMR) model for predicting death within 1 year after hospital admission

    PubMed Central

    van Walraven, Carl; McAlister, Finlay A.; Bakal, Jeffrey A.; Hawken, Steven; Donzé, Jacques

    2015-01-01

    Background: Predicting long-term survival after admission to hospital is helpful for clinical, administrative and research purposes. The Hospital-patient One-year Mortality Risk (HOMR) model was derived and internally validated to predict the risk of death within 1 year after admission. We conducted an external validation of the model in a large multicentre study. Methods: We used administrative data for all nonpsychiatric admissions of adult patients to hospitals in the provinces of Ontario (2003–2010) and Alberta (2011–2012), and to the Brigham and Women’s Hospital in Boston (2010–2012) to calculate each patient’s HOMR score at admission. The HOMR score is based on a set of parameters that captures patient demographics, health burden and severity of acute illness. We determined patient status (alive or dead) 1 year after admission using population-based registries. Results: The 3 validation cohorts (n = 2 862 996 in Ontario, 210 595 in Alberta and 66 683 in Boston) were distinct from each other and from the derivation cohort. The overall risk of death within 1 year after admission was 8.7% (95% confidence interval [CI] 8.7% to 8.8%). The HOMR score was strongly and significantly associated with risk of death in all populations and was highly discriminative, with a C statistic ranging from 0.89 (95% CI 0.87 to 0.91) to 0.92 (95% CI 0.91 to 0.92). Observed and expected outcome risks were similar (median absolute difference in percent dying in 1 yr 0.3%, interquartile range 0.05%–2.5%). Interpretation: The HOMR score, calculated using routinely collected administrative data, accurately predicted the risk of death among adult patients within 1 year after admission to hospital for nonpsychiatric indications. Similar performance was seen when the score was used in geographically and temporally diverse populations. The HOMR model can be used for risk adjustment in analyses of health administrative data to predict long-term survival among hospital patients

  20. Hospital Admission following Induced Abortion in Eastern Highlands Province, Papua New Guinea – A Descriptive Study

    PubMed Central

    Vallely, Lisa M.; Homiehombo, Primrose; Kelly-Hanku, Angela; Kumbia, Antonia; Mola, Glen D. L.; Whittaker, Andrea

    2014-01-01

    Background In Papua New Guinea abortion is restricted under the Criminal Code Act. While safe abortions should available in certain situations, frequently they are not available to the majority of women. Sepsis from unsafe abortion is a leading cause of maternal mortality. Our findings form part of a wider, mixed methods study designed to identify complications requiring hospital treatment for post abortion care and to explore the circumstances surrounding unsafe abortion. Methods Through a six month prospective study we identified all women presenting to the Eastern Highlands Provincial Hospital following spontaneous and induced abortions. We undertook semi-structured interviews with women and reviewed individual case notes, extracting demographic and clinical information. Findings Case notes were reviewed for 56% (67/119) of women presenting for post abortion care. At least 24% (28/119) of these admissions were due to induced abortion. Women presenting following induced abortions were significantly more likely to be younger, single, in education at the time of the abortion and report that the baby was unplanned and unwanted, compared to those reporting spontaneous abortion. Obtained illegally, misoprostol was the method most frequently used to end the pregnancy. Physical and mechanical means and traditional herbs were also widely reported. Conclusion In a country with a low contraceptive prevalence rate and high unmet need for family planning, all reproductive age women need access to contraceptive information and services to avoid, postpone or space pregnancies. In the absence of this, women are resorting to unsafe means to end an unwanted pregnancy, putting their lives at risk and putting an increased strain on an already struggling health system. Women in this setting need access to safe, effective means of abortion. PMID:25329982

  1. Severe Iron Deficiency Anemia in Infants and Young Children, Requiring Hospital Admission

    PubMed Central

    Lundblad, Kristin; Rosenberg, Jonathan; Mangurten, Henry; Angst, Denise B.

    2016-01-01

    Objective. This study evaluated patient characteristics, milk intake, and associated lab findings of children 6 months to 5 years old, admitted to a children’s hospital with severe iron-deficiency anemia (IDA). Methods. A chart review was conducted on patients admitted with microcytic anemia (hemoglobin concentration less than 7 g/dL), accompanied by a low serum ferritin and/or low serum iron level between January 2000 and December 2006. Results. A total of 18 children with severe IDA were evaluated. Many had parents with private insurance and jobs. Almost all children drank >24 ounces of milk daily. Hemoglobin on admission was 3.8 g/dL, and the mean of the patients’ mean corpuscular volume was 52.8 fL. Median iron levels were 4 µg/dL. Conclusions. Severe IDA is still prevalent in children, yet physicians may not perform necessary testing. The devastating long-term effects of severe IDA should prompt clinicians to screen for severe IDA in children regardless of absent risk factors. PMID:27335995

  2. Air pollution and hospital emergency room admissions for chronic obstructive pulmonary disease in Valencia, Spain.

    PubMed

    Tenías, José Maria; Ballester, Ferran; Pérez-Hoyos, Santiago; Rivera, María Luisa

    2002-01-01

    The short-term relationship between levels of air pollution and emergency room admissions for chronic obstructive pulmonary disease was assessed in Valencia, Spain. The design was an ecological time-series study in which daily variation in air pollution was related to emergency chronic obstructive pulmonary disease visits to one of the city's hospitals. The pollutants under investigation were Black Smoke, sulfur dioxide, nitrogen dioxide, carbon monoxide, and ozone. The degree of association was analyzed with Poisson autoregressive regression, for which trend, seasonal patterns, temperature, humidity, days of the week, and incidence of influenza were controlled. Increases of 10 microg/m3 in ozone levels (lag 5) and of 1 mg/m3 in carbon monoxide (lag 1) were associated with increases of 6.1% (95% confidence interval [CI] = 2.2%, 10.1%) and of 3.9% (95% CI = 1.4%, 6.6%), respectively, in the expected chronic obstructive pulmonary disease cases. There was no significant association for the remainder of the pollutants. The described effects persisted even when the authors used models of differing specifications and when generalized additive models were used. The authors concluded that the results of this investigation, together with results of earlier research, demonstrate the significant effect of pollution on various health indicaors within Valencia. PMID:12071359

  3. Adverse Drug Reactions Causing Admission to Medical Wards: A Cross-Sectional Survey at 4 Hospitals in South Africa.

    PubMed

    Mouton, Johannes P; Njuguna, Christine; Kramer, Nicole; Stewart, Annemie; Mehta, Ushma; Blockman, Marc; Fortuin-De Smidt, Melony; De Waal, Reneé; Parrish, Andy G; Wilson, Douglas P K; Igumbor, Ehimario U; Aynalem, Getahun; Dheda, Mukesh; Maartens, Gary; Cohen, Karen

    2016-05-01

    Limited data exist on the burden of serious adverse drug reactions (ADRs) in sub-Saharan Africa, which has high HIV and tuberculosis prevalence. We determined the proportion of adult admissions attributable to ADRs at 4 hospitals in South Africa. We characterized drugs implicated in, risk factors for, and the preventability of ADR-related admissions.We prospectively followed patients admitted to 4 hospitals' medical wards over sequential 30-day periods in 2013 and identified suspected ADRs with the aid of a trigger tool. A multidisciplinary team performed causality, preventability, and severity assessment using published criteria. We categorized an admission as ADR-related if the ADR was the primary reason for admission.There were 1951 admissions involving 1904 patients: median age was 50 years (interquartile range 34-65), 1057 of 1904 (56%) were female, 559 of 1904 (29%) were HIV-infected, and 183 of 1904 (10%) were on antituberculosis therapy (ATT). There were 164 of 1951 (8.4%) ADR-related admissions. After adjustment for age and ATT, ADR-related admission was independently associated (P ≤ 0.02) with female sex (adjusted odds ratio [aOR] 1.51, 95% confidence interval [95% CI] 1.06-2.14), increasing drug count (aOR 1.14 per additional drug, 95% CI 1.09-1.20), increasing comorbidity score (aOR 1.23 per additional point, 95% CI 1.07-1.41), and use of antiretroviral therapy (ART) if HIV-infected (aOR 1.92 compared with HIV-negative/unknown, 95% CI 1.17-3.14). The most common ADRs were renal impairment, hypoglycemia, liver injury, and hemorrhage. Tenofovir disoproxil fumarate, insulin, rifampicin, and warfarin were most commonly implicated, respectively, in these 4 ADRs. ART, ATT, and/or co-trimoxazole were implicated in 56 of 164 (34%) ADR-related admissions. Seventy-three of 164 (45%) ADRs were assessed as preventable.In our survey, approximately 1 in 12 admissions was because of an ADR. The range of ADRs and implicated drugs reflect South Africa's high HIV

  4. Main clinical features in patients at their first psychiatric admission to Italian acute hospital psychiatric wards. The PERSEO study

    PubMed Central

    Ballerini, Andrea; Boccalon, Roberto M; Boncompagni, Giancarlo; Casacchia, Massimo; Margari, Francesco; Minervini, Lina; Righi, Roberto; Russo, Federico; Salteri, Andrea; Frediani, Sonia; Rossi, Andrea; Scatigna, Marco

    2007-01-01

    Background Few data are available on subjects presenting to acute wards for the first time with psychotic symptoms. The aims of this paper are (i) to describe the epidemiological and clinical characteristics of patients at their first psychiatric admission (FPA), including socio-demographic features, risk factors, life habits, modalities of onset, psychiatric diagnoses and treatments before admission; (ii) to assess the aggressive behavior and the clinical management of FPA patients in Italian acute hospital psychiatric wards, called SPDCs (Servizio Psichiatrico Diagnosi e Cura = psychiatric service for diagnosis and management). Method Cross-sectional observational multi-center study involving 62 Italian SPDCs (PERSEO – Psychiatric EmeRgency Study and EpidemiOlogy). Results 253 FPA aged <= 40 were identified among 2521 patients admitted to Italian SPDCs over the 5-month study period. About half of FPA patients showed an aggressive behavior as defined by a Modified Overt Aggression Scale (MOAS) score greater than 0 Vs 46% of non-FPA patients (p = 0.3651). The most common was verbal aggression, while about 20% of FPA patients actually engaged in physical aggression against other people. 74% of FPA patients had no diagnosis at admission, while 40% had received a previous psychopharmacological treatment, mainly benzodiazepines and antidepressants. During SPDC stay, diagnosis was established in 96% of FPA patients and a pharmacological therapy was prescribed to 95% of them, mainly benzodiazepines, antipsychotics and mood stabilizers. Conclusion Subjects presenting at their first psychiatric ward admission have often not undergone previous adequate psychiatric assessment and diagnostic procedures. The first hospital admission allows diagnosis and psychopharmacological treatment to be established. In our population, aggressive behaviors were rather frequent, although most commonly verbal. Psychiatric symptoms, as evaluated by psychiatrists and patients, improved

  5. Short-Term Effects of Coarse Particulate Matter on Hospital Admissions for Cardiovascular Diseases: A Case-Crossover Study in a Tropical City.

    PubMed

    Chen, Ying-Chen; Weng, Yi-Hao; Chiu, Ya-Wen; Yang, Chun-Yuh

    2015-01-01

    This study was undertaken to determine whether there was an association between coarse particles (PM2.5-10) levels and frequency of hospital admissions for cardiovascular diseases (CVD) in Kaohsiung, Taiwan. Hospital admissions for CVD, including ischemic heart disease (IHD), stroke, congestive heart failure (CHF), and arrhythmias, and ambient air pollution data levels for Kaohsiung were obtained for the period 2006-2010. The relative risk of hospital admissions for CVD was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single-pollutant model (without adjustment for other pollutants), increased rates of admissions for CVD were significantly associated with higher coarse PM levels only on cool days (< 25°C), with a 10-μg/m(3) elevation in PM2.5-10 concentrations associated with a 3% (95% CI = 2-4%) rise in IHD admissions, 5% (95% CI = 4-6%) increase in stroke admissions, 3% (95% CI = 1-6%) elevation in CHF admissions, and 3% (95% CI = 0-6%) rise in arrhythmias admissions. No significant associations were found between coarse particle levels and number of hospital admissions for CVD on warm days. In the two-pollutant models, PM2.5-10 levels remained significantly correlated with higher rate of CVD admissions even controlling for sulfur dioxide, nitrogen dioxide, carbon monoxide, or ozone on cool days. Compared to the effect estimate associated with a 10-μg/m(3) increase in PM2.5 levels, effect estimates of frequency of CVD-related admissions associated with a 10-μg/m(3) rise in coarse PM levels were weaker. This study provides evidence that higher levels of PM2.5-10 enhance the risk of hospital admissions for CVD. PMID:26408041

  6. The Impact of Admission Diagnosis on Recurrent or Frequent Hospitalizations in 3 Dementia Subtypes: A Hospital-Based Cohort in Taiwan with 4 Years Longitudinal Follow-Ups.

    PubMed

    Chang, Chiung-Chih; Lin, Pin-Hsuan; Chang, Ya-Ting; Chen, Nai-Ching; Huang, Chi-Wei; Lui, Chun-Chung; Huang, Shu-Hua; Chang, Yen-Hsiang; Lee, Chen-Chang; Lai, Wei-An

    2015-11-01

    Increasing numbers of patients with different types of dementia have resulted in the increasing medical care loads. It is not known whether explanatory factors for recurrent or prolong hospitalization were driven by the subtypes of dementia. We analyzed 203 dementia patients aged >65-year-old with a clinical diagnosis of Alzheimer disease (AD), vascular dementia (VaD), or Parkinsonism-related dementia (PRD). With a 4-year follow-up period, logistic regression analyses were used to identify predictors of dementia diagnosis, cerebrovascular risk factors, chronic systemic diseases, and the etiology for admission for recurrent (>4 times/4 years) or prolonged hospitalization stay (>14 days per hospitalization). There were 48 AD, 96 VaD, and 59 PRD patients that completed the 4-year study. The average length of hospital stay was significant, the shortest in AD and the longest in PRD (P = 0.01), whereas the frequency of hospitalization was not different among 3 dementia subtypes. Although delirium is the most common etiology for admission in the patients, diabetes mellitus (Odds ratio, OR = 2.79, P = 0.02), pneumonia (OR = 11.21, P < 0.001), and fall-related hip fracture (OR = 4.762, P = 0.029) were significantly associated with prolong hospitalization. Patients with coronary artery disease (OR = 9.87, P = 0.02), pneumonia (OR = 84.48, P < 0.001), urinary tract infection (OR = 55.09, P < 0.001), and fall-related fracture (OR = 141.7, P < 0.001) predict recurrent hospitalization. Dementia subtypes did not influence directly on the hospitalization courses. The etiologies for admission carried higher clinical significance, compared with the coexisted systemic diseases. PMID:26579820

  7. Children living near chipboard and wood industries are at an increased risk of hospitalization for respiratory diseases: a prospective study.

    PubMed

    Marchetti, Pierpaolo; Marcon, Alessandro; Pesce, Giancarlo; Paolo, Girardi; Guarda, Linda; Pironi, Vanda; Fracasso, Maria Enrica; Ricci, Paolo; de Marco, Roberto

    2014-01-01

    Pollutants emitted from wood processing factories may be harmful to the health of the population. The aim of this prospective cohort study was to evaluate whether proximity to wood factories was associated with the risk of hospital admissions in children living in the Viadana district (Italy), where two big chipboard industries and other smaller wood factories (sawmills, multi-strata layer manufacturing) are located. In 2006, children (3-14 years) living in the Viadana district were surveyed through a parental questionnaire (n=3854), their home/school addresses were geocoded and the distances to the wood industries were calculated. Hospital discharge records for the years 2007-2009 were obtained. Cox proportional hazard regression models were used to estimate the association between hospitalization rates and distance to the factories, adjusting for sex, age, nationality, parents' education, exposure to passive smoking and reported traffic near home. During the 3-year follow-up, the risk of hospitalization for all diagnoses (Hospitalization Hazard Ratio, HHR=1.55; 95% CI: 1.24-1.95) and for respiratory diseases (HHR=1.80; 95% CI: 1.14-2.86) was greater in the children living close (<2 km) to the chipboard industries, with respect to the children who lived at ≥2 km from any wood factory. The children living close to the smaller wood factories were also at increased risk of hospitalization for respiratory diseases (HHR=1.74; 95% CI: 1.06-2.85). This study highlights a health problem for the children living close to chipboard and wood factories in the Viadana district. Further research should develop accurate exposure models based on objective measurements of air pollution in order to confirm these findings. PMID:23628305

  8. Interventions to Mitigate Emergency Department and Hospital Crowding During an Infectious Respiratory Disease Outbreak: Results from an Expert Panel

    PubMed Central

    Dugas, Andrea Freyer; Morton, Melinda; Beard, Raphaelle; Pines, Jesse M.; Bayram, Jamil D.; Hsieh, Yu-Hsiang; Kelen, Gabor; Uscher-Pines, Lori; Jeng, Kevin; Cole, Gai; Rothman, Richard

    2013-01-01

    Objective: To identify and prioritize potential Emergency Department (ED) and hospital-based interventions which could mitigate the impact of crowding during patient surge from a widespread infectious respiratory disease outbreak and determine potential data sources that may be useful for triggering decisions to implement these high priority interventions. Design: Expert panel utilizing Nominal Group Technique to identify and prioritize interventions, and in addition, determine appropriate “triggers” for implementation of the high priority interventions in the context of four different infectious respiratory disease scenarios that vary by patient volumes (high versus low) and illness severity (high versus low). Setting: One day in-person conference held November, 2011. Participants: Regional and national experts representing the fields of public health, disease surveillance, clinical medicine, ED operations, and hospital operations. Main Outcome Measure: Prioritized list of potential interventions to reduce ED and hospital crowding, respectively. In addition, we created a prioritized list of potential data sources which could be useful to trigger interventions. Results: High priority interventions to mitigate ED surge included standardizing admission and discharge criteria and instituting infection control measures. To mitigate hospital crowding, panelists prioritized mandatory vaccination and an algorithm for antiviral use. Data sources identified for triggering implementation of these interventions were most commonly ED and hospital utilization metrics. Conclusions: We developed a prioritized list of potentially useful interventions to mitigate ED and hospital crowding in various outbreak scenarios. The data sources identified to “trigger” the implementation of these high priority interventions consist mainly of sources available at the local, institutional level. PMID:23856917

  9. Effectiveness of telemonitoring integrated into existing clinical services on hospital admission for exacerbation of chronic obstructive pulmonary disease: researcher blind, multicentre, randomised controlled trial

    PubMed Central

    Hanley, Janet; McCloughan, Lucy; Todd, Allison; Krishan, Ashma; Lewis, Stephanie; Stoddart, Andrew; van der Pol, Marjon; MacNee, William; Sheikh, Aziz; Pagliari, Claudia; McKinstry, Brian

    2013-01-01

    Objective To test the effectiveness of telemonitoring integrated into existing clinical services such that intervention and control groups have access to the same clinical care. Design Researcher blind, multicentre, randomised controlled trial. Setting UK primary care (Lothian, Scotland). Participants Adults with at least one admission for chronic obstructive pulmonary disease (COPD) in the year before randomisation. We excluded people who had other significant lung disease, who were unable to provide informed consent or complete the study, or who had other significant social or clinical problems. Interventions Participants were recruited between 21 May 2009 and 28 March 2011, and centrally randomised to receive telemonitoring or conventional self monitoring. Using a touch screen, telemonitoring participants recorded a daily questionnaire about symptoms and treatment use, and monitored oxygen saturation using linked instruments. Algorithms, based on the symptom score, generated alerts if readings were omitted or breached thresholds. Both groups received similar care from existing clinical services. Main outcome measures The primary outcome was time to hospital admission due to COPD exacerbation up to one year after randomisation. Other outcomes included number and duration of admissions, and validated questionnaire assessments of health related quality of life (using St George’s respiratory questionnaire (SGRQ)), anxiety or depression (or both), self efficacy, knowledge, and adherence to treatment. Analysis was intention to treat. Results Of 256 patients completing the study, 128 patients were randomised to telemonitoring and 128 to usual care; baseline characteristics of each group were similar. The number of days to admission did not differ significantly between groups (adjusted hazard ratio 0.98, 95% confidence interval 0.66 to 1.44). Over one year, the mean number of COPD admissions was similar in both groups (telemonitoring 1.2 admissions per person

  10. Coal Mine Air Pollution and Number of Children Hospitalizations because of Respiratory Tract Infection: A Time Series Analysis.

    PubMed

    Liu, Yonglin; Liu, Juan; Chen, Fenglian; Bilal Haider, Shamsi; Wang, Qiang; Jiao, Fuyong; Qiao, Yanmei; Shi, Yanhua

    2015-01-01

    To analyze the relationship between levels of air pollution and number of children hospitalizations because of respiratory tract infection in Shenmu County, the data regarding meteorological factors, environmental pollutants, that is SO(2) and NO(2), Particulate Matter 10 (PM10), and hospitalizations of children less than 16 years of age was collected during the time duration of November 2009 to October 2012. Using SAS 9.3, descriptive data analysis for meteorological and environmental factors and hospital admissions were performed along with main air pollutants determination. Using the statistical software R 3.0.1, a generalized additive Poisson regression model was established, the linear fitting models of the air pollutant concentrations and meteorological factors were introduced considering the lag effect, and the relative risk of the main atmospheric pollutants on children hospitalization was evaluated. The results showed that the primary air pollutant in Shenmu County is PM10 and its Pearson correlation coefficient with Air Pollution Index (API) is 0.917. After control of long term climate trend, "week day effect," meteorological factors, and impact of other contaminants, it was found that, on the same day and during the lag of 1 to 10 days, PM10 concentrations had no significant effect on children hospitalization rate. PMID:26246810

  11. Coal Mine Air Pollution and Number of Children Hospitalizations because of Respiratory Tract Infection: A Time Series Analysis

    PubMed Central

    Liu, Yonglin; Liu, Juan; Chen, Fenglian; Bilal Haider, Shamsi; Wang, Qiang; Jiao, Fuyong; Qiao, Yanmei; Shi, Yanhua

    2015-01-01

    To analyze the relationship between levels of air pollution and number of children hospitalizations because of respiratory tract infection in Shenmu County, the data regarding meteorological factors, environmental pollutants, that is SO2 and NO2, Particulate Matter 10 (PM10), and hospitalizations of children less than 16 years of age was collected during the time duration of November 2009 to October 2012. Using SAS 9.3, descriptive data analysis for meteorological and environmental factors and hospital admissions were performed along with main air pollutants determination. Using the statistical software R 3.0.1, a generalized additive Poisson regression model was established, the linear fitting models of the air pollutant concentrations and meteorological factors were introduced considering the lag effect, and the relative risk of the main atmospheric pollutants on children hospitalization was evaluated. The results showed that the primary air pollutant in Shenmu County is PM10 and its Pearson correlation coefficient with Air Pollution Index (API) is 0.917. After control of long term climate trend, “week day effect,” meteorological factors, and impact of other contaminants, it was found that, on the same day and during the lag of 1 to 10 days, PM10 concentrations had no significant effect on children hospitalization rate. PMID:26246810

  12. Use of hospital services by age and comorbidity after an index heart failure admission in England: an observational study

    PubMed Central

    Goudie, Rosalind; Cowie, Martin R

    2016-01-01

    Objectives To describe hospital inpatient, emergency department (ED) and outpatient department (OPD) activity for patients in the year following their first emergency admission for heart failure (HF). To assess the proportion receiving specialist assessment within 2 weeks of hospital discharge, as now recommended by guidelines. Design Observational study of national administrative data. Setting All acute NHS hospitals in England. Participants 82 241 patients with an index emergency admission between April 2009 and March 2011 with a primary diagnosis of HF. Main outcome measures Cardiology OPD appointment within 2 weeks and within a year of discharge from the index admission; emergency department (ED) and inpatient use within a year. Results 15.1% died during the admission. Of the 69 848 survivors, 19.7% were readmitted within 30 days and half within a year, the majority for non-HF diagnoses. 6.7% returned to the ED within a week of discharge, of whom the majority (77.6%) were admitted. The two most common OPD specialties during the year were cardiology (24.7% of the total appointments) and anticoagulant services (12.5%). Although half of all patients had a cardiology appointment within a year, the proportion within the recommended 2 weeks of discharge was just 6.8% overall and varied by age, from 2.4% in those aged 90+ to 19.6% in those aged 18–45 (p<0.0001); appointments in other specialties made up only some of the shortfall. More comorbidity at any age was associated with higher rates of cardiology OPD follow-up. Conclusions Patients with HF are high users of hospital services. Postdischarge cardiology OPD follow-up rates fell well below current National Institute for Health and Care Excellence guidelines, particularly for the elderly and those with less comorbidity. PMID:27288372

  13. The effects of daily weather variables on psychosis admissions to psychiatric hospitals

    NASA Astrophysics Data System (ADS)

    McWilliams, Stephen; Kinsella, Anthony; O'Callaghan, Eadbhard

    2013-07-01

    Several studies have noted seasonal variations in admission rates of patients with psychotic illnesses. However, the changeable daily meteorological patterns within seasons have never been examined in any great depth in the context of admission rates. A handful of small studies have posed interesting questions regarding a potential link between psychiatric admission rates and meteorological variables such as environmental temperature (especially heat waves) and sunshine. In this study, we used simple non-parametric testing and more complex ARIMA and time-series regression analysis to examine whether daily meteorological patterns (wind speed and direction, barometric pressure, rainfall, sunshine, sunlight and temperature) exert an influence on admission rates for psychotic disorders across 12 regions in Ireland. Although there were some weak but interesting trends for temperature, barometric pressure and sunshine, the meteorological patterns ultimately did not exert a clinically significant influence over admissions for psychosis. Further analysis is needed.

  14. Improving Mental Status Questionnaire (MSQ) completion on admission to the Acute Surgical Receiving Unit (ASRU), Ninewells Hospital, Dundee

    PubMed Central

    Okwemba, Sylvia; Copeland, Lauren

    2014-01-01

    Delirium is common yet poorly identified in the UK. Early recognition is a key prognostic factor; delay here being associated with: increased mortality, increased morbidity, prolonged hospital stay, long term disability, and increased risk of developing dementia. Improvement in the diagnosis and management of delirium has scope to improve patient care, clinical outcomes, and ultimately an improved patient experience. As patients aged ≥75 years are at an increased risk of developing delirium, we focused the improvement project to this age group. The baseline data demonstrated that the average ≥75 year-old patient admitted to the Acute Surgical Receiving Unit (ASRU) at Ninewells Hospital had 5.4 out of 12 predisposing and precipitating risk factors for delirium; thus there was great potential for delirium to develop in these patients. During the analysis of the baseline data it became clear that we could not go ahead and implement the initial proposed improvement as the completion of the mental status questionnaire (MSQ) was inconsistent and low at 14.99%. Completion of the MSQ is vital in establishing any cognitive deficit at admission, and for providing a baseline for the continuing admission. As a consequence of this, we had to shift the main aim of the improvement project from improving the identification, diagnosis, and management of delirium, to improving the completion rate of the MSQ in our target age group. Consultations with members of the admission team were held to determine ways of improving the MSQ completion rate. It became clear that the completion of the MSQ relied on clinical staff remembering all 10 questions that constitute the test. The main intervention to facilitate improvement involved affixing a sticker with all 10 questions of the MSQ within the admissions document. The main aim was to increase the percentage of cognitive screening by the Mental State Questionnaire (MSQ) to 95% in patients aged ≥75 on admission to ASRU at Ninewells

  15. Better health-related quality of life (mental component summary), having a higher level of education, and being less than 75 years of age are predictors of hospital admission among cognitively intact nursing home residents: a 5-year follow-up study

    PubMed Central

    Drageset, Jorunn; Eide, Geir Egil; Ranhoff, Anette Hylen

    2016-01-01

    Objective To study whether health-related quality of life (HRQOL), activities of daily living (ADL), and anxiety and depression symptoms affect the risk of hospital admission and potential interactions with having a cancer diagnosis. Methods This study was a prospective observational study with 5-year follow-up and analyzed the follow-up data on hospital admissions until 2010 using baseline data from 227 cognitively intact nursing home (NH) residents (60 of whom had cancer) in 2004–2005. Data on HRQOL were collected by using the Short Form-36 Health Survey, divided into physical component summary (PCS) and mental component summary (MCS), and symptoms of anxiety and depression were collected by using the Hospital Anxiety and Depression Scale (HADS). ADL were obtained from registered observation and sociodemographic variables, diagnoses, and hospital admissions from the NH records. Personal identification numbers were linked to the record systems of the hospitals, thereby registering all hospital admissions. We analyzed the time elapsing between inclusion and the first hospital admission. Results Residents with higher HRQOL (MCS) had significantly more hospital admissions after adjustment for age, sex, marital status, education, and comorbidity. HRQOL (PCS), ADL, depression, and anxiety symptoms were not associated with hospital admissions. Cancer increased the risk after adjustment for all other risk factors but did not increase the effects of MCS, PCS, ADL, or depression or anxiety symptoms. Having a higher level of education and being less than 75 years of age were associated with hospitalization. The residents diagnosed with cancer had the most days in hospital related to diseases of the respiratory system and cancer, and diseases of the circulatory and respiratory systems were more frequent among the residents without a cancer diagnosis. Conclusion Better self-reported HRQOL (MCS) was associated with hospital admissions, whereas self-reported HRQOL (PCS), ADL

  16. Effects of sudden air pressure changes on hospital admissions for cardiovascular diseases in Prague, 1994-2009

    NASA Astrophysics Data System (ADS)

    Plavcová, Eva; Kyselý, Jan

    2014-08-01

    Sudden weather changes have long been thought to be associated with negative impacts on human health, but relatively few studies have attempted to quantify these relationships. We use large 6-h changes in atmospheric pressure as a proxy for sudden weather changes and evaluate their association with hospital admissions for cardiovascular diseases (CVD). Winter and summer seasons and positive and negative pressure changes are analysed separately, using data for the city of Prague (population 1.2 million) over a 16-year period (1994-2009). We found that sudden pressure drops in winter are associated with significant rise in hospital admissions. Increased CVD morbidity was observed neither for pressure drops in summer nor pressure increases in any season. Analysis of synoptic weather maps shows that large pressure drops in winter are associated with strong zonal flow and rapidly moving low-pressure systems with centres over northern Europe and atmospheric fronts affecting western and central Europe. Analysis of links between passages of strong atmospheric fronts and hospital admissions, however, shows that the links disappear if weather changes are characterised by frontal passages. Sudden pressure drops in winter are associated also with significant excess CVD mortality. As climate models project strengthening of zonal circulation in winter and increased frequency of windstorms, the negative effects of such weather phenomena and their possible changes in a warmer climate of the twenty-first century need to be better understood, particularly as their importance in inducing excess morbidity and mortality in winter may increase compared to cold spells.

  17. Survival to admission after out-of-hospital cardiac arrest in Seoul, South Korea

    PubMed Central

    Kim, Jin-Hue; Uhm, Tai-Hwan

    2014-01-01

    Purpose Out-of-hospital cardiac arrest (OHCA) data derived according to the Utstein Style guidelines was used to try to determine factors influencing survival to admission (STA) and epidemiological rates of OHCA. Patients and methods This was an observational study of all age groups based on data from prehospital care reports in Seoul, South Korea. The collected data were reported according to the Utstein Style template for OHCA and analyzed in order to compare STA with non-STA. Univariate analysis was conducted using a binomial logistic regression model to identify predictors associated with trauma patients. Results Eighty-three (4.8%) OHCA survivors were admitted to the emergency department with carotid pulse. The median time from arrest to emergency medical personnel defibrillation was statistically significantly shorter in STA cases (8.0 minutes) than in non-STA cases (12.0 minutes; P<0.001). Factors independently associated with better prognosis in terms of trauma patients were female sex (odds ratio [OR]: 0.67; 95% confidence interval [95% CI]: 0.50–0.91; P=0.01), arrest at home (OR: 0.36; 95% CI: 0.27–0.49; P<0.001), and witnessed arrest (OR: 2.64; 95% CI: 1.94–3.39; P<0.001). Conclusion Early basic life support, performed by either a layperson or emergency medical personnel, had a positive effect on STA. Male sex, arrest outside of the home, and witnessed arrest are significantly associated with trauma. PMID:27147881

  18. Airborne particles are a risk factor for hospital admissions for heart and lung disease.

    PubMed Central

    Zanobetti, A; Schwartz, J; Dockery, D W

    2000-01-01

    We examined the association between particulate matter [less than/equal to] 10 microm; (PM(10)) and hospital admission for heart and lung disease in ten U.S. cities. Our three goals were to determine whether there was an association, to estimate how the association was distributed across various lags between exposure and response, and to examine socioeconomic factors and copollutants as effect modifiers and confounders. We fit a Poisson regression model in each city to allow for city-specific differences and then combined the city-specific results. We examined potential confounding by a meta-regression of the city-specific results. Using a model that considered simultaneously the effects of PM(10) up to lags of 5 days, we found a 2.5% [95% confidence interval (CI), 1.8-3. 3] increase in chronic obstructive pulmonary disease, a 1.95% (CI, 1. 5-2.4) increase in pneumonia, and a 1.27% increase (CI, 1-1.5) in CVD for a 10 microg/m(3) increase in PM(10). We found similar effect estimates using the mean of PM(10) on the same and previous day, but lower estimates using only PM(10) for a single day. When using only days with PM(10) < 50 mg/m(3), the effect size increased by [greater/equal to] 20% for all three outcomes. These effects are not modified by poverty rates or minority status. The results were stable when controlling for confounding by sulfur dioxide, ozone, and carbon monoxide. These results are consistent with previous epidemiology and recent mechanistic studies in animals and humans. PMID:11102299

  19. Symptom-related emergency department visits and hospital admissions during ambulatory cancer treatment

    PubMed Central

    Siefert, Mary Lou; Blonquist, Traci M; Berry, Donna L; Hong, Fangxin

    2016-01-01

    Background People with cancer experience symptoms related to the disease and treatments. Symptom distress has a negative impact on quality of life (QoL). Attending to symptoms and side effects of treatment promotes safe and effective delivery of therapies and may prevent or reduce emergency department visits (EDVs) and unplanned hospital admissions (HAs). There is limited evidence examining symptom-related EDVs or HAs (sx-EDV/HAs) and interventions in ambulatory oncology patients. Objective To examine factors associated with sx-EDV/HAs in ambulatory oncology patients receiving chemotherapy and/or radiation. Methods This secondary analysis used data from a randomized controlled trial of ambulatory oncology patients (n = 663) who received the web-based Electronic Self-Report Assessment - Cancer intervention (symptom self-monitoring, tailored education, and communication coaching) or usual care with symptom self-monitoring alone. Group differences were described by summary statistics and compared by t test. Factors associated with the odds of at least 1 sx-EDV/HA were modeled using logistic regression. Results 98 patients had a total of 171 sx-EDV/HAs with no difference between groups. Higher odds of at least 1 sx-EDV/HA were associated with socioeconomic and clinical factors. The multivariable model indicated that work status, education level, treatment modality, and on-treatment Symptom Distress Scale-15 scores were significantly associated with having at least 1 sx-EDV/HA. Limitations This is a secondary analysis not sized to determine cause and effect. The results have limited generalizability. Conclusion Most patients did not experience an sx-EDV/HA. Demographic and clinical factors predicted an sx-EDV/HA. Funding National Institute of Nursing Research, National Institutes of Health, R01 NR008726; 2008–2011 PMID:27119127

  20. Air pollution and hospital admissions for ischemic heart disease in persons with congestive heart failure or arrhythmia.

    PubMed Central

    Mann, Jennifer K; Tager, Ira B; Lurmann, Fred; Segal, Mark; Quesenberry, Charles P; Lugg, Marlene M; Shan, Jun; Van Den Eeden, Stephen K

    2002-01-01

    We examined whether ischemic heart disease (IHD) hospital admissions were associated with air pollutants in those with and without secondary diagnoses of arrhythmia (ARR) or congestive heart failure (CHF). We assessed the occurrence of increased vulnerability among persons with these conditions to daily variations in ozone, carbon monoxide, nitrogen dioxide, or particulate matter less than or equal to 10 micro m in aerodynamic diameter (PM10). The study population consisted of members of a large health maintenance organization residing in the South Coast Air Basin of California from 1988 to 1995. After adjustment for day of week, study year, and smoothing splines for day of study, temperature, and relative humidity, CO and NO2 were both associated with admissions with the greatest effects for CO. A 1-ppm increase in 8-hr average CO was associated with a 3.60% [95% confidence interval (CI), 1.62-5.63%] increase in same-day IHD admissions in persons with a secondary diagnosis of CHF, a 2.99% (95% CI, 1.80-4.19%) increase in persons with a secondary diagnosis of ARR, and a 1.62% (95% CI, 0.65-2.59%) increase in IHD admissions in persons without either secondary diagnosis. Air pollution was most strongly associated with myocardial infarction hospital admissions. The vulnerability of the secondary CHF subgroup may be due to a greater prevalence of myocardial infarction primary diagnoses and not the modifying effect of CHF. This study suggests that people with IHD and accompanying CHF and/or ARR constitute a sensitive subgroup in relation to the effects of criteria ambient air pollutants associated with motor vehicle combustion. PMID:12460805

  1. Development and evaluation of a community respiratory physiotherapy service for children with severe neurodisability.

    PubMed

    Wolff, Antonia; Griffin, Hayley; Flanigan, Moira; Everest, Sarah; Thomas, David; Whitehouse, William

    2015-01-01

    Children with severe disability often have difficulties with secretion clearance leading to recurrent lower respiratory tract infections and prolonged hospital admissions. A community respiratory physiotherapy service was developed for this client group, including a rapid response for acute respiratory illness, and an evaluation was undertaken, comparing admissions and bed-days in hospital for respiratory tract infections, emergency admissions to hospital for any cause, and admission costs for each child for the 12 months before to the 12 months with the service. Thirty-four children aged 1 to 19 years (median 5) were eligible for the "before and after" evaluation at 28 months; most had severe cerebral palsy 22 (65%), and there were also eight (23%) children with neurodegenerative and four (12%) with neuromuscular conditions. Admissions for respiratory tract infection fell from 43 to 25 (p<0.05), respiratory admission bed-days fell from 383 to 236 (p<0.01), total non-elective admissions fell from 64 to 40 (p<0.01), with admission cost savings of GBP 78,155 (52%) per annum. This small study suggests that a community respiratory physiotherapy service can reduce hospital admissions and bed days for disabled children. The admissions cost savings have enabled the service to "pay for itself". PMID:26734442

  2. Development and evaluation of a community respiratory physiotherapy service for children with severe neurodisability

    PubMed Central

    Wolff, Antonia; Griffin, Hayley; Flanigan, Moira; Everest, Sarah; Thomas, David; Whitehouse, William

    2015-01-01

    Children with severe disability often have difficulties with secretion clearance leading to recurrent lower respiratory tract infections and prolonged hospital admissions. A community respiratory physiotherapy service was developed for this client group, including a rapid response for acute respiratory illness, and an evaluation was undertaken, comparing admissions and bed-days in hospital for respiratory tract infections, emergency admissions to hospital for any cause, and admission costs for each child for the 12 months before to the 12 months with the service. Thirty-four children aged 1 to 19 years (median 5) were eligible for the “before and after” evaluation at 28 months; most had severe cerebral palsy 22 (65%), and there were also eight (23%) children with neurodegenerative and four (12%) with neuromuscular conditions. Admissions for respiratory tract infection fell from 43 to 25 (p<0.05), respiratory admission bed-days fell from 383 to 236 (p<0.01), total non-elective admissions fell from 64 to 40 (p<0.01), with admission cost savings of GBP 78,155 (52%) per annum. This small study suggests that a community respiratory physiotherapy service can reduce hospital admissions and bed days for disabled children. The admissions cost savings have enabled the service to “pay for itself”. PMID:26734442

  3. Short-term effects of fine particulate air pollution on hospital admissions for cardiovascular diseases: a case-crossover study in a tropical city.

    PubMed

    Chang, Chih-Ching; Chen, Pei-Shih; Yang, Chun-Yuh

    2015-01-01

    This study was undertaken to determine whether there was an association between fine particles (PM2.5) levels and hospital admissions for cardiovascular diseases (CVD) in Kaohsiung, Taiwan. Hospital admissions for CVD (including ischemic heart disease [IHD], stroke, congestive heart failure [CHF], and arrhythmias) and ambient air pollution data for Kaohsiung were obtained for the period from 2006-2010. The relative risk of hospital admissions for CVD was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. For the single-pollutant model (without adjustment for other pollutants), elevated number of admissions for CVD were significantly associated with higher PM2.5 levels only on cool days (<25°C), with an interquartile range rise associated with a 47% (95% CI = 39-56%), 48% (95% CI = 40-56%), 47% (95% CI = 34-61%), and 51% (95% CI = 34-70%) increase in IHD, stroke, CHF, and arrhythmias admissions, respectively. No significant associations between PM2.5 and hospital admissions for CVD were observed on warm days. In the two-pollutant models, PM2.5 levels remained significant even controlling for sulfur dioxide, nitrogen dioxide, carbon monoxide, or ozone on cool days. This study provides evidence that higher levels of PM2.5 enhance the risk of hospital admissions for CVD in Kaohsiung, Taiwan. PMID:25674828

  4. Is Reactive Dengue NS1Antigen Test a Warning Call for Hospital Admissions?

    PubMed Central

    Kamalakannan, Banupriya; Thulasingam, Mahalakshmy; Sampath, Srinivasan

    2016-01-01

    M/IgG MAC ELISA was predominantly positive in convalescent phase sera. There were six deaths (2.3%) and the common causes of poor outcome were multiorgan failure, encephalopathy and refractory shock. Conclusion NS1 Ag assay is a useful early diagnostic marker for dengue fever but cannot be used as an early predictor of severe dengue infection. The criteria for admission in hospitals of cases of dengue fever should be based on clinical warning signs rather than positive NS1 Antigen test. PMID:27190911

  5. Cholesterol as a Mediator of Alcohol-Induced Risks for Respiratory Disease Hospitalizations among People Living With HIV

    PubMed Central

    Míguez, María José; Rosenberg, Rhonda; Burbano, Ximena; Malow, Robert

    2012-01-01

    We analyzed the role of cholesterol as a potential mediator of alcohol-increased risk of respiratory infections that required hospitalization in People Living with HIV (PLWH). Using a longitudinal clinic-based design, 346 PLWH were consecutively admitted and followed at Jackson Memorial Medical Center(enrolled in the study). Following national guidelines, PLWH were stratified according to cholesterol levels: <150 mg/dl (Hypocholesterolemia= HypoCHL), 151-200, and >200 mg/dl Hypercholesterolemia =HyperCHL), and compared on the basis of clinical outcomes, lymphocyte phenotypes and behavioral risks. Analyses indicated that compared to HyperCHL participants, HypoCHL subjects were more likely to be hospitalized, particularly for lower respiratory tract infections (LRTI). Excessive admissions were associated with more deviant lymphocyte profiles, particularly limited NK cells. In logistic regression analyses, smoking (OR=1.5), HypoCHL (OR=7.7), and alcohol (OR=1.2) were predictors of LRTI. These findings warrant further investigation of the potential use of HypoCHL as a risk marker, and the cost-effectiveness of switching prevention gears towards HypoCHL, alcohol and tobacco in PLWH. PMID:23565339

  6. Population Based Trends in the Incidence of Hospital Admission for the Diagnosis of Hepatorenal Syndrome: 1998–2011

    PubMed Central

    Suneja, Manish; Tang, Fan; Cavanaugh, Joseph E.; Polgreen, Linnea A.; Polgreen, Philip M.

    2016-01-01

    Background and Objectives. Hepatorenal syndrome carries a high risk of mortality. Understanding the incidence and mortality trends in hepatorenal syndrome will help inform future studies regarding the safety and efficacy of potential therapeutic interventions. Design and Methods. We conducted a retrospective cohort study using the Nationwide Inpatient Sample. We identified hospitalizations from January 1998–June 2011 with a primary diagnosis of hepatorenal syndrome. To characterize the incidence trends in monthly hepatorenal syndrome hospitalizations, we fit a piecewise linear model with a change point at January 2008. We examined hospital and patient characteristics before and after the change point. Results. Hospital admissions with a diagnosis of hepatorenal syndrome increased markedly between September of 2007 and March of 2008. Comparing patients who were admitted with a diagnosis of hepatorenal syndrome prior to 2008 with those after 2008, we found that length of stay increased while the mortality of patients admitted for hepatorenal syndrome decreased. Conclusion. The revision of the diagnostic criteria for hepatorenal syndrome may have contributed to the increase in the incidence of admissions for hepatorenal syndrome. However, the changes in the principles of hepatorenal syndrome management may have also contributed to the increase in incidence and lower mortality. PMID:27144022

  7. Insurance status and admission to hospital for head injuries: are we part of a two-tiered medical system?

    PubMed

    Svenson, J E; Spurlock, C W

    2001-01-01

    Previous studies have shown an association between insurance status and use of resources for inpatient care. We sought to assess whether insurance status influences decisions regarding the evaluation and treatment of head injured patients in the emergency department (ED). Head injured patients were identified from ED data from 4 hospitals reporting to the Kentucky Emergency Medical Services Information System. Multiple regression analysis using admission, ED length of stay, and ED charges as outcome variables was then performed. From 216,137 ED visits there were 8,591 (4%) head injured patients identified from the database. Eliminating those with revisits, transfers to another hospital in the database, and isolated facial lacerations, there were 3,821 cases. Controlling for age, hospital, race, primary diagnosis, and indicators of severity of the injury, insurance status was significantly associated with hospital admission. Those uninsured were the least likely to be admitted (OR 0.41; 95% CI (0.31, 0.50), whereas those with public insurance had an intermediate probability (OR 0.50 95% CI (0.37, 0.68) as compared with those with private insurance. Similarly, ED charges were lower for Medicaid patients than insured patients ($880) and tended to be slightly lower for uninsured patients ($1,043) than insured patients ($1,141) (P =.001). Length of stay in the ED was shorter for publicly insured patients (179 minutes) than uninsured (186 minutes) and privately insured patients (192 minutes) (P =.001). The extent of evaluation and admission for head injured patients is associated with insurance status. This creates a dual standard of care for patients. Practitioners should work to standardize the evaluation of patients independent of paying status. PMID:11146011

  8. From the emergency department to the general hospital: hospital ownership and market factors in the admission of the seriously mentally ill.

    PubMed

    Shen, Jay J; Cochran, Christopher R; Moseley, Charles B

    2008-01-01

    General hospitals are becoming the safety net provider for the seriously mentally ill (SMI) in the United States, but these patients are faced with a number of potential barriers when accessing these hospitals. Hospital ownership and market forces are two potential organizational and healthcare system barriers that may affect the SMI patient's access, because the psychiatric and medical services they need are unprofitable services. This study examines the relationship among hospital ownership, market forces, and admission of the SMI patient from the emergency department into the general hospital. This was a cross-sectional study of a large sample of SMI patients from the 2002 State Inpatient Datasets for five states. Multiple logistic regression was applied in the multivariable analysis. After controlling for patient, hospital, and county covariates and when compared with not-for-profit hospitals, public hospitals were more likely to admit while investor-owned hospitals were less likely to admit SMI patients. Hospitals in competitive markets were less likely to admit while hospitals with capitation revenues were slightly less likely to admit these patients. Policy options that can address this "market failure" include strengthening the public psychiatric inpatient care system, making private health insurance coverage of the SMI more equitable, revising Medicare prospective payment system to better reimburse the treatment of the SMI, and allowing not-for-profit hospitals to count care of the SMI as a community benefit. Results of this study will be useful to healthcare managers searching for ways to reduce unnecessary administrative costs while continuing to maintain the level of administrative activities required for the provision of safe, effective, and high-quality care. PMID:18720688

  9. Other Respiratory Viruses Are Important Contributors to Adult Respiratory Hospitalizations and Mortality Even During Peak Weeks of the Influenza Season

    PubMed Central

    Gilca, Rodica; Amini, Rachid; Douville-Fradet, Monique; Charest, Hugues; Dubuque, Josée; Boulianne, Nicole; Skowronski, Danuta M.; De Serres, Gaston

    2014-01-01

    Background  During peak weeks of seasonal influenza epidemics, severe respiratory infections without laboratory confirmation are typically attributed to influenza. Methods  In this prospective study, specimens and demographic and clinical data were collected from adults admitted with respiratory symptoms to 4 hospitals during the 8–10 peak weeks of 2 influenza seasons. Specimens were systematically tested for influenza and 13 other respiratory viruses (ORVs) by using the Luminex RVP FAST assay. Results  At least 1 respiratory virus was identified in 46% (21% influenza, 25% noninfluenza; 2% coinfection) of the 286 enrolled patients in 2011–2012 and in 62% (46% influenza, 16% noninfluenza; 3% coinfection) of the 396 enrolled patients in 2012–2013. Among patients aged ≥75 years, twice as many ORVs (32%) as influenza viruses (14%) were detected in 2011–2012. During both seasons, the most frequently detected ORVs were enteroviruses/rhinoviruses (7%), respiratory syncytial virus (6%), human metapneumovirus (5%), coronaviruses (4%), and parainfluenza viruses (2%). Disease severity was similar for influenza and ORVs during both seasons. Conclusions  Although ORV contribution relative to influenza varies by age and season, during the peak weeks of certain influenza seasons, ORVs may be a more frequent cause of elderly hospitalization than influenza. PMID:25734152

  10. Hospital admissions from birth to early adolescence and early-life risk factors: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study

    PubMed Central

    Menezes, Ana M. B.; Noal, Ricardo B.; Cesar, Juraci A.; Hallal, Pedro C.; Araújo, Cora Luiza; Dumith, Samuel C.; Barros, Fernando C.; Victora, Cesar G.

    2013-01-01

    The aim of this prospective analysis was to describe the cumulative incidence of hospital admissions in the first year of life and between 1 and 11 years of age and to explore associated factors. Hospital admissions were collected through regular monitoring in the first year of life, and through maternal report on admissions between 1 and 11 years. Analyses were stratified by sex and adjusted for confounding factors. 18.1% of children were hospitalized in the first year of life, and 30.7% between ages 1 and 11 years. Among boys, hospital admission in the first year was associated with low family income, paternal smoking during pregnancy, preterm delivery, and low birthweight. Among girls, in addition to the variables described for boys, black/mixed skin color was also a risk factor for hospital admission. For admissions between 1 and 11 years of age, low family income and gestational age ≥ 37 weeks were found to be significant risk factors. PMID:20963296

  11. Preparedness for admission of patients with suspected Ebola virus disease in European hospitals: a survey, August-September 2014.

    PubMed

    de Jong, M D; Reusken, C; Horby, P; Koopmans, M; Bonten, M; Chiche, Jd; Giaquinto, C; Welte, T; Leus, F; Schotsman, J; Goossens, H

    2014-01-01

    In response to the Ebola virus disease (EVD) outbreak in West Africa, the World Health Organization has advised all nations to prepare for the detection, investigation and management of confirmed and suspected EVD cases in order to prevent further spread through international travel. To gain insights into the state of preparedness of European hospitals, an electronic survey was circulated in August–September 2014 to 984 medical professionals representing 736 hospitals in 40 countries. The survey addressed the willingness and capacity to admit patients with suspected EVD as well as specific preparedness activities in response to the current Ebola crisis. Evaluable responses were received from representatives of 254 (32%) hospitals in 38 countries, mostly tertiary care centres, of which 46% indicated that they would admit patients with suspected EVD. Patient transfer agreements were in place for the majority of hospitals that would not admit patients. Compared with non-admitting hospitals, admitting hospitals were more frequently engaged in various preparedness activities and more often contained basic infrastructural characteristics such as admission rooms and laboratories considered important for infection control, but some gaps and concerns were also identified. The results of this survey help to provide direction towards further preparedness activities and prioritisation thereof. PMID:25496571

  12. Long-term PM2.5 Exposure and Neurological Hospital Admissions in the Northeastern United States

    PubMed Central

    Kioumourtzoglou, Marianthi-Anna; Schwartz, Joel D.; Weisskopf, Marc G.; Melly, Steven J.; Wang, Yun; Dominici, Francesca; Zanobetti, Antonella

    2015-01-01

    Background Long-term exposure to fine particles (particulate matter ≤ 2.5 μm; PM2.5) has been consistently linked to heart and lung disease. Recently, there has been increased interest in examining the effects of air pollution on the nervous system, with evidence showing potentially harmful effects on neurodegeneration. Objective Our objective was to assess the potential impact of long-term PM2.5 exposure on event time, defined as time to first admission for dementia, Alzheimer’s (AD), or Parkinson’s (PD) diseases in an elderly population across the northeastern United States. Methods We estimated the effects of PM2.5 on first hospital admission for dementia, AD, and PD among all Medicare enrollees ≥ 65 years in 50 northeastern U.S. cities (1999–2010). For each outcome, we first ran a Cox proportional hazards model for each city, adjusting for prior cardiopulmonary-related hospitalizations and year, and stratified by follow-up time, age, sex, and race. We then pooled the city-specific estimates by employing a random effects meta-regression. Results We followed approximately 9.8 million subjects and observed significant associations of long-term PM2.5 city-wide exposure with all three outcomes. Specifically, we estimated a hazard ratio (HR) of 1.08 (95% CI: 1.05, 1.11) for dementia, an HR of 1.15 (95% CI: 1.11, 1.19) for AD, and an HR of 1.08 (95% CI: 1.04, 1.12) for PD admissions per 1-μg/m3 increase in annual PM2.5 concentrations. Conclusions To our knowledge, this is the first study to examine the relationship between long-term exposure to PM2.5 and time to first hospitalization for common neurodegenerative diseases. We found strong evidence of association for all three outcomes. Our findings provide the basis for further studies, as the implications of such exposures could be crucial to public health. Citation Kioumourtzoglou MA, Schwartz JD, Weisskopf MG, Melly SJ, Wang Y, Dominici F, Zanobetti A. 2016. Long-term PM2.5 exposure and neurological

  13. Thirty day hospital re-admissions in patients with non ST-segment elevation acute myocardial infarction

    PubMed Central

    Tisminetzky, Mayra; McManus, David D.; Erskine, Nathaniel; Saczynski, Jane S.; Yarzebski, Jorge; Granillo, Edgard; Gore, Joel; Goldberg, Robert

    2015-01-01

    Background Limited data exist about relatively recent trends in the magnitude and characteristics of patients who are rehospitalized shortly after admission for a non ST-segment elevation acute myocardial infarction (NSTEMI). This observational study describes decade-long trends (1999-2009) in the magnitude and characteristics of patients readmitted to the hospital within 30 days of hospitalization for an incident (initial) episode of NSTEMI. Methods We reviewed the medical records of 2,249 residents of the Worcester (MA) metropolitan area who were hospitalized for an initial NSTEMI in 6 biennial periods between 1999 and 2009 at 3 central MA medical centers. Results The average age of our study population was 72 years, 90% were white, and 46% were women. The proportion of patients who were readmitted to the hospital for any cause within 30 days after discharge for a NSTEMI remained unchanged between 1999 and 2009 (approximately 15%) in both crude and multivariable adjusted analyses. Slight declines were observed for cardiovascular disease-related 30-day readmissions over the ten-year study period. Women, elderly patients, those with multiple chronic comorbidities, a prolonged index hospitalization, and patients who developed heart failure during their index hospitalization were at higher risk for being readmitted within 30-days than respective comparison groups. Conclusions Thirty day hospital readmission rates after hospital discharge for a first NSTEMI remained stable between 1999 and 2009. We identified several groups at higher risk for hospital readmission in whom further surveillance efforts and/or tailored educational and treatment approaches remain needed. PMID:25660250

  14. Impact of respiratory infection in the results of cardiac surgery in a tertiary hospital in Brazil

    PubMed Central

    Andrade, Isaac Newton Guimarães; de Araújo, Diego Torres Aladin; de Moraes, Fernando Ribeiro

    2015-01-01

    Objective To assess the impact of respiratory tract infection in the postoperative period of cardiac surgery in relation to mortality and to identify patients at higher risk of developing this complication. Methods Cross-sectional observational study conducted at the Recovery of Cardiothoracic Surgery, using information from a database consisting of a total of 900 patients operated on in this hospital during the period from 01/07/2008 to 1/07/2009. We included patients whose medical records contained all the information required and undergoing elective surgery, totaling 109 patients with two excluded. Patients were divided into two groups, WITH and WITHOUT respiratory tract infection, as the development or respiratory tract infection in hospital, with patients in the group without respiratory tract infection, the result of randomization, using for the pairing of the groups the type of surgery performed. The outcome variables assessed were mortality, length of hospital stay and length of stay in intensive care unit. The means of quantitative variables were compared using the Wilcoxon and student t-test. Results The groups were similar (average age P=0.17; sex P=0.94; surgery performed P=0.85-1.00) Mortality in the WITH respiratory tract infection group was significantly higher (P<0.0001). The times of hospitalization and intensive care unit were significantly higher in respiratory tract infection (P<0.0001). The presence of respiratory tract infection was associated with the development of other complications such as renal failure dialysis and stroke P<0.00001 and P=0.002 respectively. Conclusion The development of respiratory tract infection postoperative cardiac surgery is related to higher mortality, longer periods of hospitalization and intensive care unit stay. PMID:26313727

  15. A retrospective study of the impact of a telephone alert service (Healthy Outlook) on hospital admissions for patients with chronic obstructive pulmonary disease

    PubMed Central

    Sarran, Christophe; Halpin, David; Levy, Mark L; Prigmore, Samantha; Sachon, Patrick

    2014-01-01

    Background: Healthy Outlook is a service delivered by the UK Met Office directly to patients with chronic obstructive pulmonary disease (COPD) that has been in place since 2006. Its objective is to reduce the severity and length of COPD exacerbations, hence improving the quality of life and life expectancy. Aims: To assess the effect of the Healthy Outlook service on hospital admission rates of all general practitioners that have used the service. Methods: Control practices were selected for each of the 661 participating practices. The number of hospital admissions for each practice was extracted from the Hospital Episode Statistics database. The differences in admission rates per practice between the first year of use of the Healthy Outlook service and the previous year were compared by paired t-test analyses. Results: For admissions with a primary diagnosis of COPD, the difference between participating and control practices was −0.8% (95% confidence interval (CI)=−1.8 to 0.2%; P=0.13). For admissions with a primary or co-morbid diagnosis of COPD, the difference was −2.3% (95% CI=−4.2 to −0.4%; P=0.02). Conclusions: Participation in the Healthy Outlook service reduces hospital admission rates for patients coded on discharge with COPD (including co-morbid). PMID:25340279

  16. Discharged from a mental health admission ward: is it safe to go home? A review on the negative outcomes of psychiatric hospitalization

    PubMed Central

    Loch, Alexandre Andrade

    2014-01-01

    Before psychiatry emerged as a medical discipline, hospitalizing individuals with mental disorders was more of a social stigmatizing act than a therapeutic act. After the birth of the mental health disciplines, psychiatric hospitalization was legitimized and has proven to be indispensable, preventing suicides and helping individuals in need. However, despite more than a century passing since this legitimization occurred, psychiatric hospitalization remains a controversial issue. There is the question of possible negative outcomes after a psychiatric admission ceases to take its protective effect, and even of whether the psychiatric admission itself is related to a negative setback after discharge. This review aims to summarize some of the most important negative outcomes after discharge from a psychiatric institution. These experiences were organized into two groups: those after a brief psychiatric hospitalization, and those after a long-stay admission. The author further suggests possible ways to minimize these adversities, emphasizing the need of awareness related to this important issue. PMID:24812527

  17. Respiratory Syncytial Virus-Associated Hospitalizations in Pre-Mature Infants in Lima, Peru

    PubMed Central

    Ochoa, Theresa J.; Bautista, Rossana; Dávila, Carmen; Salazar, José Antonio; Bazán, Carlos; Guerra, Oscar; Llanos, Jean Pierre; López, Luis; Zea-Vera, Alonso; Ecker, Lucie

    2014-01-01

    We conducted a prospective cohort study in four hospitals in Lima, Peru in infants with a birth weight ≤ 1,500 g followed from birth hospital discharge up to 1 year of age to determine the incidence of respiratory syncytial virus (RSV) hospitalizations. We enrolled 222 infants from March of 2009 to March of 2010: 48 infants with a birth weight < 1,000 g and 174 infants with a birth weight of 1,000–1,500 g (birth weight = 1,197 ± 224 g; gestational age = 30.1 ± 2.6 weeks). There were 936 episodes of respiratory infections; the incidence of respiratory infections during the first 1 year of life was 5.7 episodes/child-years. The incidence of RSV respiratory infections that required emergency room management was 103.9 per 1,000 child-years, and the incidence of RSV hospitalizations was 116.2 per 1,000 child-years (244.9 in infants with a birth weight < 1,000 g and 88.9 in infants 1,000–1,500 g; P < 0.05). The incidence of RSV respiratory infections that required emergency management or hospitalization is high among pre-mature infants in Lima. PMID:25294617

  18. Recorded categories of non-principal diagnoses in Victorian public hospital transient ischaemic attack and stroke admissions.

    PubMed

    Nadathur, Shymala G

    2008-01-01

    Information about the number and types of non-principal diagnoses (NPDs) would make an important contribution to prediction of outcome and hence patient management. The study reported here is based on analysis of three fiscal years of the Victorian public hospital transient ischaemic attack (TIA) and stroke admissions. The incidence of NPDs and co-occurrence of NPD-associated prefix categories (that identify the onset or relevance of each condition to the episode) are described in each of the broad stroke subtypes. The distributions of length of stay and in-hospital deaths in the cohorts without and with NPDs and in the various prefix categories are determined. The study also compares the age and gender distribution in the various subpopulations of interest. The importance of collecting complete and accurate data on nature of NPDs and its potential in describing the complexity of presentation are discussed. PMID:18941264

  19. Quantifying alcohol-related emergency admissions in a UK tertiary referral hospital: a cross-sectional study of chronic alcohol dependency and acute alcohol intoxication

    PubMed Central

    Vardy, J; Keliher, T; Fisher, J; Ritchie, F; Bell, C; Chekroud, M; Clarey, F; Blackwood, L; Barry, L; Paton, E; Clark, A; Connelly, R

    2016-01-01

    Objectives Alcohol is responsible for a proportion of emergency admissions to hospital, with acute alcohol intoxication and chronic alcohol dependency (CAD) implicated. This study aims to quantify the proportion of hospital admissions through our emergency department (ED) which were thought by the admitting doctor to be (largely or partially) a result of alcohol consumption. Setting ED of a UK tertiary referral hospital. Participants All ED admissions occurring over 14 weeks from 1 September to 8 December 2012. Data obtained for 5497 of 5746 admissions (95.67%). Primary outcome measures Proportion of emergency admissions related to alcohol as defined by the admitting ED clinician. Secondary outcome measures Proportion of emergency admissions due to alcohol diagnosed with acute alcohol intoxication or CAD according to ICD-10 criteria. Results 1152 (21.0%, 95% CI 19.9% to 22.0%) of emergency admissions were thought to be due to alcohol. 74.6% of patients admitted due to alcohol had CAD, and significantly greater than the 26.4% with ‘Severe’ or ‘Very Severe’ acute alcohol intoxication (p<0.001). Admissions due to alcohol differed to admissions not due to alcohol being on average younger (45 vs 56 years, p<0.001) more often male (73.4% vs 45.1% males, p<0.001) and more likely to have a diagnosis synonymous with alcohol or related to recreational drug use, pancreatitis, deliberate self-harm, head injury, gastritis, suicidal ideation, upper gastrointestinal bleeds or seizures (p<0.001). An increase in admissions due to alcohol on Saturdays reflects a surge in admissions with acute alcohol intoxication above the weekly average (p=0.003). Conclusions Alcohol was thought to be implicated in 21% of emergency admissions in this cohort. CAD is responsible for a significantly greater proportion of admissions due to alcohol than acute intoxication. Interventions designed to reduce alcohol-related admissions must incorporate measures to tackle CAD. PMID:27324707

  20. Risk Factors for Psychiatric Hospital Admission for Participants in California's Full-Service Partnership Program.

    PubMed

    Penkunas, Michael J; Hahn-Smith, Stephen

    2016-08-01

    This study investigated the demographic and clinical predictors of psychiatric hospitalization during the first 2 years of treatment for adults participating in the full-service partnership (FSP) program, based on Assertive Community Treatment, in a large county in northern California. Clinical and demographic characteristics, data on prior hospitalizations, length of enrollment, and living situation for 328 FSP participants were collected from the county's internal billing system and the California Department of Health Care Services. In univariate models, the probability of hospitalization varied by diagnosis, age, and hospitalization history. In the multivariate model, younger age and frequent hospitalization prior to enrollment predicted hospitalization during enrollment. Findings support prior research on hospital recidivism and may be beneficial in refining future strategies for meeting the needs of adults with serious mental illness. PMID:25527223

  1. Healthcare resource implications of hypoglycemia-related hospital admissions and inpatient hypoglycemia: retrospective record-linked cohort studies in England

    PubMed Central

    McEwan, Philip; Larsen Thorsted, Brian; Wolden, Michael; Jacobsen, Judith; Evans, Marc

    2015-01-01

    Objective Using a retrospective cohort study, the mean length of hospital stay (LoS) and total per-patient expenditure for hypoglycemia requiring admission to hospital were estimated. In a separate matched retrospective cohort study, the effect of inpatient hypoglycemia on LoS, expenditure, and risk of all-cause mortality while admitted was investigated. Methods The cohorts consisted of patients aged ≥18 years with a diagnosis of type 1 or 2 diabetes between January 1, 2002 and October 30, 2012 in the Clinical Practice Research Datalink database, who had initiated insulin treatment and had a recording of hypoglycemia in the same period. In the matched retrospective cohort study, exposed patients (who experienced hypoglycemia in hospital) were case-matched with patients who did not experience hypoglycemia during admission (unexposed). Generalized linear regression was used to estimate LoS. Risk of all-cause mortality was evaluated via logistic regression. Results In the retrospective cohort study (1131 patients), mean LoS was 5.46 (95% CI 4.62 to 6.45) days for type 1 diabetes, and 5.04 (95% CI 4.46 to 5.71) days for type 2 diabetes. Mean cost per admission was £1034 (95% CI £855 to £1253). In the matched retrospective cohort study (1079 pairs of patients), exposed patients had a mean LoS of 11.91 days (95% CI 10.96 to 12.94 days) versus 4.80 (95% CI 4.41 to 5.23) for unexposed patients, p<0.0001. Exposed patients had a higher mortality risk compared with unexposed patients (OR 1.439 (95% CI 1.060to 1.952), p=0.0195). Total average per-patient cost for exposed patients was GBP (£)2235, 40% (p<0.0001) higher than total average admission cost in unexposed patients. Conclusions Hypoglycemia has a significant negative impact on patient outcomes, healthcare resource use, and expenditure. PMID:25815204

  2. Does Admission to Medicine or Orthopaedics Impact a Geriatric Hip Patient’s Hospital Length of Stay?

    PubMed Central

    Greenberg, Sarah E.; VanHouten, Jacob P.; Lakomkin, Nikita; Ehrenfeld, Jesse; Jahangir, Amir Alex; Boyce, Robert H.; Obremksey, William T.; Sethi, Manish K.

    2016-01-01

    Objectives The aim of our study was to determine the association between admitting service, medicine or orthopaedics, and length of stay (LOS) for a geriatric hip fracture patient. Design Retrospective. Setting Urban level 1 trauma center. Patients/Participants Six hundred fourteen geriatric hip fracture patients from 2000 to 2009. Interventions Orthopaedic surgery for geriatric hip fracture. Main Outcome Measurements Patient demographics, medical comorbidities, hospitalization length, and admitting service. Negative binomial regression used to determine association between LOS and admitting service. Results Six hundred fourteen geriatric hip fracture patients were included in the analysis, of whom 49.2% of patients (n = 302) were admitted to the orthopaedic service and 50.8% (3 = 312) to the medicine service. The median LOS for patients admitted to orthopaedics was 4.5 days compared with 7 days for patients admitted to medicine (P < 0.0001). Readmission was also significantly higher for patients admitted to medicine (n = 92, 29.8%) than for those admitted to orthopaedics (n = 70, 23.1%). After controlling for important patient factors, it was determined that medicine patients are expected to stay about 1.5 times (incidence rate ratio: 1.48, P < 0.0001) longer in the hospital than orthopaedic patients. Conclusions This is the largest study to demonstrate that admission to the medicine service compared with the orthopaedic service increases a geriatric hip fractures patient’s expected LOS. Since LOS is a major driver of cost as well as a measure of quality care, it is important to understand the factors that lead to a longer hospital stay to better allocate hospital resources. Based on the results from our institution, orthopaedic surgeons should be aware that admission to medicine might increase a patient’s expected LOS. PMID:26371621

  3. Drinking water quality and hospital admissions of elderly people for gastrointestinal illness in Eastern Massachusetts, 1998-2008.

    PubMed

    Beaudeau, Pascal; Schwartz, Joel; Levin, Ronnie

    2014-04-01

    We used a Poisson regression to compare daily hospital admissions of elderly people for acute gastrointestinal illness in Boston against daily variations in drinking water quality over an 11-year period, controlling for weather, seasonality and time trends. The Massachusetts Water Resources Authority (MWRA), which provides non-filtered water to 1.5 million people in the greater Boston area, changed its disinfection method from chlorination to ozonation during the study period so we were also able to evaluate changes in risk associated with the change in disinfection method. Other available water quality data from the MWRA included turbidity, fecal coliforms, UV-absorbance, and planktonic algae and cyanobacteriae concentrations. Daily weather, rainfall data and water temperature were also available. Low water temperature, increases in turbidity and, to a lesser extent, in fecal coliform and cyanobacteriae were associated with a higher risk of hospital admissions, while the shift from chlorination to ozonation has possibly reduced the health risk. The MWRA complied with US drinking water regulations throughout the study period. PMID:24486855

  4. Reduction in Fatalities, Ambulance Calls, and Hospital Admissions for Road Trauma After Implementation of New Traffic Laws

    PubMed Central

    Chan, Herbert; Brasher, Penelope; Erdelyi, Shannon; Desapriya, Edi; Asbridge, Mark; Purssell, Roy; Macdonald, Scott; Schuurman, Nadine; Pike, Ian

    2014-01-01

    Objectives. We evaluated the public health benefits of traffic laws targeting speeding and drunk drivers (British Columbia, Canada, September 2010). Methods. We studied fatal crashes and ambulance dispatches and hospital admissions for road trauma, using interrupted time series with multiple nonequivalent comparison series. We determined estimates of effect using linear regression models incorporating an autoregressive integrated moving average error term. We used neighboring jurisdictions (Alberta, Saskatchewan, Washington State) as external controls. Results. In the 2 years after implementation of the new laws, significant decreases occurred in fatal crashes (21.0%; 95% confidence interval [CI] = 15.3, 26.4) and in hospital admissions (8.0%; 95% CI = 0.6, 14.9) and ambulance calls (7.2%; 95% CI = 1.1, 13.0) for road trauma. We found a very large reduction in alcohol-related fatal crashes (52.0%; 95% CI = 34.5, 69.5), and the benefits of the new laws are likely primarily the result of a reduction in drinking and driving. Conclusions. These findings suggest that laws calling for immediate sanctions for dangerous drivers can reduce road trauma and should be supported. PMID:25121822

  5. eWasted time: Redundant work during hospital admission and discharge.

    PubMed

    MacMillan, Thomas E; Slessarev, Marat; Etchells, Edward

    2016-03-01

    Potential unintended consequences of health information technology include fragmentation of workflow and redundant work. We could not identify any prior direct observation studies that quantified redundant work related to health information technology in the clinical setting. Our objective was to quantify redundant work during admission and discharge to our general internal medicine service at an academic medical center. We performed a time and motion study at Sunnybrook Health Sciences Centre in Toronto, Canada. We observed 13 clinicians performing an admission or a discharge, and the type and length of each task was recorded using an Apple iPad tablet. We identified redundant tasks related to health information technology and calculated the time spent completing these tasks. We found that 22 percent of clinician time was spent on redundant tasks. Our finding highlights the importance of workflow and software integration when implementing health information technology. PMID:24916568

  6. The Bromhead Care Home Service: the impact of a service for care home residents with dementia on hospital admission and dying in preferred place of care.

    PubMed

    Garden, Gill; Green, Suzanne; Pieniak, Susan; Gladman, John

    2016-04-01

    People with dementia have worse outcomes associated with hospital admission, are more likely to have interventions and are less likely to be offered palliative care than people without dementia. Advance care planning for care home residents has been shown to reduce hospital admissions without increasing mortality. Studies have shown that staff confidence in managing delirium, a common reason for admission, improves with training. A service combining education for care home staff and advance care planning for care home residents with dementia was introduced to care homes in Boston, UK. There were improvements in staff confidence in recognition, prevention, management and knowledge of factors associated with delirium and dysphagia. 92% of carers rated the service >9/10. Admissions fell by 37% from baseline in the first year and 55% in the second and third years. All but one resident died in the preferred place of care. PMID:27037378

  7. Triumph of hope over experience: learning from interventions to reduce avoidable hospital admissions identified through an Academic Health and Social Care Network

    PubMed Central

    2012-01-01

    Background Internationally health services are facing increasing demands due to new and more expensive health technologies and treatments, coupled with the needs of an ageing population. Reducing avoidable use of expensive secondary care services, especially high cost admissions where no procedure is carried out, has become a focus for the commissioners of healthcare. Method We set out to identify, evaluate and share learning about interventions to reduce avoidable hospital admission across a regional Academic Health and Social Care Network (AHSN). We conducted a service evaluation identifying initiatives that had taken place across the AHSN. This comprised a literature review, case studies, and two workshops. Results We identified three types of intervention: pre-hospital; within the emergency department (ED); and post-admission evaluation of appropriateness. Pre-hospital interventions included the use of predictive modelling tools (PARR – Patients at risk of readmission and ACG – Adjusted Clinical Groups) sometimes supported by community matrons or virtual wards. GP-advisers and outreach nurses were employed within the ED. The principal post-hoc interventions were the audit of records in primary care or the application of the Appropriateness Evaluation Protocol (AEP) within the admission ward. Overall there was a shortage of independent evaluation and limited evidence that each intervention had an impact on rates of admission. Conclusions Despite the frequency and cost of emergency admission there has been little independent evaluation of interventions to reduce avoidable admission. Commissioners of healthcare should consider interventions at all stages of the admission pathway, including regular audit, to ensure admission thresholds don’t change. PMID:22682525

  8. Hospital Mental Health Admissions in Women after Unsuccessful Infertility Treatment and In Vitro Fertilization: An Australian Population-Based Cohort Study

    PubMed Central

    Stewart, Louise M.; Holman, C. D’Arcy J.; Semmens, James B.; Preen, David; Mai, Qun; Hart, Roger

    2015-01-01

    Objective To examine the association between in vitro fertilization (IVF) and later admission to hospital with a mental health diagnosis in women who remained childless after infertility treatment. Methods This was a population-based cohort study using linked administrative hospital and registry data. The study population included all women commencing hospital treatment for infertility in Western Australia between the years 1982 and 2002 aged 20–44 years at treatment commencement who did not have a recorded birth by the end of follow-up (15 August 2010) and did not have a hospital mental health admission prior to the first infertility admission (n=6,567). Of these, 2,623 women had IVF and 3,944 did not. We used multivariate Cox regression modeling of mental health admissions and compared women undergoing IVF treatment with women having infertility treatment but not IVF. Results Over an average of 17 years of follow-up, 411 women in the cohort were admitted to hospital with a mental health diagnosis; 93 who had IVF and 318 who did not. The unadjusted hazard ratio (HR) for a hospital mental health admission comparing women who had IVF with those receiving other infertility treatment was 0.50 (95% confidence interval [CI] 0.40–0.63). After adjustment for age, calendar year and socio-economic status the HR was 0.56 (95% CI 0.44–0.71). Conclusions IVF treatment is associated with a reduced risk of hospital mental health admissions in women after unsuccessful infertility treatment. This may be explained by the healthy cohort effect. PMID:25807258

  9. The influence of the winter North Atlantic Oscillation index on hospital admissions through diseases of the circulatory system in Lisbon, Portugal

    NASA Astrophysics Data System (ADS)

    Almendra, Ricardo; Santana, Paula; Vasconcelos, João; Silva, Giovani; Gonçalves, Fábio; Ambrizzi, Tércio

    2016-07-01

    The aim of this paper is to analyze the relationship between North Atlantic Oscillation (NAO), meteorological variables, air pollutants, and hospital admissions due to diseases of circulatory systems in Lisbon (Portugal) during winter months (2003-2012). This paper is one of the few studies analyzing the impact of NAO on health through its influence on thermal stress and air pollution and is the first to be conducted in Lisbon. This study uses meteorological data (synthetized into a thermal comfort index), air pollutant metrics, and the NAO index (all clustered in 10-day cycles to overcome daily variability of the NAO index). The relationship between morbidity, thermal comfort index, NAO index, and air pollutants was explored through several linear models adjusted to seasonality through a periodic function. The possible indirect effect between the NAO index and hospital admissions was tested, assuming that NAO (independent variable) is affecting hospital admissions (outcome variable) through thermal discomfort and/or pollution levels (tested as individual mediators). This test was conducted through causal mediation analysis and adjusted for seasonal variation. The results from this study suggest a possible indirect relationship between NAO index and hospital admissions. Although NAO is not significantly associated with hospital admissions, it is significantly associated with CO, PM2.5, NO, and SO2 levels, which in turn increase the probability of hospitalization. The discomfort index (built with temperature and relative humidity) is significantly associated with hospital admissions, but its variability is not explained by the NAO index. This study highlights the impacts of the atmospheric circulation patterns on health. Furthermore, understanding the influence of the atmospheric circulation patterns can support the improvement of the existing contingency plans.

  10. Heat-related Emergency Hospitalizations for Respiratory Diseases in the Medicare Population

    PubMed Central

    Anderson, G. Brooke; Dominici, Francesca; Wang, Yun; McCormack, Meredith C.; Bell, Michelle L.

    2013-01-01

    Rationale: The heat-related risk of hospitalization for respiratory diseases among the elderly has not been quantified in the United States on a national scale. With climate change predictions of more frequent and more intense heat waves, it is of paramount importance to quantify the health risks related to heat, especially for the most vulnerable. Objectives: To estimate the risk of hospitalization for respiratory diseases associated with outdoor heat in the U.S. elderly. Methods: An observational study of approximately 12.5 million Medicare beneficiaries in 213 United States counties, January 1, 1999 to December 31, 2008. We estimate a national average relative risk of hospitalization for each 10°F (5.6°C) increase in daily outdoor temperature using Bayesian hierarchical models. Measurements and Main Results: We obtained daily county-level rates of Medicare emergency respiratory hospitalizations (International Classification of Diseases, Ninth Revision, 464–466, 480–487, 490–492) in 213 U.S. counties from 1999 through 2008. Overall, each 10°F increase in daily temperature was associated with a 4.3% increase in same-day emergency hospitalizations for respiratory diseases (95% posterior interval, 3.8, 4.8%). Counties’ relative risks were significantly higher in counties with cooler average summer temperatures. Conclusions: We found strong evidence of an association between outdoor heat and respiratory hospitalizations in the largest population of elderly studied to date. Given projections of increasing temperatures from climate change and the increasing global prevalence of chronic pulmonary disease, the relationship between heat and respiratory morbidity is a growing concern. PMID:23491405

  11. Hospital admissions in Alicante (Spain): a comparative analysis of foreign citizens from high-income countries, immigrants from low-income countries, and Spanish citizens

    PubMed Central

    2013-01-01

    Background Over the last decade, the number of foreign citizens (FCs) in Spain has increased. There is no doubt that their health has become a relevant subject from the point of view of public healthcare. Our study aimed to describe hospital admission rates, diagnoses at hospital discharge, and mortality during hospital admissions in FCs from high-income countries (FCHICs), FCs from low-income countries (FCLICs), and autochthonous citizens (ACs). Methods A cross-sectional study was performed at two public hospitals in the city of Alicante (Spain) and its surrounding area. Utilization rates were estimated. Multivariate analysis adjusting for age and sex was performed on hospital admission rates, diagnoses at hospital discharge, service of admission, and mortality during hospital admission in FCHICs and FCLICs compared with ACs (adjusted odds ratio [AOR] with 95% confidence intervals [CI]). Results 42,839 patients ≥15 years were discharged from the hospitals. The utilization rate was lower in FCs than ACs, whose crude rate ratio was 0.676 (95% CI: 0.656-0.696). FCHICs had more risk of being diagnosed at discharge in the categories of the circulatory system (AOR: 1.55; 95% CI: 1.35-1.77), neoplasms (AOR: 1.21; 95% CI: 1.03-1.42), and injury and poisoning (AOR: 1.33; 95% CI: 1.11-1.58). FCLICs had more risk of being diagnosed in the categories of pregnancy, childbirth & puerperium (AOR: 1.33; 95% CI: 1.29-1.59), and injury and poisoning (AOR: 1.19; 95% CI: 1.03-1.36), and less risk in the mental disorder category (AOR: 0.32; 95% CI: 0.22-0.45). The length of hospitalization (in days) was lower in FCLICs (median: 3; IQR: 2–6) than both ACs (median: 4; IQR: 2–8) and FCHICs (median: 4; IQR: 2–8) (p < 0.001). The mortality rates on admission of ACs, FCHICs, and FCLICs were 4.2%, 3.3%, and 1.3%, respectively, but after adjusting for age and sex, the mortality rate risks were similar in FCHICs and FCLICs. Conclusion First, FCs utilized hospitalization less when

  12. Acute Psychiatric Hospital Admissions of Adults and Elderly Adults with Mental Retardation.

    ERIC Educational Resources Information Center

    Pary, Robert J.

    1993-01-01

    Examination of the records of 240 inpatients with mental retardation and 7 with autism discharged from a university hospital indicated that elderly adults had more medical problems than did adults, more elderly adults were transferred to a state hospital, and the most common diagnosis in both adults and elderly adults was chronic schizophrenia,…

  13. The role of intervening hospital admissions on trajectories of disability in the last year of life: prospective cohort study of older people

    PubMed Central

    Gahbauer, Evelyne A; Han, Ling; Allore, Heather G

    2015-01-01

    Objective To evaluate the role of intervening hospital admissions on trajectories of disability in the last year of life. Design Prospective cohort study. Setting Greater New Haven, Connecticut, United States, from March 1998 to June 2013. Participants 552 decedents from a cohort of 754 community living people, aged 70 years or older, who were initially non-disabled in four essential activities of daily living: bathing, dressing, walking, and transferring. Main outcome measure Occurrence of admissions to hospital and severity of disability (range 0-4), ascertained during monthly interviews for more than 15 years. Results In the last year of life, six distinct trajectories of disability were identified, from least disabled to most disabled: 95 participants (17.2%) had no disability, 61 (11.1%) had catastrophic disability, 53 (9.6%) had accelerated disability, 61 (11.1%) had progressively mild disability, 127 (23.0%) had progressively severe disability, and 155 (28.1%) had persistently severe disability. 392 (71.0%) participants had at least one hospital admission and 248 (44.9%) had multiple hospital admissions. For each trajectory the course of disability closely tracked the monthly prevalence of hospital admission. In a set of multivariable models that included several potential confounders, hospital admission in a given month had a strong independent effect on the severity of disability, in both relative and absolute terms. The largest absolute effect was observed for catastrophic disability, with a mean increase in disability score of 1.9 (95% confidence interval 1.5 to 2.4) in the setting of a hospital admission, corresponding to a rate ratio (or relative effect) of 2.0 (95% confidence interval 1.5 to 2.7). Conclusions In the last year of life, acute hospital admissions play an important role in the disabling process. Knowledge about the course of disability before these intervening events may facilitate clinical decision making at the end of life. For older

  14. Circulation of Human Respiratory Syncytial Virus Strains Among Hospitalized Children with Acute Lower Respiratory Infection in Malaysia

    PubMed Central

    Etemadi, Mohammad Reza; Sekawi, Zamberi; Othman, Norlijah; Lye, Munn-Sann; Moghaddam, Faezeh Yazdani

    2013-01-01

    Human respiratory syncytial virus (RSV) is a major viral pathogen associated with acute lower respiratory tract infections (ALRTIs) among hospitalized children. In this study, the genetic diversity of the RSV strains was investigated among nasopharyngeal aspirates (NPA) taken from children less than 5 years of age hospitalized with ALRTIs in Hospital Serdang, Malaysia. A total of 165 NPA samples were tested for the presence of RSV and other respiratory viruses from June until December 2009. RSV was found positive in 83 (50%) of the samples using reverse transcription polymerase chain reaction (RT-PCR). Further classification of 67 RSV strains showed that subgroups A and B comprised 11/67 (16.4%) and 56/67 (83.6%) of the strains, respectively. The second hypervariable region at the carboxyl-terminal of the G gene was amplified and sequenced in order to do phylogenetic study. The phylogenetic relationships of the samples were determined separately for subgroups A and B using neighbor joining (NJ), maximum parsimony (MP), and Bayesian inference (BI). Phylogenetic analysis of the 32 sequenced samples showed that all 9 RSV-A strains were clustered within NA1 genotype while the remaining 23 strains of the RSV-B subgroup could be grouped into a clade consisted of strains with 60-nucleotide duplication region. They were further classified into newly discovered BA10 and BA9 genotypes. The present finding suggests the emergence of RSV genotypes of NA1 and BA. This is the first documentation of the phylogenetic relationship and genetic diversity of RSV strains among hospitalized children diagnosed with ALRTI in Serdang, Malaysia. PMID:23641140

  15. Incidence of Hospitalization for Respiratory Syncytial Virus Infection amongst Children in Ontario, Canada: A Population-Based Study Using Validated Health Administrative Data

    PubMed Central

    Pisesky, Andrea; Benchimol, Eric I.; Wong, Coralie A.; Hui, Charles; Crowe, Megan; Belair, Marc-Andre; Pojsupap, Supichaya; Karnauchow, Tim; O'Hearn, Katie; Yasseen, Abdool S.; McNally, James D.

    2016-01-01

    Importance RSV is a common illness among young children that causes significant morbidity and health care costs. Objective Routinely collected health administrative data can be used to track disease incidence, explore risk factors and conduct health services research. Due to potential for misclassification bias, the accuracy of data-elements should be validated prior to use. The objectives of this study were to validate an algorithm to accurately identify pediatric cases of hospitalized respiratory syncytial virus (RSV) from within Ontario’s health administrative data, estimate annual incidence of hospitalization due to RSV and report the prevalence of major risk factors within hospitalized patients. Study Design and Setting A retrospective chart review was performed to establish a reference-standard cohort of children from the Ottawa region admitted to the Children’s Hospital of Eastern Ontario (CHEO) for RSV-related disease in 2010 and 2011. Chart review data was linked to Ontario’s administrative data and used to evaluate the diagnostic accuracy of algorithms of RSV-related ICD-10 codes within provincial hospitalization and emergency department databases. Age- and sex-standardized incidence was calculated over time, with trends in incidence assessed using Poisson regression. Results From a total of 1411 admissions, chart review identified 327 children hospitalized for laboratory confirmed RSV-related disease. Following linkage to administrative data and restriction to first admissions, there were 289 RSV patients in the reference-standard cohort. The best algorithm, based on hospitalization data, resulted in sensitivity 97.9% (95%CI: 95.5–99.2%), specificity 99.6% (95%CI: 98.2–99.8%), PPV 96.9% (95%CI: 94.2–98.6%), NPV 99.4% (95%CI: 99.4–99.9%). Incidence of hospitalized RSV in Ontario from 2005–2012 was 10.2 per 1000 children under 1 year and 4.8 per 1000 children aged 1 to 3 years. During the surveillance period, there was no identifiable

  16. Reassessing the high proportion of involuntary psychiatric hospital admissions in South Korea.

    PubMed

    Bola, John R; Park, Eon-Ha; Kim, Seong-Yeon

    2011-10-01

    The 2007 WHO-AIMS report on the mental health system of South Korea documented progress towards a national mental health plan, protection of human rights, and growth of community based services. Yet concern was expressed that the high proportion of involuntary to total psychiatric hospitalizations (92%) may indicate an excessively coercive system. Involuntary hospitalization in Korea rose from 117 to 132 (per 100,000) between 2000 and 2006. In 2000, the median rate in the European Union (EU) was 74 per 100,000 (Range: 6-218). While Korea's involuntary hospitalization rate is within the EU range, its proportion of involuntary hospitalizations is three times that of the highest EU country (30%, Sweden). Underdevelopment of voluntary psychiatric services and culturally mandated family referrals resulting in involuntary hospitalization are apparent reasons for the high proportion of involuntary hospitalizations. Population-based rates per 100,000 more accurately describe involuntary hospitalization than the proportion (ratio) measure used in the WHO-AIMS reports. PMID:21416122

  17. Distinguishing the associations between daily mortality and hospital admissions and nitrogen dioxide from those of particulate matter: a systematic review and meta-analysis

    PubMed Central

    Mills, I C; Atkinson, R W; Anderson, H R; Maynard, R L; Strachan, D P

    2016-01-01

    Objectives To quantitatively assess time-series studies of daily nitrogen dioxide (NO2) and mortality and hospital admissions which also controlled for particulate matter (PM) to determine whether or to what extent the NO2 associations are independent of PM. Design A systematic review and meta-analysis. Methods Time-series studies—published in peer-reviewed journals worldwide, up to May 2011—that reported both single-pollutant and two-pollutant model estimates for NO2 and PM were ascertained from bibliographic databases (PubMed, EMBASE and Web of Science) and reviews. Random-effects summary estimates were calculated globally and stratified by different geographical regions, and effect modification was investigated. Outcome measures Mortality and hospital admissions for various cardiovascular or respiratory diseases in different age groups in the general population. Results 60 eligible studies were identified, and meta-analysis was conducted on 23 outcomes. Two-pollutant model study estimates generally showed that the NO2 associations were independent of PM mass. For all-cause mortality, a 10 µg/m3 increase in 24-hour NO2 was associated with a 0.78% (95% CI 0.47% to 1.09%) increase in the risk of death, which reduced to 0.60% (0.33% to 0.87%) after control for PM. Heterogeneity between geographical region-specific estimates was removed by control for PM (I2 from 66.9% to 0%). Estimates of PM and daily mortality assembled from the same studies were greatly attenuated after control for NO2: from 0.51% (0.29% to 0.74%) to 0.18% (−0.11% to 0.47%) per 10 µg/m3 PM10 and 0.74% (0.34% to 1.14%) to 0.54% (−0.25% to 1.34%) for PM2.5. Conclusions The association between short-term exposure to NO2 and adverse health outcomes is largely independent of PM mass. Further studies should attempt to investigate whether this is a generic PM effect or whether it is modified by the source and physicochemical characteristics of PM. This finding strengthens the argument for

  18. Association between Residential Proximity to Fuel-Fired Power Plants and Hospitalization Rate for Respiratory Diseases

    PubMed Central

    Liu, Xiaopeng; Lessner, Lawrence

    2012-01-01

    Background: Air pollution is known to cause respiratory disease. Unlike motor vehicle sources, fuel-fired power plants are stationary. Objective: Using hospitalization data, we examined whether living near a fuel-fired power plant increases the likelihood of hospitalization for respiratory disease. Methods: Rates of hospitalization for asthma, acute respiratory infection (ARI), and chronic obstructive pulmonary disease (COPD) were estimated using hospitalization data for 1993–2008 from New York State in relation to data for residences near fuel-fired power plants. We also explored data for residential proximity to hazardous waste sites. Results: After adjusting for age, sex, race, median household income, and rural/urban residence, there were significant 11%, 15%, and 17% increases in estimated rates of hospitalization for asthma, ARI, and COPD, respectively, among individuals > 10 years of age living in a ZIP code containing a fuel-fired power plant compared with one that had no power plant. Living in a ZIP code with a fuel-fired power plant was not significantly associated with hospitalization for asthma or ARI among children < 10 years of age. Living in a ZIP code with a hazardous waste site was associated with hospitalization for all outcomes in both age groups, and joint effect estimates were approximately additive for living in a ZIP code that contained a fuel-fired power plant and a hazardous waste site. Conclusions: Our results are consistent with the hypothesis that exposure to air pollution from fuel-fired power plants and volatile compounds coming from hazardous waste sites increases the risk of hospitalization for respiratory diseases. PMID:22370087

  19. Predicting admissions and time spent in hospital over a decade in a population-based record linkage study: the EPIC-Norfolk cohort

    PubMed Central

    Hayat, Shabina; Khaw, K T

    2016-01-01

    Objective To quantify hospital use in a general population over 10 years follow-up and to examine related factors in a general population-based cohort. Design A prospective population-based study of men and women. Setting Norfolk, UK. Participants 11 228 men and 13 786 women aged 40–79 years in 1993–1997 followed between 1999 and 2009. Main outcomes measures Number of hospital admissions and total bed days for individuals over a 10-year follow-up period identified using record linkage; five categories for admissions (from zero to highest ≥7) and hospital bed days (from zero to highest ≥20 nights). Results Over a period of 10 years, 18 179 (72.7%) study participants had at least one admission to hospital, 13.8% with 7 or more admissions and 19.9% with 20 or more nights in hospital. In logistic regression models with outcome ≥7 admissions, low education level OR 1.14 (1.05 to 1.24), age OR per 10-year increase 1.75 (1.67 to 1.82), male sex OR 1.32 (1.22 to 1.42), manual social class 1.22 (1.13 to 1.32), current cigarette smoker OR 1.53 (1.37 to 1.71) and body mass index >30 kg/m² OR 1.41 (1.28 to 1.56) all independently predicted the outcome with p<0.0001. Results were similar for those with ≥20 hospital bed days. A risk score constructed using male sex, manual social class, no educational qualifications; current smoker and body mass index >30 kg/m², estimated percentages of the cohort in the categories of admission numbers and hospital bed days in stratified age bands with twofold to threefold differences in future hospital use between those with high-risk and low-risk scores. Conclusions The future probability of cumulative hospital admissions and bed days appears independently related to a range of simple demographic and behavioural indicators. The strongest of these is increasing age with high body mass index and smoking having similar magnitudes for predicting risk of future hospital usage. PMID:26792216

  20. Who is less likely to die in association with improved National Emergency Access Target (NEAT) compliance for emergency admissions in a tertiary referral hospital?

    PubMed

    Sullivan, Clair; Staib, Andrew; Eley, Rob; Griffin, Bronwyn; Cattell, Rohan; Flores, Judy; Scott, Ian

    2016-04-01

    Objective The aim of the present study was to identify patient and non-patient factors associated with reduced mortality among patients admitted from the emergency department (ED) to in-patient wards in a major tertiary hospital that had previously reported a near halving in mortality in association with a doubling in National Emergency Access Target (NEAT) compliance over a 2-year period from 2012 to 2014. Methods We retrospectively analysed routinely collected data from the Emergency Department Information System (EDIS) and hospital discharge abstracts on all emergency admissions during calendar years 2011 (pre-NEAT interventions) and 2013 (post-NEAT interventions). Patients admitted to short-stay wards and then discharged home, as well as patients dying in the ED, were excluded. Patients included in the study were categorised according to age, time and day of arrival to the ED, mode of transport to the ED, emergency triage category, type of clinical presentation and major diagnostic codes. Results The in-patient mortality rate for emergency admissions decreased from 1.9% (320/17022) in 2011 to 1.2% (202/17162) in 2013 (P<0.001). There was no change from 2011 to 2013 in the percentage of deaths in the ED (0.19% vs 0.17%) or those coded as in-patient palliative care (17.9% vs 22.2%). Although deaths were not associated with age by itself, the mortality rate of older patients admitted to medical wards decreased significantly from 3.5% to 1.7% (P=0.011). A higher mortality rate was seen among patients presenting to ED triage between midnight and 12 noon than at other times in 2011 (2.5% vs 1.5%; P<0.001), but this difference disappeared by 2013 (1.3% vs 1.1%; P=0.150). A similar pattern was seen among patients presenting on weekends versus weekdays: 2.2% versus 1.7% (P=0.038) in 2011 and 1.3% versus 1.1% (P=0.150) in 2013. Fewer deaths were noted among patients with acute cardiovascular or respiratory disease in 2013 than in 2011 (1.7% vs 3.6% and 1.5% vs 3

  1. Air Pollution and Acute Myocardial Infarction Hospital Admission in Alberta, Canada: A Three-Step Procedure Case-Crossover Study

    PubMed Central

    Wang, Xiaoming; Kindzierski, Warren; Kaul, Padma

    2015-01-01

    Adverse associations between air pollution and myocardial infarction (MI) are widely reported in medical literature. However, inconsistency and sensitivity of the findings are still big concerns. An exploratory investigation was undertaken to examine associations between air pollutants and risk of acute MI (AMI) hospitalization in Alberta, Canada. A time stratified case-crossover design was used to assess the transient effect of five air pollutants (carbon monoxide (CO), nitrogen dioxide (NO2), nitric oxide (NO), ozone (O3) and particulate matter with an aerodynamic diameter ≤2.5 (PM2.5)) on the risk of AMI hospitalization over the period 1999–2009. Subgroups were predefined to see if any susceptible group of individuals existed. A three-step procedure, including univariate analysis, multivariate analysis, and bootstrap model averaging, was used. The multivariate analysis was used in an effort to address adjustment uncertainty; whereas the bootstrap technique was used as a way to account for regression model uncertainty. There were 25,894 AMI hospital admissions during the 11-year period. Estimating health effects that are properly adjusted for all possible confounding factors and accounting for model uncertainty are important for making interpretations of air pollution–health effect associations. The most robust findings included: (1) only 1-day lag NO2 concentrations (6-, 12- or 24-hour average), but not those of CO, NO, O3 or PM2.5, were associated with an elevated risk of AMI hospitalization; (2) evidence was suggested for an effect of elevated risk of hospitalization for NSTEMI (Non-ST Segment Elevation Myocardial Infarction), but not for STEMI (ST segment elevation myocardial infarction); and (3) susceptible subgroups included elders (age ≥65) and elders with hypertension. As this was only an exploratory study there is a need to replicate these findings with other methodologies and datasets. PMID:26167938

  2. Global Role and Burden of Influenza in Pediatric Respiratory Hospitalizations, 1982–2012: A Systematic Analysis

    PubMed Central

    Lafond, Kathryn E.; Nair, Harish; Rasooly, Mohammad Hafiz; Valente, Fátima; Booy, Robert; Rahman, Mahmudur; Kitsutani, Paul; Yu, Hongjie; Guzman, Guiselle; Coulibaly, Daouda; Armero, Julio; Jima, Daddi; Howie, Stephen R. C.; Ampofo, William; Mena, Ricardo; Chadha, Mandeep; Sampurno, Ondri Dwi; Emukule, Gideon O.; Nurmatov, Zuridin; Corwin, Andrew; Heraud, Jean Michel; Noyola, Daniel E.; Cojocaru, Radu; Nymadawa, Pagbajabyn; Barakat, Amal; Adedeji, Adebayo; von Horoch, Marta; Olveda, Remigio; Nyatanyi, Thierry; Venter, Marietjie; Mmbaga, Vida; Chittaganpitch, Malinee; Nguyen, Tran Hien; Theo, Andros; Whaley, Melissa; Azziz-Baumgartner, Eduardo; Bresee, Joseph; Campbell, Harry; Widdowson, Marc-Alain

    2016-01-01

    Background The global burden of pediatric severe respiratory illness is substantial, and influenza viruses contribute to this burden. Systematic surveillance and testing for influenza among hospitalized children has expanded globally over the past decade. However, only a fraction of the data has been used to estimate influenza burden. In this analysis, we use surveillance data to provide an estimate of influenza-associated hospitalizations among children worldwide. Methods and Findings We aggregated data from a systematic review (n = 108) and surveillance platforms (n = 37) to calculate a pooled estimate of the proportion of samples collected from children hospitalized with respiratory illnesses and positive for influenza by age group (<6 mo, <1 y, <2 y, <5 y, 5–17 y, and <18 y). We applied this proportion to global estimates of acute lower respiratory infection hospitalizations among children aged <1 y and <5 y, to obtain the number and per capita rate of influenza-associated hospitalizations by geographic region and socio-economic status. Influenza was associated with 10% (95% CI 8%–11%) of respiratory hospitalizations in children <18 y worldwide, ranging from 5% (95% CI 3%–7%) among children <6 mo to 16% (95% CI 14%–20%) among children 5–17 y. On average, we estimated that influenza results in approximately 374,000 (95% CI 264,000 to 539,000) hospitalizations in children <1 y—of which 228,000 (95% CI 150,000 to 344,000) occur in children <6 mo—and 870,000 (95% CI 610,000 to 1,237,000) hospitalizations in children <5 y annually. Influenza-associated hospitalization rates were more than three times higher in developing countries than in industrialized countries (150/100,000 children/year versus 48/100,000). However, differences in hospitalization practices between settings are an important limitation in interpreting these findings. Conclusions Influenza is an important contributor to respiratory hospitalizations among young children worldwide

  3. An unusual outbreak of nontuberculous mycobacteria in hospital respiratory wards: Association with nontuberculous mycobacterial colonization of hospital water supply network.

    PubMed

    D'Antonio, Salvatore; Rogliani, Paola; Paone, Gregorino; Altieri, Alfonso; Alma, Mario Giuseppe; Cazzola, Mario; Puxeddu, Ermanno

    2016-06-01

    The incidence and prevalence of pulmonary nontuberculous mycobacterial (NTM) infection is increasing worldwide arousing concerns that NTM infection may become a serious health challenge. We recently observed a significant increase of NTM-positive sputa samples from patients referred to respiratory disease wards of a large tertiary hospital in Rome. A survey to identify possible NTM contamination revealed a massive presence of NTM in the hospital water supply network. After decontamination procedures, NTM presence dropped both in water pipelines and sputa samples. We believe that this observation should encourage water network surveys for NTM contamination and prompt decontamination procedures should be considered to reduce this potential source of infection. PMID:27242241

  4. Factors influencing hospital admissions and emergency department visits among children with complex chronic conditions: a qualitative study of parents' and providers' perspectives.

    PubMed

    Hudson, Shannon M; Newman, Susan D; Hester, William H; Magwood, Gayenell S; Mueller, Martina; Laken, Marilyn A

    2014-03-01

    Children with complex chronic conditions (CCC) have greater health care needs and use rates than children in general. Elevated health care use includes more frequent hospital admissions, longer hospital stays, and greater health care expenses. Prior studies have examined population characteristics associated with increased hospital admissions, emergency department (ED) use, and general healthcare use, yet few studies have investigated these events from the parents' or health care providers' point of view. The purpose of this study was to explore parents/caregivers' and health care providers' perceptions of the factors placing infants and young children with CCC at risk for or protecting them against hospital admissions and ED visits. Parents or primary caregivers participated in interviews, and health care providers in pediatric acute care, pediatric primary care, and emergency care participated in focus groups. Interview and focus group data were analyzed using directed content analysis and an ecological risk and protective factors model. The analysis revealed that parents/caregivers and health care providers described risk factors and protective factors on multiple ecological levels surrounding the child with CCC. This article presents these findings, which add to current knowledge of factors influencing hospital admissions and ED visits and may be used to inform interventions addressing high health care utilization in this population. This article concludes with the implications of the findings for future research and nursing practice. PMID:24423943

  5. Mixed Viral Infections Circulating in Hospitalized Patients with Respiratory Tract Infections in Kuwait

    PubMed Central

    Essa, Sahar; Owayed, Abdullah; Altawalah, Haya; Khadadah, Mousa; Behbehani, Nasser; Al-Nakib, Widad

    2015-01-01

    The aim of this study was to determine the frequency of viral mixed detection in hospitalized patients with respiratory tract infections and to evaluate the correlation between viral mixed detection and clinical severity. Hospitalized patients with respiratory tract infections (RTI) were investigated for 15 respiratory viruses by using sensitive molecular techniques. In total, 850 hospitalized patients aged between 3 days and 80 years were screened from September 2010 to April 2014. Among the 351 (47.8%) patients diagnosed with viral infections, viral mixed detection was identified in 49 patients (14%), with human rhinovirus (HRV) being the most common virus associated with viral mixed detection (7.1%), followed by adenovirus (AdV) (4%) and human coronavirus-OC43 (HCoV-OC43) (3.7%). The highest combination of viral mixed detection was identified with HRV and AdV (2%), followed by HRV and HCoV-OC43 (1.4%). Pneumonia and bronchiolitis were the most frequent reason for hospitalization with viral mixed detection (9.1%). There were statistical significance differences between mixed and single detection in patients diagnosed with bronchiolitis (P = 0.002) and pneumonia (P = 0.019). Our findings might indicate a significant association between respiratory virus mixed detection and the possibility of developing more severe LRTI such as bronchiolitis and pneumonia when compared with single detection. PMID:25983755

  6. Effectiveness of a Surgery Admission Unit for patients undergoing major elective surgery in a tertiary university hospital

    PubMed Central

    2010-01-01

    Background The increasing demand on hospitalisation, either due to elective activity from the waiting lists or due to emergency admissions coming from the Emergency Department (ED), requires looking for strategies that lead to effective bed management. The aim of this study was to evaluate the effectiveness of a surgery admission unit for major elective surgery patients who were admitted for same-day surgery. Methods We included all patients admitted for elective surgery in a university tertiary hospital between the 1st of September and the 31st of December 2006, as well as those admitted during the same period of 2008, after the introduction of the Surgery Admission Unit. The main outcome parameters were global length of stay, pre-surgery length of stay, proportion of patients admitted the same day of the surgery and number of cancellations. Differences between the two periods were evaluated by the T-test and Chi-square test. Significance at P < 0.05 was assumed throughout. Results We included 6,053 patients, 3,003 during 2006 and 3,050 patients during 2008. Global length of stay was 6.2 days (IC 95%:6.4-6) in 2006 and 5.5 days (IC 95%:5.8-5.2) in 2008 (p < 0.005). Pre-surgery length of stay was reduced from 0.46 days (IC 95%:0.44-0.48) in 2006 to 0.29 days (IC 95%:0.27-0.31) in 2008 (p < 0.005). The proportion of patients admitted for same-day surgery was 67% (IC 95%:69%-65%) in 2006 and 76% (IC 95%:78%-74%) in 2008 (p < 0.005). The number of cancelled interventions due to insufficient preparation was 31 patients in 2006 and 7 patients in 2008. Conclusions The implementation of a Surgery Admission Unit for patients undergoing major elective surgery has proved to be an effective strategy for improving bed management. It has enabled an improvement in the proportion of patients admitted on the same day as surgery and a shorter length of stay. PMID:20096114

  7. Expenses related to hospital admissions for the elderly in Brazil: perspectives of a decade

    PubMed Central

    da Silveira, Rodrigo Eurípedes; Santos, Álvaro da Silva; de Sousa, Mariana Campos; Monteiro, Taciana Silva Alves

    2013-01-01

    ABSTRACT Objective: To describe the profile of morbidities and expenses related to hospitalization of the elderly compared to the adult population (20 to 59 years). Methods: A descriptive, cross-sectional investigation of hospitalizations of the elderly (60 years or older) in Brazil during the period from 2002 to 2011, with data from DATASUS and based on ICD-10. Results: Although the highest number of hospitalizations were in the adult age range, the expenses were greater with the elderly, and in this case especially with mental and behavioral disorders, musculoskeletal and connective tissue diseases, followed by circulatory diseases and external causes. Conclusion: The results suggest the adoption of more comprehensive policies and increased investment in health promotion, disease prevention, and appropriate and suitable treatment for the most prevalent diseases in the elderly, particularly in primary care. PMID:24488394

  8. Referral patterns after a seizure admission in an English region: an opportunity for effective intervention? An observational study of routine hospital data

    PubMed Central

    Grainger, Ruth; Pearson, Michael; Dixon, Peter; Devonport, Elizabeth; Timoney, Michelle; Bodger, Keith; Kirkham, Jamie; Marson, Anthony

    2016-01-01

    Objectives To identify emergency seizure admissions to hospital and their subsequent access to specialist outpatient services. Design Algorithmic analysis of anonymised routine hospital data over 7 years using specialist follow-up by 3 months as the target outcome. Population All adults resident in Merseyside and Cheshire, England. Main Outcomes Whether, and when, access to the specialist advice that might prevent further admissions was offered. Results 1.4% of all emergency medical admissions are as a result of seizure. In the following 12 months 35% were readmitted and experienced a mean of 2.3 emergency department visits. Only 27% (48% of those already known to specialists and 13% of those not known) were offered appointments. Subsequent attendance at a specialist clinic is more likely if already known to a clinic, if aged <35 years, if female, or required a longer spell in hospital. Extrapolation from other work suggests 100 000 bed days per annum could be saved. Conclusions Most seizure admissions are not being referred for the help that could prevent future admissions. The majority of those that are referred are not seen within an appropriate time frame. Our service structures are not providing an optimum service for people with epilepsy. PMID:26792220

  9. Re-admissions to hospital and patient satisfaction among patients with chronic obstructive pulmonary disease after telemedicine video consultation - a retrospective pilot study

    PubMed Central

    2014-01-01

    Background Chronic obstructive pulmonary disease (COPD) is a major cause of acute hospital admissions. The main object of our study was to evaluate the effects of telemedicine video-consultation (TVC) on the frequency of hospital re-admissions due to COPD exacerbations. Our secondary aim was to assess the impact of TVC on the length of re-admission stays within 6 and 12 months follow up after TVC. Patient satisfaction was also evaluated. Methods The study was a retrospective observational study of COPD patients who after hospital discharge or during outpatient treatment for acute COPD exacerbations, were monitored for 2 weeks by TVC at home by a specialist nurse at the hospital during a pilot project period. Retrospectively, we compared the frequencies (chi-square test) and durations of hospital re-admissions (paired t-test) due to COPD exacerbations within 6 and 12 months follow up after TVC to comparable events 6 and 12 months prior to TVC. Results Among 99 patients followed for 6 months after TVC, 56 were followed for totally 12 months. The number of patients re-admitted and the number of re-admissions due to COPD exacerbations were not reduced within 6 or 12 months post-TVC, as compared to 6 and 12 months pre-TVC. The mean length of re-admission stays within 12 months post-TVC was markedly reduced as compared to pre-TVC. Patients hospitalised the last 6 and 12 months pre-TVC, had significantly shorter re-admission stays, p = 0.033 and p = 0.001, respectively. Patient satisfaction was high. Conclusion Despite the failure to demonstrate reduced frequency of re-admissions within 6 and 12 months post-TVC, the re-admission length within 12 months post-TVC was markedly reduced as compared to pre-TVC. The patient satisfaction was high. Future prospective, randomised, controlled trials must be performed before TVC can be recommended in COPD management. PMID:24475774

  10. The substantial hospitalization burden of influenza in central China: surveillance for severe, acute respiratory infection, and influenza viruses, 2010–2012

    PubMed Central

    Yu, Hongjie; Huang, Jigui; Huai, Yang; Guan, Xuhua; Klena, John; Liu, Shali; Peng, Youxing; Yang, Hui; Luo, Jun; Zheng, Jiandong; Chen, Maoyi; Peng, Zhibin; Xiang, Nijuan; Huo, Xixiang; Xiao, Lin; Jiang, Hui; Chen, Hui; Zhang, Yuzhi; Xing, Xuesen; Xu, Zhen; Feng, Zijian; Zhan, Faxian; Yang, Weizhong; Uyeki, Timothy M; Wang, Yu; Varma, Jay K

    2014-01-01

    Background Published data on influenza in severe acute respiratory infection (SARI) patients are limited. We conducted SARI surveillance in central China and estimated hospitalization rates of SARI attributable to influenza by viral type/subtype. Methods Surveillance was conducted at four hospitals in Jingzhou, China from 2010 to 2012. We enrolled hospitalized patients who had temperature ≥37·3°C and at least one of: cough, sore throat, tachypnea, difficulty breathing, abnormal breath sounds on auscultation, sputum production, hemoptysis, chest pain, or chest radiograph consistent with pneumonia. A nasopharyngeal swab was collected from each case-patient within 24 hours of admission for influenza testing by real-time reverse transcription PCR. Results Of 17 172 SARI patients enrolled, 90% were aged <15 years. The median duration of hospitalization was 5 days. Of 16 208 (94%) SARI cases tested, 2057 (13%) had confirmed influenza, including 1427 (69%) aged <5 years. Multiple peaks of influenza occurred during summer, winter, and spring months. Influenza was associated with an estimated 115 and 142 SARI hospitalizations per 100 000 during 2010–2011 and 2011–2012 [including A(H3N2): 55 and 44 SARI hospitalizations per 100 000; pandemic A(H1N1): 33 SARI hospitalizations per 100 000 during 2010–2011; influenza B: 26 and 98 hospitalizations per 100 000], with the highest rate among children aged 6–11 months (3603 and 3805 hospitalizations per 100 000 during 2010–2011 and 2011–2012, respectively). Conclusions In central China, influenza A and B caused a substantial number of hospitalizations during multiple periods each year. Our findings strongly suggest that young children should be the highest priority group for annual influenza vaccination in China. PMID:24209711

  11. Diagnoses, problems and healthcare interventions amongst older people with an unscheduled hospital admission who have concurrent mental health problems: a prevalence study

    PubMed Central

    2014-01-01

    Background Frail older people with mental health problems including delirium, dementia and depression are often admitted to general hospitals. However, hospital admission may cause distress, and can be associated with complications. Some commentators suggest that their healthcare needs could be better met elsewhere. Methods We studied consecutive patients aged 70 or older admitted for emergency medical or trauma care to an 1800 bed general hospital which provided sole emergency medical and trauma services for its local population. Patients were screened for mental health problems, and those screening positive were invited to take part. 250 participants were recruited and a sub-sample of 53 patients was assessed by a geriatrician for diagnoses, impairments and disabilities, healthcare interventions and outstanding needs. Results Median age was 86 years, median Mini-Mental State Examination score at admission was 16/30, and 45% had delirium. 19% lived in a care home prior to admission. All the patients were complex. A wide range of main admission diagnoses was recorded, and these were usually complicated by falls, immobility, pain, delirium, dehydration or incontinence. There was a median of six active diagnoses, and eight active problems. One quarter of problems was unexplained. A median of 13 interventions was recorded, and a median of a further four interventions suggested by the geriatrician. Those with more severe cognitive impairment had no less medical need. Conclusions This patient group, admitted to hospital in the United Kingdom, had numerous healthcare problems, and by implication, extensive healthcare needs. Patients with simpler conditions were not identified, but may have already been rapidly discharged or redirected to non-hospital services by the time assessments were made. To meet the needs of this group outside the hospital would need considerable investment in medical, nursing, therapy and diagnostic facilities. In the meantime, acute hospitals

  12. Retrospective evaluation of urological admissions to emergency service of a training and research hospital

    PubMed Central

    Topaktaş, Ramazan; Altın, Selçuk; Aydın, Cemil; Akkoç, Ali; Yılmaz, Yakup

    2014-01-01

    Objective: Many patients consult emergency services with urological complaints. The aim of this study was to investigate the epidemiology, clinical presentation and treatments of urological emergency cases in a training and research hospital. Material and methods: We retrospectively evaluated urological emergency patients referred to the emergency unit between July 2012 and July 2013 according to age, gender, affected organ, radiological imaging techniques and treatment. Results: Among 141.844 emergency cases, 3.113 (2.19%) were urological emergencies and 53.2% of the patients were male (mean age: 49.1), and 46.8% of them were female (median age: 42.8). The most frequent illness was genitourinary infection constituting 41.2% of the cases followed by renal colic (36.9%). Among the urological emergencies 483 (15.5%) patients were hospitalized and 152 surgical operations were performed. The mostly performed procedure was the placement of a suprapubic catheter in 34 patients constituting (22.3%) of the cases. Totally eight patients were referred to another experienced health center due to different reasons. Conclusion: Most of the urological emergency patients do not require emergency surgical interventions however, timely identification and management of urological emergencies with in-depth clinical evaluation are important to prevent late complications. Therefore the doctors working in emergency services must be heedful of urological emergencies. PMID:26328181

  13. Relationships of physiologically equivalent temperature and hospital admissions due to I30-I51 other forms of heart disease in Germany in 2009-2011.

    PubMed

    Shiue, Ivy; Perkins, David R; Bearman, Nick

    2016-04-01

    We aimed to understand relationships of the weather as biometeorological and hospital admissions due to other forms of heart disease by subtypes, which have been paid less attention, in a national setting in recent years. This is an ecological study. Ten percent of daily hospital admissions of the included hospitals (n = 1618) across Germany that were available between 1 January 2009 and 31 December 2011 (n = 5,235,600) were extracted from Statistisches Bundesamt, Germany. We identified I30-I51 other forms of heart disease by the International Classification of Diseases version 10 as the study outcomes. Daily weather data from 64 weather stations that have covered 13 German states, including air temperature, humidity, wind speed, cloud cover, radiation flux and vapour pressure, were obtained and generated into physiologically equivalent temperature (PET). Admissions due to other diseases of pericardium, nonrheumatic mitral valve disorders, nonrheumatic aortic valve disorders, cardiomyopathy, atrioventricular and left bundle-branch block, other conduction disorders, atrial fibrillation and flutter, and other cardiac arrhythmias peaked when PET was between 0 and 10 °C. Complications and ill-defined descriptions of heart disease admissions peaked at PET 0 °C. Cardiac arrest and heart failure admissions peaked when PET was between 0 and -10 °C while the rest did not vary significantly. A common drop of admissions was found when PET was above 10 °C. More medical resources could have been needed for heart health on days when PETs were <10 °C than on other days. Adaptation to such weather change for medical professionals and the general public would seem to be imperative. PMID:26620859

  14. Differences in care between general medicine and respiratory specialists in the management of patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease

    PubMed Central

    Wijayaratne, Kurugamage; Wilson, Jessica; Sivakumaran, Pathmanathan; Sriram, Krishna B.

    2013-01-01

    CONTEXT: Hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) may be managed by either respiratory specialists (RS) or general medicine physicians (GMP). While previous studies have audited the hospital AECOPD management of RS, only a small number of studies have evaluated the management of GMP. AIMS: The aims of this study were to firstly examine the differences in AECOPD management of GMP and RS and secondly compare their care to national COPD guidelines. METHODS: A retrospective review was undertaken of consecutive AECOPD patients admitted to two hospitals (one hospital where all AECOPD patients were managed by RS and another where all AECOPD patients were managed by GMP) over a 3-month period. Electronic medical records, medical case notes, pathology and radiology data for the admission were reviewed. RESULTS: There were 201 COPD exacerbations in 169 patients (49.7% male, mean age 72.3). GMP managed 84 (41.7%) exacerbations. In comparison to RS, GMP performed fewer spirometry tests, blood gas analysis and less frequently treated patients with guideline-recommended medications. Referral to pulmonary rehabilitation was poor for both groups of clinicians. Median length of stay was shorter in GMP patients versus RS patients (3 days vs. 5 days, P = 0.001). There were no differences in the 12-month re-admission (41.7% vs. 38.5%, P = 0.664) and mortality rates (10.7% vs. 6%, P = 0.292) between both groups of patients. CONCLUSION: Our study found differences in the hospital AECOPD management of GMP and RS, but these did not translate into different clinical outcomes between their patients. We also found suboptimal adherence to national COPD guidelines, suggesting that there is scope for improvement in the AECOPD management of both groups of clinicians. PMID:24250732

  15. Patterns of traumatic injury in New York City prisoners requiring hospital admission.

    PubMed

    Henning, Justin; Frangos, Spiros; Simon, Ronald; Pachter, H Leon; Bholat, Omar S

    2015-01-01

    Bellevue Hospital's prison ward cares for male prisoners requiring medical attention that exceeds the capabilities of New York City Department of Correction (NYC-DOC) infirmaries. This study evaluated the injury patterns that occur in this patient population. Data were collected on consecutive prisoners transferred from NYC-DOC for traumatic injuries from June 1, 2003, to June 1, 2006, and analyzed by retrospective chart review. Overall, 251 patients were evaluated for traumatic injuries. Injury mechanisms were violent (75.7%), nonviolent (23.5%), and self-inflicted (0.8%). Of the 241 (96%) patients admitted, 213 (84.9%) required operative intervention. The most common injuries were mandible fractures (46.5%) and facial fractures (14.9%). PMID:25559630

  16. Long-Term Burden and Respiratory Effects of Respiratory Syncytial Virus Hospitalization in Preterm Infants—The SPRING Study

    PubMed Central

    Carbonell-Estrany, Xavier; Pérez-Yarza, Eduardo G.; García, Laura Sanchez; Guzmán Cabañas, Juana M.; Bòria, Elena Villarrubia; Atienza, Belén Bernardo

    2015-01-01

    The health status of premature infants born 321-350 weeks’ gestational age (wGA) hospitalized for RSV infection in the first year of life (cases; n = 125) was compared to that of premature infants not hospitalized for RSV (controls; n = 362) through 6 years. The primary endpoints were the percentage of children with wheezing between 2-6 years and lung function at 6 years of age. Secondary endpoints included quality of life, healthcare resource use, and allergic sensitization. A significantly higher proportion of cases than controls experienced recurrent wheezing through 6 years of age (46.7% vs. 27.4%; p = 0.001). The vast majority of lung function tests appeared normal at 6 years of age in both cohorts. In children with pulmonary function in the lower limit of normality (FEV1 Z-score [-2; -1]), wheezing was increased, particularly for cases vs. controls (72.7% vs. 18.9%, p = 0.002). Multivariate analysis revealed the most important factor for wheezing was RSV hospitalization. Quality of life on the respiratory subscale of the TAPQOL was significantly lower (p = 0.001) and healthcare resource utilization was significantly higher (p<0.001) in cases than controls. This study confirms RSV disease is associated with wheezing in 32-35 wGA infants through 6 years of age. PMID:25955487

  17. Long-Term Burden and Respiratory Effects of Respiratory Syncytial Virus Hospitalization in Preterm Infants-The SPRING Study.

    PubMed

    Carbonell-Estrany, Xavier; Pérez-Yarza, Eduardo G; García, Laura Sanchez; Guzmán Cabañas, Juana M; Bòria, Elena Villarrubia; Atienza, Belén Bernardo

    2015-01-01

    The health status of premature infants born 321-350 weeks' gestational age (wGA) hospitalized for RSV infection in the first year of life (cases; n = 125) was compared to that of premature infants not hospitalized for RSV (controls; n = 362) through 6 years. The primary endpoints were the percentage of children with wheezing between 2-6 years and lung function at 6 years of age. Secondary endpoints included quality of life, healthcare resource use, and allergic sensitization. A significantly higher proportion of cases than controls experienced recurrent wheezing through 6 years of age (46.7% vs. 27.4%; p = 0.001). The vast majority of lung function tests appeared normal at 6 years of age in both cohorts. In children with pulmonary function in the lower limit of normality (FEV1 Z-score [-2; -1]), wheezing was increased, particularly for cases vs. controls (72.7% vs. 18.9%, p = 0.002). Multivariate analysis revealed the most important factor for wheezing was RSV hospitalization. Quality of life on the respiratory subscale of the TAPQOL was significantly lower (p = 0.001) and healthcare resource utilization was significantly higher (p<0.001) in cases than controls. This study confirms RSV disease is associated with wheezing in 32-35 wGA infants through 6 years of age. PMID:25955487

  18. The effect of solar-geomagnetic activity during hospital admission on coronary events within 1 year in patients with acute coronary syndromes

    NASA Astrophysics Data System (ADS)

    Vencloviene, J.; Babarskiene, R.; Milvidaite, I.; Kubilius, R.; Stasionyte, J.

    2013-12-01

    Some evidence indicates the deterioration of the cardiovascular system during space storms. It is plausible that the space weather conditions during and after hospital admission may affect the risk of coronary events in patients with acute coronary syndromes (ACS). We analyzed the data of 1400 ACS patients who were admitted to the Hospital Lithuanian University of Health Sciences, and who survived for more than 4 days. We evaluated the associations between geomagnetic storms (GS), solar proton events (SPE), and solar flares (SF) that occurred 0-3 days before and after hospital admission and the risk of cardiovascular death (CAD), non-fatal ACS, and coronary artery bypass grafting (CABG) during a period of 1 year; the evaluation was based on the multivariate logistic model, controlling for clinical data. After adjustment for clinical variables, GS occurring in conjunction with SF 1 day before admission increased the risk of CAD by over 2.5 times. GS 2 days after SPE occurred 1 day after admission increased the risk of CAD and CABG by over 2.8 times. The risk of CABG increased by over 2 times in patients admitted during the day of GS and 1 day after SPE. The risk of ACS was by over 1.63 times higher for patients admitted 1 day before or after solar flares.

  19. Age, Spatial, and Temporal Variations in Hospital Admissions with Malaria in Kilifi County, Kenya: A 25-Year Longitudinal Observational Study

    PubMed Central

    Mogeni, Polycarp; Williams, Thomas N.; Nyundo, Christopher; Bauni, Evasius; Omedo, Irene; Njuguna, Patricia; Newton, Charles R.; Osier, Faith; Berkley, James A.; Hammitt, Laura L.; Awuondo, Ken; Mturi, Neema; Snow, Robert W.; Noor, Abdisalan; Marsh, Kevin; Bejon, Philip

    2016-01-01

    Background Encouraging progress has been seen with reductions in Plasmodium falciparum malaria transmission in some parts of Africa. Reduced transmission might lead to increasing susceptibility to malaria among older children due to lower acquired immunity, and this has implications for ongoing control strategies. Methods and Findings We conducted a longitudinal observational study of children admitted to Kilifi County Hospital in Kenya and linked it to data on residence and insecticide-treated net (ITN) use. This included data from 69,104 children aged from 3 mo to 13 y admitted to Kilifi County Hospital between 1 January 1990 and 31 December 2014. The variation in malaria slide positivity among admissions was examined in logistic regression models using the following predictors: location of the residence, calendar time, the child’s age, ITN use, and the enhanced vegetation index (a proxy for soil moisture). The proportion of malaria slide-positive admissions declined from 0.56 (95% confidence interval [CI] 0.54–0.58) in 1998 to 0.07 (95% CI 0.06–0.08) in 2009 but then increased again through to 0.24 (95% CI 0.22–0.25) in 2014. Older children accounted for most of the increase after 2009 (0.035 [95% CI 0.030–0.040] among young children compared to 0.22 [95% CI 0.21–0.23] in older children). There was a nonlinear relationship between malaria risk and prevalence of ITN use within a 2 km radius of an admitted child’s residence such that the predicted malaria positive fraction varied from ~0.4 to <0.1 as the prevalence of ITN use varied from 20% to 80%. In this observational analysis, we were unable to determine the cause of the decline in malaria between 1998 and 2009, which pre-dated the dramatic scale-up in ITN distribution and use. Conclusion Following a period of reduced transmission, a cohort of older children emerged who have increased susceptibility to malaria. Further reductions in malaria transmission are needed to mitigate the increasing

  20. Anthropogenic Factors Are the Major Cause of Hospital Admission of a Threatened Species, the Grey-Headed Flying Fox (Pteropus poliocephalus), in Victoria, Australia.

    PubMed

    Scheelings, Titus Franciscus; Frith, Sarah Elizabeth

    2015-01-01

    To determine the reasons for presentation and outcomes of hospitalised grey-headed flying foxes (Pteropus poliocephalus) in Victoria, Australia, a retrospective analysis was performed on 532 records from two wildlife hospitals. Cases were categorised based on presenting signs and outcomes determined. Anthropogenic factors (63.7%) were a major cause of flying fox admissions with entanglement in fruit netting the most significant risk for bats (36.8%). Overall the mortality rate for flying fox admissions was 59.3%. This study highlights the effects of urbanisation on wild animal populations and a need for continued public education in order to reduce morbidity and mortality of wildlife, especially threatened species. PMID:26207984

  1. Anthropogenic Factors Are the Major Cause of Hospital Admission of a Threatened Species, the Grey-Headed Flying Fox (Pteropus poliocephalus), in Victoria, Australia

    PubMed Central

    Scheelings, Titus Franciscus; Frith, Sarah Elizabeth

    2015-01-01

    To determine the reasons for presentation and outcomes of hospitalised grey-headed flying foxes (Pteropus poliocephalus) in Victoria, Australia, a retrospective analysis was performed on 532 records from two wildlife hospitals. Cases were categorised based on presenting signs and outcomes determined. Anthropogenic factors (63.7%) were a major cause of flying fox admissions with entanglement in fruit netting the most significant risk for bats (36.8%). Overall the mortality rate for flying fox admissions was 59.3%. This study highlights the effects of urbanisation on wild animal populations and a need for continued public education in order to reduce morbidity and mortality of wildlife, especially threatened species. PMID:26207984

  2. Hospital-Associated Outbreak of Middle East Respiratory Syndrome Coronavirus: A Serologic, Epidemiologic, and Clinical Description

    PubMed Central

    Al-Abdallat, Mohammad Mousa; Payne, Daniel C.; Alqasrawi, Sultan; Rha, Brian; Tohme, Rania A.; Abedi, Glen R.; Nsour, Mohannad Al; Iblan, Ibrahim; Jarour, Najwa; Farag, Noha H.; Haddadin, Aktham; Al-Sanouri, Tarek; Tamin, Azaibi; Harcourt, Jennifer L.; Kuhar, David T.; Swerdlow, David L.; Erdman, Dean D.; Pallansch, Mark A.; Haynes, Lia M.; Gerber, Susan I.

    2015-01-01

    Background In April 2012, the Jordan Ministry of Health investigated an outbreak of lower respiratory illnesses at a hospital in Jordan; 2 fatal cases were retrospectively confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) to be the first detected cases of Middle East respiratory syndrome (MERS-CoV). Methods Epidemiologic and clinical characteristics of selected potential cases were assessed through serum blood specimens, medical record reviews, and interviews with surviving outbreak members, household contacts, and healthcare personnel. Cases of MERS-CoV infection were identified using 3 US Centers for Disease Control and Prevention serologic tests for detection of anti–MERS-CoV antibodies. Results Specimens and interviews were obtained from 124 subjects. Seven previously unconfirmed individuals tested positive for anti–MERS-CoV antibodies by at least 2 of 3 serologic tests, in addition to 2 fatal cases identified by rRT-PCR. The case-fatality rate among the 9 total cases was 22%. Six subjects were healthcare workers at the outbreak hospital, yielding an attack rate of 10% among potentially exposed outbreak hospital personnel. There was no evidence of MERS-CoV transmission at 2 transfer hospitals having acceptable infection control practices. Conclusions Novel serologic tests allowed for the detection of otherwise unrecognized cases of MERS-CoV infection among contacts in a Jordanian hospital-associated respiratory illness outbreak in April 2012, resulting in a total of 9 test-positive cases. Serologic results suggest that further spread of this outbreak to transfer hospitals did not occur. Most subjects had no major, underlying medical conditions; none were on hemodialysis. Our observed case-fatality rate was lower than has been reported from outbreaks elsewhere. PMID:24829216

  3. Viral Co-Infections in Pediatric Patients Hospitalized with Lower Tract Acute Respiratory Infections

    PubMed Central

    Cebey-López, Miriam; Herberg, Jethro; Pardo-Seco, Jacobo; Gómez-Carballa, Alberto; Martinón-Torres, Nazareth; Salas, Antonio; Martinón-Sánchez, José María; Gormley, Stuart; Sumner, Edward; Fink, Colin; Martinón-Torres, Federico

    2015-01-01

    Background Molecular techniques can often reveal a broader range of pathogens in respiratory infections. We aim to investigate the prevalence and age pattern of viral co-infection in children hospitalized with lower tract acute respiratory infection (LT-ARI), using molecular techniques. Methods A nested polymerase chain reaction approach was used to detect Influenza (A, B), metapneumovirus, respiratory syncytial virus (RSV), parainfluenza (1–4), rhinovirus, adenovirus (A—F), bocavirus and coronaviruses (NL63, 229E, OC43) in respiratory samples of children with acute respiratory infection prospectively admitted to any of the GENDRES network hospitals between 2011–2013. The results were corroborated in an independent cohort collected in the UK. Results A total of 204 and 97 nasopharyngeal samples were collected in the GENDRES and UK cohorts, respectively. In both cohorts, RSV was the most frequent pathogen (52.9% and 36.1% of the cohorts, respectively). Co-infection with multiple viruses was found in 92 samples (45.1%) and 29 samples (29.9%), respectively; this was most frequent in the 12–24 months age group. The most frequently observed co-infection patterns were RSV—Rhinovirus (23 patients, 11.3%, GENDRES cohort) and RSV—bocavirus / bocavirus—influenza (5 patients, 5.2%, UK cohort). Conclusion The presence of more than one virus in pediatric patients admitted to hospital with LT-ARI is very frequent and seems to peak at 12–24 months of age. The clinical significance of these findings is unclear but should warrant further analysis. PMID:26332375

  4. Impact of Market Competition on Continuity of Care and Hospital Admissions for Asthmatic Children: A Longitudinal Analysis of Nationwide Health Insurance Data 2009-2013

    PubMed Central

    Cho, Kyoung Hee; Park, Eun-Cheol; Nam, Young Soon; Lee, Seon-Heui; Nam, Chung Mo; Lee, Sang Gyu

    2016-01-01

    Background Ambulatory care-sensitive conditions, including asthma, can be managed with timely and effective outpatient care, thereby reducing the need for hospitalization. Objective This study assessed the relationship between market competition, continuity of care (COC), and hospital admissions in asthmatic children according to their health care provider. Methods A longitudinal design was employed with a 5-year follow-up period, between 2009 and 2013, under a Korean universal health insurance program. A total of 253 geographical regions were included in the analysis, according to data from the Korean Statistical Office. Data from 9,997 patients, aged ≤ 12 years, were included. We measured the COC over a 5-year period using the Usual Provider Continuity (UPC) index. Random intercept models were calculated to assess the temporal and multilevel relationship between market competition, COC, and hospital admission rate. Results Of the 9,997 patients, 243 (2.4%) were admitted to the hospital in 2009. In the multilevel regression analysis, as the Herfindahl–Hirschman Index increased by 1,000 points (denoting decreased competitiveness), UPC scores also increased (ß = 0.001; p < 0.0001). In multilevel logistic regression analysis, the adjusted odds ratio (OR) for hospital admissions for individuals with lower COC scores (≥ 2 ambulatory visits and a UPC index score of < 1) was 3.61 (95% CI: 2.98–4.38) relative to the reference group (≥ 2 ambulatory visits and a UPC index score of 1). Conclusions Market competition appears to reduce COC; decreased COC was associated with a higher OR for hospital admissions. PMID:26958850

  5. Hospital admissions of hypertension, angina, myocardial infarction and ischemic heart disease peaked at physiologically equivalent temperature 0°C in Germany in 2009-2011.

    PubMed

    Shiue, Ivy; Perkins, David R; Bearman, Nick

    2016-01-01

    We aimed to understand and to provide evidence on relationships of the weather as biometeorological and hospital admissions due to hypertension, angina, myocardial infarction and ischemic heart disease in a national setting in recent years that might help indicate when to expect more admissions for health professionals and the general public. This is an ecological study. Ten percent of daily hospital admissions from the included hospitals (n = 1618) across Germany that were available between 1 January 2009 and 31 December 2011 (n = 5,235,600) were extracted from Statistisches Bundesamt, Germany. We identified I11 hypertensive heart disease, I13 hypertensive heart and renal disease, I15 secondary hypertension, I20 angina pectoris, I21 acute myocardial infarction and I25 chronic ischemic heart disease by International Classification of Diseases version 10 as the study outcomes. Daily weather data from 64 weather stations that covered 13 German States including air temperature, humidity, wind speed, cloud cover, radiation flux and vapour pressure were obtained and generated into physiologically equivalent temperature (PET). Two-way fractional-polynomial prediction was plotted with 95% confidence intervals. Hospital admissions of hypertension, angina, myocardial infarction, heart disease peaked in winter and early spring when PETs were around 0°C. Admissions had an apparent drop when PETs reached 10°C. More medical resources could have been needed on days when PETs were around 0°C than on other days. While adaptation to such weather change for health professionals and the general public would seem to be imperative, future research with a longitudinal monitoring would still be needed. PMID:26286805

  6. Experiences of Alaskan parents with children hospitalized for respiratory syncytial virus treatment.

    PubMed

    Yael Kopacz, Nicole; Predeger, Elizabeth; Kelley, Colleen M

    2013-01-01

    The purpose of this study was to describe the experiences of Alaskan parents with children hospitalized for the treatment of the respiratory syncytial virus (RSV). Six parents participated in a qualitative descriptive study composed of individual interviews. Using content analysis, three major themes emerged: "RSV is scary," "Lots of stress; little rest" and "At what point does it become a Bingo? He's going to the hospital." Findings provided further insight into the educational needs of the participants. Advanced practice registered nurses can translate insights provided by the participants into crucial knowledge needed for the care of families at heightened risk and currently experiencing RSV. PMID:23531460

  7. Antimicrobial treatment of lower respiratory tract infections in the hospital setting.

    PubMed

    Grossman, Ronald F; Rotschafer, John C; Tan, James S

    2005-07-01

    Respiratory tract infections (RTIs) that may require hospitalization include acute exacerbations of chronic bronchitis (AECB), community-acquired pneumonia (CAP), and hospital-acquired pneumonia (HAP), which includes ventilator-associated pneumonia (VAP). Healthcare-associated pneumonia (HCAP) is treated similar to HAP and may be considered with HAP. For CAP requiring hospitalization, the current guidelines for the treatments of RTIs generally recommend either a beta-lactam and macrolide combination or a fluoroquinolone. The respiratory fluoroquinolones (levofloxacin, gatifloxacin, moxifloxacin, and gemifloxacin) are excellent antibiotics due to high levels of susceptibility among gram-negative, gram-positive, and atypical pathogens. The fluoroquinolones are active against > 98% of Streptococcus pneumoniae, including penicillin-resistant strains. Fluoroquinolones are also recommended for AECB requiring hospitalization. Evidence from clinical trials suggests that levofloxacin monotherapy is as efficacious as combination ceftriaxone-erythromycin therapy in the treatment of patients hospitalized with CAP. For early-onset HAP, VAP, and HCAP without the risk of multidrug resistance, ceftriaxone, ampicillin-sulbactam, ertapenem, or one of the fluoroquinolones is recommended. High-dose, short-course therapy regimens may offer improved treatment due to higher drug concentrations, more rapid killing, increased adherence, and the potential to reduce development of resistance. Recent studies have shown that short-course therapy with levofloxacin, azithromycin, or telithromycin in patients with CAP was effective, safe, and tolerable and may control the rate of resistance. PMID:15993675

  8. Smoking status in parents of children hospitalized with a diagnosis of respiratory system disorders.

    PubMed

    Cinar, Nursan; Dede, Cemile; Cevahir, Reyhan; Sevimli, Döndü

    2010-11-01

    The purpose of this study was to investigate the relationship between the statuses of hospitalized children with diagnosis of respiratory tract disease with cigarette use in the parents. This descriptive study was conducted in a Gowerment Hospital in the Sakarya city center in Turkey between June 2007 and June 2008. The inclusion criterion was willingness of families with children hospitalized due to diagnosis of respiratory disease to participate in the study. Data were collected from 345 parents using the questionnaire prepared by researchers. In our study parental smoking was observed in 42.3% of fathers, 7.8% mothers and for 20.9% both parents were smoking. It was found that the hospitalization rates were more than two times higher in children diagnosed with pneumonia and bronchitis and three times higher in children hospitalized for asthma whose parents smoke at home compared to those whose parents are non-smokers. Health care professionals who take care of children need to discuss the harmful effects of smoking and the importance of reducing childhood exposure to secondhand smoke; parents should be educated and encouraged not to smoke. PMID:21108615

  9. Inequality in Diabetes-Related Hospital Admissions in England by Socioeconomic Deprivation and Ethnicity: Facility-Based Cross-Sectional Analysis

    PubMed Central

    Nishino, Yoshitaka; Gilmour, Stuart; Shibuya, Kenji

    2015-01-01

    Objective To investigate the effect of social deprivation and ethnicity on inpatient admissions due to diabetes in England. Design Facility-based cross-sectional analysis. Setting National Health Service (NHS) trusts in England reporting inpatient admissions with better than 80% data reporting quality from 2010–2011 (355 facilities). Participants Non-obstetric patients over 16 years old in all NHS facilities in England. The sample size after exclusions was 5,147,859 all-cause admissions. Main Outcome Measures The relative risk of inpatient admissions and readmissions due to diabetes adjusted for confounders. Results There were 445,504 diabetes-related hospital admissions in England in 2010, giving a directly (age-sex) standardized rate of 1049.0 per 100,000 population (95% confidence interval (CI): 1046.0–1052.1). The relative risk of inpatient admission in the most deprived quintile was 2.08 times higher than that of the least deprived quintile (95% CI: 2.02–2.14), and the effect of deprivation varied across ethnicities. About 30.1% of patients admitted due to diabetes were readmitted at least once due to diabetes. South Asians showed 2.62 times (95% CI: 2.51 – 2.74) higher admission risk. Readmission risk increased with IMD among white British but not other ethnicities. South Asians showed slightly lower risk of readmission than white British (0.86, 95% CI: 0.80 – 0.94). Conclusions More deprived areas had higher rates of inpatient admissions and readmissions due to diabetes. South Asian British showed higher admission risk and lower readmission risk than white British. However, there was almost no difference by ethnicity in readmission due to diabetes. Higher rates of admission among deprived people may not necessarily reflect higher prevalence, but higher admission rates in south Asian British may be explained by their higher prevalence because their lower readmission risk suggests no inequality in primary care to prevent readmission. Better

  10. Characteristics of admissions and variations in the use of basic investigations, treatments and outcomes in Kenyan hospitals within a new Clinical Information Network

    PubMed Central

    Ayieko, Philip; Ogero, Morris; Makone, Boniface; Julius, Thomas; Mbevi, George; Nyachiro, Wycliffe; Nyamai, Rachel; Were, Fred; Githanga, David; Irimu, Grace; English, Mike

    2016-01-01

    Background Lack of detailed information about hospital activities, processes and outcomes hampers planning, performance monitoring and improvement in low-income countries (LIC). Clinical networks offer one means to advance methods for data collection and use, informing wider health system development in time, but are rare in LIC. We report baseline data from a new Clinical Information Network (CIN) in Kenya seeking to promote data-informed improvement and learning. Methods Data from 13 hospitals engaged in the Kenyan CIN between April 2014 and March 2015 were captured from medical and laboratory records. We use these data to characterise clinical care and outcomes of hospital admission. Results Data were available for a total of 30 042 children aged between 2 months and 15 years. Malaria (in five hospitals), pneumonia and diarrhoea/dehydration (all hospitals) accounted for the majority of diagnoses and comorbidity was found in 17 710 (59%) patients. Overall, 1808 deaths (6%) occurred (range per hospital 2.5%–11.1%) with 1037 deaths (57.4%) occurring by day 2 of admission (range 41%–67.8%). While malaria investigations are commonly done, clinical health workers rarely investigate for other possible causes of fever, test for blood glucose in severe illness or ascertain HIV status of admissions. Adherence to clinical guideline-recommended treatment for malaria, pneumonia, meningitis and acute severe malnutrition varied widely across hospitals. Conclusion Developing clinical networks is feasible with appropriate support. Early data demonstrate that hospital mortality remains high in Kenya, that resources to investigate severe illness are limited, that care provided and outcomes vary widely and that adoption of effective interventions remains slow. Findings suggest considerable scope for improving care within and across sites. PMID:26662925

  11. Re-evaluating the need for hospital admission and observation of pediatric traumatic brain injury after a normal head CT.

    PubMed

    Plackett, Timothy P; Asturias, Sabrina; Tadlock, Matthew; Wright, Franklin; Ton-That, Hieu; Demetriades, Demetrios; Esposito, Thomas; Inaba, Kenji

    2015-10-01

    There is no consensus on the optimal management of pediatric patients with suspected trauma brain injury and a normal head CT. This study characterizes the clinical outcomes of patients with a normal initial CT scan of the head. A retrospective chart review of pediatric blunt trauma patients who underwent head CT for closed head injury at two trauma centers was performed. Charts were reviewed for demographics, neurologic function, CT findings, and complications. 631 blunt pediatric trauma patients underwent a head CT. 63% had a negative CT, 7% had a non-displaced skull fracture, and 31% had an intracranial hemorrhage and/or displaced skull fracture. For patients without intracranial injury, the mean age was 8 years, mean ISS was 5, and 92% had a GCS of 13-15 on arrival. All patients with an initial GCS of 13-15 and no intracranial injury were eventually discharged to home with a normal neurologic exam and no patient required craniotomy. Not admitting those children with an initial GCS of 13-15, normal CT scan, and no other injuries would have saved 1.8 ± 1.5 hospital days per patient. Pediatric patients who have sustained head trauma, have a negative CT scan, and present with a GCS 13-15 can safely be discharged home without admission. PMID:25957025

  12. Prevalence of deep vein thrombosis (DVT) in non-surgical patients at hospital admission.

    PubMed

    Lawall, Holger; Hoffmanns, Wibke; Hoffmanns, Phillip; Rapp, Uli; Ames, Michael; Pira, Alessandro; Paar, W Dieter; Bramlage, Peter; Diehm, Curt

    2007-10-01

    Venous thromboembolism (VTE) is known as a common complication in surgical and non-surgical patients. We hypothesized that according to the underlying risk factors and the acute illness, the prevalence ofVTE in non-surgical patients admitted to hospital is widely underestimated. For three months each patient admitted to the department of internal medicine with an acute illness, but without known deep venous thrombosis (DVT) was investigated by ultrasound compression sonography. Patients' history, risk factors and extent of immobilisation were documented. In patients with newly detected DVT D-dimer and fibrinogen were measured as well as computer tomography scans performed. Follow-up investigations of the DVT population were performed at four weeks and three months. Six hundred seventeen patients (49.3% men) were included. In 16 patients (men = 7) a previously unknown thrombosis (2.6%) was detected, mainly in patients with acute cardio-pulmonary disease (56%) and the elderly (mean age 75.6 years). Eight patients had femoro-popliteal (50.0%), four a femoral (25.0%), and four a popliteal vein thrombosis (25.0%). Five had pulmonary embolism (31.3%). In patients with DVT D-dimer was 875 +/- 1,228 mg/l, fibrinogen 568 +/- 215 mg/dl and C-reactive-protein 58.54 +/- 73.65 mg/dl. One patient died from sepsis during hospitalisation, one died from sudden cardiac death at home. None of the other 14 surviving patients relapsed. The study shows a 2.6% risk for DVT in outpatients with acute illness admitted to the department of internal medicine. These data demonstrate the high risk of DVT is in non-surgical patients. Early prophylaxis has to be considered in internal medicine patients especially in the elderly. PMID:17938799

  13. Asthma and Respiratory Related Emergency Room Visits Associated with a Wildfire in Eastern North Carolina in the Summer of 2008

    EPA Science Inventory

    Rationale: Epidemiological studies have shown associations between the incidence of increased emergency room admissions, hospital and outpatient clinic visits for respiratory causes with the exposures to wood stove, wildfires, and other forms of organic mass burning. In June 2008...

  14. Demographic and socioeconomic inequalities in the risk of emergency hospital admission for violence: cross-sectional analysis of a national database in Wales

    PubMed Central

    Fone, David; Gartner, Andrea; Bellis, Mark A

    2016-01-01

    Objectives To investigate the risk of emergency hospital admissions for violence (EHAV) associated with demographic and socioeconomic factors in Wales between 2007/2008 and 2013/2014, and to describe the site of injury causing admission. Design Database analysis of 7 years’ hospital admissions using the Patient Episode Database for Wales (PEDW). Setting and participants Wales, UK, successive annual populations ∼2.8 million aged 0–74 years. Primary outcome The first emergency admission for violence in each year of the study, defined by the International Classification of Diseases V.10 (ICD-10) codes for assaults (X85-X99, Y00-Y09) in any coding position. Results A total of 11 033 admissions for assault. The majority of admissions resulted from head injuries. The overall crude admission rate declined over the study period, from 69.9 per 100 000 to 43.2 per 100 000, with the largest decrease in the most deprived quintile of deprivation. A generalised linear count model with a negative binomial log link, adjusted for year, age group, gender, deprivation quintile and settlement type, showed the relative risk was highest in age group 18–19 years (RR=6.75, 95% CI 5.88 to 7.75) compared with the reference category aged 10–14 years. The risk decreased with age after 25 years. Risk of admission was substantially higher in males (RR=4.55, 95% CI 4.31 to 4.81), for residents of the most deprived areas of Wales (RR=3.60, 95% CI 3.32 to 3.90) compared with the least deprived, and higher in cities (RR=1.37, 95% CI 1.27 to 1.49) and towns (RR=1.32, 95% CI 1.21 to 1.45) compared with villages. Conclusions Despite identifying a narrowing in the gap between prevalence of violence in richer and poorer communities, violence remains strongly associated with young men living in areas of socioeconomic deprivation. There is potential for a greater reduction, given that violence is mostly preventable. Recommendations for reducing inequalities in the risk of

  15. Acute lower respiratory infections in ≥5 year -old hospitalized patients in Cambodia, a low-income tropical country: clinical characteristics and pathogenic etiology

    PubMed Central

    2013-01-01

    Background Few data exist on viral and bacterial etiology of acute lower respiratory infections (ALRI) in ≥5 year –old persons in the tropics. Methods We conducted active surveillance of community-acquired ALRI in two hospitals in Cambodia, a low-income tropical country. Patients were tested for acid-fast bacilli (AFB) by direct sputum examination, other bacteria by blood and/or sputum cultures, and respiratory viruses using molecular techniques on nasopharyngeal/throat swabs. Pulmonologists reviewed clinical/laboratory data and interpreted chest X-rays (CXR) to confirm ALRI. Results Between April 2007 - December 2009, 1,904 patients aged ≥5 years were admitted with acute pneumonia (50.4%), lung sequelae-associated ALRI (24.3%), isolated pleural effusions (8.9%) or normal CXR-related ALRI (17.1%); 61 (3.2%) died during hospitalization. The two former diagnoses were predominantly due to bacterial etiologies while viral detection was more frequent in the two latter diagnoses. AFB-positive accounted for 25.6% of acute pneumonia. Of the positive cultures (16.8%), abscess-prone Gram-negative bacteria (39.6%) and Haemophilus influenzae (38.0%) were most frequent, followed by Streptococcus pneumoniae (17.7%). Of the identified viruses, the three most common viruses included rhinoviruses (49.5%), respiratory syncytial virus (17.7%) and influenza viruses (12.1%) regardless of the diagnostic groups. Wheezing was associated with viral identification (31.9% vs. 13.8%, p < 0.001) independent of age and time-to-admission. Conclusions High frequency of H. influenzae and S. pneumoniae infections support the need for introduction of the respective vaccines in the national immunization program. Tuberculosis was frequent in patients with acute pneumonia, requiring further investigation. The relationship between respiratory viruses and wheezing merits further studies. PMID:23432906

  16. Association between Highly Active Antiretroviral Therapy and Type of Infectious Respiratory Disease and All-Cause In-Hospital Mortality in Patients with HIV/AIDS: A Case Series

    PubMed Central

    Báez-Saldaña, Renata; Villafuerte-García, Adriana; Cruz-Hervert, Pablo; Delgado-Sánchez, Guadalupe; Ferreyra-Reyes, Leticia; Ferreira-Guerrero, Elizabeth; Mongua-Rodríguez, Norma; Montero-Campos, Rogelio; Melchor-Romero, Ada; García-García, Lourdes

    2015-01-01

    Background Respiratory manifestations of HIV disease differ globally due to differences in current availability of effective highly active antiretroviral therapy (HAART) programs and epidemiology of infectious diseases. Objective To describe the association between HAART and discharge diagnosis and all-cause in-hospital mortality among hospitalized patients with infectious respiratory disease and HIV/AIDS. Material and Methods We retrospectively reviewed the records of patients hospitalized at a specialty hospital for respiratory diseases in Mexico City between January 1st, 2010 and December 31st, 2011. We included patients whose discharge diagnosis included HIV or AIDS and at least one infectious respiratory diagnosis. The information source was the clinical chart. We analyzed the association between HAART for 180 days or more and type of respiratory disease using polytomous logistic regression and all-cause hospital mortality by multiple logistic regressions. Results We studied 308 patients, of whom 206 (66.9%) had been diagnosed with HIV infection before admission to the hospital. The CD4+ lymphocyte median count was 68 cells/mm3 [interquartile range (IQR): 30–150]. Seventy-five (24.4%) cases had received HAART for more than 180 days. Pneumocystis jirovecii pneumonia (PJP) (n = 142), tuberculosis (n = 63), and bacterial community-acquired pneumonia (n = 60) were the most frequent discharge diagnoses. Receiving HAART for more than 180 days was associated with a lower probability of PJP [Adjusted odd ratio (aOR): 0.245, 95% Confidence Interval (CI): 0.08–0.8, p = 0.02], adjusted for sociodemographic and clinical covariates. HAART was independently associated with reduced odds (aOR 0.214, 95% CI 0.06–0.75) of all-cause in-hospital mortality, adjusting for HIV diagnosis previous to hospitalization, age, access to social security, low socioeconomic level, CD4 cell count, viral load, and discharge diagnoses. Conclusions HAART for 180 days or more was associated

  17. Why are some patients admitted to psychiatric hospital while others are not? A study assessing risk during the admission interview and relationship to outcome.

    PubMed

    Hunt, Glenn E; O'Hara-Aarons, Maureen; O'Connor, Nick; Cleary, Michelle

    2012-04-01

    The aim of this study was to determine what patient characteristics are used to decide whether a patient is or is not admitted to a psychiatric hospital, and what happens to those not admitted. A further aim was to determine if high levels of risk on admission predict seclusions, length of stay, or readmission within 28 days. Data were collected prospectively on consecutive presentations to an admission office via case notes and electronic databases. Eighty percent (100/127) of the adults presenting to the admission office over a typical month were admitted to hospital. Patients were more likely to be admitted if they were experiencing psychosis or exacerbation of schizophrenia, referred by other doctors or mental health teams, had a legal reason for referral, or if they were homeless. There was no association between risk for violence or suicide and seclusion rates, length of stay, or being readmitted within 28 days. It was reassuring to find that 85% of those not admitted were referred to other mental health providers, and none required admission over the following month. This study found high rates of seclusion and readmissions within 1 year, which requires further study to find strategies to reduce these rates. PMID:22039923

  18. Association between Atmospheric Fine Particulate Matter and Hospital Admissions for Chronic Obstructive Pulmonary Disease in Southwestern Taiwan: A Population-Based Study

    PubMed Central

    Hwang, Su-Lun; Guo, Su-Er; Chi, Miao-Ching; Chou, Chiang-Ting; Lin, Yu-Ching; Lin, Chieh-Mo; Chou, Yen-Li

    2016-01-01

    Objectives: This paper reports on the findings of a population-based study to evaluate the relationship between atmospheric fine particulate matter (PM2.5) levels and hospital admissions for chronic obstructive pulmonary disease (COPD) in southwestern Taiwan over a three-year period, 2008–2010. Methods: Data on hospital admissions for COPD and PM2.5 levels were obtained from the National Health Insurance Research database (NHIRD) and the Environmental Protection Administration from 2008 to 2010, respectively. The lag structure of relative risks (RRs) of hospital admissions for COPD was estimated using a Poisson regression model. Results: During the study period, the overall average hospitalization rate of COPD and mean 24-h average level of PM2.5 was 0.18% and 39.37 μg/m3, respectively. There were seasonal variations in PM2.5 concentrations in southwestern Taiwan, with higher PM2.5 concentrations in both spring (average: 48.54 μg/m3) and winter (49.96 μg/m3) than in summer (25.89 μg/m3) and autumn (33.37 μg/m3). Increased COPD admissions were significantly associated with PM2.5 in both spring (February–April) and winter (October–January), with the relative risks (RRs) for every 10 μg/m3 increase in PM2.5 being 1.25 (95% CI = 1.22–1.27) and 1.24 (95% CI = 1.23–1.26), respectively, at a lag zero days (i.e., no lag days). Lag effects on COPD admissions were observed for PM2.5, with the elevated RRs beginning at lag zero days and larger RRs estimates tending to occur at longer lags (up to six days, i.e., lag 0–5 days). Conclusions: In general, findings reveal an association between atmospheric fine particulate matter (PM2.5) and hospital admissions for COPD in southwestern Taiwan, especially during both spring and winter seasons. PMID:27023589

  19. Outbreak of Middle East Respiratory Syndrome at Tertiary Care Hospital, Jeddah, Saudi Arabia, 2014

    PubMed Central

    Hastings, Deborah L.; Tokars, Jerome I.; Abdel Aziz, Inas Zakaria A.M.; Alkhaldi, Khulud Z.; Bensadek, Areej T.; Alraddadi, Basem M.; Jokhdar, Hani; Jernigan, John A.; Garout, Mohammed A.; Tomczyk, Sara M.; Oboho, Ikwo K.; Geller, Andrew I.; Arinaminpathy, Nimalan; Swerdlow, David L.

    2016-01-01

    During March–May 2014, a Middle East respiratory syndrome (MERS) outbreak occurred in Jeddah, Saudi Arabia, that included many persons who worked or received medical treatment at King Fahd General Hospital. We investigated 78 persons who had laboratory-confirmed MERS during March 2–May 10 and documented contact at this hospital. The 78 persons with MERS comprised 53 patients, 16 healthcare workers, and 9 visitors. Among the 53 patients, the most probable sites of acquisition were the emergency department (22 patients), inpatient areas (17), dialysis unit (11), and outpatient areas (3). Infection control deficiencies included limited separation of suspected MERS patients, patient crowding, and inconsistent use of infection control precautions; aggressive improvements in these deficiencies preceded a decline in cases. MERS coronavirus transmission probably was multifocal, occurring in multiple hospital settings. Continued vigilance and strict application of infection control precautions are necessary to prevent future MERS outbreaks. PMID:27089550

  20. Short-term Effect of Fine Particulate Matter on Children’s Hospital Admissions and Emergency Department Visits for Asthma: A Systematic Review and Meta-analysis

    PubMed Central

    Choi, Won-Jun

    2016-01-01

    Objectives: No children-specified review and meta-analysis paper about the short-term effect of fine particulate matter (PM2.5) on hospital admissions and emergency department visits for asthma has been published. We calculated more precise pooled effect estimates on this topic and evaluated the variation in effect size according to the differences in study characteristics not considered in previous studies. Methods: Two authors each independently searched PubMed and EMBASE for relevant studies in March, 2016. We conducted random effect meta-analyses and mixed-effect meta-regression analyses using retrieved summary effect estimates and 95% confidence intervals (CIs) and some characteristics of selected studies. The Egger’s test and funnel plot were used to check publication bias. All analyses were done using R version 3.1.3. Results: We ultimately retrieved 26 time-series and case-crossover design studies about the short-term effect of PM2.5 on children’s hospital admissions and emergency department visits for asthma. In the primary meta-analysis, children’s hospital admissions and emergency department visits for asthma were positively associated with a short-term 10 μg/m3 increase in PM2.5 (relative risk, 1.048; 95% CI, 1.028 to 1.067; I2=95.7%). We also found different effect coefficients by region; the value in Asia was estimated to be lower than in North America or Europe. Conclusions: We strengthened the evidence on the short-term effect of PM2.5 on children’s hospital admissions and emergency department visits for asthma. Further studies from other regions outside North America and Europe regions are needed for more generalizable evidence. PMID:27499163

  1. Hospital admissions due to diseases of arteries and veins peaked at physiological equivalent temperature -10 to 10 °C in Germany in 2009-2011.

    PubMed

    Shiue, Ivy; Perkins, David R; Bearman, Nick

    2016-04-01

    We aimed to understand relationships of the weather as biometeorological and hospital admissions due to diseases of arteries and veins by subtypes, which have been scarcely studied, in a national setting in recent years. This is an ecological study. Ten percent of daily hospital admissions from the included hospitals (n = 1,618) across Germany that were available between 1 January 2009 and 31 December 2011 (n = 5,235,600) were extracted from Statistisches Bundesamt, Germany. We identified I70-I79 Diseases of arteries, arterioles and capillaries and I80-I89 Diseases of veins, lymphatic vessels and lymph nodes by International Classification of Diseases version 10 as the study outcomes. Daily weather data from 64 weather stations that covered 13 German states including air temperature, humidity, wind speed, cloud cover, radiation flux and vapour pressure were obtained and generated into physiologically equivalent temperature (PET). Two-way fractional-polynomial prediction was plotted with 95 % confidence intervals. For most of the subtypes from diseases of arteries and veins, hospital admissions slightly peaked in spring and dropped when PET was at 10 °C. There were no other large differences across 12 months. Admissions of peripheral vascular diseases, arterial embolism and thrombosis, phlebitis and thrombophlebitis, oesophageal varices and nonspecific lymphadenitis peaked when PET was between 0 and -10 °C, while others peaked when PET was between 0 and 10 °C. More medical resources could have been needed on days when PETs were at -10 to 10 °C than on other days. Adaptation to such weather change for health professionals and the general public would seem to be imperative. PMID:26631019

  2. Prognostic value of procalcitonin in hospitalized patients with lower respiratory tract infections

    PubMed Central

    Nobre, Vandack; Borges, Isabela

    2016-01-01

    Lower respiratory tract infections are common and potentially lethal conditions and are a major cause of inadequate antibiotic prescriptions. Characterization of disease severity and prognostic prediction in affected patients can aid disease management and can increase accuracy in determining the need for and place of hospitalization. The inclusion of biomarkers, particularly procalcitonin, in the decision taken process is a promising strategy. This study aims to present a narrative review of the potential applications and limitations of procalcitonin as a prognostic marker in hospitalized patients with lower respiratory tract infections. The studies on this topic are heterogeneous with respect to procalcitonin measurement techniques, cutoff values, clinical settings, and disease severity. The results show that procalcitonin delivers moderate performance for prognostic prediction in patients with lower respiratory tract infections; its predictive performance was not higher than that of classical methods, and knowledge of procalcitonin levels is most useful when interpreted together with other clinical and laboratory results. Overall, repeated measurement of the procalcitonin levels during the first days of treatment provides more prognostic information than a single measurement; however, information on the cost-effectiveness of this procedure in intensive care patients is lacking. The results of studies that evaluated the prognostic value of initial procalcitonin levels in patients with community-acquired pneumonia are more consistent and have greater potential for practical application; in this case, low procalcitonin levels identify those patients with a low risk of adverse outcomes. PMID:27305038

  3. Does case management for patients with heart failure based in the community reduce unplanned hospital admissions? A systematic review and meta-analysis

    PubMed Central

    Huntley, A L; Johnson, R; King, A; Morris, R W; Purdy, S

    2016-01-01

    Objectives The aim of this systematic review of randomised controlled trials (RCTs) and controlled trials (non-RCTs, NRCTs) is to investigate the effectiveness and related costs of case management (CM) for patients with heart failure (HF) predominantly based in the community in reducing unplanned readmissions and length of stay (LOS). Setting CM initiated either while as an inpatient, or on discharge from acute care hospitals, or in the community and then continuing on in the community. Participants Adults with a diagnosis of HF and resident in Organisation for Economic Co-operation and Development countries. Intervention CM based on nurse coordinated multicomponent care which is applicable to the primary care-based health systems. Primary and secondary outcomes Primary outcomes of interest were unplanned (re)admissions, LOS and any related cost data. Secondary outcomes were primary healthcare resources. Results 22 studies were included: 17 RCTs and 5 NRCTs. 17 studies described hospital-initiated CM (n=4794) and 5 described community-initiated CM of HF (n=3832). Hospital-initiated CM reduced readmissions (rate ratio 0.74 (95% CI 0.60 to 0.92), p=0.008) and LOS (mean difference −1.28 days (95% CI −2.04 to −0.52), p=0.001) in favour of CM compared with usual care. 9 trials described cost data of which 6 reported no difference between CM and usual care. There were 4 studies of community-initiated CM versus usual care (2 RCTs and 2 NRCTs) with only the 2 NRCTs showing a reduction in admissions. Conclusions Hospital-initiated CM can be successful in reducing unplanned hospital readmissions for HF and length of hospital stay for people with HF. 9 trials described cost data; no clear difference emerged between CM and usual care. There was limited evidence for community-initiated CM which suggested it does not reduce admission. PMID:27165648

  4. Epidemiology of 11 respiratory RNA viruses in a cohort of hospitalized children in Riyadh, Saudi Arabia.

    PubMed

    Amer, Haitham M; Alshaman, Mohamed S; Farrag, Mohamed A; Hamad, Moawia E; Alsaadi, Muslim M; Almajhdi, Fahad N

    2016-06-01

    Respiratory tract infections are a principal cause of illness and mortality in children worldwide and mostly caused by viruses. In this study, the epidemiology of 11 respiratory RNA viruses was investigated in a cohort of hospitalized children at a tertiary referral center in Riyadh from February 2008 to March 2009 using conventional and real-time monoplex RT-PCR assays. Among 174 nasopharyngeal aspirates, respiratory syncytial virus (RSV) was detected in 39 samples (22.41%), influenza A virus in 34 (19.54%), metapneumovirus (MPV) in 19 (10.92%), coronaviruses in 14 (8.05%), and parainfluenza viruses (PIVs) in 11 (6.32%). RSV, PIVs and coronaviruses were most prevalent in infants less than 6 months old, whereas MPV and influenza A virus were more prominent in children aged 7-24 and 25-60 months, respectively. The majority of the viruses were identified during winter with two peaks observed in March 2008 and January 2009. The presented data warrants further investigation to understand the epidemiology of respiratory viruses in Saudi Arabia on spatial and temporal basis. J. Med. Virol. 88:1086-1091, 2016. © 2015 Wiley Periodicals, Inc. PMID:26595650

  5. The Association of Tobacco Control Policies and the Risk of Acute Myocardial Infarction Using Hospital Admissions Data

    PubMed Central

    Jan, Carmen; Lee, Marcos; Roa, Reina; Herrera, Víctor; Politis, Michael; Motta, Jorge

    2014-01-01

    Objective To evaluate the association of a nationwide comprehensive smoking ban (CSB) and tobacco tax increase (TTI) on the risk of acute myocardial infarctions (AMI) in Panama for the period of 2006 – 2010 using hospital admissions data. Methods Data of AMI cases was gathered from public and private hospitals in the country for the period of January 1, 2006 to December 31, 2010. The number of AMI cases was calculated on a monthly basis. The risk of AMI was estimated for the pre-CSB period (January 2006 to April 2008) and was used as a reference point. Three post-intervention periods were examined: (1) post-CSB from May 2008 to April 2009 (12 months); (2) post-CSB from May 2009 to November 2009 (7 months); and (3) post-TTI from December 2009 to December 2010 (13 months). Relative risks (RR) of AMI were estimated for each post intervention periods by using a Poisson regression model. Mortality registries for the country attributed to myocardial infarction (MI) were obtained from January 2001 to December 2012. The annual percentage change (APC) of the number of deaths from MI was calculated using Joinpoint regression analysis. Results A total sample size of 2191 AMI cases was selected (monthly mean number of cases 36.52±8.24 SD). Using the pre-CSB as a reference point (RR = 1.00), the relative risk of AMI during the first CSB period, the second CSB period and post-TTI were 0.982, 1.049, and 0.985, respectively. The APC of deaths from MI from January 2001 to April 2008 was 0.5%. From January 2001 to June 2010 the APC trend was 0.47% and from July 2010 to December 2012 the APC was –0.3%. Conclusions The implementation of a CSB and TTI in Panama were associated with a decrease in tobacco consumption and a reduction of the RR of AMI. PMID:24520421

  6. Emergency department visits and hospitalizations for respiratory disease on the island of Hawaii, 1981 to 1991.

    PubMed

    Mannino, D M; Ruben, S; Holschuh, F C; Holschuh, T C; Wilson, M D; Holschuh, T

    1996-03-01

    This study examined trends in and patterns of emergency department visits and hospitalizations for respiratory disease on the island of Hawaii from 1981 to 1991. We found that emergency department visit rates and hospitalization rates for both asthma and COPD for 1987 to 1991 increased in all regions of the island in comparison with such rates for 1981 to 1986. Rates of emergency department visits and hospitalizations for chronic obstructive pulmonary disease or COPD, but not asthma, were significantly higher in the high-exposure Kona side of the island than in the intermittent-exposure Hilo side of the island during 1983 and 1988 to 1990. We also found that during the weeks that winds were from the west, blowing volcanic air pollution toward Hilo, emergency department visits for asthma increased 15%. Some of the results of our study support the hypothesis that volcanic air pollution affects respiratory health on the island of Hawaii, while other results do not. Any future studies should include measurements of air pollutant levels. PMID:8882554

  7. Burden of respiratory syncytial virus in hospitalized infants and young children in Amman, Jordan

    PubMed Central

    KHURI-BULOS, NAJWA; WILLIAMS, JOHN V.; SHEHABI, ASEM A.; FAOURI, SAMIR; JUNDI, EHSAN AL; ABUSHARIAH, OMAR; CHEN, QINGXIA; ALI, S. ASAD; VERMUND, STEN; HALASA, NATASHA B.

    2010-01-01

    Acute respiratory infections (ARI) play a major role in hospitalizations in the Middle East, but the specific viral causes are unknown. We conducted prospective viral surveillance in children <5 y of age admitted with ARI and/or fever at 2 dissimilar hospitals in Amman, Jordan during peak respiratory syncytial virus (RSV) season. We collected prospective clinical and demographic data and obtained nose/throat swabs for testing for RSV by real-time polymerase chain reaction (RT-PCR). We obtained clinical and laboratory data for 728/743 (98%) subjects enrolled. The children’s median age was 4.3 months, 58.4% were males, 87% were breastfed, 4% attended day care, 67% were exposed to smokers, 7% were admitted to the intensive care unit, and 0.7% died (n = 5). Out of 728 subjects, 467 (64%) tested positive by RT-PCR for RSV. Comparing RSV-positive with RSV-negative subjects, the RSV-positive subjects had lower median age (3.6 vs 6.4 months, p < 0.001) and fewer males (55% vs 64%, p = 0.02). RSV-positive children had higher rates of oxygen use (72% vs 42%, p < 0.001), a longer hospital stay (5 vs 4 days, p = 0.001), and higher hospital charges (US$538 vs US$431, p < 0.001) than RSV-negative children. In young hospitalized Jordanian infants, the medical and financial burden of RSV was found to be high. Effective preventive measures, such as an RSV vaccine, would have a significant beneficial impact. PMID:20100116

  8. Burden of respiratory syncytial virus in hospitalized infants and young children in Amman, Jordan.

    PubMed

    Khuri-Bulos, Najwa; Williams, John V; Shehabi, Asem A; Faouri, Samir; Al Jundi, Ehsan; Abushariah, Omar; Chen, Qingxia; Ali, S Asad; Vermund, Sten; Halasa, Natasha B

    2010-05-01

    Acute respiratory infections (ARI) play a major role in hospitalizations in the Middle East, but the specific viral causes are unknown. We conducted prospective viral surveillance in children <5 y of age admitted with ARI and/or fever at 2 dissimilar hospitals in Amman, Jordan during peak respiratory syncytial virus (RSV) season. We collected prospective clinical and demographic data and obtained nose/throat swabs for testing for RSV by real-time polymerase chain reaction (RT-PCR). We obtained clinical and laboratory data for 728/743 (98%) subjects enrolled. The children's median age was 4.3 months, 58.4% were males, 87% were breastfed, 4% attended day care, 67% were exposed to smokers, 7% were admitted to the intensive care unit, and 0.7% died (n = 5). Out of 728 subjects, 467 (64%) tested positive by RT-PCR for RSV. Comparing RSV-positive with RSV-negative subjects, the RSV-positive subjects had lower median age (3.6 vs 6.4 months, p < 0.001) and fewer males (55% vs 64%, p = 0.02). RSV-positive children had higher rates of oxygen use (72% vs 42%, p < 0.001), a longer hospital stay (5 vs 4 days, p = 0.001), and higher hospital charges (US$538 vs US$431, p < 0.001) than RSV-negative children. In young hospitalized Jordanian infants, the medical and financial burden of RSV was found to be high. Effective preventive measures, such as an RSV vaccine, would have a significant beneficial impact. PMID:20100116

  9. PREVALENCE OF METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS FROM NOSE AND THROAT OF PATIENTS ON ADMISSION TO MEDICAL WARDS OF DR SOETOMO HOSPITAL, SURABAYA, INDONESIA.

    PubMed

    Kuntaman, K; Hadi, Usman; Setiawan, Firman; Koendori, Eko Budi; Rusli, Musofa; Santosaningsih, Dewi; Severin, Juliette; Verbrugh, Henri A

    2016-01-01

    Epidemiological data of methicillin resistant Staphylococcus aureus (MRSA) carriage in Indonesian hospitals are still scarce. These data are required for health management of infectious diseases in order to control hospital MRSA. The carriage rate of MRSA in nose and throat of patients on admission to Dr Soetomo Hospital Surabaya, Indonesia was 8.1% of 643 patients, 5.4% from throat, 3.9% from nose and 1.2% from both sites. Prevalence of MRSA among patients admitted to surgical and non-surgical ward was not different (8.2% and 8.0%, respectively). Although MRSA prevalence in Indonesian hospitals is low compared to many other countries worldwide, appropriate health strategies will be needed to be implemented if this infection is to be controlled. PMID:27086426

  10. Effect of a Multidisciplinary Approach for the Management of Patients With Atrial Fibrillation in the Emergency Department on Hospital Admission Rate and Length of Stay.

    PubMed

    Ptaszek, Leon M; White, Benjamin; Lubitz, Steven A; Carnicelli, Anthony P; Heist, E Kevin; Ellinor, Patrick T; Machado, Monique; Wasfy, Jason H; Ruskin, Jeremy N; Armstrong, Katrina; Brown, David F; Biddinger, Paul D; Mansour, Moussa

    2016-07-01

    Management of atrial fibrillation (AF) in the emergency department (ED) is variable because of the absence of universally adopted treatment guidelines. To address potentially preventable hospital admissions and prolonged length of stay, an AF treatment pathway was co-developed by physicians from the cardiac electrophysiology service and the department of emergency medicine at our institution. The impact of this AF pathway on patient outcomes was evaluated with a prospective, observational study conducted in a single tertiary care center from July 1, 2013, to June 30, 2014. The primary study outcome was the rate of hospital admission. The secondary outcomes were duration of ED visit and inpatient length of stay. The 94 patients treated according to the AF pathway during the study period were less likely to be admitted than the 265 patients who received routine care (16% vs 80%, p <0.001). For admitted patients, the mean length of stay was shorter for patients treated according to the AF pathway (32 vs 85 hours, p = 0.002). The time spent in the ED was longer for patients in the AF pathway (16 vs 85 hours, p <0.001). Utilization of a multidisciplinary pathway for management of AF in the ED led to a significant reduction in the rate of hospital admission. Patients who were admitted after receiving care according to the AF pathway had a shorter length of stay. In conclusion, utilization of a multidisciplinary AF pathway resulted in a 5-fold reduction in admission rate and >2-fold reduction length of stay for admitted patients. PMID:27206910

  11. Clinical Profiles Related to Timing of Death, Including In-Hospital Deaths Before Admission, in Patients With ST-Elevation Myocardial Infarction.

    PubMed

    Bogaty, Peter; L'Allier, Philippe L; Segal, Eli; Rinfret, Stéphane; Racine, Normand; Harvey, Richard; Ross, Dave; Maire, Sébastien; Kouz, Simon; Carroll, Céline; Boothroyd, Lucy J; Kezouh, Abbas; Azzi, Leila; Brown, Kevin A; Nasmith, James; Lambert, Laurie J

    2016-02-01

    Patients with ST-elevation myocardial infarction (STEMI) who die in hospital before inpatient admission are generally not included in clinical studies and registries, and the clinical profiles of patients who die earlier versus later are not well defined. We aimed to characterize all patients with STEMI who arrived at emergency departments in the province of Quebec (Canada) based on inpatient admission status and when they died. All patients who presented with symptoms and core laboratory-confirmed STEMI or left bundle branch block during 6 months in 82 hospitals in Quebec were included. Death certificates were used to identify nonadmitted deaths. Of the 2017 patients with STEMI, 340 (16.9%) died within 1 year. Of the latter, 63 (18.5%) were nonadmitted deaths (group A), 179 (52.6%) were deaths after admission but within 30 days (group B), and 98 (28.8%) were deaths after 30 days to 1 year (group C). Group A was younger and most often hemodynamically unstable, followed for both features by B then C. Earliest presentation from symptom onset and most frequent ambulance use were found in group A, followed by B, then C. Presenting electrocardiogram (ECG) features were most severe in A, then B, then C (more arrhythmias, more anterior STEMI, more leads with ST elevation, and higher ST elevation). Patients who died earliest had the least frequency of previous myocardial infarction, coronary revascularization, vascular disease, and heart failure, and the least noncardiac co-morbidity. In conclusion, patients with STEMI dying in hospital before inpatient admission contributed substantially to overall STEMI mortality. Although dying patients who presented earlier had severer presenting clinical profiles, they were paradoxically younger and had less co-morbidity. Previous co-morbidities may favor adaptive protective mechanisms on initial presentation with STEMI. PMID:26721650

  12. Cost-effectiveness of Out-of-Hospital Continuous Positive Airway Pressure for Acute Respiratory Failure

    PubMed Central

    Thokala, Praveen; Goodacre, Steve; Ward, Matt; Penn-Ashman, Jerry; Perkins, Gavin D.

    2015-01-01

    Study objective We determine the cost-effectiveness of out-of-hospital continuous positive airway pressure (CPAP) compared with standard care for adults presenting to emergency medical services with acute respiratory failure. Methods We developed an economic model using a United Kingdom health care system perspective to compare the costs and health outcomes of out-of-hospital CPAP to standard care (inhospital noninvasive ventilation) when applied to a hypothetical cohort of patients with acute respiratory failure. The model assigned each patient a probability of intubation or death, depending on the patient’s characteristics and whether he or she had out-of-hospital CPAP or standard care. The patients who survived accrued lifetime quality-adjusted life-years (QALYs) and health care costs according to their age and sex. Costs were accrued through intervention and hospital treatment costs, which depended on patient outcomes. All results were converted into US dollars, using the Organisation for Economic Co-operation and Development purchasing power parities rates. Results Out-of-hospital CPAP was more effective than standard care but was also more expensive, with an incremental cost-effectiveness ratio of £20,514 per QALY ($29,720/QALY) and a 49.5% probability of being cost-effective at the £20,000 per QALY ($29,000/QALY) threshold. The probability of out-of-hospital CPAP’s being cost-effective at the £20,000 per QALY ($29,000/QALY) threshold depended on the incidence of eligible patients and varied from 35.4% when a low estimate of incidence was used to 93.8% with a high estimate. Variation in the incidence of eligible patients also had a marked influence on the expected value of sample information for a future randomized trial. Conclusion The cost-effectiveness of out-of-hospital CPAP is uncertain. The incidence of patients eligible for out-of-hospital CPAP appears to be the key determinant of cost-effectiveness. PMID:25737210

  13. Viral Etiology of Respiratory Tract Infections in Children at the Pediatric Hospital in Ouagadougou (Burkina Faso)

    PubMed Central

    Ouédraogo, Solange; Traoré, Blaise; Nene Bi, Zah Ange Brice; Yonli, Firmin Tiandama; Kima, Donatien; Bonané, Pierre; Congo, Lassané; Traoré, Rasmata Ouédraogo; Yé, Diarra; Marguet, Christophe; Plantier, Jean-Christophe; Vabret, Astrid; Gueudin, Marie

    2014-01-01

    Background Acute respiratory infections (ARIs) are a major cause of morbidity and mortality in children in Africa. The circulation of viruses classically implicated in ARIs is poorly known in Burkina Faso. The aim of this study was to identify the respiratory viruses present in children admitted to or consulting at the pediatric hospital in Ouagadougou. Methods From July 2010 to July 2011, we tested nasal aspirates of 209 children with upper or lower respiratory infection for main respiratory viruses (respiratory syncytial virus (RSV), metapneumovirus, adenovirus, parainfluenza viruses 1, 2 and 3, influenza A, B and C, rhinovirus/enterovirus), by immunofluorescence locally in Ouagadougou, and by PCR in France. Bacteria have also been investigated in 97 samples. Results 153 children (73.2%) carried at least one virus and 175 viruses were detected. Rhinoviruses/enteroviruses were most frequently detected (rhinovirus n = 88; enterovirus n = 38) and were found to circulate throughout the year. An epidemic of RSV infections (n = 25) was identified in September/October, followed by an epidemic of influenza virus (n = 13), mostly H1N1pdm09. This epidemic occurred during the period of the year in which nighttime temperatures and humidity were at their lowest. Other viruses tested were detected only sporadically. Twenty-two viral co-infections were observed. Bacteria were detected in 29/97 samples with 22 viral/bacterial co-infections. Conclusions This study, the first of its type in Burkina Faso, warrants further investigation to confirm the seasonality of RSV infection and to improve local diagnosis of influenza. The long-term objective is to optimize therapeutic management of infected children. PMID:25360527

  14. Risk factors associated with NSAID-induced upper gastrointestinal bleeding resulting in hospital admissions: A cross-sectional, retrospective, case series analysis in valencia, spain

    PubMed Central

    Marco, José Luis; Amariles, Pedro; Boscá, Beatriz; Castelló, Ana

    2007-01-01

    Abstract Background NSAIDs are a significant cause of drug-related hospital admissions and deaths. The therapeutic effects of NSAIDs have been associated with the risk for developing adverse events, mainly in the gastrointestinal tract. Objectives The focus of this study was to identify the most common risk factors associated with NSAID-induced upper gastrointestinal bleeding (UGIB) resulting in hospital admissions. A secondary end point was the relationship between use of gastroprotective treatment and relevant risk factors to NSAID-induced UGIB in the selected population. Methods This study was a cross-sectional, retrospective, case-series analysis of NSAID-induced UGIB resulting in hospital admission to the Requena General Hospital, Valencia, Spain, occurring from 1997 to 2005. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify UGIB admissions associated with NSAIDs. To estimate the probability of association between UGIB and the use of NSAIDs, the Naranjo adverse drug reaction probability was used. Patients were categorized as high-risk to develop UGIB if they met ≥1 of the following risk criteria (relevant risk factors): aged ≥65 years (age risk factor); peptic ulcer disease or NSAID gastropathy occurring in the year before their hospital admission (history risk factor); and concomitant use of other NSAIDs, systemic corticoids, oral anticoagulants, or platelet aggregation inhibitors (concomitant medication risk factor). Patients were categorized as candidates to use gastroprotections if they met ≥1 of the relevant risk factors. Patients were categorized as users of gastroprotective treatment if they used proton pump inhibitors, histamine H2-receptor antagonists, or misoprostol at hospital admission. Results This study comprised 209 cases of NSAID-induced UGIB (129 men, 80 women: mean [SD] age, 71.5 [13.8] years; 128 [61.2%] receiving acetyl salicylic acid [ASA], with 72 [34.4%] receiving low

  15. The impact of source contribution uncertainty on the effects of source-specific PM2.5 on hospital admissions: a case study in Boston, MA.

    PubMed

    Kioumourtzoglou, Marianthi-Anna; Coull, Brent A; Dominici, Francesca; Koutrakis, Petros; Schwartz, Joel; Suh, Helen

    2014-07-01

    Epidemiologic studies of particulate sources and adverse health do not account for the uncertainty in the source contribution estimates. Our goal was to assess the impact of uncertainty on the effect estimates of particulate sources on emergency cardiovascular (CVD) admissions. We examined the effects of PM2.5 sources, identified by positive matrix factorization (PMF) and absolute principle component analysis (APCA), on emergency CVD hospital admissions among Medicare enrollees in Boston, MA, during 2003-2010, given stronger associations for this period. We propagated uncertainty in source contributions using a block bootstrap procedure. We further estimated average across-methods source-specific effect estimates using bootstrap samples. We estimated contributions for regional, mobile, crustal, residual oil combustion, road dust, and sea salt sources. Accounting for uncertainty, same-day exposures to regional pollution were associated with an across-methods average effect of 2.00% (0.18, 3.78%) increase in the rate of CVD admissions. Weekly residual oil exposures resulted in an average 2.12% (0.19, 4.22%) increase. Same-day and 2-day exposures to mobile-related PM2.5 were also associated with increased admissions. Confidence intervals when accounting for the uncertainty were wider than otherwise. Agreement in PMF and APCA results was stronger when uncertainty was considered in health models. Accounting for uncertainty in source contributions leads to more stable effect estimates across methods and potentially to fewer spurious significant associations. PMID:24496220

  16. NT-proBNP and Its Correlation with In-Hospital Mortality in the Very Elderly without an Admission Diagnosis of Heart Failure

    PubMed Central

    Spannella, Francesco; Giulietti, Federico; Fedecostante, Massimiliano; Giordano, Piero; Gattafoni, Pisana; Espinosa, Emma; Busco, Franco; Piccinini, Gina; Dessì-Fulgheri, Paolo

    2016-01-01

    Background The diagnosis of heart failure (HF) is often difficult and underestimated in very elderly comorbid patients, especially when an echocardiographic evaluation is not available or feasible. Aim: to evaluate NT-proBNP values and their correlation with in-hospital mortality in a population of very elderly hospitalized for medical conditions other than HF. Methods We performed a prospective observational study on 403 very elderly admitted to an Internal Medicine and Geriatrics Department. Exclusion criterion was an admission diagnosis of HF. Patients with at least one symptom or sign compatible with HF were tested for NT-proBNP. NT-proBNP values < 300 pg/ml were considered as an age-independent exclusion criterion for HF (high negative predictive value), while NT-proBNP values ≥ 1800 pg/ml were considered as a diagnostic criterion. Main comorbidities and laboratory parameters were considered to adjust regression analyses between NT-proBNP and in-hospital mortality. Results NT-proBNP values ≥ 1800 pg/ml were present in 61.0% of patients and 32.8% of patients laid between 300 ≤ NT-proBNP < 1800 pg/ml values. NT-proBNP values were associated with the main indices of disease severity/organ failure considered such as reduced eGFR, reduced albumin and elevated CRP. NT-proBNP values ≥ 1800 pg/ml and ln(NT-proBNP) values were significantly associated with in-hospital mortality independently from the main comorbidities and lab parameters considered. The patients, who were already taking ACE inhibitors/Angiotensin Receptor Blockers before admission, showed lower in-hospital mortality. Conclusions Testing for NT-proBNP should be strongly recommended in the hospitalized very elderly, because of the very high prevalence of underlying HF and its impact on in-hospital mortality, to identify an underlying cardiac involvement that requires appropriate treatment. PMID:27077910

  17. Forecasting COPD hospitalization in the clinic: optimizing the chronic respiratory questionnaire

    PubMed Central

    Abascal-Bolado, Beatriz; Novotny, Paul J; Sloan, Jeff A; Karpman, Craig; Dulohery, Megan M; Benzo, Roberto P

    2015-01-01

    Purpose Forecasting hospitalization in patients with COPD has gained significant interest in the field of COPD care. There is a need to find simple tools that can help clinicians to stratify the risk of hospitalization in these patients at the time of care. The perception of quality of life has been reported to be independently associated with hospitalizations, but questionnaires are impractical for daily clinical use. Individual questions from valid questionnaires can have robust predictive abilities, as has been suggested in previous reports, as a way to use patient-reported outcomes to forecast important events like hospitalizations in COPD. Our primary aim was to assess the predictive value of individual questions from the Chronic Respiratory Questionnaire Self-Assessment Survey (CRQ-SAS) on the risk of hospitalization and to develop a clinically relevant and simple algorithm that clinicians can use in routine practice to identify patients with an increased risk of hospitalization. Patients and methods A total of 493 patients with COPD prospectively recruited from an outpatient pulmonary clinic completed the CRQ-SAS, demographic information, pulmonary function testing, and clinical outcomes. The cohort had a mean age of 70 years, was 54% male, with forced expiratory volume in 1 second percentage predicted 42.8±16.7, and modified Medical Research Council dyspnea scale score of 2±1.13. Results Our analysis validated the original CRQ-SAS domains. Importantly, recursive partitioning analysis identified three CRQ-SAS items regarding fear or panic of breathlessness, dyspnea with basic activities of daily living, and depressive symptoms that were highly predictive of hospitalization. We propose a robust (area under the curve =0.70) but short and easy algorithm for daily clinical care to forecast hospitalizations in patients with COPD. Conclusion We identified three themes – fear of breathlessness, dyspnea with basic activities of daily living, and depressive

  18. Six-month outcomes following an emergency hospital admission for older adults with co-morbid mental health problems indicate complexity of care needs

    PubMed Central

    Bradshaw, Lucy E.; Goldberg, Sarah E.; Lewis, Sarah A.; Whittamore, Kathy; Gladman, John R. F.; Jones, Rob G.; Harwood, Rowan H.

    2013-01-01

    Background: two-thirds of older patients admitted as an emergency to a general hospital have co-existing mental health problems including delirium, dementia and depression. This study describes the outcomes of older adults with co-morbid mental health problems after an acute hospital admission. Methods: a follow-up study of 250 patients aged over 70 admitted to 1 of 12 wards (geriatric, medical or orthopaedic) of an English acute general hospital with a co-morbid mental health problem and followed up at 180 days. Results: twenty-seven per cent did not return to their original place of residence after the hospital admission. After 180 days 31% had died, 42% had been readmitted and 24% of community residents had moved to a care home. Only 31% survived without being readmitted or moving to a care home. However, 16% spent >170 of the 180 days at home. Significant predictors for poor outcomes were co-morbidity, nutrition, cognitive function, reduction in activities of daily living ability prior to admission, behavioural and psychiatric problems and depression. Only 42% of survivors recovered to their pre-acute illness level of function. Clinically significant behavioural and psychiatric symptoms were present at follow-up in 71% of survivors with baseline cognitive impairment, and new symptoms developed frequently in this group. Conclusions: the variable, but often adverse, outcomes in this group implies a wide range of health and social care needs. Community and acute services to meet these needs should be anticipated and provided for. PMID:23800454

  19. Cost-effectiveness Analysis of Hospital Infection Control Response to an Epidemic Respiratory Virus Threat

    PubMed Central

    Dan, Yock Young; Sim, Joe; Lim, Jeremy; Hsu, Li Yang; Chow, Wai Leng; Fisher, Dale A.; Wong, Yue Sie; Ho, Khek Yu

    2009-01-01

    The outbreak of influenza A pandemic (H1N1) 2009 prompted many countries in Asia, previously strongly affected by severe acute respiratory syndrome (SARS), to respond with stringent measures, particularly in preventing outbreaks in hospitals. We studied actual direct costs and cost-effectiveness of different response measures from a hospital perspective in tertiary hospitals in Singapore by simulating outbreaks of SARS, pandemic (H1N1) 2009, and 1918 Spanish influenza. Protection measures targeting only infected patients yielded lowest incremental cost/death averted of $23,000 (US$) for pandemic (H1N1) 2009. Enforced protection in high-risk areas (Yellow Alert) and full protection throughout the hospital (Orange Alert) averted deaths but came at an incremental cost of up to $2.5 million/death averted. SARS and Spanish influenza favored more stringent measures. High case-fatality rates, virulence, and high proportion of atypical manifestations impacted cost-effectiveness the most. A calibrated approach in accordance with viral characteristics and community risks may help refine responses to future epidemics. PMID:19961669

  20. Eight Year Prospective Study of Adenoviruses Infections in Hospitalized Children. Comparison with Other Respiratory Viruses

    PubMed Central

    Calvo, Cristina; García-García, María Luz; Sanchez-Dehesa, Rosa; Román, Cristina; Tabares, Ana; Pozo, Francisco; Casas, Inmaculada

    2015-01-01

    Human adenovirus (HAdV) cause upper and lower respiratory tract infections. However, there are few large prospective studies focused on HAdVs acute infections requiring hospitalization. From 2005 to 2013 a prospective study was conducted on children admitted with acute respiratory infections. Specimens of nasopharyngeal aspirate were taken for virological study by PCR and clinical data was recorded. HAdV specimens were genotyped. Frequency and clinical course of HAdV infections were compared with RSV, rhinovirus (RV), human bocavirus (HBoV) and influenza in the same population. HAdV was detected in 403 cases of 2371 confirmed viral infections (17.2%) , of which 154 were single virus infections (38%). We genotyped 154 HAdVs. The most frequent genotypes were HAdV-3 (24%), HAdV-6 (21%), and HAdV-5 (20%). A total of 262 children had fever (64.9%); 194 suffered hypoxia (48%), and 147 presented infiltrate in chest x-rays (36.4%). The most frequent diagnoses were recurrent wheezing or asthma (51.7%), bronchiolitis (18.3 %), and pneumonia (11.9%), and 46 (11.4%) episodes required prolonged hospitalization (>7 days) due to the severity. Adenovirus single infections were compared with single infections of 598 RSV, 494 RV, 83 influenza and 78 HBoV. Significant clinical differences were found between HAdV, RSV and RV infections. PMID:26147465

  1. Respiratory Therapy Technology Program Standards.

    ERIC Educational Resources Information Center

    Georgia Univ., Athens. Dept. of Vocational Education.

    This publication contains statewide standards for the respiratory therapy technology program in Georgia. The standards are divided into 12 categories: Foundations (philosophy, purpose, goals, program objectives, availability, evaluation; Admissions (admission requirements, provisional admission requirements, recruitment, evaluation and planning);…

  2. Respiratory viruses from hospitalized children with severe pneumonia in the Philippines

    PubMed Central

    2012-01-01

    Background Pneumonia remains a leading cause of child death in developing countries. The viruses in severe pneumonia remain poorly defined. Methods The study was conducted at the Eastern Visayas Regional Medical Center in Tacloban City, Philippines from May 2008 to May 2009. Patients aged 8 days to 13 years old who were admitted to the Department of Pediatrics with severe pneumonia were enrolled for the study. Upon admission, polymerase chain reaction was performed using nasopharyngeal swabs and blood cultures to detect respiratory viruses and bacteria, respectively. Result Among the 819 patients enrolled, at least one virus was detected in 501 cases (61.2%). In addition, 423 cases were positive for a single virus while bacteria were detected in the blood culture sample of 31 cases. The most commonly detected viruses were human rhinoviruses (n = 189), including types A (n = 103), B (n = 17), and C (n = 69), and respiratory syncytial virus (RSV) (n = 165). Novel viruses such as human metapneumovirus, human coronavirus NL63, human bocavirus, and human polyomaviruses WU and KI were also detected. There were 70 deaths, and one or more viruses were detected in 35 (50%) of these cases. Positivity only for influenza A virus (OR = 4.3, 95% CI = 1.3-14.6) was significantly associated with fatal outcome. From the blood culture, Burkholderia cepacia group (n = 9), Streptococcus pneumoniae (n = 4), Staphylococcus aureus (n = 4), Haemophilus influenzae (n = 1), and Salmonella C1 (n = 1) were also isolated. Conclusion Viruses were commonly detected in children with severe pneumonia in the Philippines. Hence, viral etiologies should be considered while developing better effective strategies to reduce child pneumonia-related deaths in developing countries. PMID:23092190

  3. A Telephone Support Program to Reduce Costs and Hospital Admissions for Patients at Risk of Readmissions: Lessons from an Evaluation of a Complex Health Intervention.

    PubMed

    Morello, Renata T; Barker, Anna L; Watts, Jennifer J; Bohensky, Megan A; Forbes, Andrew B; Stoelwinder, Johannes

    2016-06-01

    This study aimed to evaluate the effectiveness of a telephone health coaching and support service provided to members of an Australian private health insurance fund-Telephonic Complex Care Program (TCCP)-on hospital use and associated costs. A case-control pre-post study design was employed using propensity score matching. Private health insurance members (n=273) who participated in TCCP between April and December 2012 (cases) were matched (1:1) to members who had not previously been enrolled in the program or any other disease management programs offered by the insurer (n=232). Eligible members were community dwelling, aged ≥65 years, and had 2 or more hospital admissions in the 12 months prior to program enrollment. Preprogram variables that estimated the propensity score included: participant demographics, diagnoses, and hospital use in the 12 months prior to program enrollment. TCCP participants received one-to-one telephone support, personalized care plan, and referral to community-based services. Control participants continued to access usual health care services. Primary outcomes were number of hospital admission claims and total benefits paid for all health care utilizations in the 12 months following program enrollment. Secondary outcomes included change in total benefits paid, hospital benefits paid, ancillary benefits paid, and total hospital bed days over the 12 months post enrollment. Compared with matched controls, TCCP did not appear to reduce health care utilization or benefits paid in the 12 months following program enrollment. However, program characteristics and implementation may have impacted its effectiveness. In addition, challenges related to evaluating complex health interventions such as TCCP are discussed. (Population Health Management 2016;19:187-195). PMID:26237303

  4. Differences in Hospital Managers', Unit Managers', and Health Care Workers' Perceptions of the Safety Climate for Respiratory Protection.

    PubMed

    Peterson, Kristina; Rogers, Bonnie M E; Brosseau, Lisa M; Payne, Julianne; Cooney, Jennifer; Joe, Lauren; Novak, Debra

    2016-07-01

    This article compares hospital managers' (HM), unit managers' (UM), and health care workers' (HCW) perceptions of respiratory protection safety climate in acute care hospitals. The article is based on survey responses from 215 HMs, 245 UMs, and 1,105 HCWs employed by 98 acute care hospitals in six states. Ten survey questions assessed five of the key dimensions of safety climate commonly identified in the literature: managerial commitment to safety, management feedback on safety procedures, coworkers' safety norms, worker involvement, and worker safety training. Clinically and statistically significant differences were found across the three respondent types. HCWs had less positive perceptions of management commitment, worker involvement, and safety training aspects of safety climate than HMs and UMs. UMs had more positive perceptions of management's supervision of HCWs' respiratory protection practices. Implications for practice improvements indicate the need for frontline HCWs' inclusion in efforts to reduce safety climate barriers and better support effective respiratory protection programs and daily health protection practices. PMID:27056750

  5. Respiratory management of spinal muscular atrophy type 2.

    PubMed

    Gormley, Maurade C

    2014-12-01

    Respiratory insufficiency is the primary cause of morbidity and mortality among patients with spinal muscular atrophy type 2. The primary complications include ineffective cough with decreased airway clearance, nocturnal hypoventilation, diminished lung and chest wall development, and increased risk for pulmonary infection. Respiratory devices including mechanical insufflator-exsufflator and bilevel positive airway pressure are the primary devices of respiratory maintenance and treatment and are associated with decreased morbidity and fewer hospital admissions. This article discusses the primary respiratory complications of spinal muscular atrophy type 2 and the role of respiratory interventions to promote growth and development, improve cough efficacy, reverse nocturnal hypoventilation, and prevent and treat pulmonary infection. PMID:25365058

  6. Anemia, Blood Transfusion Requirements and Mortality Risk in Human Immunodeficiency Virus-Infected Adults Requiring Acute Medical Admission to Hospital in South Africa

    PubMed Central

    Kerkhoff, Andrew D.; Lawn, Stephen D.; Schutz, Charlotte; Burton, Rosie; Boulle, Andrew; Cobelens, Frank J.; Meintjes, Graeme

    2015-01-01

    Background. Morbidity and mortality remain high among hospitalized patients infected with human immunodeficiency virus (HIV) in sub-Saharan Africa despite widespread availability of antiretroviral therapy. Severe anemia is likely one important driver, and some evidence suggests that blood transfusions may accelerate HIV progression and paradoxically increase short-term mortality. We investigated the relationship between anemia, blood transfusions, and mortality in a South African district hospital. Methods. Unselected consecutive HIV-infected adults requiring acute medical admission to a Cape Town township district hospital were recruited. Admission hemoglobin concentrations were used to classify anemia severity according to World Health Organization/AIDS Clinical Trials Group criteria. Vital status was determined at 90 days, and Cox regression analyses were used to determine independent predictors of mortality. Results. Of 585 HIV-infected patients enrolled, 578 (98.8%) were included in the analysis. Anemia was detected in 84.8% of patients and was severe (hemoglobin, 6.5–7.9 g/dL) or life-threatening (hemoglobin, <6.5 g/dL) in 17.3% and 13.3%, respectively. Within 90 days of the date of admission, 13.5% (n = 78) patients received at least 1 blood transfusion with red cell concentrate and 77 (13.3%) patients died. In univariable analysis, baseline hemoglobin and receipt of blood transfusion were associated with increased mortality risk. However, in multivariable analysis, neither hemoglobin nor receipt of a blood transfusion were independently associated with greater mortality risk. Acquired immune deficiency syndrome-defining illnesses other than tuberculosis and impaired renal function independently predicted mortality. Conclusions. Newly admitted HIV-infected adults had a high prevalence of severe or life-threatening anemia and blood transfusions were frequently required. However, after adjustment for confounders, blood transfusions did not confer an

  7. Pre-hospital care seeking behaviour for childhood acute respiratory infections in south-western Nigeria.

    PubMed

    Ukwaja, Kingsley N; Talabi, Ademola A; Aina, Olufemi B

    2012-12-01

    WHO/UNICEF currently recommend that childhood malaria and pneumonia be managed together in the community; most African countries are in the process of developing this policy. We conducted a cross-sectional study to determine maternal awareness of general danger signs of childhood illnesses and the prevalence, determinants and sources of pre-hospital treatment by mothers during their child's acute respiratory illness in a poor urban community in south-western Nigeria. A total of 226 mothers were interviewed. Only 4.9% of the mothers were aware of the two pneumonia symptoms: difficult breathing and fast breathing. About 75% of the children were given pre-hospital medication at home and only 16.5% of them received the drugs within 24 hour of symptom recognition. Drug shops/patent medicine vendors (PMVs; 70.6%) were the most common source of care. Wishing to try home management first (46.6%); waiting for the child to improve (14.4%) and lack of money (31.6%) delayed care-seeking. Older maternal age (aOR 2.3; 95% CI 1.2-4.4) and having a child with cough and difficult and/or fast breathing (aOR 2.3; 95% CI 1.1-5.2) were positive predictors of pre-hospital treatment. Maternal education and adequately equipping PMVs could improve prompt access to integrated community-based child health services in Nigeria. PMID:24029675

  8. Middle East respiratory syndrome coronavirus not detected in children hospitalized with acute respiratory illness in Amman, Jordan, March 2010 to September 2012

    PubMed Central

    Khuri-Bulos, N.; Payne, D. C.; Lu, X.; Erdman, D.; Wang, L.; Faouri, S.; Shehabi, A.; Johnson, M.; Becker, M. M.; Denison, M. R.; Williams, J. V.; Halasa, N. B.

    2015-01-01

    Hospitalized children < 2 years of age in Amman, Jordan, admitted for fever and/or respiratory symptoms, were tested for Middle East respiratory syndrome coronavirus (MERS-CoV): MERS-CoV by real-time RT-PCR (rRT-PCR). This was a prospective year-round viral surveillance study in children <2 years of age admitted with acute respiratory symptoms and/or fever from March 2010 to September 2012 and enrolled from a government-run hospital, Al-Bashir in Amman, Jordan. Clinical and demographic data, including antibiotic use, were collected. Combined nasal/throat swabs were collected, aliquoted, and frozen at −80°C. Specimen aliquots were shipped to Vanderbilt University and the Centers for Disease Control and Prevention (CDC), and tested by rRT-PCR for MERS-CoV. Of the 2433 subjects enrolled from 16 March 2010 to 10 September 2012, 2427 subjects had viral testing and clinical data. Of 1898 specimens prospectively tested for other viruses between 16 March 2010 and 18 March 2012, 474 samples did not have other common respiratory viruses detected. These samples were tested at CDC for MERS-CoV and all were negative by rRT-PCR for MERS-CoV. Of the remaining 531 samples, collected from 19 March 2012 to 10 September 2012 and tested at Vanderbilt, none were positive for MERS-CoV. Our negative findings from a large sample of young Jordanian children hospitalized with fever and/or respiratory symptoms suggest that MERS-CoV was not widely circulating in Amman, Jordan, during the 30-month period of prospective, active surveillance occurring before and after the first documented MERS-CoV outbreak in the Middle East region. PMID:24313317

  9. Middle East respiratory syndrome coronavirus not detected in children hospitalized with acute respiratory illness in Amman, Jordan, March 2010 to September 2012.

    PubMed

    Khuri-Bulos, N; Payne, D C; Lu, X; Erdman, D; Wang, L; Faouri, S; Shehabi, A; Johnson, M; Becker, M M; Denison, M R; Williams, J V; Halasa, N B

    2014-07-01

    Hospitalized children < 2 years of age in Amman, Jordan, admitted for fever and/or respiratory symptoms, were tested for Middle East respiratory syndrome coronavirus (MERS-CoV): MERS-CoV by real-time RT-PCR (rRT-PCR). This was a prospective year-round viral surveillance study in children <2 years of age admitted with acute respiratory symptoms and/or fever from March 2010 to September 2012 and enrolled from a government-run hospital, Al-Bashir in Amman, Jordan. Clinical and demographic data, including antibiotic use, were collected. Combined nasal/throat swabs were collected, aliquoted, and frozen at -80°C. Specimen aliquots were shipped to Vanderbilt University and the Centers for Disease Control and Prevention (CDC), and tested by rRT-PCR for MERS-CoV. Of the 2433 subjects enrolled from 16 March 2010 to 10 September 2012, 2427 subjects had viral testing and clinical data. Of 1898 specimens prospectively tested for other viruses between 16 March 2010 and 18 March 2012, 474 samples did not have other common respiratory viruses detected. These samples were tested at CDC for MERS-CoV and all were negative by rRT-PCR for MERS-CoV. Of the remaining 531 samples, collected from 19 March 2012 to 10 September 2012 and tested at Vanderbilt, none were positive for MERS-CoV. Our negative findings from a large sample of young Jordanian children hospitalized with fever and/or respiratory symptoms suggest that MERS-CoV was not widely circulating in Amman, Jordan, during the 30-month period of prospective, active surveillance occurring before and after the first documented MERS-CoV outbreak in the Middle East region. PMID:24313317

  10. Human metapneumovirus in patients hospitalized with acute respiratory infections: A meta-analysis.

    PubMed

    Lefebvre, Annick; Manoha, Catherine; Bour, Jean-Baptiste; Abbas, Rachid; Fournel, Isabelle; Tiv, Michel; Pothier, Pierre; Astruc, Karine; Aho-Glélé, Ludwig Serge

    2016-08-01

    This meta-analysis aimed to estimate the prevalence of human metapneumovirus (hMPV) infections in patients hospitalized for acute respiratory infection (ARI) and to study factors associated with this prevalence. Medline and ScienceDirect databases were searched for prospective observational studies that screened hospitalized patients with ARI for hMPV by RT-PCR, with data available at December 27, 2014. The risk of bias was assessed regarding participation rate, definition of ARI, description of diagnostic technique, method of inclusion identical for all subjects, standardized and identical sampling method for all subjects, analysis performed according to the relevant subgroups, and presentation of data sources. Random-effect meta-analysis with arcsine transformation and meta-regressions was used. In the 75 articles included, the prevalence of hMPV among hospitalized ARI was 6.24% (95% CI 5.25-7.30). An effect of the duration of the inclusion period was observed (p=0.0114), with a higher prevalence of hMPV in studies conducted during periods of 7-11 months (10.56%, 95% CI 5.97-16.27) or complete years (7.55%, 95% CI 5.90-9.38) than in periods of 6 months or less (5.36%, 95% CI 4.29-6.54). A significant increase in the incidence with increasing distance from the equator was observed (p=0.0384). hMPV should be taken into account as a possible etiology in hospitalized ARI. PMID:27337518

  11. Asthma prescribing, ethnicity and risk of hospital admission: an analysis of 35,864 linked primary and secondary care records in East London.

    PubMed

    Hull, Sally A; McKibben, Shauna; Homer, Kate; Taylor, Stephanie Jc; Pike, Katy; Griffiths, Chris

    2016-01-01

    Inappropriate prescribing in primary care was implicated in nearly half of asthma deaths reviewed in the UK's recent National Review of Asthma Deaths. Using anonymised EMIS-Web data for 139 ethnically diverse general practices (total population 942,511) extracted from the North and East London Commissioning Support Unit, which holds hospital Secondary Uses Services (SUS)-linked data, we examined the prevalence of over-prescribing of short-acting β2-agonist inhalers (SABA), under-prescribing of inhaled corticosteroid (ICS) inhalers and solo prescribing of long-acting β2-agonists (LABA) to assess the risk of hospitalisation for people with asthma for 1 year ending August 2015. In a total asthma population of 35,864, multivariate analyses in adults showed that the risk of admission increased with greater prescription of SABA inhalers above a baseline of 1-3 (4-12 SABA: odds ratio (OR) 1.71; 95% confidence interval (CI) 1.20-2.46, ⩾13 SABA: OR 3.22; 95% CI 2.04-5.07) with increasing British Thoracic Society step (Step 3: OR 2.90; 95% CI 1.79-4.69, Step 4/5: OR 9.42; 95% CI 5.27-16.84), and among Black (OR 2.30; 95% CI 1.64-3.23) and south Asian adult populations (OR 1.83; 95% CI 1.36-2.47). Results in children were similar, but risk of hospitalisation was not related to ethnic group. There is a progressive risk of hospital admission associated with the prescription of more than three SABA inhalers a year. Adults (but not children) from Black and South Asian groups are at an increased risk of admission. Further work is needed to target care for these at-risk groups. PMID:27537194

  12. Asthma prescribing, ethnicity and risk of hospital admission: an analysis of 35,864 linked primary and secondary care records in East London

    PubMed Central

    Hull, Sally A; McKibben, Shauna; Homer, Kate; Taylor, Stephanie JC; Pike, Katy; Griffiths, Chris

    2016-01-01

    Inappropriate prescribing in primary care was implicated in nearly half of asthma deaths reviewed in the UK’s recent National Review of Asthma Deaths. Using anonymised EMIS-Web data for 139 ethnically diverse general practices (total population 942,511) extracted from the North and East London Commissioning Support Unit, which holds hospital Secondary Uses Services (SUS)–linked data, we examined the prevalence of over-prescribing of short-acting β2-agonist inhalers (SABA), under-prescribing of inhaled corticosteroid (ICS) inhalers and solo prescribing of long-acting β2-agonists (LABA) to assess the risk of hospitalisation for people with asthma for 1 year ending August 2015. In a total asthma population of 35,864, multivariate analyses in adults showed that the risk of admission increased with greater prescription of SABA inhalers above a baseline of 1–3 (4–12 SABA: odds ratio (OR) 1.71; 95% confidence interval (CI) 1.20–2.46, ⩾13 SABA: OR 3.22; 95% CI 2.04–5.07) with increasing British Thoracic Society step (Step 3: OR 2.90; 95% CI 1.79–4.69, Step 4/5: OR 9.42; 95% CI 5.27–16.84), and among Black (OR 2.30; 95% CI 1.64–3.23) and south Asian adult populations (OR 1.83; 95% CI 1.36–2.47). Results in children were similar, but risk of hospitalisation was not related to ethnic group. There is a progressive risk of hospital admission associated with the prescription of more than three SABA inhalers a year. Adults (but not children) from Black and South Asian groups are at an increased risk of admission. Further work is needed to target care for these at-risk groups. PMID:27537194

  13. The Global Contribution of Outdoor Air Pollution to the Incidence, Prevalence, Mortality and Hospital Admission for Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

    PubMed Central

    Song, Qingkun; Christiani, David C.; Wang, Xiaorong; Ren, Jun

    2014-01-01

    Objective: This study aimed to investigate the quantitative effects of outdoor air pollution, represented by 10 µg/m3 increment of PM10, on chronic obstructive pulmonary disease in China, United States and European Union through systematic review and meta-analysis. Methods: Publications in English and Chinese from PubMed and EMBASE were selected. The Cochrane Review Handbook of Generic Inverse Variance was used to synthesize the pooled effects on incidence, prevalence, mortality and hospital admission. Results: Outdoor air pollution contributed to higher incidence and prevalence of COPD. Short-term exposure was associated with COPD mortality increased by 6%, 1% and 1% in the European Union, the United States and China, respectively (p < 0.05). Chronic PM exposure produced a 10% increase in mortality. In a short-term exposure to 10 µg/m3 PM10 increment COPD mortality was elevated by 1% in China (p < 0.05) and hospital admission enrollment was increased by 1% in China, 2% in United States and 1% in European Union (p < 0.05). Conclusions: Outdoor air pollution contributes to the increasing burdens of COPD.10 µg/m3 increase of PM10 produced significant condition of COPD death and exacerbation in China, United States and European Union. Controlling air pollution will have substantial benefit to COPD morbidity and mortality. PMID:25405599

  14. Metagenomics Study of Viral Pathogens in Undiagnosed Respiratory Specimens and Identification of Human Enteroviruses at a Thailand Hospital

    PubMed Central

    Zhou, Yanfei; Fernandez, Stefan; Yoon, In-Kyu; Simasathien, Sriluck; Watanaveeradej, Veerachai; Yang, Yu; Marte-Salcedo, Omely A.; Shuck-Lee, Deidra J.; Thomas, Stephen J.; Hang, Jun; Jarman, Richard G.

    2016-01-01

    Numerous pathogens cause respiratory infections with similar symptoms. Routine diagnostics detect only a limited number of pathogens, leaving a gap in respiratory illness etiology surveillance. This study evaluated next-generation sequencing for unbiased pathogen identification. Respiratory samples collected in Thailand, Philippines, Bhutan, and Nepal, that were negative by several molecular and immunofluorescence assays, underwent viral cultivation. Samples which demonstrated cytopathic effect in culture (N = 121) were extracted and tested by Luminex xTAG respiratory viral panel (RVP) assay and deep sequencing by Roche 454 FLX Titanium system. Using RVP assay, 52 (43%) samples were positive for enterovirus or rhinovirus and another three were positive for respiratory syncytial virus B, parainfluenza 4, and adenovirus. Deep sequencing confirmed the Luminex assay results and identified additional viral pathogens. Human enteroviruses, including Enterovirus A type 71 and 12 types of Enterovirus B (EV-B) were identified from a hospital in Bangkok. Phylogenetic and recombination analysis showed high correlation of VP1 gene-based phylogeny with genome-wide phylogeny and the frequent genetic exchange among EV-B viruses. The high number and diversity of enteroviruses in the hospital in Bangkok suggests prevalent existence. The metagenomic approach used in our study enabled comprehensive diagnoses of respiratory viruses. PMID:27352877

  15. Metagenomics Study of Viral Pathogens in Undiagnosed Respiratory Specimens and Identification of Human Enteroviruses at a Thailand Hospital.

    PubMed

    Zhou, Yanfei; Fernandez, Stefan; Yoon, In-Kyu; Simasathien, Sriluck; Watanaveeradej, Veerachai; Yang, Yu; Marte-Salcedo, Omely A; Shuck-Lee, Deidra J; Thomas, Stephen J; Hang, Jun; Jarman, Richard G

    2016-09-01

    Numerous pathogens cause respiratory infections with similar symptoms. Routine diagnostics detect only a limited number of pathogens, leaving a gap in respiratory illness etiology surveillance. This study evaluated next-generation sequencing for unbiased pathogen identification. Respiratory samples collected in Thailand, Philippines, Bhutan, and Nepal, that were negative by several molecular and immunofluorescence assays, underwent viral cultivation. Samples which demonstrated cytopathic effect in culture (N = 121) were extracted and tested by Luminex xTAG respiratory viral panel (RVP) assay and deep sequencing by Roche 454 FLX Titanium system. Using RVP assay, 52 (43%) samples were positive for enterovirus or rhinovirus and another three were positive for respiratory syncytial virus B, parainfluenza 4, and adenovirus. Deep sequencing confirmed the Luminex assay results and identified additional viral pathogens. Human enteroviruses, including Enterovirus A type 71 and 12 types of Enterovirus B (EV-B) were identified from a hospital in Bangkok. Phylogenetic and recombination analysis showed high correlation of VP1 gene-based phylogeny with genome-wide phylogeny and the frequent genetic exchange among EV-B viruses. The high number and diversity of enteroviruses in the hospital in Bangkok suggests prevalent existence. The metagenomic approach used in our study enabled comprehensive diagnoses of respiratory viruses. PMID:27352877

  16. Dust events as a risk factor for daily hospitalization for respiratory and cardiovascular diseases in Minqin, China

    NASA Astrophysics Data System (ADS)

    Meng, Ziqiang; Lu, Bin

    Dust events are common air pollution events in parts of the world with arid, semi-arid, or desert areas. There is little research on the association between respiratory and cardiovascular health and dust events in places which are close to the deserts. The aim of this study is to evaluate the health effects of dust events in a location where traffic and industry are underdeveloped and dust events are most frequent in China. The setting allows the opportunity to reduce confounding by anthropogenically derived particulate matter and to confirm the health effects of dust events. The present study was done using daily counts of hospitalizations in Minqin (1994-2003) for respiratory and cardiovascular diseases (International Classification of Diseases, Tenth revision) for males and females. Using a semi-parametric generalized additive model and controlling for long-term temporal trends, day of the week, meteorological factors, and seasonal influence, counts of hospitalization were analyzed for dust events in a Poisson regression. Relative risks (RRs) were used to estimate the risk of dust events for respiratory and cardiovascular hospitalizations. In the year-round model, dust events with a lag of 3 days were significantly associated with total respiratory hospitalization for males and females, with RRs of 1.14 (95% confidence interval (CI) 1.01-1.29) and 1.18 (95% CI 1.00-1.41); dust events with a lag of 4 days were significantly associated with upper respiratory tract infection (URTI) in males (RR 1.28, 95% CI 1.04-1.59), and dust events with a lag of 6 days were significantly associated with pneumonia in males, with an RR of 1.17 (95% CI 1.00-1.38). A significant association between dust events with a lag of 3 days and hypertension in males was also found (RR 1.30, 95% CI 1.03,1.64). In the seasonal analysis model, the associations between the dust events and respiratory and cardiovascular hospitalizations were stronger in spring and in winter, respectively. The

  17. Frequency of Intensive Care Unit admission after elective interventional neuroradiological procedures under general anesthesia in a tertiary care hospital

    PubMed Central

    Shamim, Faisal; Asghar, Ali; Karam, Karima

    2015-01-01

    Background: The aim of this study was to determine the frequency of patients admitted to Intensive Care Unit (ICU) after elective interventional neuroradiology (INR) procedures under general anesthesia. Materials and Methods: We retrospectively evaluated 121 patients underwent INR procedures performed with general anesthesia within a 5-year period. Information including demographics, aneurysm/arteriovenous malformations pathology (ruptured or un-ruptured), preoperative neurological status, co-morbidities, complications during procedure and postoperative admission in ICU were recorded on a predesigned form. Results: Elective INR procedure for both ruptured (n = 29, 24%) and un-ruptured (n = 85, 70.25%) aneurysms was performed. Rate of postoperative admission in ICU was significantly high in patients with preoperative ruptured aneurysm (P < 0.01). High rate of neurological deficit, sub-arachnoid hemorrhage (SAH) and hypertension in patients were significant factors of postoperative admission in ICU (P < 0.05). Out of 24 patients, 12 were admitted to ICU postoperatively because of procedure-related complications and 11 were sent due to preexisting significant co-morbidities with added complication of SAH. Conclusion: The authors conclude that patients without major co-morbidities, intraoperative complications, or complex aneurysm morphology can be safely observed in a regular ward rather than being admitted to the ICU. PMID:25558194

  18. Aerosolized ribavirin treatment of respiratory syncytial virus infection in infants hospitalized during an epidemic.

    PubMed

    Conrad, D A; Christenson, J C; Waner, J L; Marks, M I

    1987-02-01

    Thirty-three infants with predisposing conditions and/or severely symptomatic with respiratory syncytial virus (RSV) infection were treated with aerosolized ribavirin during a 12-week period at Oklahoma Children's Memorial Hospital. These patients were compared with 97 untreated patients with RSV infection hospitalized during the same epidemic. Despite preconditions which selected for a more seriously ill treatment group, patients who received ribavirin showed prompter resolution of the illness than did untreated controls. Greatest clinical improvement in treated patients occurred between the first and second days of ribavirin therapy; mean ribavirin treatment duration was 4.5 days. Ten of 22 ribavirin-treated patients continued to excrete RSV after conclusion of antiviral therapy. No adverse hematologic, renal or metabolic effects occurred with ribavirin therapy. Our experience with ribavirin therapy during a major epidemic confirms and extends the results of previous controlled evaluations demonstrating this treatment safe and effective in high risk and seriously ill infants with RSV bronchiolitis and bronchopneumonia. PMID:3562136

  19. [Respiratory symptoms caused by the use of electrocautery in physicians being trained in surgery in a Mexican hospital].

    PubMed

    Navarro-Meza, María Cristina; González-Baltazar, Raquel; Aldrete-Rodríguez, María Guadalupe; Carmona-Navarro, David Enrique; López-Cardona, María Guadalupe

    2013-03-01

    In order to determine the frequency of respiratory symptoms among residents from surgical specialties dures exposed to the electrocautery smoke, a cross-sectional study was conducted in February 2012. 50 third-year residents from different surgical specialties coming from a third-level hospital belonging to the Institute of Security and Social Services of the State Workers in Jalisco, Mexico, were included. The subject selection was non-probabilistic. A questionnaire on respiratory symptoms developed in Cuba was used for data collection. The most common symptoms were sensation of a lump in the throat (58%), and a sore throat (22%). The specialty with the highest rate of exposure was neurosurgery (24.1 min/surgical procedure). All, the physicians from this specialty had respiratory symptoms. We conclude that the cauterization smoke may be considered a risk for developing respiratory symptoms among physicians with surgical specialties. PMID:23612810

  20. A respiratory alert model for the Shenandoah Valley, Virginia, USA

    NASA Astrophysics Data System (ADS)

    Hondula, David M.; Davis, Robert E.; Knight, David B.; Sitka, Luke J.; Enfield, Kyle; Gawtry, Stephen B.; Stenger, Phillip J.; Deaton, Michael L.; Normile, Caroline P.; Lee, Temple R.

    2013-01-01

    Respiratory morbidity (particularly COPD and asthma) can be influenced by short-term weather fluctuations that affect air quality and lung function. We developed a model to evaluate meteorological conditions associated with respiratory hospital admissions in the Shenandoah Valley of Virginia, USA. We generated ensembles of classification trees based on six years of respiratory-related hospital admissions (64,620 cases) and a suite of 83 potential environmental predictor variables. As our goal was to identify short-term weather linkages to high admission periods, the dependent variable was formulated as a binary classification of five-day moving average respiratory admission departures from the seasonal mean value. Accounting for seasonality removed the long-term apparent inverse relationship between temperature and admissions. We generated eight total models specific to the northern and southern portions of the valley for each season. All eight models demonstrate predictive skill (mean odds ratio = 3.635) when evaluated using a randomization procedure. The predictor variables selected by the ensembling algorithm vary across models, and both meteorological and air quality variables are included. In general, the models indicate complex linkages between respiratory health and environmental conditions that may be difficult to identify using more traditional approaches.

  1. A respiratory alert model for the Shenandoah Valley, Virginia, USA.

    PubMed

    Hondula, David M; Davis, Robert E; Knight, David B; Sitka, Luke J; Enfield, Kyle; Gawtry, Stephen B; Stenger, Phillip J; Deaton, Michael L; Normile, Caroline P; Lee, Temple R

    2013-01-01

    Respiratory morbidity (particularly COPD and asthma) can be influenced by short-term weather fluctuations that affect air quality and lung function. We developed a model to evaluate meteorological conditions associated with respiratory hospital admissions in the Shenandoah Valley of Virginia, USA. We generated ensembles of classification trees based on six years of respiratory-related hospital admissions (64,620 cases) and a suite of 83 potential environmental predictor variables. As our goal was to identify short-term weather linkages to high admission periods, the dependent variable was formulated as a binary classification of five-day moving average respiratory admission departures from the seasonal mean value. Accounting for seasonality removed the long-term apparent inverse relationship between temperature and admissions. We generated eight total models specific to the northern and southern portions of the valley for each season. All eight models demonstrate predictive skill (mean odds ratio = 3.635) when evaluated using a randomization procedure. The predictor variables selected by the ensembling algorithm vary across models, and both meteorological and air quality variables are included. In general, the models indicate complex linkages between respiratory health and environmental conditions that may be difficult to identify using more traditional approaches. PMID:22438053

  2. Decreased mortality in patients hospitalized due to respiratory diseases after installation of an intensive care unit in a secondary hospital in the interior of Brazil

    PubMed Central

    Diogo, Luciano Passamani; Bahlis, Laura Fuchs; Wajner, André; Waldemar, Fernando Starosta

    2015-01-01

    Objective To evaluate the association between the in-hospital mortality of patients hospitalized due to respiratory diseases and the availability of intensive care units. Methods This retrospective cohort study evaluated a database from a hospital medicine service involving patients hospitalized due to respiratory non-terminal diseases. Data on clinical characteristics and risk factors associated with mortality, such as Charlson score and length of hospital stay, were collected. The following analyses were performed: univariate analysis with simple stratification using the Mantel Haenszel test, chi squared test, Student’s t test, Mann-Whitney test, and logistic regression. Results Three hundred thirteen patients were selected, including 98 (31.3%) before installation of the intensive care unit and 215 (68.7%) after installation of the intensive care unit. No significant differences in the clinical and anthropometric characteristics or risk factors were observed between the groups. The mortality rate was 18/95 (18.9%) before the installation of the intensive care unit and 21/206 (10.2%) after the installation of the intensive care unit. Logistic regression analysis indicated that the probability of death after the installation of the intensive care unit decreased by 58% (OR: 0.42; 95%CI 0.205 -0.879; p = 0.021). Conclusion Considering the limitations of the study, the results suggest a benefit, with a decrease of one death per every 11 patients treated for respiratory diseases after the installation of an intensive care unit in our hospital. The results corroborate the benefits of the implementation of intensive care units in secondary hospitals. PMID:26465244

  3. Patient characteristics associated with risk of first hospital admission and readmission for acute exacerbation of chronic obstructive pulmonary disease (COPD) following primary care COPD diagnosis: a cohort study using linked electronic patient records

    PubMed Central

    Hunter, L C; Lee, R J; Butcher, I; Weir, C J; Fischbacher, C M; McAllister, D; Wild, S H; Hewitt, N; Hardie, R M

    2016-01-01

    Objectives To investigate patient characteristics of an unselected primary care population associated with risk of first hospital admission and readmission for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Design Retrospective open cohort using pseudonymised electronic primary care data linked to secondary care data. Setting Primary care; Lothian (population approximately 800 000), Scotland. Participants Data from 7002 patients from 72 general practices with a COPD diagnosis date between 2000 and 2008 recorded in their primary care record. Patients were followed up until 2010, death or they left a participating practice. Main outcome measures First and subsequent admissions for AECOPD (International Classification of Diseases (ICD) 10 codes J44.0, J44.1 in any diagnostic position) after COPD diagnosis in primary care. Results 1756 (25%) patients had at least 1 AECOPD admission; 794 (11%) had at least 1 readmission and the risk of readmission increased with each admission. Older age at diagnosis, more severe COPD, low body mass index (BMI), current smoking, increasing deprivation, COPD admissions and interventions for COPD prior to diagnosis in primary care, and comorbidities were associated with higher risk of first AECOPD admission in an adjusted Cox proportional hazards regression model. More severe COPD and COPD admission prior to primary care diagnosis were associated with increased risk of AECOPD readmission in an adjusted Prentice-Williams-Peterson model. High BMI was associated with a lower risk of first AECOPD admission and readmission. Conclusions Several patient characteristics were associated with first AECOPD admission in a primary care cohort of people with COPD but fewer were associated with readmission. Prompt diagnosis in primary care may reduce the risk of AECOPD admission and readmission. The study highlights the important role of primary care in preventing or delaying a first AECOPD admission. PMID:26801463

  4. Impact of positive chest X-ray findings and blood cultures on adverse outcomes following hospitalized pneumococcal lower respiratory tract infection: a population-based cohort study

    PubMed Central

    2013-01-01

    Background Little is known about the clinical presentation and outcome of pneumococcal lower respiratory tract infection (LRTI) without positive chest X-ray findings and blood cultures. We investigated the prognostic impact of a pulmonary infiltrate and bacteraemia on the clinical course of hospitalized patients with confirmed pneumococcal LRTI. Methods We studied a population-based multi-centre cohort of 705 adults hospitalized with LRTI and Streptococcus pneumoniae in LRT specimens or blood: 193 without pulmonary infiltrate or bacteraemia, 250 with X-ray confirmed pneumonia, and 262 with bacteraemia. We compared adverse outcomes in the three groups and used multiple regression analyses to adjust for differences in age, sex, comorbidity, and lifestyle factors. Results Patients with no infiltrate and no bacteraemia were of similar age but had more comorbidity than the other groups (Charlson index score ≥1: no infiltrate and no bacteraemia 81% vs. infiltrate without bacteraemia 72% vs. bacteraemia 61%), smoked more tobacco, and had more respiratory symptoms. In contrast, patients with a pulmonary infiltrate or bacteraemia had more inflammation (median C-reactive protein: no infiltrate and no bacteraemia 82 mg/L vs. infiltrate without bacteraemia 163 mg/L vs. bacteraemia 316 mg/L) and higher acute disease severity scores. All adverse outcomes increased from patients with no infiltrate and no bacteraemia to those with an infiltrate and to those with bacteraemia: Length of hospital stay (5 vs. 6 vs. 8 days); intensive care admission (7% vs. 20% vs. 23%); pulmonary complications (1% vs. 5% vs. 14%); and 30-day mortality (5% vs. 11% vs. 21%). Compared with patients with no infiltrate and no bacteraemia, the adjusted 30-day mortality rate ratio was 1.9 (95% confidence interval (CI) 0.9-4.1) in patients with an infiltrate without bacteraemia and 4.1 (95% CI 2.0-8.5) in bacteraemia patients. Adjustment for acute disease severity and inflammatory markers weakened these

  5. Outbreaks of Middle East Respiratory Syndrome in Two Hospitals Initiated by a Single Patient in Daejeon, South Korea

    PubMed Central

    2016-01-01

    Background A Middle East Respiratory Syndrome coronavirus (MERS-CoV) outbreak in South Korea in 2015 started by a single imported case and was amplified by intra- and inter-hospital transmission. We describe two hospital outbreaks of MERS-CoV infection in Daejeon caused by a single patient who was infected by the first Korean case of MERS. Materials and Methods Demographic and clinical information involving MERS cases in the Daejeon cluster were retrospectively collected and potential contacts and exposures were assessed. The incubation periods and serial intervals were estimated. Viral RNAs were extracted from respiratory tract samples obtained from the index case, four secondary cases and one tertiary case from each hospital. The partial S2 domain of the MERS-CoV spike was sequenced. Results In Daejeon, a MERS patient (the index case) was hospitalized at Hospital A in the first week of illness and was transferred to Hospital B because of pneumonia progression in the second week of illness, where he received a bronchoscopic examination and nebulizer therapy. A total of 23 secondary cases (10 in Hospital A and 13 in Hospital B) were detected among patients and caregivers who stayed on the same ward with the index case. There were no secondary cases among healthcare workers. Among close hospital contacts, the secondary attack rate was 15.8% (12/76) in Hospital A and 14.3% (10/70) in Hospital B. However, considering the exposure duration, the incidence rate was higher in Hospital B (7.7/100 exposure-days) than Hospital A (3.4/100 exposure-days). In Hospital B, the median incubation period was shorter (4.6 days vs. 10.8 days), the median time to pneumonia development was faster (3 days vs. 6 days) and mortality was higher (70% vs. 30.8%) than in Hospital A. MERS-CoV isolates from 11 cases formed a single monophyletic clade, with the closest similarity to strains from Riyadh. Conclusion Exposure to the MERS case in the late stage (2nd week) of diseases appeared to

  6. Hospital admissions for severe mental illness in England: Changes in equity of utilisation at the small area level between 2006 and 2010

    PubMed Central

    White, Jonathan; Gutacker, Nils; Jacobs, Rowena; Mason, Anne

    2014-01-01

    Severe Mental Illness (SMI) encompasses a range of chronic conditions including schizophrenia, bipolar disorder and psychoses. Patients with SMI often require inpatient psychiatric care. Despite equity being a key objective in the English National Health Service (NHS) and in many other health care systems worldwide, little is known about the socio-economic equity of hospital care utilisation for patients with SMI and how it has changed over time. This analysis seeks to address that gap in the evidence base. We exploit a five-year (2006–2010) panel dataset of admission rates at small area level (n = 162,410). The choice of control variables was informed by a systematic literature search. To assess changes in socio-economic equity of utilisation, OLS-based standardisation was first used to conduct analysis of discrete deprivation groups. Geographical inequity was then illustrated by plotting standardised and crude admission rates at local purchaser level. Lastly, formal statistical tests for changes in socio-economic equity of utilisation were applied to a continuous measure of deprivation using pooled negative binomial regression analysis, adjusting for a range of risk factors. Our results suggest that one additional percentage point of area income deprivation is associated with a 1.5% (p < 0.001) increase in admissions for SMI after controlling for population size, age, sex, prevalence of SMI in the local population, as well as other need and supply factors. This finding is robust to sensitivity analyses, suggesting that a pro-poor inequality in utilisation exists for SMI-related inpatient services. One possible explanation is that the supply or quality of primary, community or social care for people with mental health problems is suboptimal in deprived areas. Although there is some evidence that inequity has reduced over time, the changes are small and not always robust to sensitivity analyses. PMID:25262312

  7. Influenza A virus among the hospitalized young children with acute respiratory infection. Is influenza A co infected with respiratory syncytial virus?

    PubMed Central

    Alavi, Seyed Mohammad; Makvandi, Manoochehr; Najafi-Fard, Saied; Alavi, Leila

    2012-01-01

    Background: Both influenza A virus (IAV) and respiratory syncytial virus (RSV) cause acute respiratory infection (ARI) in infants and young children. This study was conducted to determine Influenza A virus and its co infection with RSV among the hospitalized children with ARI. Methods: A total of 153 throat samples of the hospitalized young children aged between below one year and 5 years with the clinical signs of ARI were collected from the different hospitals in Khuzestan from June 2009 to April 2010. The samples were tested for Influenza A viruses by real time PCR. Positive IAV samples were tested for influenza A sub type H1N1 and for RSV by the nested PCR. Results: In this study, from the total 153 samples, 35 samples (22.9%) including 15 (42.8%) females and 20 (57.2%) males were positive for influenza A viruses. From the 35 positive samples for IAV, 14 were positive for swine H1N1 subtype. All the positive samples for influenza showed negative for RSV infection which revealed no coinfection with RSV. The prevalence of influenza A among age/sex groups was not significant. Conclusion: Influenza A is a prevalent viral agent isolated from young children with ARI. Influenza A subtype H1N1 was accounted for the 40 percent all laboratory-proven diagnoses of influenza in 2009. No evidence of coinfection of influenza A and RSV has been observed in the present study. PMID:24009929

  8. Fine Particulate Air Pollution and Hospital Emergency Room Visits for Respiratory Disease in Urban Areas in Beijing, China, in 2013

    PubMed Central

    Wang, Shuo; Wang, Chao; Huang, Fangfang; Gao, Qi; Wu, Lijuan; Tao, Lixin; Guo, Jin; Wang, Wei; Guo, Xiuhua

    2016-01-01

    Background Heavy fine particulate matter (PM2.5) air pollution occurs frequently in China. However, epidemiological research on the association between short-term exposure to PM2.5 pollution and respiratory disease morbidity is still limited. This study aimed to explore the association between PM2.5 pollution and hospital emergency room visits (ERV) for total and cause-specific respiratory diseases in urban areas in Beijing. Methods Daily counts of respiratory ERV from Jan 1 to Dec 31, 2013, were obtained from ten general hospitals located in urban areas in Beijing. Concurrently, data on PM2.5 were collected from the Beijing Environmental Protection Bureau, including 17 ambient air quality monitoring stations. A generalized-additive model was used to explore the respiratory effects of PM2.5, after controlling for confounding variables. Subgroup analyses were also conducted by age and gender. Results A total of 92,464 respiratory emergency visits were recorded during the study period. The mean daily PM2.5 concentration was 102.1±73.6 μg/m3. Every 10 μg/m3 increase in PM2.5 concentration at lag0 was associated with an increase in ERV, as follows: 0.23% for total respiratory disease (95% confidence interval [CI]: 0.11%-0.34%), 0.19% for upper respiratory tract infection (URTI) (95%CI: 0.04%-0.35%), 0.34% for lower respiratory tract infection (LRTI) (95%CI: 0.14%-0.53%) and 1.46% for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) (95%CI: 0.13%-2.79%). The strongest association was identified between AECOPD and PM2.5 concentration at lag0-3 (3.15%, 95%CI: 1.39%-4.91%). The estimated effects were robust after adjusting for SO2, O3, CO and NO2. Females and people 60 years of age and older demonstrated a higher risk of respiratory disease after PM2.5 exposure. Conclusion PM2.5 was significantly associated with respiratory ERV, particularly for URTI, LRTI and AECOPD in Beijing. The susceptibility to PM2.5 pollution varied by gender and age. PMID

  9. Estimating the hospitalization burden associated with influenza and respiratory syncytial virus in New York City, 2003–2011

    PubMed Central

    Goldstein, Edward; Greene, Sharon K; Olson, Donald R; Hanage, William P; Lipsitch, Marc

    2015-01-01

    Background Hospitalization burden associated with influenza and respiratory syncytial virus (RSV) is uncertain due to ambiguity in the inference methodologies employed for its estimation. Objectives Utilization of a new method to quantitate the above burden. Methods Weekly hospitalization rates for several principal diagnoses from 2003 to 2011 in New York City by age group were regressed linearly against incidence proxies for the major influenza subtypes and RSV adjusting for temporal trends and seasonal baselines. Results Average annual rates of influenza-associated respiratory hospitalizations per 100 000 were estimated to be 129 [95% CI (79, 179)] for age <1, 36·3 (21·6, 51·4) for ages 1–4, 10·6 (7·5, 13·7) for ages 5–17, 25·6 (21·3, 29·8) for ages 18–49, 65·5 (54·0, 76·9) for ages 50–64, 125 (105, 147) for ages 65–74, and 288 (244, 331) for ages ≥75. Additionally, influenza had a significant contribution to hospitalization rates with a principal diagnosis of septicemia for ages 5–17 [0·76 (0·1, 1·4)], 18–49 [1·02 (0·3, 1·7)], 50–64 [4·0 (1·7, 6·3)], 65–74 [8·8 (2·2, 15·6)], and ≥75 [38·7 (25·7, 52·9)]. RSV had a significant contribution to the rates of respiratory hospitalizations for age <1 [1900 (1740, 2060)], ages 1–4 [117 (70, 167)], and ≥75 [175 (44, 312)] [including chronic lower respiratory disease, 90 (43, 140)] as well as pneumonia & influenza hospitalizations for ages 18–49 [6·2 (1·1, 11·3)] and circulatory hospitalizations for ages ≥75 [199 (13, 375)]. Conclusions The high burden of RSV hospitalizations among young children and seniors age ≥75 suggests the need for additional control measures such as vaccination to mitigate the impact of annual RSV epidemics. Our estimates for influenza-associated hospitalizations provide further evidence of the burden of morbidity associated with influenza, supporting current guidelines regarding influenza vaccination and antiviral treatment. PMID

  10. Rhinovirus-C detection in children presenting with acute respiratory infection to hospital in Brazil.

    PubMed

    Fawkner-Corbett, David W; Khoo, Siew Kim; Duarte, Carminha M; Bezerra, Patricia G M; Bochkov, Yury A; Gern, James E; Le Souef, Peter N; McNamara, Paul S

    2016-01-01

    Human rhinovirus (RV) is a common cause of acute respiratory infection (ARI) in children. We aimed to characterize the clinical and demographic features associated with different RV species detected in children attending hospital with ARI, from low-income families in North-east Brazil. Nasopharyngeal aspirates were collected from 630 children <5 years with ARI. Clinical diagnosis and disease severity were also recorded. Samples were analyzed by multiplex PCR for 18 viral and atypical bacterial pathogens; RV positive samples underwent partial sequencing to determine species and type. RV was the fourth commonest pathogen accounting for 18.7% of pathogens detected. RV was commonly detected in children with bronchiolitis, pneumonia, and asthma/episodic viral wheeze (EVW). Species and type were assigned in 112 cases (73% RV-A; 27% RV-C; 0% RV-B). Generally, there were no differences in clinical or demographic characteristics between those infected with RV-A and RV-C. However, in children with asthma/EVW, RV-C was detected relatively more frequently than RV-A (23% vs. 5%; P = 0.04). Our findings highlight RV as a potentially important pathogen in this setting. Generally, clinical and demographic features were similar in children in whom RV-A and C species were detected. However, RV-C was more frequently found in children with asthma/EVW than RV-A. PMID:26100591

  11. Six features of Medicare coordinated care demonstration programs that cut hospital admissions of high-risk patients.

    PubMed

    Brown, Randall S; Peikes, Deborah; Peterson, Greg; Schore, Jennifer; Razafindrakoto, Carol M

    2012-06-01

    As policy makers seek to slow the growth in Medicare spending, they have appropriately focused attention on beneficiaries with multiple chronic conditions. Many care coordination and disease management programs designed to improve beneficiaries' care and reduce their need for hospitalizations have been tested, but few have been successful. This study, however, found that four of eleven programs that were part of the Medicare Coordinated Care Demonstration reduced hospitalizations by 8-33 percent among enrollees who had a high risk of near-term hospitalization. The six approaches practiced by care coordinators in at least three of the four programs were as follows: supplementing telephone calls to patients with frequent in-person meetings; occasionally meeting in person with providers; acting as a communications hub for providers; delivering evidence-based education to patients; providing strong medication management; and providing timely and comprehensive transitional care after hospitalizations. When care management fees were included, the programs were essentially cost-neutral, but none of these programs generated net savings to Medicare. Our results suggest that incorporating these approaches into medical homes, accountable care organizations, and other policy initiatives could reduce hospitalizations and improve patients' lives. However, the approaches would save money only if care coordination fees were modest and organizations found cost-effective ways to deliver the interventions. PMID:22665827

  12. Shocking Admission

    ERIC Educational Resources Information Center

    Hoover, Eric; Millman, Sierra

    2007-01-01

    Marilee Jones's career had been a remarkable success. She joined Massachusetts Institute of Technology's (MIT's) admissions office in 1979, landing a job in Cambridge at a time when boys ruled the sandbox of the admissions profession. Her job was to help MIT recruit more women, who then made up less than one-fifth of the institute's students. She…

  13. Practice patterns for lower respiratory tract infections in hospital patients with particular focus on bacteriological examinations and injection antibiotics use

    PubMed Central

    Wada, Mikio; Nakayama, Takeo; Ishizaki, Tatsuro; Satoh, Toshihiko; Ikeda, Shunya

    2013-01-01

    Background Various types of medical institutions perform treatments for lower respiratory tract infections. However, few studies have assessed and compared practice patterns across different medical institutions in Japan. To assess practice patterns for community-acquired lower respiratory tract infections among patients who needed hospitalization, we examined the use of injection antibiotics and the implementation of bacteriological examinations, and compared these across medical institutions. We then evaluated whether bacteriological examinations were being adequately implemented. Methods A cross-sectional study was conducted using a database of health insurance claims. Subjects were patients (≥16 years old) who received injection antibiotics to treat lower respiratory tract infections, and who were listed among 2004–2007 insurance claims data. For each type of antibiotic, we obtained the dose prescribed, the number of patients treated, and the frequency of bacteriological examinations. Results A total of 1649 patients were evaluated. The implementation rate of Gram stain and sputum culture was 14% at clinics (<20 beds), approximately 30% at small hospitals (20–99 beds), and 40%–45% at medium-sized (100–499 beds) and large hospitals (≥500 beds). As a whole, beta-lactams were most frequently used, accounting for 80% of all antibiotics used. Among beta-lactams, penicillins comprised 25% of the total amount of drugs used at hospitals with ≥300 beds, but approximately 13% at clinics and small hospitals. Conclusion Practice patterns varied depending on the size of the medical institution. The implementation rate of bacteriological examinations was not high enough, especially at clinics and small hospitals. PMID:23898230

  14. Incidence, characteristics and risk factors of adverse drug reactions in hospitalized children – a prospective observational cohort study of 6,601 admissions

    PubMed Central

    2013-01-01

    Background Adverse drug reactions (ADRs) are an important cause of harm in children. Current data are incomplete due to methodological differences between studies: only half of all studies provide drug data, incidence rates vary (0.6% to 16.8%) and very few studies provide data on causality, severity and risk factors of pediatric ADRs. We aimed to determine the incidence of ADRs in hospitalized children, to characterize these ADRs in terms of type, drug etiology, causality and severity and to identify risk factors. Methods We undertook a year-long, prospective observational cohort study of admissions to a single UK pediatric medical and surgical secondary and tertiary referral center (Alder Hey, Liverpool, UK). Children between 0 and 16 years 11 months old and admitted for more than 48 hours were included. Observed outcomes were occurrence of ADR and time to first ADR for the risk factor analysis. Results A total of 5,118 children (6,601 admissions) were included, 17.7% of whom experienced at least one ADR. Opiate analgesics and drugs used in general anesthesia (GA) accounted for more than 50% of all drugs implicated in ADRs. Of these ADRs, 0.9% caused permanent harm or required admission to a higher level of care. Children who underwent GA were at more than six times the risk of developing an ADR than children without a GA (hazard ratio (HR) 6.40; 95% confidence interval (CI) 5.30 to 7.70). Other factors increasing the risk of an ADR were increasing age (HR 1.06 for each year; 95% CI 1.04 to 1.07), increasing number of drugs (HR 1.25 for each additional drug; 95% CI 1.22 to 1.28) and oncological treatment (HR 1.90; 95% CI 1.40 to 2.60). Conclusions ADRs are common in hospitalized children and children who had undergone a GA had more than six times the risk of developing an ADR. GA agents and opiate analgesics are a significant cause of ADRs and have been underrepresented in previous studies. This is a concern in view of the increasing number of pediatric short

  15. Drug related admissions to medical wards

    PubMed Central

    Hallas, Jesper; Gram, Lars F.; Grodum, Ellen; Damsbo, Niels; Brøsen, Kim; Haghfelt, Torben; Harvald, Bent; Beck-Nielsen, Jørgen; Worm, Jørgen; Birger Jensen, Kurt; Davidsen, Otto; Frandsen, Niels E.; Hagen, Claus; Andersen, Morten; Frølund, Flemming; Kromann-Andersen, Hans; Schou, Jens

    1992-01-01

    1 In total 1999 consecutive admissions to six medical wards were subjected to a prospective high-intensity drug event monitoring scheme to assess the extent and pattern of admissions caused by adverse drug reactions (ADRs) or dose related therapeutic failures (TF), in a population-based design. The wards were sub-specialised in general medicine, geriatrics, endocrinology, cardiology, respiratory medicine and gastroenterology. 2 Considering definite, probable and possible drug events, the prevalence of drug related hospital admissions was 11.4% of which 8.4% were caused by ADRs and 3.0% by TFs. There were large inter-department differences. 3 The six classes of drugs most frequently involved in admissions caused by ADRs were anti-rheumatics and analgesics (27%), cardiovascular drugs (23%), psychotropic drugs (14%), anti-diabetics (12%), antibiotics (7%), and corticosteroids (5%). Non-compliance accounted for 66% of the TFs with diuretics and anti-asthmatics most frequently involved. 4 The pattern of drugs involved in ADRs was compared with the regional drug sales statistics. Drugs with a particularly high rate of ADR related admissions per unit dispensed were nitrofurantoin and insulin (617 and 182 admissions per 1,000,000 defined daily doses), while low rates were seen for diuretics and benzodiazepines (10 and 7 admissions per 1,000,000 defined daily doses). Confidence intervals were wide. 5 Patients who had their therapy prescribed by a hospital doctor had a slightly higher prevalence of drug events than those who were treated by a general practitioner (12.6% vs 11.8%). The reverse applied for drug events assessed as avoidable (3.3% vs 4.6%). Although these differences were not statistically significant, it may suggest general practitioners as the appropriate target for interventive measures. 6 Only one ADR was reported to The Danish Committee on Adverse Drug Reactions, indicating a severe under-reporting and a potential for gross selectivity. The data collection

  16. Disparities among 2009 Pandemic Influenza A (H1N1) Hospital Admissions: A Mixed Methods Analysis – Illinois, April–December 2009

    PubMed Central

    Soyemi, Kenneth; Medina-Marino, Andrew; Sinkowitz-Cochran, Ronda; Schneider, Amy; Njai, Rashid; McDonald, Marian; Glover, Maleeka; Garcia, Jocelyn; Aiello, Allison E.

    2014-01-01

    During late April 2009, the first cases of 2009 pandemic influenza A (H1N1) (pH1N1) in Illinois were reported. On-going, sustained local transmission resulted in an estimated 500,000 infected persons. We conducted a mixed method analysis using both quantitative (surveillance) and qualitative (interview) data; surveillance data was used to analyze demographic distribution of hospitalized cases and follow-up interview data was used to assess health seeking behavior. Invitations to participate in a telephone interview were sent to 120 randomly selected Illinois residents that were hospitalized during April–December 2009. During April–December 2009, 2,824 pH1N1 hospitalizations occurred in Illinois hospitals; median age (interquartile range) at admission was 24 (range: 6–49) years. Hospitalization rates/100,000 persons for blacks and Hispanics, regardless of age or sex were 2–3 times greater than for whites (blacks, 36/100,000 (95% Confidence Interval ([95% CI], 33–39)); Hispanics, 35/100,000 [95%CI,32–37] (; whites, 13/100,000[95%CI, 12–14); p<0.001). Mortality rates were higher for blacks (0.9/100,000; p<0.09) and Hispanics (1/100,000; p<0.04) when compared with the mortality rates for whites (0.6/100,000). Of 33 interview respondents, 31 (94%) stated that they had heard of pH1N1 before being hospitalized, and 24 (73%) did not believed they were at risk for pH1N1. On average, respondents reported experiencing symptoms for 2 days (range: 1–7) before seeking medical care. When asked how to prevent pH1N1 infection in the future, the most common responses were getting vaccinated and practicing hand hygiene. Blacks and Hispanics in Illinois experienced disproportionate pH1N1 hospitalization and mortality rates. Public health education and outreach efforts in preparation for future influenza pandemics should include prevention messaging focused on perception of risk, and ensure community wide access to prevention messages and practices. PMID:24776852

  17. Study on the association between residential exposure to N, N-dimethylformamide and hospitalization for respiratory disease

    NASA Astrophysics Data System (ADS)

    Wang, Cui; Tian, WeiLi; Wei, YuMei; Li, XiaoXiao; Zhang, QingYu; Huang, ChanKe

    2013-10-01

    Some studies have confirmed the adverse effects of N, N-dimethylformamide (DMF) on the different organs in occupational exposure workers. However, to the best of our knowledge, risk assessment in the general population has not been available. In this study, a time series analysis of the relationship between DMF exposure and respiratory hospitalization was performed in Longwan district of China in 2008. Generalized additive model (GAMs) reflected that a 101.0 μg m-3 (inter-quartile range) increase in the 1-day lag concentration of DMF resulted in a 1.17 (95% CI: 1.09-1.25) increased relative risk of hospitalization for respiratory problems. The dose-response curve representing the relationship between DMF and the logarithm of the number of hospitalization was adequately linear at 4-200 μg m-3. We proposed a risk on respiratory disease in non-occupational DMF exposure. More information is required to verify this observation and the other endpoints to general population should be investigated during long-term DMF exposure.

  18. “Causes of death in asthma, COPD and non-respiratory hospitalized patients: a multicentric study”

    PubMed Central

    2013-01-01

    Background There is limited information on the causes of death in asthma patients. To determine the causes of death in hospitalized asthmatic patients and to compare with those observed in COPD patients and non-respiratory individuals, with a particular interest in associations with previous cardiovascular disease. Methods Retrospective case–control study which analyzed the deaths of all hospitalized patients admitted for any reason during January, April, July and October of 2008 in 13 Spanish centers. Medical records of deceased patients were reviewed, and demographic and clinical data were collected. Results A total of 2,826 deaths (mean age 75 years, 56% men) were included in the analysis, of which 82 (2.9%) were of patients with asthma and 283 (10%) with COPD. The most common causes of death in asthma patients were cardiovascular diseases (29.3%), malignancies (20.7%) and infections (14.6%); in COPD patients they were malignancies (26.5%), acute respiratory failure (25.8%) and cardiovascular diseases (21.6%). Asthma, compared to COPD patients, died significantly less frequently from acute respiratory failure and lung cancer. A multivariate logistic regression analysis failed to associate asthma with cardiovascular deaths. Conclusions Cardiovascular disease is the most frequent cause of death among hospitalized asthma patients. The specific causes of death differ between asthma and COPD patients. PMID:24321217

  19. Why Should I Talk about Emotion? Communication Patterns Associated with Physician Discussion of Patient Expressions of Negative Emotion in Hospital Admission Encounters

    PubMed Central

    Adams, Kristen; Cimino, Jenica EW; Arnold, Robert M.; Anderson, Wendy G.

    2012-01-01

    Objective To describe hospital-based physicians' responses to patients' verbal expressions of negative emotion and identify patterns of further communication associated with different responses. Methods Qualitative analysis of physician-patient admission encounters audio-recorded between August 2008-March 2009 at two hospitals within a university system. A codebook was iteratively developed to identify patients' verbal expressions of negative emotion. We categorized physicians' responses by their immediate effect on further discussion of emotion - focused away (away), focused neither toward nor away (neutral), and focused toward (toward) - and examined further communication patterns following each response type. Results In 79 patients' encounters with 27 physicians, the median expression of negative emotion was 1, range 0–14. Physician responses were 25% away, 43% neutral, and 32% toward. Neutral and toward responses elicited patient perspectives, concerns, social and spiritual issues, and goals for care. Toward responses demonstrated physicians' support, contributing to physician-patient alignment and agreement about treatment. Conclusion Responding to expressions of negative emotion neutrally or with statements that focus toward emotion elicits clinically relevant information and is associated with positive physician-patient relationship and care outcomes. Practice Implications Providers should respond to expressions of negative emotion with statements that allow for or explicitly encourage further discussion of emotion. PMID:22575434

  20. Comparison of CATs, CURB-65 and PMEWS as Triage Tools in Pandemic Influenza Admissions to UK Hospitals: Case Control Analysis Using Retrospective Data

    PubMed Central

    Myles, Puja R.; Nguyen-Van-Tam, Jonathan S.; Lim, Wei Shen; Nicholson, Karl G.; Brett, Stephen J.; Enstone, Joanne E.; McMenamin, James; Openshaw, Peter J. M.; Read, Robert C.; Taylor, Bruce L.; Bannister, Barbara; Semple, Malcolm G.

    2012-01-01

    Triage tools have an important role in pandemics to identify those most likely to benefit from higher levels of care. We compared Community Assessment Tools (CATs), the CURB-65 score, and the Pandemic Medical Early Warning Score (PMEWS); to predict higher levels of care (high dependency - Level 2 or intensive care - Level 3) and/or death in patients at or shortly after admission to hospital with A/H1N1 2009 pandemic influenza. This was a case-control analysis using retrospectively collected data from the FLU-CIN cohort (1040 adults, 480 children) with PCR-confirmed A/H1N1 2009 influenza. Area under receiver operator curves (AUROC), sensitivity, specificity, positive predictive values and negative predictive values were calculated. CATs best predicted Level 2/3 admissions in both adults [AUROC (95% CI): CATs 0.77 (0.73, 0.80); CURB-65 0.68 (0.64, 0.72); PMEWS 0.68 (0.64, 0.73), p<0.001] and children [AUROC: CATs 0.74 (0.68, 0.80); CURB-65 0.52 (0.46, 0.59); PMEWS 0.69 (0.62, 0.75), p<0.001]. CURB-65 and CATs were similar in predicting death in adults with both performing better than PMEWS; and CATs best predicted death in children. CATs were the best predictor of Level 2/3 care and/or death for both adults and children. CATs are potentially useful triage tools for predicting need for higher levels of care and/or mortality in patients of all ages. PMID:22509303

  1. Adverse drug reactions and off-label and unlicensed medicines in children: a prospective cohort study of unplanned admissions to a paediatric hospital

    PubMed Central

    Bellis, Jennifer R; Kirkham, Jamie J; Nunn, Anthony J; Pirmohamed, Munir

    2014-01-01

    Aims To examine the impact of off-label and unlicensed (OLUL) prescribing on adverse drug reactions (ADRs) causing unplanned admissions to a paediatric hospital. Methods Prescription data from a 12 month prospective cohort study of ADRs detected in children admitted to a paediatric hospital were scrutinized. The relative risk for off-label and unlicensed medicines being implicated in an ADR was calculated. Logistic regression analyses were carried out with exposure to off-label and unlicensed medicines and number of off-label and unlicensed medicines administered as predictor variables. Results Off-label and unlicensed medicines were more likely to be implicated in an ADR than authorized medicines (relative risk 1.67, 95% CI 1.38, 2.02, P < 0.001). There was a 25% increase in ADR risk (95% CI 1.16, 1.35, P < 0.001) with each additional authorized medicine and 23% (95% CI 1.10, 1.36, P < 0.001) with each additional off-label or unlicensed medicine. Logistic regression analysis focusing on non-oncology patients demonstrated that the number of authorized medicines (odds ratio 1.33, 95% CI 1.23, 1.44, P < 0.001), but not the number of off-label and unlicensed medicine courses, was a predictor of ADR risk. Conclusions In a heterogeneous population of children admitted to a secondary/tertiary hospital, off-label and unlicensed medicines are more likely to be implicated in an ADR than authorized medicines. This was largely driven by ADRs related to drugs used in oncological practice, where the usage of off-label or unlicensed medicines was associated with a higher ADR risk than in non-oncological areas. PMID:23919928

  2. [The Health Department of Sicily "Regional recommendations for hospital discharge and communication with patients after admission due to a cardiologic event" decree].

    PubMed

    Abrignani, Maurizio Giuseppe; De Luca, Giovanni; Gabriele, Michele; Tourkmani, Nidal

    2014-06-01

    Mortality and rehospitalizations still remain high after discharge for an acute cardiologic event. In this context, hospital discharge represents a potential pitfall for heart disease patients. In the setting of care transitions, the discharge letter is the main instrument of communication between hospital and primary care. Communication, besides, is an integral part of high-quality, patient-centered interventions aimed at improving the discharge process. Inadequate information at discharge significantly affects the quality of treatment compliance and the adoption of lifestyle modifications for an effective secondary prevention. The Health Department of Sicily, in 2013, established a task force with the aim to elaborate "Regional recommendations for hospital discharge and communication with patients after admission due to a cardiologic event", inviting to participate GICR-IACPR and many other scientific societies of cardiology and primary care, as discharge letter and communication are fundamental junctions of care transitions in cardiology. These recommendations have been published as a specific decree and contain: a structured model of discharge letter, which includes all of the parameters characterizing patients at high clinical risk, high thrombotic risk and low risk according to the Consensus document ANMCO/GICR-IACPR/GISE; is thus possible to identify these patients, choosing consequently the most appropriate follow-up pathways. A particular attention has been given to the "Medication Reconciliation" and to the identification of therapeutic targets; an educational Kit, with different forms on cardiac diseases, risk factors, drugs and lifestyle; a check-list about information given to the patient and caregivers. The "Recommendations" represent, in conclusion, the practical realization of the fruitful cooperation between scientific societies and political-administrative institutions that has been realized in Sicily in the last years. PMID:25845093

  3. Shared component modelling as an alternative to assess geographical variations in medical practice: gender inequalities in hospital admissions for chronic diseases

    PubMed Central

    2011-01-01

    Background Small area analysis is the most prevalent methodological approach in the study of unwarranted and systematic variation in medical practice at geographical level. Several of its limitations drive researchers to use disease mapping methods -deemed as a valuable alternative. This work aims at exploring these techniques using - as a case of study- the gender differences in rates of hospitalization in elderly patients with chronic diseases. Methods Design and study setting: An empirical study of 538,358 hospitalizations affecting individuals aged over 75, who were admitted due to a chronic condition in 2006, were used to compare Small Area Analysis (SAVA), the Besag-York-Mollie (BYM) modelling and the Shared Component Modelling (SCM). Main endpoint: Gender spatial variation was measured, as follows: SAVA estimated gender-specific utilization ratio; BYM estimated the fraction of variance attributable to spatial correlation in each gender; and, SCM estimated the fraction of variance shared by the two genders, and those specific for each one. Results Hospitalization rates due to chronic diseases in the elderly were higher in men (median per area 21.4 per 100 inhabitants, interquartile range: 17.6 to 25.0) than in women (median per area 13.7 per 100, interquartile range: 10.8 to 16.6). Whereas Utilization Ratios showed a similar geographical pattern of variation in both genders, BYM found a high fraction of variation attributable to spatial correlation in both men (71%, CI95%: 50 to 94) and women (62%, CI95%: 45 to 77). In turn, SCM showed that the geographical admission pattern was mainly shared, with just 6% (CI95%: 4 to 8) of variation specific to the women component. Conclusions Whereas SAVA and BYM focused on the magnitude of variation and on allocating where variability cannot be due to chance, SCM signalled discrepant areas where latent factors would differently affect men and women. PMID:22188979

  4. The use of digoxin in patients with worsening chronic heart failure: reconsidering an old drug to reduce hospital admissions.

    PubMed

    Ambrosy, Andrew P; Butler, Javed; Ahmed, Ali; Vaduganathan, Muthiah; van Veldhuisen, Dirk J; Colucci, Wilson S; Gheorghiade, Mihai

    2014-05-13

    Digoxin is the oldest cardiac drug still in contemporary use, yet its role in the management of patients with heart failure (HF) remains controversial. A purified cardiac glycoside derived from the foxglove plant, digoxin increases ejection fraction, augments cardiac output, and reduces pulmonary capillary wedge pressure without causing deleterious increases in heart rate or decreases in blood pressure. Moreover, it is also a neurohormonal modulator at low doses. In the pivotal DIG (Digitalis Investigation Group) trial, digoxin therapy was shown to reduce all-cause and HF-specific hospitalizations but had no effect on survival. With the discovery of neurohormonal blockers capable of reducing mortality in HF with reduced ejection fraction, the results of the DIG trial were viewed as neutral, and the use of digoxin declined precipitously. Although modern drug and device-based therapies have dramatically improved the survival of ambulatory patients with HF, outcomes for patients with worsening chronic HF, defined as deteriorating signs and symptoms on standard therapy often leading to unscheduled clinic or emergency department visits or hospitalization, have largely remained unchanged over the past 2 decades. The available data suggest that a therapeutic trial of digoxin may be appropriate in patients with worsening chronic heart failure who remain symptomatic. PMID:24613328

  5. Serum bilirubin value predicts hospital admission in carbon monoxide-poisoned patients. Active player or simple bystander?

    PubMed Central

    Cervellin, Gianfranco; Comelli, Ivan; Buonocore, Ruggero; Picanza, Alessandra; Rastelli, Gianni; Lippi, Giuseppe

    2015-01-01

    OBJECTIVES: Although carbon monoxide poisoning is a major medical emergency, the armamentarium of recognized prognostic biomarkers displays unsatisfactory diagnostic performance for predicting cumulative endpoints. METHODS: We performed a retrospective and observational study to identify all patients admitted for carbon monoxide poisoning during a 2-year period. Complete demographical and clinical information, along with the laboratory data regarding arterial carboxyhemoglobin, hemoglobin, blood lactate and total serum bilirubin, was retrieved. RESULTS: The study population consisted of 38 poisoned patients (23 females and 15 males; mean age 39±21 years). Compared with discharged subjects, hospitalized patients displayed significantly higher values for blood lactate and total serum bilirubin, whereas arterial carboxyhemoglobin and hemoglobin did not differ. In a univariate analysis, hospitalization was significantly associated with blood lactate and total serum bilirubin, but not with age, sex, hemoglobin or carboxyhemoglobin. The diagnostic performance obtained after combining the blood lactate and total serum bilirubin results (area under the curve, 0.90; 95% CI, 0.81-0.99; p<0.001) was better than that obtained for either parameter alone. CONCLUSION: Although it remains unclear whether total serum bilirubin acts as an active player or a bystander, we conclude that the systematic assessment of bilirubin may, alongside lactate levels, provide useful information for clinical decision making regarding carbon monoxide poisoning. PMID:26375565