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Hospitalization Rates (hospitalization + rate)
Selected AbstractsEffect of Statin (HMG-Co-A-Reductase Inhibitor) Use on 1-Year Mortality and Hospitalization Rates in Older Patients with Cardiovascular Disease Living in Nursing HomesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2002Charles B. Eaton MD OBJECTIVES: To quantify the effect of statins on 1-year mortality, hospitalizations, and decline in physical function among patients with cardiovascular disease (CVD) aged 65 and older living in nursing homes. DESIGN: Retrospective cohort study. SETTING: All Medicare/Medicaid certified nursing homes (N = 1,492) in Maine, New York, Mississippi, and South Dakota. PARTICIPANTS: We identified 51,559 older patients with CVD from a population database that merged sociodemographic data and functional, clinical, and drug treatments from more than 300,000 newly admitted nursing home residents from 1992 to 1997. Statin users (n = 1,313) were matched with nonusers (n = 1,313) in the same facilities. MEASUREMENTS: All-cause mortality, hospitalization, combined endpoint of mortality or hospitalization, and decline in physical function were determined at 1 year, and survival analysis was performed. RESULTS: Prevalence of statin use in this frail older cohort with CVD was 2.6%. Statin use varied by age, gender, comorbid condition, medication use, and cognitive and physical function. One-year mortality was 229/1,000 person-years in the statin group and 404/1,000 person-years in the nonusers, with an adjusted hazard rate ratio (HRR) of 0.69, 95% confidence interval (CI) = 0.58,0.81. The estimated number needed to treat was seven (95% CI = 5,13). This association with improved all-cause mortality was evident for women and men and for age groups 75 to 84, and 85 and older. CONCLUSION: Statin therapy is associated with improved clinical outcomes, including reduction in 1-year all-cause mortality, and the combined endpoint of death or hospitalization in a frail older population with CVD. Some caution should be taken in interpreting these results because potential bias from residual confounding could affect these results. [source] Asthma Hospitalization Rates Among Children, and School Building Conditions, by New York State School Districts, 1991-2001JOURNAL OF SCHOOL HEALTH, Issue 8 2006Erin Belanger This study examined patterns of asthma hospitalization and possible factors contributing to asthma hospitalizations, including sociodemographics and school environmental factors, among school-age children (5-18 years) in New York State (NYS) over an 11-year period (1991-2001). Asthma hospitalization data from the Statewide Planning and Research Cooperative System and the 1990 and 2000 census population files were geocoded into NYS school districts statewide, and school district asthma hospitalization rates were then calculated. Building Condition Survey for each school was then utilized to create summary measures of school building conditions for each school district. Hospitalization rates were linked to district school building conditions by using logistic regression analysis that controlled for poverty. Calculation of time trends revealed overall declines in asthma rates among school-age children for NYS from 1991 to 2001. This general decline was found in each sociodemographic group. The mean rate for NYS from 1991 to 2001 was 27/10,000. Poorly rated building systems that were significantly associated with increased school district asthma hospitalization rates were roofing (odds ratio [OR] = 1.76; 95% confidence interval [CI95] = 1.13-2.74), windows (OR = 1.66; CI95= 1.08-2.54), exterior walls (OR = 2.24; CI95= 1.31-3.83), floor finishes (OR = 1.75; CI95= 1.14-2.69), and boiler/furnace (OR = 1.71; CI95= 1.99-2.94). This does not indicate a definite link between these systems and asthma hospitalizations since the available building system information is very general and crude. (J Sch Health. 2006;76(8):408-413) [source] Hospitalization risk following initiation of highly active antiretroviral therapyHIV MEDICINE, Issue 5 2010SA Berry Objectives While highly active antiretroviral therapy (HAART) decreases long-term morbidity and mortality, its short-term effect on hospitalization rates is unknown. The primary objective of this study was to determine hospitalization rates over time in the year after HAART initiation for virological responders and nonresponders. Methods Hospitalizations among 1327 HAART-naïve subjects in an urban HIV clinic in 1997,2007 were examined before and after HAART initiation. Hospitalization rates were stratified by virological responders (,1 log10 decrease in HIV-1 RNA within 6 months after HAART initiation) and nonresponders. Causes were determined through International Classification of Diseases, 9th Revision (ICD-9) codes and chart review. Multivariate negative binomial regression was used to assess factors associated with hospitalization. Results During the first 45 days after HAART initiation, the hospitalization rate of responders was similar to their pre-HAART baseline rate [75.1 vs. 78.8/100 person-years (PY)] and to the hospitalization rate of nonresponders during the first 45 days (79.4/100 PY). The hospitalization rate of responders fell significantly between 45 and 90 days after HAART initiation and reached a plateau at approximately 45/100 PY from 91 to 365 days after HAART initiation. Significant decreases were seen in hospitalizations for opportunistic and nonopportunistic infections. Conclusions The first substantial clinical benefit from HAART may be realized by 90 days after HAART initiation; providers should keep close vigilance at least until this time. [source] Rising hospitalization rates for inflammatory bowel disease in the United States between 1998 and 2004,INFLAMMATORY BOWEL DISEASES, Issue 12 2007Geoffrey C. Nguyen MD Abstract Background: Recent epidemiological studies suggest that the prevalences of Crohn's disease (CD) and ulcerative colitis (UC) are increasing in the United States. We sought to determine whether nationwide rates of inflammatory bowel disease (IBD) hospitalizations have increased in response to temporal trends in prevalence. Methods: We identified all admissions with a primary diagnosis of CD or UC, or 1 of their complications in the Nationwide Inpatient Sample between 1998 and 2004. National estimates of hospitalization rates and rates of surgery were determined using the U.S. Census population as the denominator. Results: There were an estimated 359,124 and 214,498 admissions for CD and UC, respectively. The overall hospitalization rate for CD was 18.0 per 100,000 and that for UC was 10.8 per 100,000. There was a 4.3% annual relative increase in hospitalization rate for CD (P < 0.0001) and a 3.0% annual increase for UC (P < 0.0001). Surgery rates were 3.4 bowel resections per 100,000 for CD and 1.2 colectomies per 100,000 for UC and remained stable. There were no temporal patterns for average length of stay for CD (5.8 days) or for UC (6.8 days). The national estimate of total inpatient charges attributable to CD increased from $762 million to $1,330 million between 1998 and 2004, and that for UC increased from $592 million to $945 million. Conclusions: Hospitalization rates for IBD, particularly CD, have increased within a 7-year period, incurring a substantial rise in inflation-adjusted economic burden. The findings reinforce the need for effective treatment strategies to reduce IBD complications. (Inflamm Bowel Dis 2007) [source] Asthma Hospitalization Rates Among Children, and School Building Conditions, by New York State School Districts, 1991-2001JOURNAL OF SCHOOL HEALTH, Issue 8 2006Erin Belanger This study examined patterns of asthma hospitalization and possible factors contributing to asthma hospitalizations, including sociodemographics and school environmental factors, among school-age children (5-18 years) in New York State (NYS) over an 11-year period (1991-2001). Asthma hospitalization data from the Statewide Planning and Research Cooperative System and the 1990 and 2000 census population files were geocoded into NYS school districts statewide, and school district asthma hospitalization rates were then calculated. Building Condition Survey for each school was then utilized to create summary measures of school building conditions for each school district. Hospitalization rates were linked to district school building conditions by using logistic regression analysis that controlled for poverty. Calculation of time trends revealed overall declines in asthma rates among school-age children for NYS from 1991 to 2001. This general decline was found in each sociodemographic group. The mean rate for NYS from 1991 to 2001 was 27/10,000. Poorly rated building systems that were significantly associated with increased school district asthma hospitalization rates were roofing (odds ratio [OR] = 1.76; 95% confidence interval [CI95] = 1.13-2.74), windows (OR = 1.66; CI95= 1.08-2.54), exterior walls (OR = 2.24; CI95= 1.31-3.83), floor finishes (OR = 1.75; CI95= 1.14-2.69), and boiler/furnace (OR = 1.71; CI95= 1.99-2.94). This does not indicate a definite link between these systems and asthma hospitalizations since the available building system information is very general and crude. (J Sch Health. 2006;76(8):408-413) [source] Asthma Outcomes at an Inner-City School-Based Health CenterJOURNAL OF SCHOOL HEALTH, Issue 1 2001Nicole Lurie§ ABSTRACT Childhood asthma has reached near-epidemic levels in the US cities. Innovative strategies to identify children with asthma and prevent asthma morbidity are needed. This study measured asthma outcomes after initiation of an inner-city elementary school health center with a schoolwide focus on asthma detection and treatment. The site was an inner-city elementary school in Minneapolis, Minn. The study design incorporated a pre and post comparison with a longitudinal cohort of children (n=67) and a cross-sectional cohort of children before (n=156) and after (n=114) the intervention. Hospitalization rates for asthma decreased 75% to 80% over the study period. Outpatient visits for care in the absence of asthma symptoms doubled (p<.01), and the percentage of students seeing a specialist for asthma increased (p<.01). Use of peak flow meters, use of asthma care plans, and use of inhalers also improved (p<.01). While no change occurred in school absenteeism, parents reported that their children had less awakening with asthma and that asthma was less disruptive to family plans. This schoolwide intervention that included identification of children with asthma, education, family support, and clinical care using an elementary school health center was effective in improving asthma outcomes for children. [source] Persistent Orthopnea and the Prognosis of Patients in the Heart Failure ClinicCONGESTIVE HEART FAILURE, Issue 4 2004Luís Beck Da Silva MD Heart failure (HF) is a public health problem with ever-growing costs. Signs such as jugular venous pressure and third heart sound have been associated with disease prognosis. Symptoms of heart failure are frequently subjective, and their real value is often overlooked. The authors aimed to assess the relationship between orthopnea and left ventricular ejection fraction (LVEF) and hospitalization rate in patients referred to the HF clinic. One hundred fifty-three new consecutive patients referred to the HF clinic from September 2001 to July 2002 were reviewed. Information about orthopnea was available at baseline and at a 6-month to 1-year follow-up. One hundred thirty-one patients had a baseline multigated radionuclide ventriculogram scan, and 68 patients had a follow-up multigated radionuclide ventriculogram scan available. The patients were divided into groups by presence of orthopnea and compared with respect to LVEF and hospitalization rate. Patients with or without orthopnea had similar LVEFs at baseline (32%±17% vs. 33%±15%, respectively; p=NS). However, patients who were orthopnea-free at the follow-up visit had a significant LVEF improvement whereas patients with ongoing orthopnea at follow-up had no LVEF improvement (11%±13% vs. ,1%±6%; p<0.001). Patients who presented with persistent orthopnea had a significantly higher rate of hospitalization (64% vs. 15.3%; p=0.0001). Persistent orthopnea in HF patients is associated with a significantly higher rate of hospitalization and with worsening or no improvement in LVEF. Patients with persistent orthopnea may require a more aggressive approach to improve their outcome. This result may help centers with limited access to LVEF measurements to better stratify HF patients' risk. [source] Hospitalization risk following initiation of highly active antiretroviral therapyHIV MEDICINE, Issue 5 2010SA Berry Objectives While highly active antiretroviral therapy (HAART) decreases long-term morbidity and mortality, its short-term effect on hospitalization rates is unknown. The primary objective of this study was to determine hospitalization rates over time in the year after HAART initiation for virological responders and nonresponders. Methods Hospitalizations among 1327 HAART-naïve subjects in an urban HIV clinic in 1997,2007 were examined before and after HAART initiation. Hospitalization rates were stratified by virological responders (,1 log10 decrease in HIV-1 RNA within 6 months after HAART initiation) and nonresponders. Causes were determined through International Classification of Diseases, 9th Revision (ICD-9) codes and chart review. Multivariate negative binomial regression was used to assess factors associated with hospitalization. Results During the first 45 days after HAART initiation, the hospitalization rate of responders was similar to their pre-HAART baseline rate [75.1 vs. 78.8/100 person-years (PY)] and to the hospitalization rate of nonresponders during the first 45 days (79.4/100 PY). The hospitalization rate of responders fell significantly between 45 and 90 days after HAART initiation and reached a plateau at approximately 45/100 PY from 91 to 365 days after HAART initiation. Significant decreases were seen in hospitalizations for opportunistic and nonopportunistic infections. Conclusions The first substantial clinical benefit from HAART may be realized by 90 days after HAART initiation; providers should keep close vigilance at least until this time. [source] Similar geographic variations of mortality and hospitalization associated with IBD and Clostridium difficile colitisINFLAMMATORY BOWEL DISEASES, Issue 3 2010Amnon Sonnenberg MD Abstract Background: Superinfection with Clostridium difficile can aggravate the symptoms of preexisting inflammatory bowel disease (IBD). The study served to assess whether the geographic variation of IBD within the United States might be influenced by C. difficile infection. Methods: Hospitalization data of the Healthcare Cost and Utilization Project (HCUP) from 2001,2006 and mortality data from 1979,2005 of the US were analyzed by individual states. Hospitalization and mortality associated with Crohn's disease (CD), ulcerative colitis (UC), and C. difficile colitis were correlated with each other, using weighted least square linear regression with the population size of individual states as weight. Results: Among the hospitalization rates, there were strong correlations between both types of IBD, as well as each type of IBD with C. difficile colitis. Similarly, among the mortality rates there were strong correlations between both types of IBD, as well as each type of IBD with C. difficile colitis. Lastly, each type of hospitalization rate was also strongly correlated with each type of mortality rate. In general, hospitalization and mortality associated with IBD tended to be frequent in many of the northern states and infrequent in the Southwest and several southern states. Conclusions: The similarity in the geographic distribution of the 3 diseases could indicate the influence of C. difficile colitis in shaping the geographic patterns of IBD. It could also indicate that shared environmental risk factors influence the occurrence of IBD, as well as C. difficile colitis. (Inflamm Bowel Dis 2010) [source] Rising hospitalization rates for inflammatory bowel disease in the United States between 1998 and 2004,INFLAMMATORY BOWEL DISEASES, Issue 12 2007Geoffrey C. Nguyen MD Abstract Background: Recent epidemiological studies suggest that the prevalences of Crohn's disease (CD) and ulcerative colitis (UC) are increasing in the United States. We sought to determine whether nationwide rates of inflammatory bowel disease (IBD) hospitalizations have increased in response to temporal trends in prevalence. Methods: We identified all admissions with a primary diagnosis of CD or UC, or 1 of their complications in the Nationwide Inpatient Sample between 1998 and 2004. National estimates of hospitalization rates and rates of surgery were determined using the U.S. Census population as the denominator. Results: There were an estimated 359,124 and 214,498 admissions for CD and UC, respectively. The overall hospitalization rate for CD was 18.0 per 100,000 and that for UC was 10.8 per 100,000. There was a 4.3% annual relative increase in hospitalization rate for CD (P < 0.0001) and a 3.0% annual increase for UC (P < 0.0001). Surgery rates were 3.4 bowel resections per 100,000 for CD and 1.2 colectomies per 100,000 for UC and remained stable. There were no temporal patterns for average length of stay for CD (5.8 days) or for UC (6.8 days). The national estimate of total inpatient charges attributable to CD increased from $762 million to $1,330 million between 1998 and 2004, and that for UC increased from $592 million to $945 million. Conclusions: Hospitalization rates for IBD, particularly CD, have increased within a 7-year period, incurring a substantial rise in inflation-adjusted economic burden. The findings reinforce the need for effective treatment strategies to reduce IBD complications. (Inflamm Bowel Dis 2007) [source] Nursing Home Facility Risk Factors for Infection and Hospitalization: Importance of Registered Nurse Turnover, Administration, and Social FactorsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2002Sheryl Zimmerman PhD OBJECTIVES: Determine the relationship between a broad array of structure and process elements of nursing home care and (a) resident infection and (b) hospitalization for infection. DESIGN: Baseline data were collected from September 1992 through March 1995, and residents were followed for 2 years; facility data were collected at the midpoint of follow-up. SETTING: A stratified random sample of 59 nursing homes across Maryland. PARTICIPANTS: Two thousand fifteen new admissions aged 65 and older. MEASUREMENTS: Facility-level data were collected from interviews with facility administrators, directors of nursing, and activity directors; record abstraction; and direct observation. Main outcome measures included infection (written diagnosis, a course of antibiotic therapy, or radiographic confirmation of pneumonia) and hospitalization for infection (indicated on medical records). RESULTS: The 2-year rate of infection was 1.20 episodes per 100 resident days, and the hospitalization rate for infection was 0.17 admissions per 100 resident days. Except for registered nurse (RN) turnover, which related to both infection and hospitalization, different variables related to each outcome. High rates of incident infection were associated with more Medicare recipients, high levels of physical/occupational therapist staffing, high licensed practical nurse staffing, low nurses' aide staffing, high intensity of medical and therapeutic services, dementia training, staff privacy, and low levels of psychotropic medication use. High rates of hospitalization for infection were associated with for-profit ownership, chain affiliation, poor environmental quality, lack of resident privacy, lack of administrative emphasis on staff satisfaction, and low family/friend visitation rates. Adjustment for resident sex, age, race, education, marital status, number of morbid diagnoses, functional status, and Resource Utilization Group, Version III score did not alter the relationship between the structure and process of care and outcomes. CONCLUSIONS: The association between RN turnover and both outcomes underscores the relationship between nursing leadership and quality of care in these settings. The relationship between hospitalization for infection and for-profit ownership and chain affiliation could reflect policies not to treat acute illnesses in house. The link between social factors of care (environmental quality, prioritizing staff satisfaction, resident privacy, and facility visitation) and hospitalization indicates that a nonmedical model of care may not jeopardize, and may in fact benefit, health-related outcomes. All of these facility characteristics may be modifiable, may affect healthcare costs, and may hold promise for other, less-medical, forms of residential long-term care. [source] Effect of Nonsteroidal Anti-Inflammatory Drug Use on the Rate of Gastrointestinal Hospitalizations Among People Living in Long-Term CareJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2001Kate L. Lapane PhD OBJECTIVES: Gastrointestinal (GI) complications are the most-common serious adverse reactions associated with nonsteroidal anti-inflammatory drugs (NSAIDs). We quantified the effect of specific NSAIDs on the rate of GI hospitalizations among older people living in long-term care. DESIGN: Retrospective cohort study. SETTING: All Medicare/Medicaid certified nursing homes in four states (Maine, Minnesota, New York, and South Dakota). PARTICIPANTS: We identified 125,516 newly admitted residents from a database of all residents (1992,1996) of all Medicare/Medicaid certified nursing homes in four states. Using the federally mandated Minimum Data Set, which includes information on all drugs received (prescription and over-the-counter), we identified patients who received at least one prescription for aspirin (n = 19,101) or NSAIDs (n = 9,777). The control population consisted of all institutionalized persons who did not receive these drugs. MEASUREMENTS: From Health Care Financing Administration inpatient claims, we identified the first hospitalization for GI perforation, ulcer, or hemorrhage that occurred during the year of follow up (ICD9-CM discharge codes: 531,534, 578). Cox proportional hazards models provided adjusted estimates of rate ratios. RESULTS: NSAID exposure increased the GI-event-related hospitalization rate in both men (rate ratios (RR) = 2.64; 95% confidence interval (CI) = 1.17,5.99) and women (RR = 3.23; 95% CI = 1.85,5.65). The rate of GI hospitalizations for both men and women taking sulindac, naproxen, or indomethacin was higher than for nonusers. The risk of GI-event-related hospitalizations was greatest among women exposed to diflunisal (RR = 6.08; 95% CI = 2.27,16.26) or oxaprozin (RR = 6.03; 95% CI = 2.49,14.58). CONCLUSIONS: Despite the high background rate of GI events, most NSAIDs increased the risk of GI hospitalization. Careful attention to choice of agent and dosing is needed in prescribing NSAIDs in this frail, older population. [source] Intussusception: Trends in clinical presentation and managementJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 5 2006FRANCES A JUSTICE Abstract Background:, The association of a rotavirus vaccine and intussusception has renewed interest in understanding the incidence, clinical presentation and outcome of intussusception. Methods:, A retrospective chart review of all patients diagnosed with intussusception at Royal Children's Hospital, Melbourne over a 6.5-year period (1 January 1995,30 June 2001) was conducted using patients identified by a medical record database (ICD-9-CM code 560.0 1993,1997; ICD-10-CM code 56.1 1998,2001). Patient profile, clinical presentation, diagnosis methods, treatment and outcome were analyzed and compared to data previously reported on children with intussusception at the same hospital during 1962,1968. Results:, The hospitalization rate for primary idiopathic intussusception increased marginally from 0.19 to 0.27 per 1000 live births during the period 1962,1968 to 1995,2001. Most patients (80%) were <12 months of age (median age 7 months, range 2,72 months). The combination of abdominal pain, lethargy and vomiting was reported in 78% of infants. Air enema confirmed the diagnosis of intussusception in 186 of 191 cases (97%) and air reduction was successful in most cases (82%). Factors associated with increased risk of intestinal resection included abdominal distension (32%), bowel obstruction on abdominal X-ray (27%) and hypovolemic shock (40%). No mortality was observed in the present study. Conclusions:, Over the past 40 years at Royal Children's Hospital, Melbourne the hospitalization rate due to primary idiopathic intussusception has marginally increased from 0.19 to 0.27 per 1000 live births. Diagnosis and treatment using air enema has been highly successful, resulting in a reduction in patients requiring surgery and reduced hospital stays. [source] Viral respiratory infections in hospitalized and community control children in Alaska,,JOURNAL OF MEDICAL VIROLOGY, Issue 7 2010Rosalyn J. Singleton Abstract Respiratory syncytial virus (RSV) in Alaska Native children from the Yukon Kuskokwim (YK) Delta is associated with a hospitalization rate five times higher than that reported for the general US child population. The role of other viral respiratory pathogens has not been studied in this population. YK Delta children <3 years of age hospitalized with respiratory infections and same aged community control children were prospectively enrolled between October 2005 and September 2007. Polymerase chain reaction detection of viruses was performed on nasopharyngeal samples. Characteristics of hospitalized and asymptomatic control children were analyzed. From October 2005 to September 2007, 440 hospitalized and 425 control children were analyzed. Respiratory viruses were detected in 90% (395) of hospitalized children: 194 (44%) rhinovirus, 131 (30%) adenovirus, 102 (23%) RSV, 77 (18%) para influenza viruses (PIV), 66 (15%) human metapneumovirus (hMPV), 23 (5%) influenza, and 25 (6%) coronavirus. Fifty-two percent (221) of control children had a virus detected, most commonly rhinovirus (33%), and adenovirus (16%). RSV, PIV, hMPV, and influenza were significantly more common in hospitalized cases than control children, but rhinovirus, adenovirus, and coronavirus were not. RSV and hMPV were associated with higher severity of illness. In this study, RSV remains the most important virus associated with respiratory hospitalization, although hMPV and PIV were also common. RSV and hMPV were associated with more severe illness. Rhinovirus and adenovirus were detected in two-thirds of hospitalized children, but their frequent detection in control children made their role in respiratory hospitalization uncertain. J. Med. Virol. 82:1282,1290, 2010. © 2010 Wiley-Liss, Inc. [source] Palivizumab efficacy in preterm infants with gestational age ,30 weeks without bronchopulmonary dysplasiaPEDIATRIC PULMONOLOGY, Issue 3 2007Marianne Grimaldi MD Abstract The present study was designed to determine the efficacy of administration of palivizumab to preterm infants with gestational age (GA) ,30 weeks without bronchopulmonary dysplasia (BPD). All patients born with GA ,30 weeks without BPD on Day 28 and hospitalized for RSV bronchiolitis in Burgundy (12 hospitals) from December 1 to April 30 of the next year were included in this prospective observational study during five successive RSV seasons (1999,2000, 2000,2001, 2001,2002, 2002,2003, and 2003,2004). Palivizumab was given to premature infants with a gestational age ,30 weeks without BPD in the 2002,2003 and 2003,2004 periods only. In the cohort of premature infants with GA ,30 weeks without BPD, the respiratory syncytial virus (RSV) bronchiolitis hospitalization rate was reduced significantly (P,<,0.01) in the two seasons with palivizumab prophylaxis (2002,2003: 0% and 2003,2004: 2%) versus the three previous RSV seasons (1999,2000: 14.3%; 2000,2001: 16.7%; 2001,2002: 10.2%). The number needed to treat to prevent one hospitalization for RSV bronchiolitis was 6 (95%CI: 4,11). Such favorable results have not been always found in the few available postmarketing epidemiological studies on hospitalization rate after palivizumab prophylaxis. Differences in health care organization could explain those discrepancies. Pediatr Pulmonol. 2007; 42:189,192. © 2007 Wiley-Liss, Inc. [source] Effects of socioeconomic status on presentation with acute lower respiratory tract disease in children in Salvador, Northeast BrazilPEDIATRIC PULMONOLOGY, Issue 4 2002Cristiana M. Nascimento-Carvalho MD Abstract Two different socioeconomic groups of children with pneumonia were studied, and their clinical and demographic aspects were evaluated. The diagnosis of pneumonia was based on findings of cough and tachypnea, or on crackles on auscultation or on radiologically confirmed infiltrate. This was a prospective cross-sectional study conducted at the Professor Hosannah de Oliveira Pediatric Center, which cares for children of lower socioeconomic status (PHOPC), and at one private hospital which cares for children from middle to high socioeconomic status (Aliança Hospital, AH). Demographics and clinical differences were assessed by the Pearson chi-square test or Fisher's exact test as appropriate; means of continuous variables were compared by Mann-Whitney U-test. In a 26-month period, 3,431 cases were recruited. The 2,476 cases identified at the PHOPC were younger than the 955 identified at AH (2.2,±,2.3 vs. 4.5,±,3.1 years, P,<,0.0001) and had higher scores for severity (3.5,±,1.5 vs. 2.7,±,1.7, P,<,0.0001), duration of hospitalization (days) (10.9,±,12.1 vs. 6.2,±,7, P,<,0.0001), frequency of tobacco smoker in the household (48% vs. 31%, P,<,0.0001), cardiopathy (15.3% vs. 5.9%, P,=,0.003), fever (44.4% vs. 36.3%, P,=,0.0001), tachypnea (67.6% vs. 32.3%, P,<,0.0001), crackles (69.5% vs. 64.9%, P,=,0.02), somnolence (19.9% vs. 10.4%, P,<,0.0001), malnutrition (13.7% vs. 5%, P,<,0.0001), hospitalization rate (27.4% vs. 22.5%, P,=,0.003), and death (0.9% vs. 0.1%, P,=,0.009). However, other features were more frequent among AH cases: parent's university level of education (38.2% vs. 1.0%, P,<,0.0001), underlying chronic illness (40.6% vs. 28.5%, P,<,0.0001), asthma (62.7% vs. 50.8%, P,=,0.01), rhinitis (9.2% vs. 0.4%, P,<,0.0001), previous use of antibiotics (34.3% vs. 27.1%, P,=,0.001), and wheezing (53.1% vs. 42.2%, P,<,0.0001). Children of lower socioeconomic status have more serious lower respiratory tract disease, whereas children with pneumonia of middle to high socioeconomic status have more allergic diseases (rhinitis, asthma) and wheezing. Pediatr Pulmonol. 2002; 33:244,248. © 2002 Wiley-Liss, Inc. [source] Bendectin and birth defects II: Ecological analysesBIRTH DEFECTS RESEARCH, Issue 2 2003Jeffrey S. Kutcher BACKGROUND Bendectin was the primary pharmaceutical treatment of nausea and vomiting of pregnancy (NVP) in the United States until the early 1980s. Its manufacture was then discontinued after public allegations that it was causing birth defects. Subsequently, meta-analyses of the many epidemiological cohort and case/control studies used to examine that hypothesis have demonstrated the absence of a detectable teratogenic effect. This study presents an ecological analysis of the same hypothesis that examines specific malformations. METHODS Annual birth defect prevalence data for the 1970s to the 1990s have been obtained for specific birth defects from the Center for Disease Control's nationwide Birth Defect Monitoring Program. These data for the US have been compared graphically to the annual US Bendectin sales for the treatment of NVP. Data have also been obtained for annual US rates for hospitalization for NVP. The three data sets have been temporally compared in graphic analysis. RESULTS The temporal trends in prevalence rates for specific birth defects examined from 1970 through 1992 did not show changes that reflected the cessation of Bendectin use over the 1980,84 period. Further, the NVP hospitalization rate doubled when Bendectin use ceased. CONCLUSIONS The population results of the ecological analyses complement the person-specific results of the epidemiological analyses in finding no evidence of a teratogenic effect from the use of Bendectin. Birth Defects Research (Part A) 67:88,97, 2003. © 2003 Wiley-Liss, Inc. [source] Community-acquired pneumonia (CAP) in children in Oslo, NorwayACTA PAEDIATRICA, Issue 2 2009Anita C Senstad Abstract Aim: To investigate the epidemiology and clinical characteristics of community acquired pneumonia (CAP) in children before the introduction of the 7-valent pneumococcal vaccine in the national vaccination programme. Methods: For the period 21 May 2003 to 20 May 2005 hospitalization rates for pneumonia in children were obtained from retrospective studies of medical journals. Pneumonia was also studied prospectively in children less than sixteen years old referred to Ullevål University Hospital (Oslo) in the same time period. Results: The overall observed hospitalization rate of pneumonia was 14.7/10 000 (95% CI: 12.2,17.1), for children under five it was 32.8/10 000 (95% CI: 26.8,38.8), and for children under two 42.1/10 000 (95% CI: 32.0,52.3). In the clinical study 123 children, of whom 59% (73) were boys, met the inclusion criteria and were enrolled. Only 2.4% (3) had pneumonia complicated with pleural effusion and in general few complications were observed. No patients required assisted ventilation, and none were transferred to the intensive care unit. Penicillin was effective as treatment for pneumonia. Conclusion: Pneumonia, seen in a paediatric department in Oslo, is a common but benign disease. Penicillin is effective as treatment for pneumonia in Norwegian children. [source] Tolerability, Safety, and Efficacy of ,-Blockade in Black Patients With Heart Failure in the Community Setting: Insights From a Large Prospective ,-Blocker RegistryCONGESTIVE HEART FAILURE, Issue 1 2007William T. Abraham MD Heart failure (HF) clinical trials suggest different responses of blacks and whites to ,-blockers. Differences between clinical trial and community settings may also have an impact. The Carvedilol Heart Failure Registry (COHERE) observed experience with carvedilol in 4280 patients with HF in a community setting. This analysis compares characteristics, outcomes, and carvedilol dosing of blacks and whites in COHERE. Compared with whites (n=3433), blacks (n=523) had more severe HF symptoms despite similar systolic function. At similar carvedilol maintenance doses, symptoms improved in 33% of blacks vs 28% of whites, while worsening in 10% and 11%, respectively (both nonsignificant), and HF hospitalization rates were reduced comparably in both groups (,58% vs ,56%, respectively; both P<.001). Incidence and hazard ratios of death were similar in blacks and whites (6.9% vs 7.5%, hazard ratio 1.2 vs 1.0, P=.276). Thus carvedilol was similarly effective in blacks and whites with HF in the community setting, consistent with carvedilol clinical trials. [source] Emergency Department Treatment of Viral Gastritis Using Intravenous Ondansetron or Dexamethasone in ChildrenACADEMIC EMERGENCY MEDICINE, Issue 10 2006Christine M. Stork PharmD Abstract Objectives To compare the efficacy of intravenous ondansetron or dexamethasone compared with intravenous fluid therapy alone in children presenting to the emergency department with refractory vomiting from viral gastritis who had failed attempts at oral hydration. Methods This double-blind, randomized, controlled trial was performed in a tertiary care pediatric emergency department. Children aged 6 months to 12 years presenting with more than three episodes of vomiting in the past 24 hours, mild/moderate dehydration, and failed oral hydration were included. Patients with other medical causes were excluded. Subjects were randomized to dexamethasone 1 mg/kg (15 mg maximum), ondansetron 0.15 mg/kg, or placebo (normal saline [NS], 10 mL). All subjects also received intravenous NS at 10,20 mL/kg/hr. Oral fluid tolerance was evaluated at two and four hours. Those not tolerating oral fluids at four hours were admitted. Discharged patients were evaluated at 24 and 72 hours for vomiting and repeat health care visits. The primary study outcome was hospitalization rates between the groups. Data were analyzed using chi-square test, Kruskal,Wallis test, Mantel,Haenszel test, and analysis of variance, with p < 0.05 considered significant. Results A total of 166 subjects were enrolled; data for analysis were available for 44 NS-treated patients, 46 ondansetron-treated patients, and 47 dexamethasone-treated patients. Hospital admission occurred in nine patients (20.5%) receiving placebo (NS alone), two patients (4.4%) receiving ondansetron, and seven patients (14.9%) receiving dexamethasone, with ondansetron significantly different from placebo (p = 0.02). Similarly, at two hours, more ondansetron-treated patients (39 [86.6%]) tolerated oral hydration than NS-treated patients (29 [67.4%]; relative risk, 1.28; 95% confidence interval = 1.02 to 1.68). There were no differences in number of mean episodes of vomiting or repeat visits to health care at 24 and 72 hours in the ondansetron, dexamethasone, or NS groups. Conclusions In children with dehydration secondary to vomiting from acute viral gastritis, ondansetron with intravenous rehydration improves tolerance of oral fluids after two hours and reduces the hospital admission rate when compared with intravenous rehydration with or without dexamethasone. [source] Medication decisions and clinical outcomes in the Canadian National Outcomes Measurement Study in SchizophreniaACTA PSYCHIATRICA SCANDINAVICA, Issue 2006R. Williams Objective:, To evaluate over a 2-year period, patients from academic/non-academic centres, from each region of Canada, to determine whether location or other variables such as medication type, gender or income was associated with outcome as defined by non-hospitalization and persistence on original treatment. Method:, A total of 448 patients were recruited from academic and non-academic centres across all provinces of Canada and followed up for 2 years. Results:, Patients from British Columbia had significantly lower rates of hospitalization than patients from other provinces. Male patients showed greater symptomatic improvement at 2 years from initial assessment compared to females. Patients on clozapine, risperidone and olanzapine were least likely to be hospitalized. Conclusion:, There were some regional differences noted in both utilization of types of antipsychotic medications and hospitalization rates. In this sample of stable out-patients over 70% who started on monotherapy with clozapine, risperidone, olanzapine and quetiapine remained on the same medication over the 2-year study period. [source] Patterns and trends in alcohol-related hospitalizations in Victoria, Australia, 1987/88,1995/96DRUG AND ALCOHOL REVIEW, Issue 4 2000KIRSTEN HANLIN Abstract The objective of this study was to examine patterns and yearly trends in alcohol-related hospitalization rates during the period 1987/88,1995/96 for men and women living in metropolitan and rural/remote Victoria. Alcohol-related hospitalizations were extracted from the Victorian Inpatient Minimum Dataset (VMD) for the years 1987/88,1995/96 (public hospitals) and 1993/94,1995/96 (private hospitals), and adjusted by the appropriate aetiological fractions. Sex-specific age-adjusted rates we expressed per 10000 residents/year. During 1993/94,1995/96, alcohol-related hospitalizations comprised 1.0% of all Victorian hospitalizations (about 12000/year), with men accounting for over two-thirds of alcohol-related hospitalizations. Approximately half of the alcohol-related hospitalizations were for disease conditions and the other half for external cause (injury) conditions. About 80% of all alcohol-related hospitalizations were to public hospitals, with the exception of alcohol dependence (63% to private hospitals). Alcohol-related hospitalization rates were generally higher for people living in rural/remote areas compared to urban areas. During 1987/88,1995/96, the age-adjusted alcohol-related hospitalization rates in public hospitals did not change significantly for disease conditions (14.8,14.7 for men and 6.3,6.4 for women) or female external cause conditions (6.7,6.1), but decreased for external cause conditions (18.4,15.5). In private hospitals during 1993/94,1995/96, the age-adjusted alcohol-related hospitalization rates for disease conditions decreased (5.4,4.1 for men and 3.7,3.0 for women) but increased for external cause conditions (1.8,2.4 for men and 1.0,1.2 for women). These patterns and time-trends in Victorian alcohol-related hospitalizations reflect a combination of alcohol-related morbidity levels, hospital admission practices and patterns and levels of service provision. They suggest a potential need to focus on services and programmes in rural/remote Victoria. [source] One-year outcome of an early intervention in psychosis service: a naturalistic evaluationEARLY INTERVENTION IN PSYCHIATRY, Issue 3 2007Swaran P. Singh Abstract Aim: We conducted a 1-year prospective evaluation of an early intervention in psychosis service (Early Treatment and Home-based Outreach Service (ETHOS)) during its first 3 years of operation in South-west London, UK. Methods: All patients referred to ETHOS underwent structured assessments at baseline and at 1-year follow-up. In addition, hospitalization rates of ETHOS patients (intervention group) were compared with a non-randomized parallel cohort (comparison group) of first-episode patients treated by community mental health teams. Results: The Early Treatment and Home-based Outreach Servicepatients experienced significant improvements in symptomatic and functional outcomes, especially vocational recovery. The service received only a quarter of eligible patients from referring teams. ETHOS patients did not differ from the comparison group in number of admissions, inpatient days or detention rates. Although number of referrals increased over time, there was no evidence that patients were being referred earlier. Conclusions: There is now robust evidence for the effectiveness of specialist early intervention services. However, such services must be adequate resourced, including an early detection team and provision of their own inpatient unit. [source] Association of self-reported alcohol use and hospitalization for an alcohol-related cause in Scotland: a record-linkage study of 23 183 individualsADDICTION, Issue 4 2009Scott A. McDonald ABSTRACT Aims To investigate the extent to which self-reported alcohol consumption level in the Scottish population is associated with first-time hospital admission for an alcohol-related cause. Design Observational record-linkage study. Setting Scotland, 1995,2005. Participants A total of 23 183 respondents aged 16 and over who participated in the 1995, 1998 and 2003 Scottish Health Surveys, followed-up via record-linkage from interview date until 30 September 2005. Measurements Rate of first-time hospital admission with at least one alcohol-related diagnosis. Cox proportional hazards regression analysis was applied to estimate the relative risk of first-time hospitalization with an alcohol-related condition associated with usual alcohol consumption level (1,7, 8,14, 15,21, 22,35, 36,49, 50+ units/week and ex-drinker, compared with <1 unit per week). Findings Of the SHS participants, 527 were hospitalized for an alcohol-related cause during 135 313 person-years of follow-up [39 first admissions per 10 000 person-years, 95% confidence interval (CI) 36,42]. Alcohol-related hospitalization rates were considerably higher for males (61/10 000 person-years, 95% CI 54,67) than for females (22/10 000 person-years, 95% CI 18,26). Compared with the lowest alcohol consumption category (<1 unit per week), the relative risk of first-time alcohol-related admission increased with reported consumption: age-adjusted hazard ratios ranged from 3 (1,5) for 1,7 units/week to 19 (10,37) for 50+ units/week (males); and from 2 (1,3) for 1,7 units/week to 28 (14,56) for 50+ units/week (females). After adjusting for age and usual alcohol consumption, the relative risk of first-time alcohol-related admission remained significantly higher for males reporting binge drinking and for both males and females residing in the most deprived localities. Conclusions Moderate and higher levels of usual alcohol consumption and binge drinking are serious risk factors for alcohol-related hospitalization in the Scottish population. These findings contribute to our understanding of the relationship between alcohol intake and alcohol-related morbidity. [source] Hospitalizations for opioid poisoning: a nation-wide population-based study in Denmark, 1998,2004ADDICTION, Issue 1 2009Anne-Mette Bay Bjørn ABSTRACT Aims To assess hospitalization rates (HR) for poisoning with heroin, methadone or strong analgesics and relate them to quantities of prescribed methadone and strong analgesics in Denmark between 1998 and 2004. Design Population-based ecological study. Settings We extracted data on all emergency department visits and hospital admissions registered in the Danish National Patient Registry with a diagnosis of poisoning with heroin (n = 1688), methadone (n = 173) or strong analgesics (n = 384). To ascertain sale of prescribed medications we used data from the Danish Medicines Agency. Measurements Age- and gender-standardized HR and defined daily doses (DDD) per 1000 people per day. Findings HR for heroin poisoning was 4.4 [95% confidence interval (CI): 3.8,4.9] per 100 000 person-years (p-y) in 1998 and 4.6 (CI: 4.0,5.2) per 100 000 p-y in 2004. HR for methadone poisoning increased from 0.1 (CI: 0.0,0.2) per 100 000 p-y in 1998 to 1.1 (CI: 0.8,1.4) per 100 000 p-y in 2004. HR for poisoning with strong analgesics increased from 0.6 (CI: 0.4,0.9) per 100 000 p-y in 1998 to 2.1 (CI: 1.8,2.6) per 100 000 p-y in 2004. The sale of prescribed strong analgesics (5.0 DDD per 1000 people per day in 1998 to 5.9 DDD in 2004) and methadone (3.0 DDD per 1000 people per day in 1998 to 3.4 DDD in 2004) increased slightly between 1998 and 2004. Conclusion Increasing sale of prescribed methadone and strong analgesics coincided with increasing HRs of poisoning with these drugs, whereas HR of heroin poisoning varied. Further longitudinal studies are important for the guidance of future policy making. [source] The Effect of Seatbelt Use on Injury Patterns, Disposition, and Hospital Charges for EldersACADEMIC EMERGENCY MEDICINE, Issue 12 2002Andrew Coley MD Objective: To study the relationships between seatbelt use and injury patterns, hospital charges, morbidity, and mortality in elder motor vehicle crash victims. Methods: A retrospective review of individuals at least 65 years old presenting to an urban emergency department (ED) after a motor vehicle crash. Results: Over a two-year period, 339 patients had documentation of seatbelt use or non-use at the time of the crash. Of these, 241 (71%) patients had been wearing a seatbelt and 98 (29%) had not. Elders not using seatbelts were more likely to require hospitalization (29% unbelted vs. 17% belted) and had a higher mortality rate. Injury patterns were different in the two groups. Emergency department charges were significantly different between belted and unbelted elders ($351 vs. $451, p = 0.01) and head computed tomography (CT) utilization was higher in the unbelted group (25.6% vs 12.7%, p = 0.005). Conclusions: Improved seatbelt compliance in elders can reduce injuries, hospitalization rates, ED charges, and mortality resulting from motor vehicle crashes. [source] Hospitalization risk following initiation of highly active antiretroviral therapyHIV MEDICINE, Issue 5 2010SA Berry Objectives While highly active antiretroviral therapy (HAART) decreases long-term morbidity and mortality, its short-term effect on hospitalization rates is unknown. The primary objective of this study was to determine hospitalization rates over time in the year after HAART initiation for virological responders and nonresponders. Methods Hospitalizations among 1327 HAART-naïve subjects in an urban HIV clinic in 1997,2007 were examined before and after HAART initiation. Hospitalization rates were stratified by virological responders (,1 log10 decrease in HIV-1 RNA within 6 months after HAART initiation) and nonresponders. Causes were determined through International Classification of Diseases, 9th Revision (ICD-9) codes and chart review. Multivariate negative binomial regression was used to assess factors associated with hospitalization. Results During the first 45 days after HAART initiation, the hospitalization rate of responders was similar to their pre-HAART baseline rate [75.1 vs. 78.8/100 person-years (PY)] and to the hospitalization rate of nonresponders during the first 45 days (79.4/100 PY). The hospitalization rate of responders fell significantly between 45 and 90 days after HAART initiation and reached a plateau at approximately 45/100 PY from 91 to 365 days after HAART initiation. Significant decreases were seen in hospitalizations for opportunistic and nonopportunistic infections. Conclusions The first substantial clinical benefit from HAART may be realized by 90 days after HAART initiation; providers should keep close vigilance at least until this time. [source] Similar geographic variations of mortality and hospitalization associated with IBD and Clostridium difficile colitisINFLAMMATORY BOWEL DISEASES, Issue 3 2010Amnon Sonnenberg MD Abstract Background: Superinfection with Clostridium difficile can aggravate the symptoms of preexisting inflammatory bowel disease (IBD). The study served to assess whether the geographic variation of IBD within the United States might be influenced by C. difficile infection. Methods: Hospitalization data of the Healthcare Cost and Utilization Project (HCUP) from 2001,2006 and mortality data from 1979,2005 of the US were analyzed by individual states. Hospitalization and mortality associated with Crohn's disease (CD), ulcerative colitis (UC), and C. difficile colitis were correlated with each other, using weighted least square linear regression with the population size of individual states as weight. Results: Among the hospitalization rates, there were strong correlations between both types of IBD, as well as each type of IBD with C. difficile colitis. Similarly, among the mortality rates there were strong correlations between both types of IBD, as well as each type of IBD with C. difficile colitis. Lastly, each type of hospitalization rate was also strongly correlated with each type of mortality rate. In general, hospitalization and mortality associated with IBD tended to be frequent in many of the northern states and infrequent in the Southwest and several southern states. Conclusions: The similarity in the geographic distribution of the 3 diseases could indicate the influence of C. difficile colitis in shaping the geographic patterns of IBD. It could also indicate that shared environmental risk factors influence the occurrence of IBD, as well as C. difficile colitis. (Inflamm Bowel Dis 2010) [source] Rising hospitalization rates for inflammatory bowel disease in the United States between 1998 and 2004,INFLAMMATORY BOWEL DISEASES, Issue 12 2007Geoffrey C. Nguyen MD Abstract Background: Recent epidemiological studies suggest that the prevalences of Crohn's disease (CD) and ulcerative colitis (UC) are increasing in the United States. We sought to determine whether nationwide rates of inflammatory bowel disease (IBD) hospitalizations have increased in response to temporal trends in prevalence. Methods: We identified all admissions with a primary diagnosis of CD or UC, or 1 of their complications in the Nationwide Inpatient Sample between 1998 and 2004. National estimates of hospitalization rates and rates of surgery were determined using the U.S. Census population as the denominator. Results: There were an estimated 359,124 and 214,498 admissions for CD and UC, respectively. The overall hospitalization rate for CD was 18.0 per 100,000 and that for UC was 10.8 per 100,000. There was a 4.3% annual relative increase in hospitalization rate for CD (P < 0.0001) and a 3.0% annual increase for UC (P < 0.0001). Surgery rates were 3.4 bowel resections per 100,000 for CD and 1.2 colectomies per 100,000 for UC and remained stable. There were no temporal patterns for average length of stay for CD (5.8 days) or for UC (6.8 days). The national estimate of total inpatient charges attributable to CD increased from $762 million to $1,330 million between 1998 and 2004, and that for UC increased from $592 million to $945 million. Conclusions: Hospitalization rates for IBD, particularly CD, have increased within a 7-year period, incurring a substantial rise in inflation-adjusted economic burden. The findings reinforce the need for effective treatment strategies to reduce IBD complications. (Inflamm Bowel Dis 2007) [source] Role of influenza and other respiratory viruses in admissions of adults to Canadian hospitalsINFLUENZA AND OTHER RESPIRATORY VIRUSES, Issue 1 2008Dena L. Schanzer Objective, We sought to estimate age-specific hospitalization rates attributed to influenza and other virus for adults. Methods, Admissions from Canada's national hospitalization database (Canadian Institute of Health Information), from 1994/95 to 1999/2000, were modeled as a function of proxy variables for influenza, respiratory syncytial virus (RSV) and other viral activity, seasonality and trend using a Poisson regression model and stratified by age group. Results, The average annual influenza-attributed hospitalization rate for all adults, 20 years of age or older, over the study period, which included three severe seasons, was an estimated 65/100 000 population (95% CI 63,67). Among persons aged 65 and over, 270,340 admissions per 100 000 population per year were attributed to influenza, while 30,110, 60,90 and 130,350 per 100 000 were attributed to RSV, parainfluenza (PIV) and other respiratory viruses, respectively. Although marked season-to-season variation in age-specific hospitalization rates attributable to influenza was observed in persons 50 years of age and older, increasing risk with age was preserved at all time periods. Conclusions, Influenza, RSV, PIV and other respiratory viruses were all associated with morbidity requiring hospitalization, while influenza was responsible for peak respiratory admissions. The burden of health care utilization associated with respiratory viruses is appreciable beginning in the sixth decade and increases significantly with age. [source] | ||||||||||||||||||||||||||||