Additive effect of wildfires on hospital admission in the Pantanal wetland, Brazil.

Heat wave prevention plans are traditionally implemented according to a temperature limit above which mortality begins to rise. Although these prevention plans are obviously designed to avoid deaths, it is also necessary to establish the impact of extreme temperatures on hospital admissions in order to put hospital alert plans into action for dealing with people affected by heat wave victims. We used data on daily emergency admissions between May and September, from 1995 to 2000, in the Hospital General Universitario Gregorio Marañón in Madrid. The causes for admission were considered as 'organic' (International Classification of Diseases, ICD-9: 1-799), circulatory (ICD-9: 390-459) and respiratory (ICD-9: 460-519). We stratified them according to the following age groups: all ages, from 0 to 10, 18 to 44, 45 to 64, 65 to 74 and above 75 years. The methodology used was Autorregresive Integrated Moving Average (ARIMA) modelling, including variables related to atmospheric pollution, seasonality and trends. The results show that the temperature above which hospital admissions soar coincides with the temperature limit above which mortality sharply rises, which, in turn, coincides with percentile 95 of the maximum daily temperature series for summer months. The pattern of hospital admissions is completely different from that of mortality. The rise in hospital admissions due to all causes and age groups is clearly smaller than that detected for mortality. These results suggest that people die rapidly from circulatory diseases before they can be admitted to hospital. This datum is vital with regard to implementing prevention plans prior to the arrival of the heat wave, if they are to effectively reduce mortality.

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.

Although regulatory improvements for air quality in the European Union have been made, air pollution is still a pressing problem and, its impact on health, both mortality and morbidity, is a topic of intense research nowadays. The main goal of this work is to assess the impact of the exposure to air pollutants on the number of daily hospital admissions due to respiratory causes in 58 spatial locations of Portugal mainland, during the period 2005-2017. To this end, INteger Generalised AutoRegressive Conditional Heteroskedastic (INGARCH)-based models are extensively used. This family of models has proven to be very useful in the analysis of serially dependent count data. Such models include information on the past history of the time series, as well as the effect of external covariates. In particular, daily hospitalisation counts, air quality and temperature data are endowed within INGARCH models of optimal orders, where the automatic inclusion of the most significant covariates is carried out through a new block-forward procedure. The INGARCH approach is adequate to model the outcome variable (respiratory hospital admissions) and the covariates, which advocates for the use of count time series approaches in this setting. Results show that the past history of the count process carries very relevant information and that temperature is the most determinant covariate, among the analysed, for daily hospital respiratory admissions. It is important to stress that, despite the small variability explained by air quality, all models include on average, approximately two air pollutants covariates besides temperature. Further analysis shows that the one-step-ahead forecasts distributions are well separated into two clusters: one cluster includes locations exclusively in the Lisbon area (exhibiting higher number of one-step-ahead hospital admissions forecasts), while the other contains the remaining locations. This results highlights that special attention must be given to air quality in Lisbon metropolitan area in order to decrease the number of hospital admissions.

Background/Aim: Coal plays an irreplaceable role in the energy use in China, however, it causes severe air pollution and adverse health impacts, i.e. outpatient /emergency visit, hospital admission, and death. Hospital admission of the exposed population costs large direct medical expenses, but its quantitative estimate is rarely studied in China. In this article we evaluated the direct economic burden caused by hospital admissions due to coal burning in Beijing. Methods: The data of daily air quality and hospital admissions with the related medical expenses for ischemic heart disease (IHD), lung cancer (LC), chronic obstructive pulmonary disease (COPD) and stroke in Jan 1st, 2013-Oct 22nd, 2014 were collected in Beijing. Time series study using a generalized additive model was used to evaluate the exposure-response relationship between PM2.5 concentration and hospital admission (for the four diseases as a whole and each). With the contribution rate of coal burning for PM2.5 and the insurance rate in Beijing, the extra hospital admissions caused by coal burning was estimated, and then the mean medical expenses were used to figure out the economic burden. Results: The daily average concentration of PM2.5 was 89.90 (6.28-397.30) μg/m3 during the study period. 162,009 patients were admitted for the four diseases, with a daily average of 247 inpatients. An increase of 10μg/m3 of PM2.5 could increase the risk of hospital admission for the four diseases by 0.66% (95%CI: 0.59%, 0.73%). Accordingly, at least 2287 extra inpatients occurred because of coal burning, with the total economic loss of 65.69 million RMB. The highest two extra inpatient numbers were from IHD (at least 898, 39.27%) and stroke (at least 868, 37.95%), which caused about 41.85% and 28.94% of the total medical expenses. Conclusions: Coal burning caused adverse health impact and huge economic burden on the exposed population in Beijing, especially on IHD and stroke patients.

P-574 Introduction: The U.S. Centers for Disease Control and Prevention (CDC), the U.S. Environmental Protection Agency (EPA), and the public health departments in the States of Maine, New York and Wisconsin have collaborated in the Public Health Air Surveillance Evaluation (PHASE) project. The PHASE project was designed to develop, evaluate, and demonstrate the advantages and limitations of different methods of generating air quality data that could be systematically and routinely linked with public health surveillance data as part of the CDC's Environmental Public Health Tracking Network. Methods: The three public health departments collected health tracking data associated with cardiovascular and respiratory health events. In doing so, the states developed consistent case definitions and addressed spatial representativeness of the health data. EPA provided air quality data for ozone and fine particles based on ambient air monitors, from an application of the Community Multiscale Air Quality (CMAQ) predictive model, and for statistically developed estimates using the air monitors and the predictive model. With these air quality data sets, the three states applied a “case-crossover” analysis technique to evaluate the association between the health and air quality data. Results: The statistical technique produced less error than the CMAQ predictions when compared to a set of independent air quality monitor data. Figure 1 compares the fine particle CMAQ predictions and the ambient fine particle data in metropolitan New York City. Figure 2 compared the statistical technique estimates and the ambient fine particle data in metropolitan New York City. The qualitative contrast shows the effect of the statistical technique. The associations between air quality measures and health data were found to be generally consistent with time series epidemiologic studies.FIGURE 1: Comparison of hierarchical Bayesian model and monitor data (PM 2.5).Thirty-six km grid cell covering New York City metropolitan area.FIGURE 2: Comparison of CMAQ model and monitor data (PM 2.5). Thirty-six km grid cell covering New York City metropolitan area.Discussion and Conclusions: This collaboration demonstrated the ability to link surveillance air quality and health data. This will enable a legislative mandate to establish environmental public health tracking in the U.S. The techniques have been evaluated and implementation activities are underway. Next steps include: a menu-driven software tool to link health and air quality data and readily available air quality data available. This will enable health department professionals to link and analyze air quality and health data routinely.

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

Deploying a longitudinal perspective, we observe how cirrhosis caused mortality rates in Portugal are converging with the levels reported in the European Union (15 countries). However, we still lack analysis of the burden of alcoholic cirrhosis in terms of hospital admissions and associated mortality. As Portugal may be considered a paradigmatic case in Europe, our aim was to characterize the evolution of hospital admissions for alcoholic cirrhosis between 1993 and 2008 and draw conclusions for other countries. Retrospective analysis of the hepatic cirrhosis admissions in 97 Portuguese state hospitals was carried out based on the National Registry. We report a convergence in terms of mortality rates resulting from cirrhosis between Portugal and European Union (a differential of 6.7 deaths per 100 000 habitants in 1994 to 0.4 in 2008). We accounted for 81 543 hospital admissions for cirrhosis: 84% for alcoholic cirrhosis and 16% for non-alcoholic cirrhosis. Hospital admissions have increased 29% in men and with no increase in women. In the male, alcoholic cirrhosis patient group aged between 40 and 54, the rise in hospital admissions was more pronounced with an increase of around 45%. These patients underwent longer lengths of stay and reported higher mortality rates and passing away 20 years earlier than the average national expectancy of life. These data draw attention to the burden of alcohol consumption not only in Portugal but also in other countries and its impacts on hospital systems and on policy making.

This study explores the relationship between wildfires, climate change, and public health in Brazil, focusing on the impacts observed in the Amazon, Cerrado, and Pantanal biomes between 2023 and 2024. The research employs a systematic literature review and secondary data analysis, incorporating studies from the past two decades and data from recognized sources such as INPE, Fiocruz, and the Ministry of Health. Quantitative data on hospital admissions, air quality indices, and wildfire activity were cross-validated and analyzed using sensitivity techniques to ensure robustness. The primary objective is to examine the combined effects of wildfires and atmospheric pollution on human health, with a specific focus on respiratory and cardiovascular conditions, and to propose actionable public policies to mitigate these impacts. The findings reveal a clear link between climate change-induced fires, the release of delicate particulate matter (PM2.5), and significant health impacts, including a 30% rise in hospital admissions for respiratory issues and a 15% increase in cardiovascular emergencies during peak fire seasons. Particularly vulnerable groups, such as children and the elderly, were disproportionately affected, with notable increases in cases of asthma, pneumonia, and heart failure. The study also highlights the role of environmental degradation and agricultural practices in amplifying wildfire risks, worsening air quality, and intensifying public health crises. The results confirm a significant increase in pollution and health issues in the regions most affected by wildfires, emphasizing the need for air quality monitoring systems, public awareness campaigns, and stricter enforcement of environmental regulations. It concludes that implementing integrated and multidisciplinary policies, combining environmental preservation, healthcare readiness, and public education, is essential to address climate change and wildfires' ongoing and future impacts on Brazilian populations.

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice, and its prevalence is expected to further increase in the future. AF patients not only have a high number of comorbidities, but they also have an increased risk of hospital admissions compared to individuals without AF. Nevertheless, predicting hospital admission risk among patients with AF remains difficult, and possible preventive strategies unclear. Based on these gaps in knowledge, the overall goal of this PhD thesis was to investigate the incidence of and causes for all-cause hospital admission in patients with AF. The specific aims were (1) to perform a systematic review and meta-analysis summarizing the current evidence of the incidence of and associated risk factors for hospital admissions in AF patients; (2) to identify risk factors for hospital admissions in our own cohorts and subsequently use this knowledge to develop and validate a risk score for predicting hospital admissions; (3) to identify psychosocial factors associated with hospital admissions in patients with AF. Methods: For the meta-analysis, we performed a comprehensive literature search in PubMed, EMBASE and CENTRAL, and pooled incidence rates for hospital admissions using random-effects models. Factors associated with observed between-study heterogeneity were identified using meta-regression analysis. For the second and third study, we used data of two ongoing, prospective observational cohort studies, the Basel Atrial Fibrillation Cohort Study (BEAT-AF) and the Swiss Atrial Fibrillation Cohort Study (Swiss-AF) in which 3,968 patients with diagnosed AF were enrolled. Unplanned hospital admissions were defined as any unpredicted admission leading to at least one overnight stay. For the second study, we used the Swiss-AF data set as the derivation cohort and performed a variable selection using the least absolute shrinkage and selection operator (LASSO) method. Multivariable adjusted Cox regression analyses were performed to assess the effect of the selected variables on all-cause hospitalization. Based on regression coefficients we constructed a risk score and subsequently validated the score in the external validation cohort (BEAT-AF). For the third study, we used psychosocial factors, such as marital status, education, level of depression and health perception, and investigated their effects on risk of hospital admission. Cox regression analyses adjusted for conventional risk factors for hospital admission were performed to calculate hazard ratio (HR). Results: We included 35 studies of 311’314 AF patients in the meta-analysis. The pooled incidence of all-cause hospital admissions was 43.7 per 100 person-years. AF patients were more often admitted for cardiovascular causes (26.3 per 100 person-years), but the risk of non-cardiovascular hospitalizations was substantial (15.7 per 100 person-years). Associated factors for hospital admission were older age, longer follow-up time and prevalent chronic pulmonary disease or cancer. In the second study we found that the most important predictors for all-cause hospital admission were age (75-79 years: adjusted hazard ratio [aHR], 1.33; 95% confidence interval [95% CI], 1.00-1.77; 80-84 years: aHR, 1.51; 95% CI, 1.12-2.03; 85 years: aHR, 1.88; 95% CI, 1.35-2.61), prior pulmonary vein isolation (aHR, 0.74; 95% CI, 0.60-0.90), hypertension (aHR, 1.16; 95% CI, 0.99-1.36), diabetes (aHR, 1.38; 95% CI, 1.17-1.62), coronary heart disease (aHR, 1.18; 95% CI, 1.02-1.37), prior stroke/TIA (aHR, 1.28; 95% CI, 1.10-1.50), heart failure (aHR, 1.21; 95% CI, 1.04-1.41), peripheral artery disease (aHR, 1.31; 95% CI, 1.06-1.63), cancer (aHR, 1.33; 95% CI, 1.13-1.57), renal failure (aHR, 1.18, 95% CI, 1.01-1.38), and previous falls (aHR, 1.44; 95% CI, 1.16-1.78). A risk score with these variables was well calibrated, and achieved a C statistic of 0.64 (95% CI, 0.61-0.66) in the derivation and 0.59 (95% CI, 0.56-0.63) in the external validation cohort. In the third study including patients from Swiss-AF, 1582 (67.1%) were married, 156 (6.6%) were single, 287 (12.2%) were divorced, and 333 (14.1%) were widowed. Two hundred and seventy six patients (11.7%) had at most a primary education, 1171 (49.7) had secondary education, and 911 (38.6%) had a college or university degree. Depression or depressive symptoms was present in 99 (4.2%) patients. Median health perception was 75 (interquartile range [IQR], 60-85) on a scale ranging from 0-100, with higher scores indicated better health perception. The highest risk of all-cause hospital admission was observed in single (aHR, 1.35; 95% CI, 1.05-1.75) or divorced patients (aHR, 1.26; 95% CI, 1.03-1.54), and in those who reported low health perception (aHR for <75 points, 1.40; 95% CI, 1.21-1.61). Conclusions: The overall incidence of hospital admissions in patients with AF is high. The risk of hospital admissions is related to multiple cardiovascular and non-cardiovascular risk factors, including several psychosocial factors and subjective health perception. Outlook: Given the high risk among AF patients of being admitted to the hospital and the high burden of associated risk factors, new multidisciplinary preventive strategies are needed with the goal to reduce hospital admissions, unfavorable patient outcomes and healthcare costs.

The Burden of Community-Acquired Pneumonia Requiring Admission to an ICU in the United States

Hepatitis B remains a significant global public health concern, particularly in low- and middle-income countries, where prevention and control measures often face challenges. In Brazil, substantial efforts have been made over the years to combat the burden caused by hepatitis B through public health interventions, including vaccination programs, antenatal screening, and prevention of vertical transmission. However, despite these advancements, disparities in disease trends persist across regions and vulnerable populations, requiring ongoing analysis and intervention. This study aimed to analyze the trend in hospital admissions for hepatitis B in Brazil from 2008 to 2023. Data were collected from the SUS Hospital Information System. Statistical analyses were conducted using the Joinpoint Regression Program (version 5.0.2), applying a 5% significance level to identify significant trends over the study period. A total of 19,735 hospitalizations for hepatitis B were recorded during the study period. The overall trend showed a significant decline in hospital admissions, reflecting the effectiveness of public health interventions such as expanded vaccination coverage, screening programs, and prevention strategies. Despite this overall decline, notable regional disparities were observed. The midwest region exhibited an increasing trend in hospitalizations, contrasting with the national decline. Furthermore, a concerning rise in hospital admissions among infants under one year of age was identified, indicating potential shortcomings in the prevention of the vertical transmission of the virus. This study highlights both the successes and persistent challenges in controlling hepatitis B hospitalizations in Brazil. Maintaining high vaccination coverage and implementing targeted public health campaigns for vulnerable populations are crucial for sustaining progress. The regional disparities and failures in vertical transmission prevention require continued attention and intervention to advance toward the goal of eliminating hepatitis B as a public health threat in Brazil.

Decreased severity of disease during the first global omicron variant covid-19 outbreak in a large hospital in tshwane, south africa

Purpose : Odontogenic infections, which originate from teeth or their surrounding structures, are prevalent in the head and neck regions. The COVID-19 pandemic has altered healthcare-seeking behaviors due to policies adapted to impede the spread of virus, potentially impacting the management and severity of odontogenic infections. This study aims to investigate changes in characteristics of patients admitted to the hospital suffering from odontogenic infections before and after the COVID-19 outbreak.Patients and Methods : A retrospective study was conducted on patients admitted to the Department of Oral and Maxillofacial Surgery at Dankook University Hospital from March 2017 to February 2023. Patients were divided into two groups based on pre and post-COVID-19 outbreak (Group 1 and Group 2, respectively). Clinical parameters, treatment modalities were compared between groups. Additionally within Group 2, COVID-19 positive and negative patients were compared, and Group 2 was subdivide into five groups according to different waves of COVID-19 outbreak.Results : Following the COVID-19 outbreak, there was a significant increase in hospital admissions odontogenic infections. Group 2 exhibited higher severity scores, affected spaces, and surgical interventions compared to Group 1 patients. COVID-19 positive patients demonstrated elevated severity parameters. Subgroup analysis within Group 2 revealed the highest severity during the second wave of the COVID-19 outbreak.Conclusion : COVID-19 outbreak correlated with a rise in hospital admissions and severity of odontogenic infections. Thus, healthcare providers should anticipate changes in odontogenic infection patterns during pandemics and adapt management strategies accordingly.

BackgroundThere is limited evidence supporting a relationship of ambient particulate matter (PM), especially PM1, with hospital admissions, hospital costs, and length of hospital stay (LOS) due to cardiovascular disease (CVD). We used a generalized additive model (GAM) to estimate the associations of these indicators due to CVD for each 10 μg/m3 increase in the level of PM1, PM2.5, and PM10, and the attributable risk caused by PM on CVD was determined using the WHO air quality guidelines from 2005 and 2021.ResultsFor each 10 μg/m3 increase in the level of each PM and for a 0-day lag time, there were significant increases in daily hospital admissions for CVD (PM1: 1.006% [95% CI 0.859, 1.153]; PM2.5: 0.454% [95% CI 0.377, 0.530]; PM10: 0.263% [95% CI 0.206, 0.320]) and greater daily hospital costs for CVD (PM1: 523.135 thousand CNY [95% CI 253.111, 793.158]; PM2.5: 247.051 thousand CNY [95% CI 106.766, 387.336]; PM10: 141.284 thousand CNY [95% CI 36.195, 246.373]). There were no significant associations between PM and daily LOS. Stratified analyses demonstrated stronger effects in young people and males for daily hospital admissions, and stronger effects in the elderly and males for daily hospital costs. Daily hospital admissions increased linearly with PM concentration up to about 30 µg/m3 (PM1), 60 µg/m3 (PM2.5), and 90 µg/m3 (PM10), with slower increases at higher concentrations. Daily hospital costs had an approximately linear increase with PM concentration at all tested concentrations. In general, hospital admissions, hospital costs, and LOS due to CVD were greater for PM2.5 than PM10, and the more stringent 2021 WHO guidelines indicated greater admissions, costs, and LOS due to CVD.ConclusionsShort-term elevation of PM of different sizes was associated with an increased risk of hospital admissions and hospital costs due to CVD. The relationship with hospital admissions was strongest for men and young individuals, and the relationship with hospital costs was strongest for men and the elderly. Smaller PM is associated with greater risk.

Epidemiología de la insuficiencia cardiaca en España en los últimos 20 años