Daily Hospital Research Articles

The rescue of medical education crippled by the COVID-19 pandemic.

The ravages caused by the COVID-19 pandemic have affected medical education by losing the tutorial teaching that we carried out in out Institution. The strategies implemented through information and communication technologies are described in this article. With the strategies carried out, it was possible to continue with all the theoretical education virtually at a distance, including the daily hospital rounds, the presentation of clinical cases, the remote analysis of laboratory and cabinet methods, as well as the teaching of the physical examination and the acquisition of diagnostic aid methods. In addition, the number of attendants for the weekly academic general session of the institute increased from 100 in-person attendants to 500 virtual attendants (average), with approximately 5000 reproductions of the recorded sessions. The advantages and disadvantages of these new techniques and the challenges for the future are discussed in this manuscript. Undoubtedly, the pandemic has caused damage to the teaching of two generations of medical students during 2020 and 2021, and we are still afraid that, in 2022, it will persist. Therefore, in our opinion, the medical education implemented by us is not ideal, but, at least, it constitutes a good palliative for the harm that the pandemic caused to medical education.

Effects of Daily Mean Temperature on Daily Hospital Admissions for Coronary Artery Disease: A Retrospective Study.

Temperature changes unfavorably impact on cardiovascular disease. However, the association between temperature changes and coronary artery disease (CAD) is not well documented. This study aimed to explore the association between daily mean temperature and daily CAD hospital admissions on the southeast coast of China (Fuzhou City). A total of 1883 CAD patients who underwent percutaneous coronary intervention between 2017 and 2019 were obtained. The severity of CAD was evaluated by the Gensini score. Distributed lag non-linear model (DLNM) combined with a quasi-Poisson regression model was used to examine the delayed effect between daily mean temperature and daily CAD hospital admissions. Stratified analyses were performed by Gensini score and severity of lesions. The relative risk (RR) with a 95% confidence interval (CI) was used to assess the relationship. Extreme cold (8°C) (RR=0.49, 95% CI: 0.25-0.99) and moderate cold (10°C) (RR=0.56, 95% CI: 0.31-0.99) daily mean temperature with a lag of 0-20 days were correlated with lower risk of daily CAD hospital admissions. Moderate heat (30°C) (RR=1.80, 95% CI: 1.01-3.20) and extreme heat (32°C) (RR=2.02, 95% CI: 1.01-4.04) daily mean temperature with a lag of 0-20 days related to a higher risk of daily CAD hospital admissions. Similar results were observed for daily mean temperature with a lag of 0-25 days. Stratified analysis showed the lagged effect of daily mean temperature (lag 0, 0-5, 0-15, 0-20, and 0-25 days) on the daily CAD hospital admissions was observed only in patients with a Gensini score ≤39 (tertile 1). Cold temperatures may have a protective effect on daily CAD hospital admissions in the Fuzhou area, whereas hot temperatures can have an adverse effect.

The Impact of COVID-19 on Trauma Emergency Patients in Southeastern Iran.

With the COVID-19 outbreak in countries around the world, the countries' healthcare systems underwent an unprecedented shock. This study aimed to examine the resilience of the medical service delivery system in providing emergency services during the Covid-19 pandemic. This study was conducted in a reference hospital in Kerman that provided emergency services to trauma patients. It compared service delivery before and after COVID-19, as well as during the COVID-19 peak and non-peak periods. The compared variables were the number of trauma patients admitted to the hospital and the ICU, the number of patients who died in the hospital due to trauma, and the length of stay in the hospital and the ICU. The pre- and post-COVID-19 comparisons showed no significant difference in the number of daily hospital admissions, ICU admissions, and patient deaths. The median length of stay in the ICU was significantly reduced by almost 2 days during the COVID-19 outbreak. However, the length of stay at the hospital was almost the same. Furthermore, a comparison of the COVID-19 peaks and non-peak periods indicated no statistically significant difference in the number of admissions in the ICU, hospital and ICU length of stay, and trauma-induced mortality. Despite the substantial workload imposed by COVID-19 on hospitals, especially during the peak periods of the disease, the provision of medical services to emergency trauma patients did not drop significantly, and the quality of services provided to patients was within the acceptable range.

Short-term effects of exposure to ambient PM2.5 and its components on hospital admissions for threatened and spontaneous abortions: A multicity case-crossover study in China

BackgroundThe adverse effects of short-term exposure to PM2.5 and its components on hospital admissions for threatened and spontaneous abortions (TSAB) are still controversial. MethodsData on daily hospitalizations for TSAB and PM2.5 and its components, including sulfate (SO42−), nitrate (NO3−), ammonium salt (NH4+), organic matter (OM), and black carbon (BC), were collected from January 2015 to December 2021 (total 2,557 days) in five cities in China. Case-crossover analyses were conducted to investigate the short-term associations between PM2.5 and its components and TSAB. Additionally, the modification effects by age (<35 and ≥35 years), season (cold and warm seasons), and the “Three-Year Action Plan to Win the Blue Sky Defense War” (before and after implementation) on the above associations were further conducted. ResultsFor each 10 μg/m3 (1 μg/m3 for BC) increase, the strongest relative risks (95% confidence intervals) of hospitalization for TSAB were 1.011 (1.001–1.021) for PM2.5 in lag02, 1.060 (1.003–1.120) for SO42− in lag02, 1.035 (1.000–1.070) for NO3− in lag02, 1.065 (1.009–1.124) for NH4+ in lag02, 1.047 (1.008–1.088) for OM in lag01 and 1.029 (1.005–1.054) for BC in lag02 (all P <0.05). Furthermore, significant modifying effects of age and the Action Plan were found. The effects of NO3− (lag2), NH4+ (lag2), and BC (lag2) were more pronounced in mothers aged ≥35 years and the effects of PM2.5 (lag4), NO3− (lag4), NH4+ (lag4), OM (lag4), and BC (lag4) was more pronounced in the period before the Action Plan was implemented (all P modification <0.05). ConclusionShort-term exposure to ambient PM2.5 and its components (SO42−, NO3−, NH4+, OM, and BC) was related to increased risks of hospitalization for TSAB. The effects were more pronounced in mothers aged ≥35 years and the period before the Action Plan.

Identifying barriers and facilitators to adopting healthier dietary choices in clinical care: a cross-sectional observational study.

Adopting healthier diets can drastically improve societal health. Our environment plays a crucial role in daily dietary choices and hospitals in particular can stimulate patients to adopt healthier eating habits. Unfortunately, no robust clinically applicable cuing tools exist to help guide in-hospital dietary interventions. The purpose of this study was to identify patient-related barriers and facilitators to adopting healthier dietary choices. This cross-sectional observational study was conducted on the cardiology ward of a university medical center between June 2020 and January 2021. Of the 594 patients asked and the 312 completed surveys on healthy eating intentions, 285 responses were considered for analysis. Notably, the majority of respondents were male (68.8%), with an average hospital stay of 3.3 days. The results indicate that cardiac patients attribute significantly greater influence on their dietary behavior to doctors compared to other caregivers, including dieticians (X2 = 37.09, df = 9, p < 0.001). Also, younger patients (below 70 years of age) were more inclined to plan changing dietary behavior than older patients. Most mentioned facilitators for adopting a healthier diet were more information/counseling, help in preparing food, support from family and friends, and more emphasis from a doctor. The study highlights the importance of involving doctors in formulating dietary policies and patient-directed interventions within hospital settings. It also sheds light on the barriers and facilitators for promoting healthier dietary behaviors among patients during their hospitalization.

The impact of heat waves and cold spells on pneumonia risk: A nationwide study

Climate change affects human health and has been linked to several infectious diseases in recent year. However, there is limited assessment on the impact of heat waves and cold spells on pneumonia risk. This study aims to examine the association of heat waves and cold spells with daily pneumonia hospitalizations in 168 cities in China. Data on pneumonia hospitalizations between 2014 and 2017 were extracted from a national claim database of 280 million beneficiaries. We consider combining temperature intensity and duration to define heat waves and cold spells.This association was quantified using a quasi-Poisson generalized linear model combined with a distributed lag nonlinear model. Exposure-response curves and potential effect modifiers were also estimated. We found that the peak relative risk (RR) of cold spells on daily hospitalizations for pneumonia was observed in relatively mild cold spells with a threshold below the 3 days at the 2nd percentile (RR = 1.69, 95% CI: 1.46–1.92). The risk of heat waves increased with the thresholds, and the greatest risk was found for extremely heatwave period of 4 days at the 98th percentile (RR = 1.69, 95% CI: 1.46–1.92). Heat waves and cold spells are more likely to adversely affect women. In conclusion, our study provided novel and strong evidence that exposure to heat waves and cold spells was associate with increased hospital visits for pneumonia, especially in females. This is the first national study in China to comprehensively evaluate the influence of heat waves and cold spells on pneumonia risk, and the findings may offer valuable insights into the impact of climate change on public health.

Meteorological factors, ambient air pollution, and daily hospital admissions for depressive disorder in Harbin: A time-series study.

The literature has discussed the relationship between environmental factors and depressive disorders; however, the results are inconsistent in different studies and regions, as are the interaction effects between environmental factors. We hypothesized that meteorological factors and ambient air pollution individually affect and interact to affect depressive disorder morbidity. To investigate the effects of meteorological factors and air pollution on depressive disorders, including their lagged effects and interactions. The samples were obtained from a class 3 hospital in Harbin, China. Daily hospital admission data for depressive disorders from January 1, 2015 to December 31, 2022 were obtained. Meteorological and air pollution data were also collected during the same period. Generalized additive models with quasi-Poisson regression were used for time-series modeling to measure the non-linear and delayed effects of environmental factors. We further incorporated each pair of environmental factors into a bivariate response surface model to examine the interaction effects on hospital admissions for depressive disorders. Data for 2922 d were included in the study, with no missing values. The total number of depressive admissions was 83905. Medium to high correlations existed between environmental factors. Air temperature (AT) and wind speed (WS) significantly affected the number of admissions for depression. An extremely low temperature (-29.0 ℃) at lag 0 caused a 53% [relative risk (RR)= 1.53, 95% confidence interval (CI): 1.23-1.89] increase in daily hospital admissions relative to the median temperature. Extremely low WSs (0.4 m/s) at lag 7 increased the number of admissions by 58% (RR = 1.58, 95%CI: 1.07-2.31). In contrast, atmospheric pressure and relative humidity had smaller effects. Among the six air pollutants considered in the time-series model, nitrogen dioxide (NO2) was the only pollutant that showed significant effects over non-cumulative, cumulative, immediate, and lagged conditions. The cumulative effect of NO2 at lag 7 was 0.47% (RR = 1.0047, 95%CI: 1.0024-1.0071). Interaction effects were found between AT and the five air pollutants, atmospheric temperature and the four air pollutants, WS and sulfur dioxide. Meteorological factors and the air pollutant NO2 affect daily hospital admissions for depressive disorders, and interactions exist between meteorological factors and ambient air pollution.

Observations of COVID-19 vaccine coverage and vaccine hesitancy on COVID-19 outbreak: An American ecological study

In this ecological study, we aim to establish the role vaccines play in bringing the pandemic under control, as well as the impact of pathogen variants, vaccine hesitancy, and medical resource availability during the process by utilizing publicly available data. The study spans a three-year data collection period for daily hospital admissions due to COVID-19 and the daily reported cases of COVID-19 across all 50 states in the USA. In doing so, we aim to demonstrate the difference in severity of the SARS-CoV-2 pathogen among vaccinated and unvaccinated populations in the USA. The study assesses the correlation of COVID-19 vaccines (e.g., Pfizer, Moderna, and Janssen) and disease outcomes (transmissibility, severity, and deaths) caused by different strains of SARS-CoV-2 and establishes a negative correlation between COVID-19 vaccine and disease outcomes. By considering potential confounders in vaccine hesitancy, medical resource availability and vaccine dosage, we demonstrate the aforementioned to be insubstantial in predicting disease outcomes while the latter displays a contrasting significance in terms of disease outcomes. Between all the major variants of concern, the Delta and Omicron variants in particular have been associated with higher virulence and transmissibility factors respectively. Hence, the CDC continues to encourage the US population to get vaccinated since vaccines are one of the most effective ways to protect the community from potential outbreaks and prevent severe disease manifestations.

Financial and health impact of two models of providing prostheses in a public health systemImpacto econômico e sanitário de dois modelos de fornecimento de próteses em um sistema público de saúde

Compare the health outcomes and financial outcomes of two systems for the procurement of prostheses: the traditional system, in which procurement is initiated when a product is requested; and the "Prosthesis Bank" model, based on a current inventory of supplies. Descriptive-analytical study of users of Ministry of Health services in the province of Buenos Aires, Argentina. The patients belonged to two study groups: 1) prostheses were provided through the traditional computerized system for hospital procurement and contracting, known as SIPACH; and 2) prostheses were provided by the Prosthesis Bank. The study was limited to endovascular prostheses (coronary stents) and hip prostheses. Official government databases were used. The study period was from 01/01/2018 to 31/10/2022. The variables analyzed were: age, sex, diagnosis, hospital, type of implant or prosthesis, date of request, date received, unit price, direct and indirect costs, average cost of daily hospitalization, cost-effectiveness, and budgetary impact. A total of 4 106 applications were analyzed. In the traditional system: 13.5% of patients did not get their prostheses; it took 50 days longer than with the Prosthesis Bank; and total costs were higher in SIPACH (coronary stent, +463%; hip prosthesis, +133%). The Prosthesis Bank saved USD 3.2 million annually and prevented 22 deaths through early provision of endovascular prostheses. The Prosthesis Bank proved to be superior to the traditional model for providing prostheses, both in terms of health-by achieving better access, shortening waiting times, and avoiding deaths-and financially-by significantly reducing unit and overall prices, achieving significant savings in allocated budgets.

Ambient air pollution and hospital admissions for acute aortic dissection in Shantou, China: A time-series analysis

Acute aortic dissection (AAD) is an extremely serious cardiovascular emergency. This study aimed to explore the acute association between short-term exposure to air pollution and hospitalization for AAD and to quantify the burden of disease due to air pollution exposure in the coastal city of Shantou in southeast China. Data on daily AAD hospitalizations and air pollutants were collected from January 1, 2015, to December 31, 2019. The overdispersed generalized additive model was adopted to estimate the relationship between air pollution and AAD hospitalizations. Stratified analysis was then conducted by age and sex. The burden of disease was expressed in terms of attributable fractions and numbers. A total of 2111 AAD hospitalizations were identified. For a 10 μg/m3 increase in the concentration of fine particulate matter (PM2.5), inhalable particulate matter (PM10), carbon monoxide (CO), sulfur dioxide (SO2) and ozone (O3) at lag 01, the corresponding relative risks (RRs) and 95% confidence intervals (CIs) were 1.0917 (1.0449–1.1407), 1.0595 (1.0275–1.0925), 1.0043 (1.0013–1.0073), 1.1994 (1.0369–1.3872) and 1.0257 (1.0050–1.0468), respectively. However, no significant effects of nitrogen dioxide (NO2) on AAD hospitalizations were found. Elderly individuals (≥60 years) and males were more susceptible to pollutants than their corresponding groups. In the two-pollutant model, the estimates of PM2.5 and PM10 were relatively robust. Taking the World Health Organization (WHO) air quality standard as a reference, 13.0% of AAD hospitalizations were attributable to PM2.5 exposure, followed by PM10 (6.1%) and O3 (3.3%) exposure. Our results showed that short-term exposure to air pollutants, especially PM2.5 and PM10, was significantly associated with AAD and contributed to a significant disease burden. This study provides a reference for the future implementation of targeted air pollution control interventions.

Ambient temperature and seasonal variation in inpatient mortality from respiratory diseases: a retrospective observational study.

The seasonal fluctuation in mortality and hospital admissions from respiratory diseases, with a winter peak and a summer trough, is widely recognized in extratropical countries. However, little is known about the seasonality of inpatient mortality and the role of ambient temperature remains uncertain. We aimed to analyse the association between ambient temperature and in-hospital mortality from respiratory diseases in the provinces of Madrid and Barcelona, Spain. We used data on daily hospitalisations, weather (ie, temperature and relative humidity) and air pollutants (ie, PM2.5, PM10, NO2and O3) for the Spanish provinces of Madrid and Barcelona during 2006-2019. We applied a daily time-series quasi-Poisson regression in combination with distributed lag non-linear models (DLNM) to assess, on the one hand, the seasonal variation in fatal hospitalisations and the contribution of ambient temperature, and on the other hand, the day-to-day association between temperature and fatal hospital admissions. The analyses were stratified by sex, age and primary diagnostic of hospitalisation. The study analysed 1710012 emergency hospital admissions for respiratory diseases (mean [SD] age, 60.4 [31.0] years; 44.2% women), from which 103845 resulted in in-hospital death (81.4 [12.3] years; 45.1%). We found a strong seasonal fluctuation in in-hospital mortality from respiratory diseases. While hospital admissions were higher during the cold season, the maximum incidence of inpatient mortality was during the summer and was strongly related to high temperatures. When analysing the day-to-day association between temperature and in-hospital mortality, we only found an effect for high temperatures. The relative risk (RR) of fatal hospitalisation at the 99th percentile of the distribution of daily temperatures vs the minimum mortality temperature (MMT) was 1.395 (95% eCI: 1.211-1.606) in Madrid and 1.612 (1.379-1.885) in Barcelona. In terms of attributable burden, summer temperatures (June-September) were responsible for 16.2% (8.8-23.3) and 22.3% (15.4-29.2) of overall fatal hospitalisations from respiratory diseases in Madrid and Barcelona, respectively. Women were more vulnerable to heat than men, whereas the results by diagnostic of admission showed heat effects for acute bronchitis and bronchiolitis, pneumonia and respiratory failure. Unless effective adaptation measures are taken in hospital facilities, climate warming could exacerbate the burden of inpatient mortality from respiratory diseases during the warm season. European Research Council Consolidator Grant EARLY-ADAPT, European Research Council Proof-of-Concept Grants HHS-EWS and FORECAST-AIR.

Ukrainian migrants’ and war refugees’ admissions to hospital: evidence from the Polish Nationwide General Hospital Morbidity Study, 2014–2022

BackgroundConsidering the rapid influx of Ukrainian migrants and war refugees into Poland, the knowledge of their health condition is becoming increasingly important for health system policy and planning.The aim of the study was to assess war-related changes in the frequency and structure of hospitalizations among Ukrainian migrants and refugees in Poland.MethodsThe study is based on the analysis of hospital admission records of Ukrainian patients, which were collected in the Nationwide General Hospital Morbidity Study from 01.01.2014 to 31.12.2022.ResultsIn the study period, 13,024 Ukrainians were hospitalized in Poland, 51.7% of whom had been admitted to hospital after February 24, 2022. After the war broke out, the average daily hospital admissions augmented from 2.1 to 21.6 person/day. A noticeable increase in the share of women (from 50% to 62%) and children (from 14% to 51%) was also observed. The average age of patients fell from 33.6 ± 0.2 years to 24.6 ± 0.3 years. The most frequently reported hospital events among the migrants until 23.02.2022 were injuries (S00-T98) – 26.1%, pregnancy, childbirth and the puerperium (O00-O99) – 18.4%, and factors influencing health status and contact with health services (Z00-Z99) – 8.4%. After the war started, the incidence of health problems among migrants and war refugees changed, with pregnancy, childbirth and the puerperium (O00-O99) being the most common – 14.9%, followed by abnormal clinical and lab findings (R00-R99) – 11.9%, and infectious and parasitic diseases (A00-B99) – 11.0%.ConclusionsOur findings may support health policy planning and delivering adequate healthcare in refugee-hosting countries.

Effect of Short-Term Exposure to Air Pollutants on Hospital Admissions for End-Stage Renal Disease Patients Undergoing Hemodialysis

To evaluate the association between short-term exposure to air pollutants of end-stage renal disease (ESRD) patients on maintenance hemodialysis and the number of daily hospital admissions. The data on hospitalizations were obtained from the database of the municipal Urban Employees' Basic Medical Insurance and Urban Residents' Basic Medical Insurance of a city in Southwest China. Single and multiple pollutant generalized additive models were utilized to estimate the effect of air pollutants (CO, NO2, O3, PM10, PM2.5, and SO2) on patient admissions after the lag time of different numbers of days. In addition, subgroup analyses stratified by sex, age, PM2.5 and PM10 concentration thresholds, seasonality, and comorbidity status for cardiovascular diseases and hypertension were conducted. In the single pollutant models, the pollutants significantly associated with patient admissions and the corresponding lag time of the strongest association were as follows, every time CO increased by 0.1 mg/m3, there was a 2.39% increase (95% confidence interval [CI]: 0.96%-3.83%) in patient admissions after 7 days of lag time; every time NO2, O3, PM2.5, PM10, and SO2 increased by 10 μg/m3, patient admissions increased by 4.02% (95% CI: 1.21%-6.91%) after 7 days of lag time, 3.57% (95% CI: 0.78%-6.44%) after 0-4 days of lag time, 2.00% (95% CI: 1.07%-2.93%) after 6 days of lag time, 1.19% (95% CI: 0.51%-1.88%) after 7 days of lag time, and 8.37% (95% CI: 3.08%-13.93%) after 7 days of lag time, respectively. In the multiple pollutant model, every time O3 and PM2.5 increased by 10 μg/m3, there was an increase of 3.18% (95% CI: 0.34%-6.09%) in daily patient admissions after 0-4 days of lag time and an increase of 1.85% (95% CI: 0.44%-3.28%) after 7 days of lag time. Furthermore, subgroup analyses showed that seasonality, the severity of air pollution, and patients' comorbidities might be the effect modifiers for the association between ambient air pollution and hospital admissions in ESRD patients receiving maintenance hemodialysis. Air pollution is closely associated with hospital admissions in ESRD patients undergoing maintenance hemodialysis and the strength of this association varies according to seasonality, the severity of air pollution, and patients' status of comorbidities.

Heat wave exposure and increased heat-related hospitalizations in young children in South Korea: A time-series study

BackgroundNumerous studies have investigated the association between heat wave exposure increased heat-related hospitalizations in the general population. However, little is known about heat-related morbidity in young children who are more vulnerable than the general population. Therefore, we aimed to evaluate the association between hospitalization for heat-related illness in children and heat wave exposure in South Korea. MethodsWe used the National Health Insurance Service (NHIS) database, which provides medical records from 2015 to 2019 in South Korea. We defined daily hospitalizations for heat-related illness of children younger than five years during the summer period (June to August). We considered the definition of heat waves considering the absolute temperature and percentile. A total of 12 different heat waves were used. A time-series analysis was used to investigate the association between heat wave exposure and heat-related hospitalization among children younger than five years. We used a two-stage design involving a meta-analysis after modeling by each region. ResultsWe included 16,879 daily heat-related hospitalizations among children younger than five years. Overall, heat wave exposure within two days was most related for heat-related hospitalizations in young children. The relative risk (RR) due to heat wave exposure within two days (lag2) (12 definitions: 70th to 90th percentile of maximum temperature) ranged from 1.038 (95% confidence interval (CI): 0.971, 1.110) to 1.083 (95% CI: 1.036, 1.133). We found that boys were more vulnerable to heat exposure than girls. In addition, we found that urban areas were more vulnerable to heat exposure than rural areas. ConclusionsIn our study, heat wave exposure during summer was found to be associated with an increased risk of hospitalization for heat-related illness among children younger than five years. Our findings suggest the need for summer heat wave management and prevention for children.

Identifying patients' cardiovascular vulnerability against atmospheric parameters and air pollution

Abstract Background Atmospheric parameters are direct environmental factors on the human body. There is a growing concern that atmospheric parameters might have a potential cardiovascular (CV) effect and increase morbidity and mortality. The health effects of climate change and air pollution are already major public health issues. In the future, the growing concern about unfavorable atmospheric situations and air pollution can further increase this problem. Despite the importance of different atmospheric parameters’ CV risks, there are few studies about identifying vulnerable populations against atmospheric parameters and air pollution. Purpose We aimed to explore vulnerable populations against atmospheric parameters. Methods The study comprised 7230 hospitalized patients with acute CV diseases (ACVDs). Demographic and individual CV risk factor data were collected for each patient. We examined the relationship between demographic characteristics (age, sex) and CV risk factors (hypertension, hyperlipidemia, diabetes, previous CV diseases) and meteorological and air pollution parameters on a day-to-day basis in a 5-year time period (2017-2021) using a General Additive Model with cubic splines of covariates, regularized by a ridge penalty, and employing generalized cross-validation. Results Patients with diabetes were detected as the most vulnerable group against atmospheric parameters. The interaction between temperature change (5°C≤) and elevated ozone concentration (90 µg/m³≤) showed a positive association with daily diabetic patients’ hospitalization counts (p&amp;lt;0.001). The relative strength of the association with demographic characteristics was the largest between daily temperature variation (5°C≤) and patients with age 55 or more (p=0.002). The effect of temperature change (5°C≤) and elevated ozone concentration (90 µg/m³≤) was positively associated with the daily hospitalization counts of male patients (p&amp;lt;0.001). Conclusions In our study, we can identify vulnerable subpopulations that have increased CV risk during specific atmospheric conditions. The importance of our findings is growing in the context that extreme atmospheric conditions and air pollution are likely to become more common in the future. In conclusion, a better understanding of vulnerability could help establish new CV prevention strategies.

Improving Discharge Rates to Home With the Help of Mobility Technicians: A Step in the Right Direction.

Background Early ambulation during acute hospitalization has been associated with improved clinical outcomes for patients. Despite the benefits of mobility in the hospital setting, physical therapists and nursing staff are often constrained by time. Mobility technicians (MTs) are individuals with specialized training who have emerged as a potential solution by providing safe ambulation for patients during their hospital stay. Objectives The purpose of this quality improvement project was to investigate the impact of MTs on clinical and financial outcomes for admitted patients at a high-volume tertiary institution. Methods A quality improvement project was implemented at Jersey Shore University Medical Center, Neptune City, from October 2022 to March 2023. The study was a prospective, single-institution cohort study and included patients admitted to two medical floors. Patients were divided into an experimental group that received services from MTs and a control group that did not receive this service but was eligible based on clinical status. The primary endpoint was the proportion of patients discharged to home. Secondary outcomes included the length of stay and financial impact. Results A total of 396 admitted patients were included, with 222 patients in the MT group and 174 in the non-MT group. Patients in the MT group were discharged home more frequently, at a rate of 79.7% compared to 66.1% for patients in the non-MT group (p = 0.002). MTs contributed to an average 2.4-day reduction in the length of hospital stay (7.8 days vs. 10.2 days, p = 0.007). The MT intervention led to an estimated net savings of $148,500 during the six-month study period. Additionally, 2.9 daily hospital beds were created. Conclusion Implementing an MT program significantly increased the discharge-to-home rates and decreased hospital length of stay. Preliminary analysis suggests that this intervention is cost-effective and can assist institutions in managing increased hospital capacity strain through the creation of additional hospital beds.

Impact of Haze Event on Daily Admission of Respiratory System Patients in Peninsular Malaysia

Diseases of the respiratory system, especially in children and the elderly, are significantly related to air pollution. Exposure to air pollution has led to an increase in the number of patients who need hospital treatment. The purpose of this study was to learn about the effects of changes in the levels of major pollutant components on the number of daily hospital admissions of respiratory system patients. The generalised linear lag model is used in this study to demonstrate the lag structure of the exposure-response impacts. The results show that particulate matter (PM10), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3) component factors, as well as meteorological factors like wind speed and ultraviolet (UV) radiation, affect the number of hospital admissions of respiratory system patients. The best model is a lag 6 negative binomial regression model. Daily hospital admission is positively correlated with PM10, NO2, and wind speed, and negatively correlated with CO, O3, and UV radiation. According to the findings of the study, fine particulate matter (PM2.5) and sulphur dioxide (SO2), as well as temperature, humidity, and wind direction, are not significantly contributing factors in the number of respiratory system patients admitted to hospitals.

Long-term effects of angiotensin receptor neprilysin inhibitor therapy in heart failure patients with reduced ejection fraction: A retrospective cohort study.

Heart failure is an increasing public health issue with substantial morbidity and mortality rates. This study aimed to evaluate the efficacy, safety, and long-term outcomes of angiotensin receptor neprilysin inhibitor (ARNi) in the treatment of heart failure with reduced ejection fraction (HFrEF) 5 years after treatment initiation. This retrospective study analyzed a cohort of 75 patients diagnosed with HFrEF over a period of 5 years after the initiation of ARNi therapy. The initial clinical condition, laboratory and echocardiographic measurements including left ventricular ejection fraction (LVEF), New York Heart Association functional classes (NYHA-FC) and the prognostic nutritional index were compared to the corresponding values obtained after a 5-year period of ARNi therapy. In addition, the number of annual hospitalizations, mortality rates and any history of adverse effects during the follow-up period were recorded. The N-terminal pro-brain natriuretic peptide (NT-proBNP) level, LVEF, and NYHA-FC values demonstrated significant improvement at the end of the 5-year follow-up period (all parameters, P < .001). Although the observed increase in the prognostic nutritional index was not statistically significant (P = .077), it is worth noting. A significant reduction in daily diuretic doses and hospitalizations due to heart failure was observed following the use of ARNi (all comparisons, P < .001). The prevalence of hypotension was around 16% (being symptomatic in 4%), making it the most frequently observed adverse event. The 5-year cardiovascular mortality rate was 17.3%. The use of ARNi in HFrEF patients was associated with a notable improvement in NYHA-FC, LVEF, and NT-proBNP levels in the long-term, while also leading to a better nutritional status and reduced need for diuretics and annual hospitalization. Additionally, ARNi usage has been associated with improved nutritional status, decreased reliance on diuretics, and reduced frequency of annual hospitalizations. These effects were associated with a lack of significant increase in adverse effects. These results may contribute to a better understanding of ARNi's long-term effects on patient outcomes.

Daily temperature variability in cities and mental health-related hospitalizations

Abstract Despite plausible behavioral and physiological pathways, limited evidence exists on how temperature variability is associated with acute mental health-related episodes. This analysis explored associations between daily temperature range (DTR) and mental health-related hospitalizations in New York State during 1995-2014. A case-crossover design with distributed lag non-linear DTR terms (0-6 days) estimated associations between ZIP Code-level DTR and hospitalizations for mood, anxiety, adjustment, and schizophrenia disorders, adjusting for daily mean temperature, and how associations varied by age, sex, admission type and season. For all outcomes, across most DTR distribution, divergence from the study period daily mean (7.7 °C) yielded a positive association to a threshold (5.2 °C, 25th percentile; 12.2 °C, 90th percentile), beyond which negative associations were observed. For mood disorders, an increase in DTR from 7.7 °C to 12.2 °C was associated with a cumulative 4.8% (95%CI, 4.0%−5.6%) increase in daily hospitalization rates. This increase was highest during transition seasons (6.0%, 4.5%−7.4%) compared with summer (1.8%, 0.6%−3.0%) and winter (-0.6%, -0.7%−1.9%). Evidence for effect-modification by age group and admission type was inconsistent across outcomes, without evidence for effect modification by sex. This study highlights potential impacts of increased temperature variability in a changing climate on mental health-related outcomes.

Daily Summer Temperatures and Hospitalization for Acute Cardiovascular Events: Impact of Outdoor PM 2.5 Oxidative Potential on Observed Associations Across Canada.

Oxidative stress plays an important role in the health impacts of both outdoor fine particulate air pollution (PM 2.5 ) and thermal stress. However, it is not clear how the oxidative potential of PM 2.5 may influence the acute cardiovascular effects of temperature. We conducted a case-crossover study of hospitalization for cardiovascular events in 35 cities across Canada during the summer months (July-September) between 2016 and 2018. We collected three different metrics of PM 2.5 oxidative potential each month in each location. We estimated associations between lag-0 daily temperature (per 5ºC) and hospitalization for all cardiovascular (n = 44,876) and ischemic heart disease (n = 14,034) events across strata of monthly PM 2.5 oxidative potential using conditional logistical models adjusting for potential time-varying confounders. Overall, associations between lag-0 temperature and acute cardiovascular events tended to be stronger when outdoor PM 2.5 oxidative potential was higher. For example, when glutathione-related oxidative potential (OP GSH ) was in the highest tertile, the odds ratio (OR) for all cardiovascular events was 1.040 (95% confidence intervals [CI] = 1.004, 1.074) compared with 0.980 (95% CI = 0.943, 1.018) when OP GSH was in the lowest tertile. We observed a greater difference for ischemic heart disease events, particularly for older subjects (age >70 years). The acute cardiovascular health impacts of summer temperature variations may be greater when outdoor PM 2.5 oxidative potential is elevated. This may be particularly important for ischemic heart disease events.