Discharge Record Research Articles

Decline in hospitalization rates for herpes zoster in Italy (2003-2018): reduction in the burden of disease or changing of hospitalization criteria?

Herpes Zoster (HZ) is a very demanding disease caused by the reactivation of latent Varicella Zoster Virus. The main aim of this study was to estimate the burden of the HZ hospitalizations in Italy from 2003 to 2018 evaluating temporal trends. Retrospective population-based study analyzing Hospital Discharge Records. Hospitalization records reporting the ICD-9 CM 053.X code in the principal diagnosis or in any of the five secondary diagnoses were considered as cases. Trends of hospitalization rates have been evaluated by Joinpoint analyses. Overall, 99,036 patients were hospitalized with HZ in the 16-year period of the study, and 83,720 (84.5%) of these patients were over 50years. Hospitalization rate was 10.4 per 100,000 persons/year with a significant decreasing trend from 13.9 in 2003-2006 to 7.8 in 2015-2018 (p < 0.001). Hospitalization rates showed a 20-fold higher risk among subjects aged over 80years and 11-fold higher risk among 70-79-year-old subjects with respect to those aged less than 50years. Over time, a statistically significant increase was observed for the case fatality rate (from 1.2 to 1.7%; p < 0.001) and the median length of stay (from 7 to 8days; p < 0.001). Zoster is a disease that causes hospitalization as relatively frequent complication and the observed reduced trend over time could be due to a restriction in hospitalization criteria instead of a reduced burden of disease. The decreasing trend should be carefully interpreted, since it could have an impact on promoting herpes zoster vaccination.

Heart failure and in-hospital mortality in elderly patients after elective noncardiac surgery in Spain

BackgroundPatients with heart failure (HF) undergoing noncardiac surgical procedures is rising worldwide. This study was aiming at analyzing the impact of heart failure (HF) on the outcomes (mortality, complications, readmissions, and length of stay) of elderly patients undergoing elective major noncardiac surgical procedures in Spain. MethodsA retrospective observational study of patients undergoing noncardiac surgery was conducted. The Minimum Basic Data Set (MBDS) was used to collect information about the demographic characteristics of patients discharged from hospitals of the Spanish National Health System (SNHS), variables related to patients’ medical conditions and surgeries conducted during the episode. ResultsA total of 996,986 selected procedures in the discharge record were identified in the period 2007–2015. HF was recorded as a secondary diagnosis in 22,367 discharges (2.24%). The mean age of patients was 76.6±7.27 years, with a difference in patients without and with HF: 76.5 (95% CI: 76.47–76.50) vs 82.8 (95% CI: 82.71–82.90). The number of selected surgical procedures increased by 13.2% (117,487 in 2015 vs. 103,744 in 2007), and the proportion of presence HF as a comorbidity increased by 24.4% (2.4% in 2015 v 1.9% in 2007). The proportion of women was higher in the HF group: 53.2% (95% CI: 53.18–53.22) vs 64.3% (95% CI: 64.20–64.44), with a longer average length of stay: 7.9 (95% CI: 7.9–7.9) vs 14.9 (95% CI 14.7–15.0) days, and women had a higher proportion of comorbidities. HF was found to be an independent risk factor in-hospital mortality in the multilevel risk adjustment model (OR=2.3; 95% CI: 2.2–2.4). ConclusionsPatients with HF undergoing any of the selected surgical procedures are older; there was women predominance and there is also an important burden of comorbidities than patients without HF undergoing these surgical procedures. HF in the selected procedures, increasing in-hospital mortality, mean length of stay, and the occurrence of adverse events in the Spanish population. The percentage of patients with HF who underwent the selected surgical procedures increased in the study period.

Health impact of the emissions from a refinery: case-control study on the adult population living in two municipalities in Lomellina, Italy

&#x0D; Background: In the municipalities of Sannazzaro de’ Burgondi and Ferrer Erbognone (District of Lomellina, Pavia, Lombardy, Italy), an oil refinery is operating since 1963. In 2008, the company running the plant (eni S.p.A.) asked the competent bodies the permission for building a new facility (“EST”). The present work is aimed at evaluating the ante-operam health impacts of the existing facility refinery.&#x0D; Methods: A case-control study design was implemented. Cases were subjects admitted to hospital in 2002-2014 due to acute respiratory, cardiovascular or gastrointestinal conditions. Controls were selected among those who had not been hospitalised in that timespan. Cases and controls had to be alive at enrolment, aged 20-64 years, and were frequency-matched by age, gender and municipality. Data were extracted from the health insurance registry and from Hospital Discharge Records (ATS Pavia). Enrolled subjects were asked to complete a mailed survey. Environmental exposure was the fallout of refinery emissions (PM10) at participants’ homes, as predicted by an AERMOD model.&#x0D; Results: 541 respondents (125 cases, 416 controls) were included in the analyses. Response bias was excluded. Individual PM10 exposure was not significantly different between cases and controls, while it was significantly associated with municipality (being higher in Sannazzaro). The crude effect estimate of PM10 over case/control status indicated a not-significant excess of hospitalisation with the increase in PM10 exposure. Multivariate analyses confirmed those results.&#x0D; Conclusion: Findings indicate a possible excess of hospitalisation risk in most exposed people, but the effect is not statistically significant and may be affected by bias.&#x0D;

Survivorship of 4,748 Contemporary Total Ankle Replacements from the French Discharge Records Database.

Studies of survivorship of primary total ankle replacements (TARs) beyond 5 years have shown varying results among early and modern designs. National cohorts give valuable insights about TAR outcomes, revision risk factors, and specific designs. The purpose of this study was to investigate implant survivorship and risk factors for revision of contemporary TARs using our national database. This observational study included patients identified in the national PMSI (Programme médicalisé des systèmes d'information) database as having undergone TAR from 2010 to 2019. Demographics, discharge data, concomitant procedures, and type of implant were extracted. Kaplan-Meier estimations were performed to determine time to revision using metal component revision for implant failure and revision for deep infection as end points. Weighted Cox models were used for risk factor analysis, including risks of early revision (within the first 2 years). The adjusted hazard ratios (HRadj) were reported with 95% confidence intervals. A cohort of 4,748 patients was extracted. The mean age at surgery was 63 years; 43% of the patients were female. The mean follow-up was 5 years (range, 1 to 10 years). Revisions were noted in 817 cases (17%), including 734 with metal component revision and 83 with revision due to deep infection. The 1-year, 2-year, 5-year, and 10-year survivorship free of metal component revision was 95%, 90%, 84%, and 78%, respectively. Younger age, implants derived from second-generation designs, and an institutional volume of ≤10 TARs per year were found to be independent predictors of revision for any cause. In addition to the above factors (except for implant generation), male sex and concomitant osteotomies and/or fusion were found to be significant predictors for any early revision. The 10-year survivorship free of metal component revision after TAR was 78%, which was consistent with other national registries. Revisions were associated with young age, associated arthritis or deformities requiring concomitant fusion or osteotomy, and implants derived from second-generation designs. Institutions where >10 procedures were performed per year were associated with better TAR survivorship. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Enhancing Diabetes Surveillance Across Alberta by Adding Laboratory and Pharmacy Data to the National Diabetes Surveillance System Methods

ObjectivesThe National Diabetes Surveillance System (NDSS) case definition, which identifies a case of diabetes using administrative health records as “two physician claims or one hospital discharge abstract record, within a 2-year period for a diagnosis bearing International Classification of Disease codes for diabetes,” was compared with expanded case definitions, including pharmacy (PHARM) and laboratory (LAB) data. The PHARM definition included any therapeutic antihyperglycemic agents, and the LAB definition included thresholds of ≥1 glycated hemoglobin measurement of ≥6.5%, or 2 instances of random glucose ≥11.1 mmol/L or fasting glucose ≥7.0 mmol/L. MethodsIn this retrospective study we used administrative data from the Diabetes Infrastructure for Surveillance, Evaluation, and Research project. Descriptive statistics were used to characterize participants by several subgroups. ResultsThe NDSS identified 291,242 diabetes cases, indicating a provincial prevalence of 6.83%. Using LAB plus PHARM identified 52,040 additional cases, so the combination of NDSS or LAB or PHARM identified the largest number of cases (n=343,282), increasing the diabetes prevalence estimate to 8.06%. These 3 sources resulted in 7 unique subsets: NDSS only (n=42,606), PHARM only (n=16,310), LAB only (n=32,202), NDSS+LAB (n=32,582), NDSS+PHARM (n=22,503), LAB+PHARM (n=3,528) and NDSS+LAB+PHARM (n=193,551). Refinement using demographic and clinical characteristics allowed presumptive cases of polycystic ovarian syndrome to be excluded. ConclusionsThe widely used NDSS case definition can be enhanced by the addition of LAB and PHARM data. Including PHARM and LAB data identified subsets of the diabetes population, which can maximize the yield for detection of diabetes cases in Alberta and provide a richer understanding of this population to target interventions to improve health outcomes.

Association of lightning occurrence with precipitation cloud column structure at a fixed position

In this study, a C-band frequency-modulated continuous-wave (C-FMCW) radar, with its feature of vertical detection, was combined with lightning discharge recordings within a 3 km range to investigate the dependence of lightning occurrence on the structure of precipitation cloud columns (PCCs) from the perspective of a fixed position. The results show that, relative to PCCs without lightning, PCCs with lightning exhibit greater maximum reflectivity, maximum upward radial velocity, maximum velocity spectrum width, cloud top height, and vertically integrated liquid in terms of their average values, and wider-range distributions of these parameters. Using the Light Gradient Boosting Machine algorithm, a lightning diagnosis program that integrates multiple C-FMCW radar parameters was developed. Its hit rate of lightning occurrence is 93.5% and it has a threat score of 0.421. The maximum velocity spectrum width above the melting layer was found to be the most effective in distinguishing PCCs with or without lightning. It was suggested that the hydrometeor properties at a specific location, specifically the size diversity and content of ice-phase particles, should be the key elements determining the occurrence of lightning in PCCs.

Remote Speech Analysis in the Evaluation of Hospitalized Patients With Acute Decompensated Heart Failure

ObjectivesThis study assessed the performance of an automated speech analysis technology in detecting pulmonary fluid overload in patients with acute decompensated heart failure (ADHF). BackgroundPulmonary edema is the main cause of heart failure (HF)-related hospitalizations and a key predictor of poor postdischarge prognosis. Frequent monitoring is often recommended, but signs of decompensation are often missed. Voice and sound analysis technologies have been shown to successfully identify clinical conditions that affect vocal cord vibration mechanics. MethodsAdult patients with ADHF (n = 40) recorded 5 sentences, in 1 of 3 languages, using HearO, a proprietary speech processing and analysis application, upon admission (wet) to and discharge (dry) from the hospital. Recordings were analyzed for 5 distinct speech measures (SMs), each a distinct time, frequency resolution, and linear versus perceptual (ear) model; mean change from baseline SMs was calculated. ResultsIn total, 1,484 recordings were analyzed. Discharge recordings were successfully tagged as distinctly different from baseline (wet) in 94% of cases, with distinct differences shown for all 5 SMs in 87.5% of cases. The largest change from baseline was documented for SM2 (218%). Unsupervised, blinded clustering of untagged admission and discharge recordings of 9 patients was further demonstrated for all 5 SMs. ConclusionsAutomated speech analysis technology can identify voice alterations reflective of HF status. This platform is expected to provide a valuable contribution to in-person and remote follow-up of patients with HF, by alerting to imminent deterioration, thereby reducing hospitalization rates. (Clinical Evaluation of Cordio App in Adult Patients With CHF; NCT03266029)

Epilepsy Centers in the United States

The modern era of epilepsy surgery began at Queen's Square in the 1880s. Resections were directed by semiology alone and outcomes were improved through a meticulous surgical approach. The first EEG recordings of interictal epileptiform discharges were recorded in the 1930s. During the 1940s and 1950s, interictal EEG findings were used to plan temporal lobectomies. In the 1970s, the advent of CT imaging and routine preoperative video EEG monitoring revolutionized the approach to the evaluation for epilepsy surgery. Subsequent developments of MRI, PET, laser resections, stimulation therapies, and other advances have continued to optimize preoperative and surgical approaches in the management of drug-resistant epilepsy (DRE).

ACCURACY OF CLINICAL DIAGNOSIS IN ACUTE APPENDICITIS

INTRODUCTION: Acute appendicitis is the most common abdominal emergency. The lifetime risk of developing appendicitis he is approximately 7% and is usually required surgical treatment. The clinical diagnosis may be straight forward in patients who present with classical signs and symptoms, atypical presentations may result in Diagnostic confusion and delay in treatment. The delay in early diagnosis lead to disease prognosis, which lead to increase in morbidity of the patient. MATERIALS AND METHODS: The study was conducted in department of surgery, Maharajah's Institute Of Medical Sciences, during the period of 1vyear. All patients operated for appendicectomy during that period were included. All the patients complete clinical history and physical examination data were collected. All patients data with operative and discharge record were correlated with the case notes wherever necessary RESULTS: Even in the most experienced the hands the diagnosis of appendicitis can be challenging, and is predominantly a clinical one. Accurate clinical history and physical examination are important to prevent unnecessary surgery and avoid complications. Probability of appendicitis depends on age, clinical settings and symptoms. Application of Alvarado scoring system in diagnosis of appendicitis can provide high degree of positive predictive value and thus diagnostic accuracy. CONCLUSION: No symptom or sign maybe ascribed to acute appendicitis as patognomonic. Acute appendicitis in emergency setting may be successfully rolled in with high accuracy based on lack of appetite, elevated WBC count. For successful diagnosis through assessment that contains adequate evaluation of laboratory parameters in combination with clinical and radiological ndings.

Unprecedented acceleration of winter discharge of Upper Yenisei River inferred from tree rings

The Yenisei River is the largest contributor of freshwater and energy fluxes among all rivers draining to the Arctic Ocean. Modeling long-term variability of Eurasian runoff to the Arctic Ocean is complicated by the considerable variability of river discharge in time and space, and the monitoring constraints imposed by a sparse gauged-flow network and paucity of satellite data. We quantify tree growth response to river discharge at the upper reaches of the Yenisei River in Tuva, South Siberia. Two regression models built from eight tree-ring width chronologies of Larix sibirica are applied to reconstruct winter (Nov–Apr) discharge for the period 1784–1997 (214 years), and annual (Oct–Sept) discharge for the period 1701–2000 (300 years). The Nov–Apr model explains 52% of the discharge variance whereas Oct–Sept explains 26% for the calibration intervals 1927–1997 and 1927–2000, respectively. This new hydrological archive doubles the length of the instrumental discharge record at the Kyzyl gauge and resets the temporal background of discharge variability back to 1784. The reconstruction finds a remarkable 80% upsurge in winter flow over the last 25 years, which is unprecedented in the last 214 years. In contrast, annual discharge fluctuated normally for this system, with only a 7% increase over the last 25 years. Water balance modeling with CRU data manifests a significant discrepancy between decadal variability of the gauged flow and climate data after 1960. We discuss the impact on the baseflow rate change of both the accelerating permafrost warming in the discontinuous zone of South Siberia and widespread forest fires. The winter discharge accounts for only one third of the annual flow, yet the persistent 25 year upsurge is alarming. This trend is likely caused by Arctic Amplification, which can be further magnified by increased winter flow delivering significantly more fresh water to the Kara Sea during the cold season.

Emerging National Trends in Ankle Prosthesis: A 15-Year Analysis of the Italian National Hospital Discharge Records

Total ankle replacement (TAR) has gained popularity in recent years becoming the mainstream treatment for conditions like rheumatoid arthritis, posttraumatic arthritis and severe osteochondral lesions of the talus. The aim of the study was to assess the nationwide number of implants performed in a 15-year period (2001-2016) and to identify trends like patients’ interregional migratory flows and their accessibility to this procedure. Data for this study were obtained from the Italian National Hospital Discharge records (SDO), obtained from the National Ministry of Health. The selected SDOs were evaluated for demographic data, like the patient's age and gender, for geographical data, including the region of hospitalization and the region of origin of the patient, and for hospitalization data, like the hospital stay length and the principal source of payment. In a 15-year span, a sharp increase in the number of TARs was observed with a 600% growth. The incidence was 0.16 per 100,000 persons in 2001 and increased to 0.915 per 100,000 persons in 2016. Most TAR were performed in northern Italy (73.9%), followed by central Italy (16.7%) and lastly southern Italy (9.4%). The rates of utilization of TAR increased every year from 2001 to 2016, indicating that demand for ankle arthroplasties is growing faster regarding to other procedures performed in Italy. The surgical cost was covered, in the majority of cases, by the National Health System and may play a role in the rising rates of TAR.

Global Reach-Level 3-Hourly River Flood Reanalysis (1980–2019)

AbstractBetter understanding and quantification of river floods for very local and “flashy” events calls for modeling capability at fine spatial and temporal scales. However, long-term discharge records with a global coverage suitable for extreme events analysis are still lacking. Here, grounded on recent breakthroughs in global runoff hydrology, river modeling, high-resolution hydrography, and climate reanalysis, we developed a 3-hourly river discharge record globally for 2.94 million river reaches during the 40-yr period of 1980–2019. The underlying modeling chain consists of the VIC land surface model (0.05°, 3-hourly) that is well calibrated and bias corrected and the RAPID routing model (2.94 million river and catchment vectors), with precipitation input from MSWEP and other meteorological fields downscaled from ERA5. Flood events (above 2-yr return) and their characteristics (number, spatial distribution, and seasonality) were extracted and studied. Validations against 3-hourly flow records from 6,000+ gauges in CONUS and daily records from 14,000+ gauges globally show good modeling performance across all flow ranges, good skills in reconstructing flood events (high extremes), and the benefit of (and need for) subdaily modeling. This data record, referred as Global Reach-Level Flood Reanalysis (GRFR), is publicly available at https://www.reachhydro.org/home/records/grfr.

Estimating human leishmaniasis burden in Spain using the capture-recapture method, 2016-2017.

Leishmaniasis is endemic and a mandatory reporting disease in Spain since 1982. However, between 1996 and 2014, surveillance on public health was decentralized and only some autonomous regions monitored the disease. The aim of this study is to estimate the incidence of leishmaniasis and to evaluate the extent of underreporting in Spain. A capture-recapture (CRC) study was conducted to calculate the incidence of human leishmaniasis using reports from the National Surveillance Network (RENAVE) and the Hospital Discharge Records of the National Health System (CMBD) for 2016 and 2017. During the study period, 802 cases were reported to RENAVE and there were 1,149 incident hospitalizations related to leishmaniasis. The estimated incidence rates through the CRC study were 0.79 per 100,000 inhabitants for visceral leishmaniasis (VL), 0.88 (cutaneous leishmaniasis (CL)) and 0.12 (mucocutaneous leishmaniasis (MCL)) in 2016 and 0.86 (VL), 1.04 (CL) and 0.12 (MCL) in 2017. An underreporting of 14.7–20.2% for VL and 50.4–55.1% for CL was found. The CRC method has helped us to assess the sensitivity and representativeness of leishmaniasis surveillance in Spain, being a useful tool to assess whether the generalization of leishmaniasis surveillance throughout the Spanish territory achieves a reduction in underreporting.

Reduction in Neurological Disease Hospitalization Rate During Covid-19 Pandemic in Abruzzo

BackgroundAs a consequence of the Covid-19 outbreak, Italy has adopted unprecedented preventive measures such as large-scale application of social isolation and hospital rearrangements. These measures have led to difficulty in managing diseases and hospitalizations, particularly acute and severe conditions such as neurological morbidities. The aim of the present analysis is to investigate the change in hospital admissions for neurological diseases over the first nine months of 2020 in Abruzzo region.MethodsData were obtained from the Hospital Discharge Records of all Abruzzo. We analyzed all the hospitalizations included in Major Diagnostic Categories 1 (neurological diseases). First, we distinguished both between public or private hospitalizations and ordinary or day-hospital admissions. Second, we compared the first nine months of 2020 with a mean of the same months in the two previous years. Finally, we calculated the variable percentage.ResultsA huge reduction in MCD 1 series hospitalizations was observed in each subgroup. Specifically, ordinary regimen had a peak of -47,3% in April. Day-hospital admissions were the most affected by Covid-19 with a peak of more than 90% in April both in public and private hospitals. The largest reduction occurred in private hospitals, both in ordinary (-75% in April) and DH admissions (-93,8% in March).ConclusionsDespite the severity of the diseases included in MDC 1 (i.e. ischemic stroke, intracranial hemorrhage), a significant decline was detected in hospital admissions in Abruzzo. Subsequently, a high number of subjects might have not received the necessary health assistance leading to an increase in mortality and morbidity for these severe pathologies. Additionally, patients might have avoided seeking hospital care in response to the fear of contagion triggered either by media or as a result of the stay-at-home government recommendations.Key messages An alarming reduction in all types of hospitalizations for neurological diseases occurred over the first months of pandemic in Abruzzo.Greater management efforts are needed to reduce the morbidity and mortality rates associated with the reduced hospital admissions during the pandemic.

Metabotropic Glutamate Receptors 1 Regulates Rat Carotid Body Response to Acute Hypoxia via Presynaptic Mechanism.

Background: The carotid body (CB) plays a critical role in oxygen sensing; however, the role of glutamatergic signaling in the CB response to hypoxia remains uncertain. We previously found that functional multiple glutamate transporters and inotropic glutamate receptors (iGluRs) are expressed in the CB. The aim of this present research is to investigate the expression of group I metabotropic glutamate receptors (mGluRs) (mGluR1 and 5) in the CB and its physiological function in rat CB response to acute hypoxia.Methods: RT-PCR and immunostaining were conducted to examine the mRNA and protein expression of group I mGluRs in the human and rat CB. Immunofluorescence staining was performed to examine the cellular localization of mGluR1 in the rat CB. In vitro carotid sinus nerve (CSN) discharge recording was performed to detect the physiological function of mGluR1 in CB response to acute hypoxia.Results: We found that (1) mRNAs of mGluR1 and 5 were both expressed in the human and rat CB. (2) mGluR1 protein rather than mGluR5 protein was present in rat CB. (3) mGluR1 was distributed in type I cells of rat CB. (4) Activation of mGluR1 inhibited the hypoxia-induced enhancement of CSN activity (CSNA), as well as prolonged the latency time of CB response to hypoxia. (5) The inhibitory effect of mGluR1 activation on rat CB response to hypoxia could be blocked by GABAB receptor antagonist.Conclusion: Our findings reveal that mGluR1 in CB plays a presynaptic feedback inhibition on rat CB response to hypoxia.

In JME patients, prolonged and short epileptiform discharges have an opposite relationship with the sleep-wake cycle

We recently demonstrated that the recording of epileptiform discharges (EDs) longer than 2,68 s with prolonged EEG, in Juvenile Myoclonic patients predict motor seizure recurrence. The aim of this study is to verify whether the longer and shorter EDs have a different distribution in relation to the sleep-wake cycle.

Longitudinal changes of laboratory measurements after discharged from hospital in 268 COVID-19 pneumonia patients.

Monitoring recovery process of coronavirus disease 2019 (COVID-19) patients released from hospital is crucial for exploring residual effects of COVID-19 and beneficial for clinical care. In this study, a comprehensive analysis was carried out to clarify residual effects of COVID-19 on hospital discharged patients. Two hundred sixty-eight cases with laboratory measured data at hospital discharge record and five follow-up visits were retrospectively collected to carry out statistical data analysis comprehensively, which includes multiple statistical methods (e.g., chi-square, T-test and regression) used in this study. Study found that 13 of 21 hematologic parameters in laboratory measured dataset and volume ratio of right lung lesions on CT images highly associated with COVID-19. Moderate patients had statistically significant lower neutrophils than mild and severe patients after hospital discharge, which is probably caused by more efforts on severe patients and slightly neglection of moderate patients. COVID-19 has residual effects on neutrophil-to-lymphocyte ratio (NLR) of patients who have hypertension or chronic obstructive pulmonary disease (COPD). After released from hospital, female showed better performance in T lymphocytes subset cells, especially T helper lymphocyte% (16% higher than male). According to this sex-based differentiation of COVID-19, male should be recommended to take clinical test more frequently to monitor recovery of immune system. Patients over 60 years old showed unstable recovery process of immune cells (e.g., CD45 + lymphocyte) within 75 days after discharge requiring longer clinical care. Additionally, right lung was vulnerable to COVID-19 and required more time to recover than left lung. Criterion of hospital discharge and strategy of clinical care should be flexible in different cases due to residual effects of COVID-19, which depend on several impact factors. Revealing remaining effects of COVID-19 is an effective way to eliminate disorder of mental health caused by COVID-19 infection.

Health Care Costs in Patients with and without Secondary Hyperparathyroidism in Spain

To analyze the economic burden of secondary hyperparathyroidism (sHPT) in Spain by quantifying differences in costs of pharmacological treatments and associated cardiovascular events (CVE) between renal patients with and without sHPT. We used data collected in the NEFRONA cohort study and obtained treatment and CVE costs from the BOT PLUS database and Hospital Discharge Records in the Spanish Health System (CMBD-H), respectively. We examined data from 2445 renal patients followed during 2years for chronic kidney disease (CKD) progression and 4years for CVE, stratifying by presence of sHPT. Patient characteristics, administered treatments and CVE were directly extracted from NEFRONA registries. Dosage for each treatment regimen was assumed based on guidelines and multiplied by official unit costs to obtain treatment costs. Costs of CVE were based on ICD-9-CM. Prevalence of sHPT in the cohort was 65.6% (63.6; 67.6). Average yearly pharmacological costs for patients without sHPT were 610.33€, while costs were 1483.17€ for sHPT patients (average increase of 143.0%). Two hundred three patients registered CVE, resulting in 4-year average costs of 582.57€ for non-sHPT patients compared to 941.87€ for sHPT patients (61.7% average increase). Bivariate analyses considering presence of dialysis, hypercalcemia or hyperphosphatemia and stratified by sHPT showed higher costs for sHPT patients. These results show that sHPT is associated with substantially higher costs of both, pharmacological treatments and associated CVEs. Preventing the development of sHPT with early management in the course of CKD could possibly lead to better health outcomes and cost balance for health care systems.

Pregnancy and Neonatal Outcomes Among Deaf and Hard of Hearing Women: Results From Nationally Representative Data.

Although the literature suggests that women with disabilities are at increased risk for pregnancy complications and adverse birth outcomes, there are few population-based studies of pregnancy outcomes among deaf and hard of hearing (DHH) women in the United States. To compare pregnancy complications and neonatal outcomes between deliveries to DHH and non-DHH women using national hospitalization discharge record data. We used the 2007-2016 Healthcare Cost and Utilization Project National Inpatient Sample to compare pregnancy complications and outcomes among deliveries to DHH women with deliveries to non-DHH women using bivariate and Poisson regressions, controlling for sociodemographic, hospital, and clinical characteristics. DHH women had an increased risk of adverse pregnancy outcomes and chronic medical conditions, including preexisting diabetes (relative risk [RR], 2.01; 95% confidence interval, 1.68-2.42; p<.001), gestational diabetes (RR, 1.31; 95% CI, 1.19-1.44; p<.001), chronic hypertension (RR, 1.51; 95% CI, 1.33-1.72; p<.001), preeclampsia and eclampsia (RR, 1.35; 95% CI, 1.21-1.51; p<.01), placenta previa (RR, 1.62; 95% CI, 1.22-2.16; p<.01), placental abruption (RR, 1.43; 95% confidence interval, 1.15-1.78; p<.01), labor induction (RR, 1.16; 95% CI, 1.05-1.27; p<.01), chorioamnionitis (RR, 1.43; 95% CI, 1.22-1.69; p<.001), cesarean delivery (RR, 1.09; 95% CI, 1.04-1.14; p<.001), premature rupture of membranes (RR, 1.34; 95% CI, 1.20-1.50; p<.001), antepartum hemorrhage (RR, 1.36; 95% CI, 1.13-1.64; p<.001), and postpartum hemorrhage (RR, 1.30; 95% CI, 1.13-1.49; p<.001). After adjustment for socioeconomic and hospital characteristics, the risk for gestational diabetes, preeclampsia and eclampsia, placenta previa, and chorioamnionitis remained unexplained. DHH women are at increased risk for adverse pregnancy, fetal, and neonatal outcomes, illuminating the need for awareness among obstetric and primary care providers as well as the need for systematic investigation of outcomes and evidence-based guidelines.

Nonfatal Firearm Injuries by Intent in the United States: 2016-2018 Hospital Discharge Records from the Healthcare Cost and Utilization Project.

IntroductionIn addition to the nearly 40,000 firearm deaths each year, nonfatal firearm injuries represent a significant public health burden to communities in the United States. We aimed to describe the incidence and rates of nonfatal firearm injuries.MethodsWe calculated nonfatal firearm injury estimates using the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality, including the Nationwide Emergency Department Samples and the National Inpatient Samples. We used the International Classification of Diseases, 10th Revision, Clinical Modification to identify firearm injury episodes. Deaths in the emergency department (ED) or as inpatients were excluded.ResultsIn addition to the 118,171 persons shot and killed by firearms from 2016–2018, 228,380 people were shot (ratio 1.9:1) and treated at a hospital ED or admitted to hospital, a rate of 23.4 nonfatal firearm injury episodes per 100,000 population. The number of nonfatal injury episodes varied by year: 2018 had the lowest at 69,692, compared to 84,776 in 2017 and 73,912 in 2016. Unintentional injury episodes were the most frequent, accounting for 58.5% (n = 81,217) and 38.9% (n = 34,820) of total nonfatal firearm hospital discharges from the ED and inpatients, respectively. Assault episodes were the next most frequent, at 36.3% (n = 50,482) of ED and 49.5% (n = 44,290) of inpatient discharges. The highest rate of nonfatal firearm injury by five-year age group was for 20- to 24-year-olds. With an annual rate of 73.53 per 100,000 population, the rates for ages 20–24 were more than 10 times higher than the rates for patients younger than 15 or 60 years and older. More than half (53.4%, n = 121,884) of hospital-treated, nonfatal firearm injury episodes were patients living in ZIP codes with a median household income in the lowest quartile, compared to 7.5% (n = 17,102) for patients residing in the highest income quartile ZIP codes, a sevenfold difference.ConclusionFor every person shot and killed by a gun in the US, two more are wounded. Unlike firearm deaths, which are predominantly suicides, most nonfatal firearm injury episodes are unintentional or with an assault intent. Having a reliable source of nonfatal injury data is essential to understanding the incidence of firearm injuries.