Discharge Record Research Articles

Impact of atrial fibrillation on inpatient cost for ischemic stroke in the USA.

Atrial fibrillation is a significant risk factor for ischemic stroke and increases cost of treatment. To estimate the incremental inpatient cost and length of stay due to atrial fibrillation among adults hospitalized with a primary diagnosis of ischemic stroke after controlling for sociodemographic, clinical, and hospital characteristics in a nationally representative discharge record of US population. Hospital discharge records with a primary diagnosis of ischemic stroke were identified from the National Inpatient Sample data for the years 2010-2013. Generalized linear model with log link and least-square means were utilized to estimate the incremental inpatient cost and length of stay in ischemic stroke due to atrial fibrillation after controlling for sociodemographic, clinical, and hospital characteristics. Among 434,544 hospital discharge records with a primary diagnosis of ischemic stroke, 90,190 (20.76%) discharge records had a secondary diagnosis of atrial fibrillation. The average inpatient cost for all discharge records with a primary diagnosis of ischemic stroke was (mean = $13,072, median = $9270.87) significantly (p < 0.0001) higher compared to all discharge records without ischemic stroke (mean = $12,543.07, median = $7517.13). The mean length of stay for all records was 4.55 days (95% CI = 4.53-4.56). Among those identified with ischemic stroke, adjusted mean inpatient cost was higher by $2829 (95% CI = $2708-$2949) and mean length of stay was greater by 0.85 (95% CI = 0.81-0.89) for those with atrial fibrillation compared to those without. The presence of atrial fibrillation was associated with increased inpatient cost and length of stay among patients diagnosed with ischemic stroke. Increased inpatient cost and length of stay call for a more comprehensive patient care approach including targeted interventions among adults diagnosed with ischemic stroke and atrial fibrillation, which could potentially reduce the overall cost in this population.

Is there a C-reactive protein value beyond which one should consider infection as the cause of acute heart failure?

BackgroundHeart Failure (HF) is a low grade inflammatory condition. High sensitivity C-reactive protein (hsCRP) is an established marker of inflammation. A cut-off value of hsCRP beyond which an infection should be sought has never been studied in HF. We aimed to determine the best hsCRP cut-off for infection prediction in acute HF.MethodsWe analyzed patients included in an acute HF registry – EDIFICA (Estratificação de Doentes com InsuFIciência Cardíaca Aguda). Admission hsCRP measurement was available as part of the registry’s protocol. Patients with acute coronary syndrome as the cause of acute HF were excluded from the registry. Infection was considered according to the diagnosis registered in the discharge record. A receiver-operating characteristic (ROC) curve was used to determine the best hsCRP cut-off for infection prediction.ResultsWe studied 615 patients. Mean age was 76 years, 45.2% were male, 60.3% had systolic dysfunction. Median admission hsCRP was 20.3 (9.5–55.5)mg/L; in 41.6% the cause of decompensation was an infection. The area under the ROC curve for admission hsCRP in the prediction of infection was 0.79 (0.76–0.83); the best hsCRP cut-off was 25 mg/L with a sensitivity of 72.7%, specificity 77.2%, positive predictive value 69.4% and negative predictive value 79.9%. Age and elevated hsCRP independently associated with an infection as the precipitant of acute HF.ConclusionsWe suggest 25 mg/L as a cut-off beyond which an infection should be sought underlying acute HF. Almost 80% of the patients with hsCRP< 25 mg/L are not infected and 69.4% of those with higher hsCRP have a concomitant infection.

Lack of impact of rotavirus vaccines on seizure-related hospitalizations in children under 5 years old in Spain

ABSTRACTIntroduction: Up to date the impact of rotavirus (RV) vaccines on seizures has been poorly evaluated, with some studies but not all, showing different degrees of protection.Objectives: To assess the impact of RV vaccines on convulsions-related hospitalizations among children under 5 years of age residing in the Region of Valencia, Spain.Methods: A population-based, ecological study using the hospital discharge record (MBDS), the population-based administrative database (SIP) and the vaccine register (SIV), among Valencia Region's children <5 years old, during 2003 – 2015. Impact of vaccination on seizures-related hospitalization rates (780.3* ICD-9-MC code) was estimated by a multivariate Bayesian mixed Poisson regression model.Results: Since RV vaccines licensure in 2007, its coverage rate increased up to around 42%. When the impact of vaccination against seizures was controlled for potential confounders in the multivariate analysis, there was a non-statistically significant protective effect.Conclusions: We could not find any impact of RV vaccine coverage on seizure-related hospitalizations in children <5 years.

Cardiac modulation of alpha motoneuron discharges.

Recordings of alpha motoneuron discharges from branches of the intercostal and abdominal nerves in anesthetized cats were analyzed for modulation during the cardiac cycle. Cardiac modulation was assessed by the construction of cross-correlation histograms between the R-wave of the ECG and the largest amplitude efferent spikes. In all but two recordings (which were believed to have either no or few alpha spikes), the histograms showed relatively short duration peaks and/or troughs (widths at half amplitude 4-50 ms) at lags of 10-150 ms. These observations were deduced to result from activity in oligosynaptic pathways, probably from muscle spindle afferents, whose discharges are known to be synchronized to the cardiac pulse. The results suggest that onward transmission of the cardiac signal from thoracic muscle afferents (and possibly from other dynamically sensitive afferents) to other parts of the central nervous system is highly likely and that therefore these afferents could contribute to cardiac interoception. NEW & NOTEWORTHY It has been recognized since 1933 that muscle spindles respond to the cardiac pulse, but it is unknown whether this cardiac signal is transmitted to other levels in the nervous system. Here we show that a cardiac signal, likely arising from muscle spindles, is present in the efferent activities of thoracic and abdominal muscle nerves, suggesting probable onward transmission of this signal to higher levels and therefore that muscle spindles could contribute to cardiac interoception.

Partial TrkB receptor activation suppresses cortical epileptogenesis through actions on parvalbumin interneurons

Post-traumatic epilepsy is one of the most common and difficult to treat forms of acquired epilepsy worldwide. Currently, there is no effective way to prevent post-traumatic epileptogenesis. It is known that abnormalities of interneurons, particularly parvalbumin-containing interneurons, play a critical role in epileptogenesis following traumatic brain injury. Thus, enhancing the function of existing parvalbumin interneurons might provide a logical therapeutic approach to prevention of post-traumatic epilepsy. The known positive effects of brain-derived neurotrophic factor on interneuronal growth and function through activation of its receptor tropomyosin receptor kinase B, and its decrease after traumatic brain injury, led us to hypothesize that enhancing trophic support might improve parvalbumin interneuronal function and decrease epileptogenesis. To test this hypothesis, we used the partial neocortical isolation (‘undercut’, UC) model of posttraumatic epileptogenesis in mature rats that were treated for 2 weeks, beginning on the day of injury, with LM22A-4, a newly designed partial agonist at the tropomyosin receptor kinase B. Effects of treatment were assessed with Western blots to measure pAKT/AKT; immunocytochemistry and whole cell patch clamp recordings to examine functional and structural properties of GABAergic interneurons; field potential recordings of epileptiform discharges in vitro; and video-EEG recordings of PTZ-induced seizures in vivo. Results showed that LM22A-4 treatment 1) increased pyramidal cell perisomatic immunoreactivity for VGAT, GAD65 and parvalbumin; 2) increased the density of close appositions of VGAT/gephyrin immunoreactive puncta (putative inhibitory synapses) on pyramidal cell somata; 3) increased the frequency of mIPSCs in pyramidal cells; and 4) decreased the incidence of spontaneous and evoked epileptiform discharges in vitro. 5) Treatment of rats with PTX BD4–3, another partial TrkB receptor agonist, reduced the incidence of bicuculline-induced ictal episodes in vitro and PTZ induced electrographic and behavioral ictal episodes in vivo. 6) Inactivation of TrkB receptors in undercut TrkBF616A mice with 1NMPP1 abolished both LM22A-4-induced effects on mIPSCs and on increased perisomatic VGAT-IR. Results indicate that chronic activation of the tropomyosin receptor kinase B by a partial agonist after cortical injury can enhance structural and functional measures of GABAergic inhibition and suppress posttraumatic epileptogenesis. Although the full agonist effects of brain-derived neurotrophic factor and tropomyosin receptor kinase B activation in epilepsy models have been controversial, the present results indicate that such trophic activation by a partial agonist may potentially serve as an effective therapeutic option for prophylactic treatment of posttraumatic epileptogenesis, and treatment of other neurological and psychiatric disorders whose pathogenesis involves impaired parvalbumin interneuronal function.

How do Community Hospitals respond to the healthcare needs of elderly patients? A population-based observational study in the Emilia-Romagna Region.

Intermediate Care Services have been developed to provide high-quality and sustainable care to the elderly patients with chronic diseases. Italian Community Hospitals, inspired by the British model, are an example of Intermediate Care. The aim of this study was: (1) to describe the healthcare needs met by the Community Hospitals of Emilia-Romagna, Northern Italy, by depicting the characteristics of hospitalized patients, and (2) to evaluate process and outcome indicators by conducting a comparative assessment of the quality of care. Observational retrospective cohort study. The study population included patients living in Emilia-Romagna who were discharged during 2016 from the 14 Community Hospitals of the region. Data were retrieved from the Regional Informative System of Community Hospitals database; multi-morbidity profiles were identified through the Hospital Discharge Records Database and the Outpatient Pharmaceutical Database. In-hospital variation of the 5-level Modified Barthel Index and hospital readmissions within 3 months of discharge were retrieved for each patient. The presence of recurrent patterns of multi-morbidity, i.e., clinical conditions that tend to co-occur, was investigated using unsupervised cluster analysis. The study population included 2,121 patients. Mean age was 79.5 years, mean Community Hospital stay was 22.4 days (range 13.1 - 31.5 days) and 62.5% of the patients were females. The most common sources of admission were hospital (71.8%) and home (27.0%). Routine discharges were 60.0%, planned home discharges were 13.6%, and transfers to public or private hospitals were 10.8%. We identified two multi-morbidity clusters unevenly distributed across Community Hospitals. Mean number of co-occurring chronic conditions per patient was different in the two clusters (3.0 vs. 4.7, p < 0.004). Mean Modified Barthel Index at admission and discharge was 32.2 and 47.6, respectively. Mean difference of 15.3 between values at admission and discharge was statistically significant (p < 0.001). Three-month hospital readmissions occurred for 20.2% of patients. The development of Intermediate Care Services, and in particular Community Hospitals, requires guidelines and protocols to define who among the patients can benefit more from this type of care. It is necessary to assess the quality of care provided by these facilities through appropriate and internationally comparable measures, including patient experience indicators.

Runoff variations in Lake Balkhash Basin, Central Asia, 1779–2015, inferred from tree rings

Long highly-resolved proxies for runoff are in high demand for hydrological forecasts and water management in arid Central Asia. An accurate (R2 = 0.53) reconstruction of October-September discharge of the Ili River in Kazakhstan, 1779–2015, is developed from moisture-sensitive tree rings of spruce sampled in the Tian Shan Mountains. The fivefold extension of the gauged discharge record represents the variability of runoff in the Lake Balkhash Basin for the last 235 years. The reconstruction shows a 40 year long interval of low discharge preceded a recent high peak in the first decade of the 2000s followed by a decline to more recent levels of discharge not seen since the start of the gauged record. Most reconstructed flow extremes (± 2σ) occur outside the instrumental record (1936–2015) and predate the start of large dam construction (1969). Decadal variability of the Ili discharge corresponds well with hydrological records of other Eurasian internal drainages modeled with tree rings. Spectral analysis identifies variance peaks (highest near 42 year) consistent with main hemispheric oscillations of the Eurasian climatic system. Seasonal comparison of the Ili discharge with sea-level-pressure and geopotential height data suggests periods of high flow likely result from the increased contribution of snow to runoff associated with the interaction of Arctic air circulation with the Siberian High-Pressure System and North Atlantic Oscillation.

Assessing the impacts of dams and levees on the hydrologic record of the Middle and Lower Mississippi River, USA

The impacts of dams and levees on the long-term (>130 years) discharge record was assessed along a ~1200 km segment of the Mississippi River between St. Louis, Missouri, and Vicksburg, Mississippi. To aid in our evaluation of dam impacts, we used data from the U.S. National Inventory of Dams to calculate the rate of reservoir expansion at five long-term hydrologic monitoring stations along the study segment. We divided the hydrologic record at each station into three periods: (1) a pre-rapid reservoir expansion period; (2) a rapid reservoir expansion period; and (3) a post-rapid reservoir expansion period. We then used three approaches to assess changes in the hydrologic record at each station. Indicators of hydrologic alteration (IHA) and flow duration hydrographs were used to quantify changes in flow conditions between the pre- and post-rapid reservoir expansion periods. Auto-regressive interrupted time series analysis (ARITS) was used to assess trends in maximum annual discharge, mean annual discharge, minimum annual discharge, and standard deviation of daily discharges within a given water year. A one-dimensional HEC-RAS hydraulic model was used to assess the impact of levees on flood flows. Our results revealed that minimum annual discharges and low-flow IHA parameters showed the most significant changes. Additionally, increasing trends in minimum annual discharge during the rapid reservoir expansion period were found at three out of the five hydrologic monitoring stations. These IHA and ARITS results support previous findings consistent with the observation that reservoirs generally have the greatest impacts on low-flow conditions. River segment scale hydraulic modeling revealed levees can modestly increase peak flood discharges, while basin-scale hydrologic modeling assessments by the U.S. Army Corps of Engineers showed that tributary reservoirs reduced peak discharges by a similar magnitude (2 to 30%). This finding suggests that the effects of dams and levees on peak flood discharges are in part offsetting one another along the modeled river segments and likely other substantially leveed segments of the Mississippi River.

Observed sediment and solute transport from the Kangerlussuaq sector of the Greenland Ice Sheet (2006–2016)

ABSTRACT New measurements of Watson River sediment and solute concentrations and an extended river discharge record improved by acoustic Doppler current profiler (ADCP) measurements are used to calculate the total sediment and solute transport from a large ice-sheet sector in southern west Greenland. For the 2006–2016 period, the mean annual sediment and solute transport was 17.5 ± 7.2 × 106 t and 85 ± 30 × 103 t, respectively (standard deviation given). The highest annual transport occurred in 2010, attaining values of 29.6 × 106 t and 138 × 103 t, respectively. The corresponding annual average values of specific transport are 1.39 × 103 t km−2 a−1 for sediment and 6.7 t km−2 a−1 for solutes from the approximately 12,600 km2 (95% ice covered) catchment, yielding an area-average erosion rate of 0.5 mm a−1. The specific transport is likely several times higher under the ice sheet near the margin where all meltwater passes than it is in the interior where the ice sheet is frozen to the bed. We conclude that the Greenland Ice Sheet is a large supplier of sediment and solutes to the surrounding fjords and seas. We find that the proglacial area can be a net source of sediments during high floods and we confirm that an increased amount of meltwater-transported sediments can explain the expansion of deltas around Greenland, contradictory to delta erosion observed elsewhere in the Arctic in recent years.

Diverging patterns of cardiovascular diseases across immigrant groups in Northern Italy

BackgroundOnly fragmentary data are available on the burden of non-communicable diseases among immigrants in Europe, mostly limited to mortality by cause. Aim of the study is to investigate the prevalence of cardiovascular diseases across different immigrant groups in the Veneto Region (North-Eastern Italy). MethodsThe resident population aged 20–59 was classified according to country of citizenship. The Adjusted Clinical Groups System was adopted to identify selected cardiovascular conditions by linkage of Hospital Discharge Records, Emergency Room visits, Chronic disease registry for copayment exemptions, the Home care database, and drugs reimbursed by the Regional Health Service. Age standardized prevalence rates were compared across population groups, and rate ratios (RR) with 95% confidence intervals (CI) were computed taking the Italian population as reference. ResultsThe prevalence of diabetes was higher across all immigrant groups compared to Italians. Specific risk patterns could be identified associated to different ethnicities: South Asian immigrants were at very high risk of diabetes, dyslipidemia, and ischemic heart disease (males RR 2.3, CI 1.9–2.8; females RR 2.0, CI 1.2–3.5). Immigrants from Africa were affected by high rates of hypertension, cerebrovascular diseases, and heart failure, with a more pronounced unfavorable profile among females (hypertension RR 3.0, CI 2.6–3.3; cerebrovascular diseases RR 1.7, CI 1.1–2.7). ConclusionsWide differences in the prevalence of cardiovascular diseases could be detected across immigrant groups. These findings represent a first step towards systematic chronic disease surveillance by ethnicity, a fundamental tool for shaping culturally-tailored prevention strategies.

Clinical significance of heart rate variability decrease in elderly patients with multiple organ disorders

Objective To explore the clinical significance of the heart rate viability decrease in the elderly patients with multiple organ disorders. Methods Two hundred and fifty-nine elderly patients with multiple organ disorders, with underlying diseases as coronary heart disease, hypertension, diabetes, cerebrovascular disease, chronic obstructive pulmonary disease, chronic bronchitis and malignant tumor were enrolled in this study, a retrospective analysis was made on the dynamic electrocardiogram data of the research objects.According to SDNN, 123 cases were assigned into the normal HRV group (SDNN≥100ms); 50 cases were divided into the moderately decreased HRV group (50ms≤SDNN<100ms), and 36 cases were divided into the severely decreased HRV group(SDNN<50ms). The average heart rate within 24 hours, clinical diagnosis, and discharge record of the three groups were analyzed. Results As HRV decreased, SDNN decreased gradually (normal HRV group 116 (104~131) ms, moderately decreased HRV group 85 (67.5~91) ms, severely decreased HRV group 40 (35~48) ms), the average heart rate within 24 hours gradually increased (normal HRV group 67 (60~76) times/min, moderately decreased HRV group 78(66~84) times/min, severely decreased HRV group 91( 80~112) times/min ), the differences among the three groups were statistically different (P 0.05). The rate of malignant tumor in severely decreased HRV group was 8.3%, significantly higher than that in normal HRV group (0), the difference was statistically significant (P<0.01). In severely decreased HRV group, the rates of chronic obstructive pulmonary disease (25%), chronic renal failure (30.56%), respiratory failure (25%), uremic cardiomyopathy (13.89%), hypoproteinaemia (41.67%) and anemia (41.67%) were significantly higher than those in normal HRV group (1.63%, 0.9%, 0.81%, 0, 6.5%, 8.94%) and moderately decreased HRV group (7%, 11%, 2%, 3%, 11%, 11%), the differences were statistically significant (P<0.05). In moderately decreased HRV group, the rate of chronic renal failure (11%) was higher than that in normal HRV group (0.9%), the difference was statistically significant (P<0.05). Mortality in severely decreased HRV group (41.66%) was significantly higher than that in normal HRV group (2.44%) and moderately decreased HRV group (8%), the difference among the three groups was statistically significant (P<0.05). Conclusion For elderly patients with multiple organ disorders, along with severely decreased HRV, they face the risks of severe imbalances of automatic nervous system, fast heart rate, serious illness, poor nutrition, high mortality. Key words: Elderly; Multiple Organ Disorders; Dynamic Electrocardiogram; Heart Rate Variability

Sediment Transport Time Scales and Trapping Efficiency in a Tidal River

AbstractObservations and a numerical model are used to characterize sediment transport in the tidal Hudson River. A sediment budget over 11 years including major discharge events indicates the tidal fresh region traps about 40% of the sediment input from the watershed. Sediment input scales with the river discharge cubed, while seaward transport in the tidal river scales linearly, so the tidal river accumulates sediment during the highest discharge events. Sediment pulses associated with discharge events dissipate moving seaward and lag the advection speed of the river by a factor of 1.5 to 3. Idealized model simulations with a range of discharge and settling velocity were used to evaluate the trapping efficiency, transport rate, and mean age of sediment input from the watershed. The seaward transport of suspended sediment scales linearly with discharge but lags the river velocity by a factor that is linear with settling velocity. The lag factor is 30–40 times the settling velocity (mm s−1), so transport speeds vary by orders of magnitude from clay (0.01 mm s−1) to coarse silt (1 mm s−1). Deposition along the tidal river depends strongly on settling velocity, and a simple advection‐reaction equation represents the loss due to settling on depositional shoals. The long‐term discharge record is used to represent statistically the distribution of transport times, and time scales for settling velocities of 0.1 mm s−1 and 1 mm s−1 range from several months to several years for transport through the tidal river and several years to several decades through the estuary.

Burden of Pneumonia-Associated Hospitalizations: United States, 2001-2014

The epidemiology of pneumonia has likely evolved in recent years, reflecting an aging population, changes in population immunity, and socioeconomic disparities. Using the National (Nationwide) Inpatient Sample, estimated numbers and rates of pneumonia-associated hospitalizations for 2001-2014 were calculated. A pneumonia-associated hospitalization was defined as one in which the discharge record listed a principal diagnosis of pneumonia or a secondary diagnosis of pneumonia if the principal diagnosis was respiratory failure or sepsis. There were an estimated 20,361,181 (SE, 95,601) pneumonia-associated hospitalizations in the United States during 2001-2014 (average annual age-adjusted pneumonia-associated hospitalization rate of 464.8 per 100,000 population [95%CI, 462.5-467.1]). The average annual age-adjusted pneumonia-associated hospitalization rate decreased over the study period (P < .0001). In-hospital death occurred in 7.4%(SE, 0.03) of pneumonia-associated hospitalizations. Non-Hispanic American Indian/Alaskan Natives and non-Hispanic blacks had the highest average annual age-adjusted rates of pneumonia-associated hospitalization of all race/ethnicities at 439.2 (95%CI, 415.9-462.5) and 438.6 (95%CI, 432.5-444.7) per 100,000 population, respectively. During 2001-2014, the proportion of pneumonia-associated hospitalizations colisting an immunocompromising condition increased from 18.7%(SE, 0.2) in 2001 to 29.9%(SE, 0.2) in 2014. Total charges for pneumonia-associated hospitalizations in 2014 were over $84 billion. Pneumonia is a major cause of morbidity and mortality in the United States. Differences in rates and outcomes of pneumonia-associated hospitalizations between sociodemographic groups warrant further investigation. The immunocompromised population has emerged as a group experiencing a disproportionate burden of pneumonia-associated hospitalizations.

Patterns and Outcomes of Cutaneous Adverse Drug Reactions in a Hospital Based Study

Introduction : Drug reactions are one of the common reasons for admission in the Dermatological beds. Data on the culprit drugs and patterns of reaction are very scarce in Nepal.Objective:To determine the patterns of drug reactions admitted in Tribhuwan University (TU) Teaching hospital, the causes of drug reactions, duration of hospital stay, duration of steroid use and the outcome of the treatment.Material and Methods: This was a retrospective study done in TU Teaching Hospital. The admissions and discharge record of admitted patients from 15th April 2008 to 14th April 2012 were analyzed for the variables mentioned above.Results: There were 61 new patients of drug reactions; however only files of 42 patients could be studied.The mean age of the patients was 32.26 ± 15.26 with male to female ratio of 1.8:1. Stevens Johnson’s syndrome (35.7%) was the commonest cause of admission followed by drug induced erythroderma (16.7%) and toxic epidermal necrolysis (11.9%). Carbamazepine, Phenytoin and allopurinol were the most common drugs for the reactions. The median time for the appearance of the lesions was 20.07 days. The median duration of hospital stay was 7 days. Steroids were used for initial treatment for around 4.9 ± 1.7 days. 83.3% of the patients improved while 11.9% succumbed despite optimal management.Conclusion: Severe drug reactions were the common reasons for admissions in our hospital. Anti-epileptics were the leading cause for the reactions. Steroids were used for initial period and rapidly tapered off in short duration. Overall, the outcomes of the treatment were good.

The disease burden of human cystic echinococcosis based on HDRs from 2001 to 2014 in Italy.

BackgroundCystic echinococcosis (CE) is an important neglected zoonotic parasitic infection belonging to the subgroup of seven Neglected Zoonotic Disease (NZDs) included in the World Health Organization’s official list of 18 Neglected Tropical Diseases (NTDs). CE causes serious global human health concerns and leads to significant economic losses arising from the costs of medical treatment, morbidity, life impairments and fatality rates in human cases. Moreover, CE is endemic in several Italian Regions. The aim of this study is to perform a detailed analysis of the economic burden of hospitalization and treatment costs and to estimate the Disability Adjusted Life Years (DALYs) of CE in Italy.Methods and findingsIn the period from 2001 to 2014, the direct costs of 21,050 Hospital Discharge Records (HDRs) belonging to 12,619 patients with at least one CE-related diagnosis codes were analyzed in order to quantify the economic burden of CE. CE cases average per annum are 901 (min—max = 480–1,583). Direct costs include expenses for hospitalizations, medical and surgical treatment incurred by public and private hospitals and were computed on an individual basis according to Italian Health Ministry legislation. Moreover, we estimated the DALYs for each patient. The Italian financial burden of CE is around € 53 million; the national average economic burden per annum is around € 4 million; the DALYs of the population from 2001 to 2014 are 223.35 annually and 5.26 DALYs per 105 inhabitants.ConclusionIn Italy, human CE is responsible for significant economic losses in the public health sector. In humans, costs associated with CE have been shown to have a great impact on affected individuals, their families and the community as a whole. This study could be used as a tool to prioritize and make decisions with regard to a surveillance system for this largely preventable yet neglected disease. It demonstrates the need of implementing a CE control program aimed at preventing the considerable economic and social losses it causes in high incidence areas.

Hepatitis C hospitalizations in Spain, 2004-2013: a retrospective epidemiological study

BackgroundHepatitis C is an important public health problem about which there is currently scarce epidemiological information. The objective of this study is to describe and analyse the demographic and epidemiological characteristics of hospitalized cases of hepatitis C in the Spanish population between 2004 and 2013.MethodsThe study uses the Hospital Discharge Records Database of the Spanish National Health System. It is a retrospective descriptive epidemiological study. The variables analysed were year of infection, age, sex, diagnostic category, days admitted and co-morbidity.ResultsThere have been a total of 351,996 hospitalizations; 225,138 men (64%) and 126,858 women (36%). They are divided between acute hepatitis 8161 (2.3%); chronic hepatitis 325,185 (92.4%) and unspecified hepatitis 18,650 (5.3%). The mean age for men is 53.7 (+/−15.2) and for women 62.3 (+/−17.3). 22.8% also present with an Human immunodeficiency virus (HIV) disease coinfection, and 14.7% with opioid dependencies. The trend is for a gradual increase in cases without statistical significance.ConclusionsThe Hepatitis C cases hospitalized had high levels of chronicity, which entails two distinct patterns of illness in men and women – who are affected in different age ranges.

Fluxes of particulates and nutrients during hydrologically defined seasonal periods in an ice‐affected great Arctic river, the Mackenzie

AbstractLarge circumpolar rivers influence the biogeochemistry of coastal shelf ecosystems and Arctic Ocean circulation. From 2007 to 2010, Mackenzie River nutrients were measured immediately upstream of the Mackenzie Delta. Total suspended sediment (TSS) and the dissolved and particulate fractions of carbon, nitrogen, and phosphorus were measured throughout the water year, stratified by hydrologically defined seasonal periods. Sampling was most frequent during the ice breakup and freshet periods to capture changes in sediment and nutrient concentrations that occurred with rapidly changing discharge. Our 4 year sampling coverage yielded constituent‐specific concentration‐discharge relationships that differed among seasonal hydrological periods for 6 of 12 constituents. Results revealed that having data from the rising‐water freshet, when ice effects drive much higher water levels for a given discharge than during open water, had a surprisingly modest effect on annual flux calculations for most constituents. The rising freshet, however, was dominated by high relative levels of C‐rich dissolved organic matter, P‐rich particles, and N‐rich inorganic nutrients. Comparisons with fluxes based on volume‐weighted means of sample concentrations revealed that most, though not all, river fluxes were strongly driven by short‐term concentration‐discharge dynamics rather than by total annual discharge. Comparisons with fluxes derived for the Mackenzie discharge record, where results from other years are available, suggest that concentration‐discharge relations may not be robust beyond the observation period in this system. Constituent fluxes herein differ from previously published fluxes for the Mackenzie (e.g., lower TSS, higher dissolved organic carbon), likely reflecting more frequent measurements, more representative characterization of differing hydrological periods, and possible changes in concentration‐discharge relations during the longer‐term Mackenzie record.

Association of endometrial hyperplasia and cancer with a history of gestational diabetes.

Excess circulating insulin may contribute to endometrial cancer (EC) development; studies suggest increased risk of EC associated with type 2 diabetes. We investigated whether gestational diabetes is associated with increased risk of EC and its precursor, endometrial hyperplasia (EH). We conducted a population-based, case-control study of women in Washington State. Cases were women with a hospital discharge record indicating the presence of EH/EC who could be linked to a prior delivery hospitalization or birth record from 1987 to 2013 (n=593). Controls were randomly selected from remaining deliveries, frequency matched 10:1 on delivery year and maternal age at delivery (n=5,743). Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). After adjustment for race/ethnicity, maternal age at delivery, and delivery year, EH/EC was associated with a history of gestational diabetes (OR 1.73, 95% CI 1.27-2.35). This association was present for both EH and EC (OR 1.61, 95% CI 1.00-2.60 and OR 1.80, 95% CI 1.22-2.65, respectively). After adjustment for prepregnancy body mass index, the OR for EH/EC was attenuated and became statistically non-significant (OR 1.22, 95% CI 0.87-1.72), except in women <50years old at the time of case ascertainment (OR 1.49, 95% CI 1.00-2.20). Associations were slightly stronger for EC than EH. We observed an association between EH/EC and a history of gestational diabetes specific to younger women. Future studies focusing on the relationships between gestational diabetes, obesity, and EC, including age at diagnosis, are warranted.

Monitoring Outcome of Joint Arthroplasty in Italy: Implementation of the National Registry

Purpose Arthroplasty registries have an important role in improving outcomes in joint surgery. As the demand for joint arthroplasty continues to increase, growing attention is being paid to the establishment of national registries, which contribute to the enhancement of the quality of patients' care. Indeed, providing postmarketing surveillance data in terms of safety and effectiveness of medical devices, registries contribute to the best orthopaedic practice and support public health decision making. In this context, a project aimed at implementing a national arthroplasty registry in Italy has appeared to be essential, and the activities performed in the last years have consolidated data collection of hip and knee replacements. Methods Based on a close cooperation among public health institutions, clinicians, and involved stakeholders, the architecture of the registry is built on three pillars: (1) data collected using Hospital Discharge Records (HDRs) integrated by an additional dataset, (2) implants identified and characterized in a dedicated medical devices library, and (3) a federation of regional registries coordinated by a public health institution, the Italian National Institute of Health. Results Besides the organizational structure, statistical analyses on joint arthroplasty from national HDR database (2001–2014) and Italian registry data (2014) are presented. Currently, the institutions participating in the registry on a voluntary basis show 80% of completeness for hip and 58% for knee, and represent approximately 18% of the national volume. Conclusion To make data collection effective, participation should be mandatory and ruled by a national law. Level of Study Level III, observational analytic study.

Friendship, Love, and Hip Hop. An Ethnography of African American Men in Psychiatric Custody By Katie Rose Hejtmanek. Basingstoke: Palgrave Macmillan, 2015 ISBN 978-1-137-54472-8, 267 pp, £65.00 (hb), £51.99 (eb)

Friendship, Love, and Hip Hop. An Ethnography of African American Men in Psychiatric Custody By Katie Rose Hejtmanek. Basingstoke: Palgrave Macmillan, 2015 ISBN 978-1-137-54472-8, 267 pp, £65.00 (hb), £51.99 (eb)