General Hospital Services Research Articles

Older men with bipolar disorder diagnosed in early and later life: Physical health morbidity and general hospital service use

BackgroundBipolar disorder (BD) has been associated with greater health morbidity burden, but it is unclear if this association is affected by age at the time of diagnosis and how this might impact on the use of general hospital services. MethodsCross-sectional study investigating the prevalence of common medical morbidities among participants with early (EOBD) and late onset diagnosis of BD (LOBD – age at diagnosis ≥ 60 years) derived from a community-representative sample of 37,183 men aged 65–85 years. Cohort study over a follow up period of up to 17.7 years investigating the hazard of general hospital use among older men associated with EOBD and LOBD taking into account age and prevalent medical morbidities. Results250 older men had a recorded diagnosis of BD, 75 of whom had LOBD. Diabetes, stroke and diseases of the respiratory and digestive systems were more frequent in men with than without BD. There were no differences in the distribution of medical morbidities between men with EOBD and LOBD. The adjusted hazard ratio (HR) of contact with general hospital services was significantly higher among men with EOBD (HR = 1.33; 95%CI = 1.14, 1.54) and LOBD (HR = 1.27, 95%CI = 1.06, 1.51) compared with older men without BD. Older men with EOBD had the highest number of contacts with general hospital services during follow up, although men with EOBD and LOBD did not differ in the number of contacts due to episodes of mania or depression. The medical reasons for contact with general hospital services of men with EOBD and LOBD overlapped but were not identical. ConclusionsOlder men with BD experience greater health morbidity than men without BD. Older men with BD access hospital services for the management of physical morbidities earlier and more frequently than men without BD. Age at the time of diagnosis of BD has limited impact on the risk of contact with general medical services, although subtle differences in the physical morbidity of men with EOBD and LOBD warrant further investigation.

Organisation and delivery of liaison psychiatry services in general hospitals in England: results of a national survey

ObjectivesTo describe the current provision of hospital-based liaison psychiatry services in England, and to determine different models of liaison service that are currently operating in England.DesignCross-sectional observational study comprising an...

Current situation of Chagas seology in a General Hospital Service Area of Buenos Aires City

Current situation of Chagas seology in a General Hospital Service Area of Buenos Aires City

Medically unexplained syndromes: irritable bowel syndrome, fibromyalgia and chronic fatigue

SUMMARYThis is a review of three of the more common medically unexplained syndromes that present for treatment to liaison psychiatry services in general medical hospitals: chronic fatigue syndrome, fibromyalgia and irritable bowel syndrome. The three are interrelated, extremely disabling and comorbid mood disorders are frequent. In general, treatment, whether psychological or medical, has very modest impact. The disputed classification of medically unexplained syndromes is also reviewed. There is a clear gulf between the views and experiences of patients with these syndromes and the medical establishment. In this article I summarise give the evidence for pharmacological, psychosocial and ‘alternative’ or ‘complementary’ interventions for a range of disorders, about which there is some dispute. I leave it to the reader to decide which interventions hold the most promise.LEARNING OBJECTIVES•To become aware of the high prevalence of medically unexplained syndromes•To review the effectiveness of treatment of medically unexplained syndromes•To be familiar with the conflict between health professionals and patients and the difficulty this continues to createDECLARATION OF INTERESTNone.

Psychiatric and Psychosomatic Consultation-Liaison Services in General Hospitals: Systematic Review and Meta-Analysis of Effects on Depression and Anxiety

Psychiatric and Psychosomatic Consultation-Liaison Services in General Hospitals: Systematic Review and Meta-Analysis of Effects on Depression and Anxiety

F109. BOUNDARIES BETWEEN DEFICIT AND NONDEFICIT SCHIZOPHRENIA: LONG TERM STABILITY AND OUTCOMES

BackgroundNegative symptoms of schizophrenia are admittedly associated with a poorer outcome regarding aspects such as functionality, quality of life and cognitive performance. Patients with prominent, persistent and primary negative symptoms have been considered to manifest a putative subtype called “Deficit schizophrenia” (DS). However, the boundaries of deficit and nondeficit forms were put in question since the publication of a study that considered separately a group of patients with persistent negative symptoms whose primary nature could not be asserted, the “ambiguous nondeficit” group, who would be otherwise categorized as nondefict according to the gold standard instrument: the Schedule for the Assessment of the Deficit Syndrome (SDS). Those patients presented psychopathological features, quality of life, insight and cognitive function quite different from the nondeficit group, and closer to the deficit group. The objectives of the present study are to investigate the stability of the categorization regarding the presence of DS in three groups: “deficit”(DS), “nondeficit” (ND) and “ambiguous nondeficit” (SND) over a long term follow-up and to evaluate clinical outcomes in the different groups.MethodsWe will contact 85 patients with schizophrenia, considered clinically stable in the previous year, who participated in a study about the DS in 2009/2010. Back then, they were recruited in two sites: an outpatient service of a university general hospital (49 patients) and a community-based mental health service (36 patients). Patients will be assessed with the same instruments adopted in the first study: a questionnaire for clinical and demographic information; BPRS, SAPS, SANS, Calgary Depression Scale, the SDS, QLS, and a battery of neurocognitive tests. We started the recruitment by the patients originally treated in the outpatient clinic.ResultsHere we present partial results. Of the 49 patients, 5 refused to participate in the follow-up study, 3 died prematurely, and 1 had the diagnostic changed for bipolar disorder. Assessment interval was 6.9 years ± 0.5 Among the 20 reassessed patients, mean age at baseline was 36.9 ± 8.9 years, mean duration of mental illness was 16 ± 10.1 years, and 75% were men. They had in mean, 10.7 ± 3.3 years of education, only 20% had any work activity, 15% were married and 55% had a low socioeconomic position. These demographic aspects slightly worsened: only 15% had an occupation at follow-up, and 60% fell in the lower socioeconomic position. Regarding the SDS classification, 4 of 9 ND patients at the baseline were reclassified as DS; 1 of 7 DS was reclassified as ND, the other 6 remained DS; from the AND, 3 were considered DS and 1 ND, from a total of 4. At the end, there were 13 DS and 7 ND, while at the baseline they were: 7 DS, 9 ND and 4 AND. Concerning psychopathology, 80% of the patients had an increase in SANS and the most expressive increase was in nondeficit group (an average of 5.4 points), although the average in DS group remained the higher (18.9 points). Still, SAPS and Calgary remained low in all three subgroups, with a mean of 6.20 and 2.20 points, respectively. As to medication, 70% of the baseline were in use of Clozapine (67% of ND, 57% of DS and 100% of the AND group) and that total number remained the same during the follow up.DiscussionOur preliminary results are derived from a small sample. Although we cannot draw definite conclusion, these outcomes suggest trends that are worth observing: the worsening of negative symptoms among patients and the tendency of conversion to DS group, especially among the “ambiguous” group. This advocates against the dichotomous division of deficit and nondeficit schizophrenia and speaks in favor of a dimensional understanding of negative symptoms.

T81. LONG-TERM COURSE OF COGNITIVE PERFORMANCE IN PATIENTS WITH CHRONIC SCHIZOPHRENIA

BackgroundCognitive deficits are prevalent among patients with schizophrenia and are robustly associated with functioning and outcome. Although cognitive deficits are known to be present at the prodromal phase and to worsen at the onset of the disease, the long-term course of cognitive impairments are less well established. Many studies have focused on first episode psychosis with relatively short lengths of follow-up. Thus, the aim of this study is to investigate changes in cognitive performance of chronic schizophrenia patients in a variety of neurocognitive tests over a seven-year test-retest period.MethodsWe will contact 85 patients with schizophrenia (as defined by the DSM-IV-TR), considered clinically stable in the previous year, who participated in a study about the deficit syndrome of schizophrenia carried out in 2009 and 2010. Back then, they were recruited in two sites: an outpatient psychiatric service of a university general hospital (49 patients) and a community-based mental health service for patients with severe mental illness (36 patients), both in Campinas, Sao Paulo, Brazil. Patients will be assessed with the same instruments adopted in the first study: a questionnaire for clinical and demographic information; SAPS, SANS, Calgary Depression Scale and a battery of neurocognitive tests comprising: Digit Span Forward (DSF), Digit Span Backward (DSB), Rey Complex Figure Copy (RCFC), Rey Complex Figure Memory (RCFM), Digit symbol-coding (DSC), Picture Completion (PC), Matrix Reasoning (MR), Vocabulary (V), Trail Test A (TTA), Trail Test B (TTB), Phonological Fluency (PF) and Semantic Fluency (SF). To test differences in neurocognitive performance, and in symptoms severity at base and at follow-up we used the Wilcoxon Test.ResultsWe present in this poster partial results. Among the 20 reassessed patients the mean age at baseline was 36.9 ± 8.9 years, mean duration of mental illness was 16 ± 10.1 years, 75% were men. They had, in mean, 10.7 ± 3.3 years of education, only 20% had any work activity, and 15% were married. Mean length of test-retest interval was 6.9 years (minimum 6 and maximum 7.7). At follow-up, 4 patients had improved their education, but only 3 (15%) had any work activity. Up to now 19 patients completed the cognitive reassessment. Severity of positive and of depressive symptoms was low at base line (mean score on SAPS 5.5 ± 4.8; mean score on Calgary 1.5 ± 1.9) and remained low at follow-up (SAPS 6.2 ± 4.4, Calgary 2.2 ± 2.2), with no significant change. Patients, as a group, had moderate negative symptoms were at baseline (mean SANS score 10.5 ± 6.9) and had their negative symptoms worsened at follow-up (SANS 14.8 ± 7.1), p=0.005. Patients had a worse performance at follow-up in 4 out of 12 tests: DSF (3.8 ± 1.5 at follow-up versus 10.1 ± 2.8 at baseline, p < 0.000), DSB (3.4 ± 1.9 at follow-up versus 4.3 ± 2.2, p=0.005), RCFC (14.8 ± 9.4 versus 30.2 ± 8.6, p < 0.000) and RCFM (5.9 ± 6.5 versus 13.9 ± 9.8, p < 0.000). In the remaining 8 tests: DSC, PC, MR, V, TTA, TTB, PF and SF, there were no significant differences in performance between baseline and follow-up assessments.DiscussionOur preliminary results are derived from a small sample. Although we cannot draw definite conclusions, we identified different patterns of longitudinal course for different cognitive domains with attention, shot-term memory, working memory, visual-spatial ability and executive functions presenting a decline over time; whereas other domains, such as visual memory, visual perception, learning memory, verbal comprehension, motor function, remaining stable in patient through patients’ 4th and 5th decades of life.

S251. QUALITY OF LIFE OF CHRONIC SCHIZOPHRENIA PATIENTS IN THE LONG TERM FOLLOW-UP

BackgroundIn recent years the goal of the treatment of patients with schizophrenia has shifted from symptom remission to the improvement in health as a whole. In this context, concepts such as quality of life (QoL), social and occupational functioning gained interest. The aim of this study is to investigate changes in QoL of chronic schizophrenia patients in the long-term follow-up and their associations with symptoms and level of community functioning.MethodsWe will contact 85 patients with schizophrenia, considered clinically stable in the previous year, who participated in a study about the deficit syndrome of schizophrenia in 2009/2010. Back then, they were recruited in two sites: an outpatient service of a university general hospital (49 patients) and a community-based service (36 patients). Patients will be assessed with the same instruments adopted in the first study: SAPS, SANS, Calgary Depression Scale and Quality of Life Scale (QLS), plus the Personal and Social Performance Scale (PSP), not used at baseline. We started recruitment by the patients originally treated in the outpatient clinic.ResultsUntil now, of the 49 patients, 2 dropped out treatment, 8 had been transferred to other services, 5 refused to participate, 1 had the diagnostic changed to bipolar disorder and 3 had died precociously. Of the deaths, 1 was due to complications secondary to the use of clozapine, 1 due to suicide and 1 patient was murdered by another patient during a psychiatric hospitalization. Up to now, 20 patients completed reassessment, mean age at baseline was 36.9 ± 8.9 years, mean duration of mental illness was 16 ± 10.1 years, and 75% were men. They had in mean, 10.7 ± 3.3 years of education, only 4 had any work activity and 55% had a low socioeconomic position. Assessment interval was 6.9 years ± 0.5. Some demographic aspects slightly worsened: only 15% had an occupation at follow-up, and 60% fell in the lower socioeconomic position. Between assessments, 8 (40%) patients have had periods of noncompliance to medication, 5 had psychiatric hospitalizations, three of them involuntarily. At follow-up 70% of the patients were using clozapine and, despite that, some presented residual positive symptoms (SAPS 6.2 ± 4.8); Calgary mean score was low (2.2 ± 2.2) and, except for the patient who died, there was no new suicide attempts between assessments. Negative symptoms severity was moderate in general (mean SANS 14.8 ± 7.2). Patients as a group had no significant change in QLS scores (61.5 ± 28.2 versus 60.1 ± 28.2 at follow-up). However, 15% of patients had an improvement greater than 20% in their QLS scores, and 30% had a worsening of their scores greater than 20%. Baseline scores on SANS (p=0.005), SAPS (p=0.03) and number of hospitalizations (p=0.03) were negatively correlated with follow-up QLS scores; and years of schooling at baseline was positively correlated (p=0.2). Baseline QLS scores were strongly associated with current QLS scores, as well as with PSP scores (both with P <0.000) at follow-up. Regarding PSP outcomes, 50% of patients were classified in the 70-31 interval (disabilities of various degrees) and 25% were under 30, requiring intensive support.DiscussionThe results presented are partial, obtained with a provisional small sample size. Nevertheless, they show some interesting trends as the possible existence of two patterns of outcome regarding QoL in chronic schizophrenia patients: of significant improvement and one of worsening. If those initial findings are to be confirmed, our next step will be to investigate characteristics associated to improvement or deterioration of QoL in spite of a relative stability of symptoms. That sort of information is of great relevance in the pursuit of recovery for schizophrenia patients.

Appendagitis: a non-surgical cause of acute abdominal pain. Case report

Background: Epiploic appendices are pediculated, serosa-coated fat formations that are found on the outer surface of the colon, into the peritoneal cavity; their inflammation, torsion or infarction is also known as epiploic appendicitis or appendagitis. Clinical case: We present the case of a 35-year-old man who went to the Emergency Service of the High Specialty Naval General Hospital because of sudden onset, progressive right iliac fossa pain, which was approached with laboratory and cabinet studies, integrating the diagnosis of probable acute appendicitis; surgical application sheets and informed consent were fi lled to perform open appendectomy, incidentally fi nding a cecal appendix 5 cm × 1 cm in diameter, with normal macroscopic characteristics, and infarction of ascending colon epiploic appendix at the ileocecal valve. Conclusion: This case is presented to highlight the clinical characteristics of appendagitis or epiploic appendicitis, which can help clinicians suspect this benign pathology and reach the correct diagnosis, avoiding unnecessary surgical risk.

Consumption of psychoactive substances in hospitalized patients in the pneumology service of a third-level general hospital

ABSTRACTAntecedents: Unhealthy lifestyles may often be linked to the consumption of both legal and illegal substances such as tobacco and alcohol. Notorious examples include several types of cancer, cardiopulmonary diseases, chronic obstructive pulmonary disease, and liver cirrhosis.Patients and methods: Exploratory study of 109 patients hospitalized for pneumologic ailments and substance abuse, lifestyle, and adherence to previous treatment. Demographic data, lifestyle, adherence to treatment, and addictive consumption of legal and illegal substances were assessed.Results and conclusions: The studied group showed in general an unhealthy lifestyle (71.7%). The incidence of substance use was 13.5%, higher than the Mexican national average of 1.8% in 2011. The most consumed elements were alcohol and tobacco.

Psychopathology of adolescents with an intellectual disability who present to general hospital services.

Adolescents with intellectual disability have increased rates of psychopathology compared with their typically developing peers and present to hospital more frequently for ambulant conditions. The aim of this study is to describe the psychopathology and related characteristics of a sample of adolescents with intellectual disability who presented to general hospital services. We investigated a cohort of adolescents with intellectual disability in South East Queensland, Australia between January 2006 and June 2010. Demographic and clinical data were obtained via mailed questionnaires and from general practice notes. Psychopathology was measured with the Short Form of the Developmental Behaviour Checklist. Of 98 individuals presenting to hospital, 71 (72.5%) had significant levels of psychopathology. Unknown aetiology for the intellectual disability was associated with presence of problem behaviours. Adolescents with more severe intellectual disability were more likely to have major problem behaviours. Co-morbid physical health issues were not associated with psychopathology. Only 12 (12.1%) adolescents had undergone specialized mental health intervention. The general hospital environment may offer opportunities for liaison psychiatry services to screen and provide management expertise for adolescent individuals with intellectual disability presenting for physical health issues.

Socio-demographic characteristics, clinical profile and prevalence of existing mental illness among suicide attempters attending emergency services at two hospitals in Hawassa city, South Ethiopia: a cross-sectional study

BackgroundSuicide is a major public health problem worldwide. It contributes for more than one million deaths each year. Since previous suicidal attempt was considered as the best predictor of future suicide, identifying factors behind suicidal attempt are helpful to design suicide prevention strategies. The aim of this study was to assess socio-demographic characteristics, clinical profile and prevalence of existing mental illness among patients presenting with suicidal attempt to emergency services of general hospitals in South Ethiopia.MethodsWe conducted a cross-sectional study on patients presenting with complications of suicidal attempt to emergency departments of two general hospitals in Hawassa city from November, 2014 to August, 2015. Data was collected using semi-structured questionnaire which contained socio-demographic and clinical variables. The Mini International Neuropsychiatric Interview version 5 (MINI PLUs) was used to assess the prevalence of existing mental illness among study participants. Data was entered and analyzed using IBM SPSS statistics 21 software package.ResultsA total of 96 individuals were assessed, of whom 56 (58.3%) were females. The mean age of study participants was 21.5 (8.0) years. The majority, 75 (78.1%), of the study participants were aged below 25 years. Ingesting pesticide poisons and corrosive agent were used by the majority to attempt suicide. Mental illness was found in only three (3.1%) of the study participants. Impulsivity (the time between decision to attempt suicide and the actual attempt of less than 5 min) was reported by 30 (31.2%) of the study participants, of whom 18 (60%) were males. Males were found three times more likely to attempt suicide impulsively than women (COR = 3.0, 95% CI 1.2–7.3). Quarreling with family members, facing financial crisis, and having unplanned and unwanted pregnancy were reported by the majority of study participants as immediate reasons to attempt suicide.ConclusionsThe presence of stressful life events and impulsivity behind suicidal behavior of the younger generation implies that designing suicide prevention strategies for this group is crucial. Moreover, further research is needed to systematically examine the relationship between the presence of mental illness and suicidal attempt with a larger sample size and more robust methodology.

Ambientation/acculturation of a psychologist as “methodological internship” for developing qualitative research to study clinical supervisions at a psychiatric outpatient service of Brazilian general hospital

Qualitative research in a psychiatric setting requires methodological updates on its modus operandi for professionals who migrated paradigmatically from other academic areas. The mere adoption of the concept of acculturation, from anthropology to field of health services, may not correspond to specificities of assistance and research in this field.ObjectiveTo discuss results of a certain environment and acculturation strategy for development of humanistic research that took place in a psychiatric outpatient service of a university hospital.MethodObservation of environment of psychiatric supervision for qualitative method in health setting, in period of six months. The first author, doctoral student, psychologist, systematically attended discussions of clinical cases, observing relationship between supervisors and residents. Data were recorded in field diary, followed by free-floating readings and critical analyses. These were also submitted to peer reviewers of the LPCQ-laboratory of clinical-qualitative research.Results– The experience, similar to an “internship”, has been confirmed as necessary to conduct qualitative research in this field;– It allowed accurate apprehension of features of environmental functioning and, above all, cultural dimensions of language of participants;– This proved pertinent for clearing the theme-problem to be researched;– Postgraduate researchers, in particular those graduates under other paradigms, have strengthened their methodological knowledge on this field, and have been inserted epistemologically for which they will have built new knowledge;– Finally, this methodological stage improved the so-called active observation and phenomenological listening of the researchers regarding those observed.ConclusionsThe experience contributed significantly to establishing and validating the qualitative methodological course.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Present situation and development direction of home healthcare

With the population ageing, increasing health needs and demands, changing family structure and the transformation of general hospital service model, home care as an important part of primary care, has been brought more and more attention. Home healthcare would relieve the pressure caused by increasing needs of elderly care and transformation of hospital functions, so it should have greater development in the future. This article reviews the present situation and the future development direction of home healthcare in China. Key words: Home nursing; Home-based care for the aged

Greater healthcare utilization and costs among Black persons compared to White persons with aphasia in the North Carolina stroke belt

PurposeTo examine racial differences in healthcare utilization and costs for persons with aphasia (PWA) being treated in acute care hospitals in North Carolina (NC). MethodsNC Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) data from 2011–2012 were analyzed to examine healthcare utilization and costs of care for stroke patients with aphasia. Analyses emphasized length of stay, charges and cost of general hospital services. Generalized linear models (GLM) were constructed to determine the impact of demographic characteristics, stroke/illness severity, and observed hospital characteristics on utilization and costs. Hospital fixed effects were included to yield within-hospital estimates of disparities. ResultsGLM models demonstrated that Blacks with aphasia experienced 1.9days longer lengths of stay compared to Whites with aphasia after controlling for demographic characteristics, 1.4days controlling for stroke/illness severity, 1.2days controlling for observed hospital characteristics, and ~1 extra day controlling for unobserved hospital characteristics. Similarly, Blacks accrued ~$2047 greater total costs compared to Whites after controlling for demographic characteristics, $1659 controlling for stroke/illness severity, $1338 controlling for observed hospital characteristics, and ~$1311 greater total costs after controlling for unobserved hospital characteristics. ConclusionsIn the acute hospital setting, Blacks with aphasia utilize greater hospital services during longer hospitalizations and at substantially higher costs in the state of NC. A substantial portion of the adjusted difference was related to the hospital treating the patient. However, even after controlling for the hospital, the differences remained clinically and statistically significant.

Associations between intimate partner violence, depression, and suicidal behavior among women attending antenatal and general outpatients hospital services in Thailand

Battered women are exposed to multiple types and different severity of intimate partner abuse, however, little is known about the relationship between severity and different types of intimate partner violence (IPV) (physical, sexual, psychological, and danger) and symptoms of depression and suicidal behavior in a sample of women attending antenatal care or general outpatient hospital services in Thailand. A cross-sectional study was conducted among adult women who were consecutively sampled and screened for IPV in antenatal care and general outpatient clinics in nine randomly selected hospitals in two provinces in the central region. The measures included the "Severity of Violence Against Women Scale," "Edinburgh Postnatal Depression Scale 10," "Danger Assessment Scale," and one item for suicidal behavior. Hierarchical regressions were used to assess the effects of the different types of IPV on depression and suicidal behavior. Of the final sample (N = 207) that screened positive for IPV, 49.3% scored positive for depression, and 17.6% reported suicidal threats or attempts in the past 12 months. One type of IPV (sexual) was significantly associated with depression, whereas psychological abuse and femicide risk or danger was correlated with suicidal behavior. A high proportion of women with IPV suffered from depression and suicidal behavior. The study provides evidence of an association between the severity of IPV and mental health problems (depression and suicidal behavior). In assessing IPV, the different identified dimensions contributing to poor mental health should be incorporated.

Hyperuricemia in Patients with Chronic Renal Failure in the General Hospital of National Reference of N’Djamena (Chad)

Introduction: Hyperuricemia is defined as a level of serum uric acid greater than or equal to 70 mg/l (420 μmol/l) in men and 60 mg/l (360 μmol/l) in women. Several studies have shown that it is a risk factor or a factor of progression of chronic kidney disease. Recent experimental and epidemiological data correlate the association of hyperuricemia with chronic kidney disease (CKD), arterial hypertension and cardiovascular diseases, thus raising the question of the usefulness of therapeutics in the prevention of renal diseases. The objective of this study is to seek a link between chronic kidney disease and hyperuricemia. Materials and Methods: This is a descriptive and analytical study conducted at hemodialysis unit and cardiology service of General Hospital of National reference of N’Djamena (Chad) from 1th January to 1th October 2013 (10 months). We included all chronic kidney disease patients hospitalized in hemodialysis unit and cardiology service who presented associated hyperuricemia. Results: There were 712 CKD patients who were hospitalized. Among them, there were 108 patients who were included in the study and who had hyperuricemia as a prevalence of 15.20%. The average age of patients was 35.5 years and the sex ratio was 3/1. The age group between 40 to 60 years represented 54.6%. There were 41.7% of traders. Hypertensive patients accounted for 49.1%; association of diabetes and hypertension was noted in 12.90%. Renal insufficiency was moderate in 43.5% of patients. Hyperuricemia was present in more than 90% of patients. Profession, age, hematuria, proteinuria and hypertension were statistically positively related to hyperuricemia. Treatment consisted of prescribing allopurinol in 84% of patients. In more than 11% of patients the progression was unfavorable. Conclusion: The implication of hyperuricemia in chronic kidney disease has been proved in several recent studies. However, randomized studies at very long scales have to be carried out to conclude from its real impact on the prevention and treatment of chronic kidney disease.

Discharging older patients.

Significant numbers of older people with dementia use general hospital services, and ensuring the safe and appropriate discharge home of patients with poor cognition, impaired judgement, misperception or reduced risk awareness is complex and challenging for many healthcare professionals.

Facilitating the discharge of patients with dementia.

Significant numbers of older people with dementia use general hospital services, and facilitating the safe discharge of patients with poor cognition, impaired judgement, misperception or reduced risk awareness is challenging for many healthcare professionals.

Elderly Koreans who consider suicide: Role of healthcare use and financial status

This study investigated associations between the use of healthcare services and financial status and suicidal ideation (SI) in the past year among elderly people. Additionally, this study explored gender differences in such associations. Cross-sectional data of 1743 elderly people aged 65 years and above, who participated in the 2009 Korea National Health and Nutrition Examination Survey, were analyzed. The results showed that lack of preventive care and failure to obtain necessary healthcare services during the last 12 months had a significant effect on SI, especially among elderly women. Low financial status (i.e., receipt of National Basic Livelihood Security (NBLS) assistance) was significantly associated with SI among elderly men. The findings of this study emphasize the need for community-based suicide intervention services, especially for elderly men who receive NBLS and elderly women who do not undergo medical checkups and fail to obtain necessary medical services. Multiple intervention approaches, including the provision of community-based geriatric psychiatric services, improved social support, links with general hospital services, and local monitoring programs, are likely to be useful.