Greater Number Of Admissions Research Articles

Impact of Cannabis Use, Substance Use Disorders, and Psychiatric Diagnoses on COVID-19 Outcomes: A Retrospective Cohort Study.

Objective: While psychiatric disorders have been recognized as a risk factor for COVID-19 outcomes, the impact of substance use disorders (SUD) on COVID-19 outcomes has not, to date, been examined in a systematic manner. We examined the association between SUD (cannabis, cocaine, alcohol, opioid, and benzodiazepine) as well as psychiatric diagnoses (schizophrenia, mood disorders, anxiety disorders) and COVID-19 outcomes in a large, retrospective cohort study. Methods: COVID-19–positive patients admitted to a large health care system in the US between January and December 2020 were included in this study. SUD and psychiatric diagnoses were identified from urine toxicology reports and ICD-10 diagnosis codes in the electronic medical record, respectively. Multivariable logistic regression was performed controlling for potential confounders such as age, race, sex, smoking status, and medical comorbidities. COVID-19–relevant outcomes included mortality, need for intensive care unit (ICU) admission, need for ventilatory support, length of hospitalization, and number of hospitalizations. Results: Among COVID-19 patients (N = 6,291), those with SUD were more likely to require ICU admission (adjusted odds ratio = 1.46, P = .003) and ventilatory support (AOR = 1.49, P = .01). The association between SUD and ICU admission was driven by alcohol use disorder (AUD), whereas that between SUD and ventilatory support was driven by both AUD and opioid use disorder (OUD). Patients with SUD were more likely to have a longer mean maximum length of hospitalization (11.32 vs 8.62 days, P < .0001) and a greater mean number of hospital admissions in 2020 (2.96 vs 2.33, P < .0001). These associations were significant for cannabis use disorder, AUD, OUD, and benzodiazepine use disorder. The association with greater number of admissions was also significant for cocaine use disorder. Patients with psychiatric diagnoses were also more likely to have a greater maximum length of hospitalization (11.93 vs 8.39 days, P < .0001) and hospital admissions (2.72 vs 2.31, P < .0001). These associations were significant for schizophrenia, mood disorders, and anxiety disorders. Conclusions: COVID-19 patients with SUD had greater likelihood of requiring critical interventions, such as ICU admission and ventilatory support. SUD and psychiatric diagnoses were also associated with a longer duration of hospitalization and greater number of hospital admissions. These findings identify COVID-19 patients with SUD and psychiatric comorbidities as a high-risk group.

Differences in Clinical Outcomes of Adults Referred to a Homeless Transitional Care Program Based on Multimorbid Health Profiles: A Latent Class Analysis.

Background: People experiencing homelessness face significant medical and psychiatric illness, yet few studies have characterized the effects of multimorbidity within this population. This study aimed to (a) delineate unique groups of individuals based on medical, psychiatric, and substance use disorder profiles, and (b) compare clinical outcomes across groups.Methods: We extracted administrative data from a health system electronic health record for adults referred to the Durham Homeless Care Transitions program from July 2016 to June 2020. We used latent class analysis to estimate classes in this cohort based on clinically important medical, psychiatric and substance use disorder diagnoses and compared health care utilization, overdose, and mortality at 12 months after referral.Results: We included 497 patients in the study and found 5 distinct groups: “low morbidity” (referent), “high comorbidity,” “high tri-morbidity,” “high alcohol use,” and “high medical illness.” All groups had greater number of admissions, longer mean duration of admissions, and more ED visits in the 12 months after referral compared to the “low morbidity” group. The “high medical illness” group had greater mortality 12 months after referral compared to the “low morbidity” group (OR, 2.53, 1.03–6.16; 95% CI, 1.03–6.16; p = 0.04). The “high comorbidity” group (OR, 5.23; 95% CI, 1.57–17.39; p < 0.007) and “high tri-morbidity” group (OR, 4.20; 95% CI, 1.26–14.01; p < 0.02) had greater 12-month drug overdose risk after referral compared to the referent group.Conclusions: These data suggest that distinct groups of people experiencing homelessness are affected differently by comorbidities, thus health care programs for this population should address their risk factors accordingly.

Analysis of health administration data to inform health service planning for paediatric palliative care

BackgroundHealth service planning in paediatric palliative care is complex, with the diverse geographical and demographic characteristics adding to the challenge of developing services across different nations. Accurate and reliable data...

A retrospective analysis of hospitalisation for diseases of the pulp and periapical tissues in NHS Grampian 2011-2015: geographic, socioeconomic and increased primary care availability effects.

Objectives A study of hospital admissions for diseases of pulp and periapical tissues in NHS Grampian and the effects of socioeconomic, geographic location and primary dental care availability on hospital admissions.Design Retrospective analysis of hospitalisation data from NHS Grampian Health Intelligence database for the five-year period (1 January 2011 to 31 December 2015), if their primary diagnosis was disease of the pulp or periapical tissues. The influence of the Scottish Index of Multiple Deprivation (SIMD) scores on hospital admissions for pulp or periapical diseases were assessed and compared. Data from general dental practitioners (GDPs) providing primary care were obtained from the National Services Scotland practitioner services board.Results There were 963 admissions to NHS Grampian hospitals over the five-year period. The most frequent hospitalisation admission code was K047 'periapical abscess without sinus', accounting for 59.3% of all admissions. Hospital admissions decreased from 185 in 2011 to 122 in 2015, and coincided with a 50% rise in the number of GDPs providing primary care dentistry within the region (171 in 2011 to 256 in 2015). SIMD 5 (least deprived) had the greatest number of admissions (68) in 2011 compared with the most deprived (11). In 2015, SIMD 4 had the most admissions (41) compared to SIMD 1 (12).Conclusion A reduction in hospital admissions for pulp/periapical abscesses appears to coincide with an increase in GDPs providing primary care dental services. Barriers to providing dental treatment in primary care should be minimised to reduce the burden of care on NHS hospitals for preventable dental diseases such as periapical abscesses.

Administrative Prävalenz und Versorgungssituation der Demenz im Krankenhaus – Eine versorgungsepidemiologische Studie basierend auf GKV-Daten sächsischer Versicherter

The increasing number of people with dementia will challenge the health care system, especially acute care. Using health insurance claims data, the study objective was to examine the regional patterns of the administrative prevalence of dementia, the prevalence of dementia in hospitals and the care situation in hospitals. We used 2014 claims data from AOK PLUS, the largest statutory health insurance service in Saxony. If dementia was diagnosed either in an outpatient or inpatient setting in 3 of 4 quarters in a year, a person was categorised as a dementia case (n=61,700). The analysis of health care status included 61,239 patients with dementia and 183,477 control subjects. The control group was matched using the criteria of gender, age and region of residence. For those older than 65 years, the overall administrative prevalence rate of dementia was 9.3%. The estimated prevalence for those in hospitals was 16.7%. In 2014, there were 33% more admissions, 36% more hospital days and 18% higher costs per person-year among people diagnosed with dementia than the control subjects. The longer annual hospital stays and the higher costs were primarily caused by the greater number of admissions of people with dementia. Inpatient service use was, compared to people without dementia, characterized by a need for care and assistance, rather than by a need for medical therapeutic and diagnostic procedures. To improve the health care situation of people with dementia, to adapt to the challenges facing hospitals and to reduce the financial burden caused by dementia, more efforts are needed to improve the health care situation. Measures include, among others, improvements in recognition of dementia and reduction of unnecessary hospital stays.

Is paliperidone palmitate more effective than other long-acting injectable antipsychotics?

Paliperidone palmitate is one of the most widely prescribed long-acting injectable (LAI) antipsychotics in the UK. However, it is relatively expensive and there are few data comparing its effectiveness to that of other LAI antipsychotics. We sought to address this issue by analyzing a large anonymized electronic health record (EHR) dataset from patients treated with LAI antipsychotics. EHR data were obtained from 1281 patients in the South London and Maudsley NHS Foundation Trust (SLaM) who started treatment with a LAI antipsychotic between 1 April 2011 and 31 January 2015. The number of days spent as a psychiatric inpatient and the number of admissions to a psychiatric hospital were analyzed in each of the 3 years before and after LAI prescription. Patients treated with paliperidone palmitate (n = 430; 33.6%) had a greater number of inpatient days and a greater number of admissions in the year prior to treatment than those treated with other LAI antipsychotics. Nevertheless, in the 3 years after initiation there were no significant differences between paliperidone and the other LAI antipsychotics in the number of days as an inpatient (B coefficient 5.4 days, 95% confidence interval (CI) -57.3 to 68.2, p = 0.86) or number of hospital admissions (Incidence rate ratio 1.07, 95% CI 0.62 to 1.83, p = 0.82). Paliperidone palmitate was more likely to be prescribed in patients with more frequent and lengthy hospital admissions prior to initiation. However, the absence of differences in outcomes after initiation indicates that paliperidone palmitate was not more effective than other cheaper LAI antipsychotics.

Perfil de idosos admitidos em serviço de fisioterapia frente à sazonalidade

*** Profile of elderly admitted to a physical therapy center as a function of seasonality ***AIMS: To analyze the profile and the prevalence of diseases in elderly patients admitted to a physical therapy center in a medium-sized Brazilian city located in a subtropical zone in two different seasons of the year.METHODS: A cross-sectional study assessed the medical records of patients treated during summer and winter months in 2011. Medical records of male and female elderly patients (aged over 60 years) were included, and those without information on present medical diagnosis were excluded. Age and sex and both current and previous diagnostic records were analyzed. The chi-square test was used for the comparative analysis of the profile of the elderly patients for both seasons.RESULTS: Seventy-one medical records were analyzed. The mean age was 69.2±8.1 years and 48 (70.4%) patients were female. There was a higher prevalence of trauma-orthopedic diseases (60.6%). The greatest number of admissions was in winter (62.0%). At the time of referral, there were 17 cases (63.0%) of trauma-orthopaedic diseases in summer and 26 (59.1%) in winter; 3 cases (11.1%) of rheumatologic diseases in summer and 10 (22.7%) in winter; 5 cases (18.5%) of neurologic disorders in summer and 4 (9.1%) in winter; and 2 cases (7.4%) of postoperative complications in summer and 4 (9.1%) in winter (p=0.64).CONCLUSIONS: There was a greater demand for referrals of elderly patients to the physical therapy center in winter than in summer, with a predominance of female patients in both seasons. The most prevalent causes of referral were related to trauma-orthopaedic diseases, but there was no significant difference in the frequency of diagnoses according to season. Knowledge about the profile of the elderly admitted to physical therapy centers is important for targeting actions at this age group, conducting information, prevention, and health promotion campaigns.

A day in the life of a paediatric surgeon

Objectives This study aimed to create a snapshot picture of the global workload of paediatric surgeons and identify differences between countries. Methods Surgeons from 13 paediatric surgical units in different countries across the world were asked to record the number and type of admissions to the paediatric surgery service over a 24-h period from 8 a.m. on 23 May 2012. Results Data were recorded for 13 units from 13 countries: 11 low and middle income countries (LMICs) and two high-income countries (HICs). Dar es Salaam, Tanzania, had the greatest number of admissions. Two units in HICs had the lowest number of admissions, other than the Nigerian unit, which only had three admissions due to a hospital strike on the day surveyed. The percentage of emergency admissions ranged from 38 to 83%. Those units with the highest number of total admissions tended to also have the highest proportion of emergencies. Trauma was the most frequently reported admission reason, accounting for 18% of admissions. However, there were no cases of trauma in HIC units. Conclusion The spectrum of paediatric surgery differs between countries, in particular between LMICs and HICs. Units in LMICs tend to have a greater number of admissions, including a wider variety of conditions and a higher proportion of emergency work. Paediatric surgery in LMICs faces many challenges. This highlights the importance of training specialist paediatric surgeons in these countries. Further data are still needed to fully outline the burden of disease in paediatric surgery, especially in LMICs. Keywords : epidemiology, global surgery, paediatric surgery

The epidemiological profile of Pediatric Intensive Care Center at Hospital Israelita Albert Einstein

This study outlined the epidemiological profiles of patients who were admitted to the Pediatric Intensive Care Center at Albert Einstein Israelite Hospital during 2009. Data were retrospectively collected for all patients admitted to the PICC during 2009. A total of 433 medical charts were reviewed, and these data were extracted using the DATAMARTS System and analyzed using the statistical software package STATA, version 11.0. There were no statistically significant differences in regards to patient gender, and the predominant age group consisted of patients between the ages of 1 to 4 years. The average occupancy rate was 69.3% per year, and there was a greater number of admissions during April, August, and October. The average length of stay at the hospital ranged from 9.7 to 19.1 days. Respiratory diseases were the main cause for admission to the Pediatric Intensive Care Center, and the mortality rate of the patients admitted was 1.85%. Respiratory diseases were the most common ailment among patients admitted to the Pediatric Intensive Care Center, and the highest mortality rates were associated with neoplastic diseases.

Bronquiolitis grave. Cambios epidemiológicos y de soporte respiratorio

Introduction Bronchiolitis generates lots of admissions during the cold months in the paediatric intensive care units (PICU). New forms of respiratory support are being used and could improve the care of these patients. Objectives To analyse the epidemiological and respiratory support changes of children admitted to the PICU. Patients and methods An observational, retrospective, descriptive and analytical study of patients with the diagnosis of bronchiolitis admitted to the PICU of a tertiary hospital during the respiratory syncytial virus (RSV) epidemic months between 2005 and 2010. Results A total of 229 patients were admitted, of whom 83% were infected with RSV. The mean age was 1.48 months, with children under 3 months being the greatest number of admissions (73.3%). December was the month with the highest number of admissions (52%). Mortality was 0.9%. The mean time of stay in the PICU and on respiratory assistance were 4 and 3 days, respectively (no significant differences between the periods studied). Patients with RSV bronchiolitis were younger than the negative RSV (mean 2.61 months and 4.05 months, P = .023). Active respiratory support was required in 73% of cases. The percentage of patients who required active respiratory support increased over the years (Z = 3.81, P = .00014), especially high flow nasal oxygen therapy (Z = 3.62, P = .00028). An inverse relationship was observed between patient age and length of stay in PICU (Beta = −0.245, P≤.0001) and days on respiratory support (Beta = −0.167, P = .039). Conclusions Most patients admitted to the PICU are less than 3 months old. Mortality was 0.9%. Respiratory support (especially non-invasive mechanical ventilation and high flow nasal oxygen therapy) is used increasingly often. The youngest patients need more days in PICU and more respiratory support.

The Effectiveness and Ethical Justification of Psychiatric Outpatient Commitment

Studies link involuntary outpatient commitment with improved patient outcomes, fueling debate on its ethical justification. This study compares inpatient utilization for committed outpatients in the 1990s with those who were not under outpatient civil commitment orders. Findings reveal committed outpatients had higher utilization of inpatient services and restraint episodes prior to their commitment compared with a control group. Committed outpatients also were more likely to have been on discharge status at the time of admission, have been admitted involuntarily under emergency legal procedures, and have had a greater number of admissions and hospital days prior to their commitment. Following commitment, patients had fewer hospitalizations, shorter lengths of stay, fewer seclusion episodes and hours, and fewer restraint episodes and hours. Findings are discussed within the context of parens patriae and therapeutic jurisprudence, and support medical and public policy justifications for ethical uses of outpatient civil commitment laws for seriously mentally ill patients.

Development of a registry to evaluate hospital admissions related to chemotherapy toxicity in a community cancer center

6062 Background: While most chemotherapy (CT) administration occurs in routine care settings, there is a lack of data on toxicity (TOX) outside of clinical trials. After developing a mechanism for identifying all patients with CT-related hospitalizations in our center we created a prospective registry of such admissions in order to examine trends in TOX, modify practice, and establish benchmarks for severe TOX in a community cancer center. Methods: The North Shore Cancer Center is a community-based cancer facility in Peabody, MA. Eligible population consisted of all adult patients admitted to hospital within 30 days of their last CT administration. Each admission was reviewed by a panel of hospital staff to determine whether it was treatment-related; admission information was collected using a standard form. Results: Between 10/01/2001 and 10/31/2003 there were 335 hospitalizations among patients receiving CT, 110 (33%) of which were deemed CT-related. During this time period 7,632 patient months of parenteral CT were administered. The median time from last CT administration to admission was 7 d. Median age of the cohort was 67 (range 21–93) and 43% were male. NHL (25%) and colorectal cancer (17%) were the most frequent diagnoses. Approximately 54% of patients were receiving CT with palliative intent. Most common reasons for admission were infection or gastrointestinal TOX (37% each). Platinum- (25%) or fluorouracil-based (22%) regimens and CHOP (22%) resulted in the greatest number of admissions. The mean length of stay was 7.3 d (range 0–49); 6 patients died during hospitalization (5%). When the registry was reviewed to identify areas where care may be improved, several admissions for decadron-related hyperglycemia in non-diabetic patients with myeloma were identified. This resulted in introduction of glucose monitoring guidelines with no subsequent admissions for this TOX since then. Conclusions: About one third of hospital admissions in patients receiving CT are treatment-related and most occur in patients with advanced cancer. Collection of data on toxicity is feasible in the routine setting and can facilitate quality improvement. Author Disclosure Employment or Leadership Consultant or Advisory Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Ortho Biotech

Surgical Interventions at Field Hospitals during the Iran and Iraq War (1980–1987)

Surgical treatment of wounded soldiers in the field began in World War II, and the care of the wounded was aided by air, ground, and marine transportation. Even with highly developed facilities, medical care should be started as soon as possible. The Islamic Republic of Iran was under an economic blockade during its war with Iraq. Field hospitals were considered a solution to the problem of transportation shortages. The aim of this study was to assess the surgical interventions of these hospitals. In a descriptive cross-sectional study, data for 7,718 patients admitted to field hospitals (among a total of 173,823 casualties) were analyzed. A checklist was used as the data-collection tool. The data were entered and analyzed by the Statistical Program for the Social Sciences. The type of surgical intervention, duration of the surgery, and frequency of the interventions in each hospital were examined. Laparotomy was the most common and tracheostomy the least common intervention. Shahid Baghaei Field Hospital had the greatest number of admissions. Of all the patients in the Southern Command District who underwent any kind of surgery, 21.53% were operated on in the complex of field hospitals. The surgery time in these hospitals was 156 +/- 69 minutes (mean +/- SD). A great number of the procedures were lifesaving (including laparotomy and chest tube insertion). It seems that these hospitals played a key role in reducing mortality and morbidity during the war.

The role of cognitive‐behavioural therapy in the management of pain in patients with sickle cell disease

Painful crisis is the most common manifestation of sickle cell disease and accounts for the second greatest number of admissions with an average length of stay of 7 days in central London. Despite this frequency of admissions, the management of pain is fraught with problems. This is not surprising since the psychological challenges presented by sickle cell disease are manifold, resulting in significant psychological distress for some individuals. This paper considers the literature on the psychosocial impact of sickle cell disease, and the American research evidence which suggests that pain management strategies that incorporate a psychological intervention can significantly reduce psychological distress as well as hospital admissions. Britain has been slow to incorporate psychology in the pain management strategies, and we have embarked on research to fill this gap. Although this research constitutes work in progress, an argument is put forward for utilizing the cognitive-behavioural perspective in the management of pain in sickle cell disease and we conclude by giving a brief summary of pilot work which is both the foundation and justification for the current ongoing research.

Intracellular Hemoglobin S Polymerization and the Clinical Severity of Sickle Cell Anemia

AbstractRecent work has enabled us to quantitate the four variables (2,3-DPG concentration, pHi, non-S hemoglobin composition, and O2 saturation) that modulate the equilibrium solubility (csat) of Hb S inside sickle erythrocytes (SS RBCs). Using measured values of mean corpuscular hemoglobin concentration (MCHC), 2,3-DPG concentration, and %Hb (F+A2), along with estimates of pHiand the Δcsat due to partial oxygenation of SS RBCs in the microcirculation, we calculated the mean polymer fraction (fp) in erythrocytes from 46 SS homozygotes. Values of fp derived from the conservation of mass equation ranged from 0.30 to 0.59. MCHC and %Hb F were major determinants of the magnitude of fp; 2,3-DPG concentration and pHialso contributed, but to a lesser extent. A clinical severity score (CSS) was assigned to each patient based on mean hospitalization rate. There was a weak, but statistically significant, negative correlation between fp and steady state hematocrit (P = .017), but none between fp and whole blood hemoglobin concentration (P = .218). Although there was no correlation between fp and mean number of hospitalization days per year, patients with the greatest number of admissions and hospitalization days were found only among those who had an fp > 0.45. All five patients who died during the follow-up period (median, 7 years; range, 3 to 10 years) had fp values ≥0.48. However, patients with few admissions, low hospitalization days, and long survivals occurred at all fp levels. These results suggest that the clinical course of homozygous SS disease cannot be predicted by mean fpcalculations, which assume a homogeneous distribution of the five variables that modulate intraerythrocytic polymerization. A heterogeneous distribution is more likely; so the amount of polymerized Hb S could vary considerably among cell populations. Factors such as membrane abnormalities and endothelial cell interactions may also contribute to clinical severity.

Intracellular Hemoglobin S Polymerization and the Clinical Severity of Sickle Cell Anemia

Recent work has enabled us to quantitate the four variables (2,3-DPG concentration, pHi, non-S hemoglobin composition, and O2 saturation) that modulate the equilibrium solubility (csat) of Hb S inside sickle erythrocytes (SS RBCs). Using measured values of mean corpuscular hemoglobin concentration (MCHC), 2,3-DPG concentration, and %Hb (F+A2), along with estimates of pHiand the Δcsat due to partial oxygenation of SS RBCs in the microcirculation, we calculated the mean polymer fraction (fp) in erythrocytes from 46 SS homozygotes. Values of fp derived from the conservation of mass equation ranged from 0.30 to 0.59. MCHC and %Hb F were major determinants of the magnitude of fp; 2,3-DPG concentration and pHialso contributed, but to a lesser extent. A clinical severity score (CSS) was assigned to each patient based on mean hospitalization rate. There was a weak, but statistically significant, negative correlation between fp and steady state hematocrit (P = .017), but none between fp and whole blood hemoglobin concentration (P = .218). Although there was no correlation between fp and mean number of hospitalization days per year, patients with the greatest number of admissions and hospitalization days were found only among those who had an fp &gt; 0.45. All five patients who died during the follow-up period (median, 7 years; range, 3 to 10 years) had fp values ≥0.48. However, patients with few admissions, low hospitalization days, and long survivals occurred at all fp levels. These results suggest that the clinical course of homozygous SS disease cannot be predicted by mean fpcalculations, which assume a homogeneous distribution of the five variables that modulate intraerythrocytic polymerization. A heterogeneous distribution is more likely; so the amount of polymerized Hb S could vary considerably among cell populations. Factors such as membrane abnormalities and endothelial cell interactions may also contribute to clinical severity.

The cost of diabetic foot problems.

Diabetic foot problems are the commonest and most morbid complications of diabetes and constitute a major cost to any health care system. Foot problems result in the greatest number of admissions to hospital, and these become extremely costly. The demonstration in many areas of the health service that care, education, and the provision of good support to people results in fewer foot problems must be the spur for all those involved in diabetes care to improve services in all localities. Foot ulceration is much more common in deprived areas, and urgent research is required to determine exactly why this occurs so that appropriate remedies can be applied.

Birth Weight and Hospital Readmission of Infants Born Prematurely

To determine whether the hospital readmission rate of infants born prematurely was greatest in those whose birth weight was less than 750 g. A prospective cohort study. Regional neonatal intensive care unit. Consecutive very-low-birth-weight (< 1500 g) infants admitted to the neonatal intensive care unit; infants with congenital abnormalities were excluded. Two-year follow-up was completed for 109 (90.8%) of these patients. Following discharge from the neonatal intensive care unit, infants were seen at 6-month intervals at which time a detailed history was taken and examinations were performed. Hospital admissions were documented and confirmed from the medical records. Infants with birth weights of less than 750 g and those of very-low gestational age (< or = 28 weeks) made up the greatest number of admissions and had the longest hospital stays. In the first year of life, the duration of stay was inversely related to birth weight. Increased survival of extremely low-birth-weight infants has important implications for resource allocation of pediatric beds.

The comparison of health care systems through regional analysis: The case of hospital admissions in Belgium and The Netherlands

One of the problems in the international comparison of health care systems is the small number of units of analysis. Usually only a small number of systems is compared which makes cross-sectional statistical analysis impossible. The two obvious solutions to this problem—neither of which is generally feasible—are either to enlarge the number of systems being compared or to use time series on a small number of health care systems. Quite another solution is to study regional variations within and between a small number of systems. The number of regions has to be sufficiently large to make statistical analysis possible. This is the solution chosen in this article. The phenomenon which is central to our analysis is the number of hospital admissions per 1000 of the population. To explain variations in the hospital admission rate, it is hypothesized that there are a number of variables that have the same kind of influence on hospital admission rates in all western industrialized countries (such as the supply of hospital beds and the health status of the population). On the other hand there are determinants of regional variation in the number of admissions which either exert an influence dependent on the nature of the system, or are unique to a particular health care system. Concerning the first group of hypotheses (the general model), our analysis based on data for 1974 showed that the only variables to have a clear and equal influence on the regional variation in hospital admission rates in the Netherlands as well as in Belgium are the number of hospital beds per 1000 inhabitants and standardized mortality (an operationalization of the concept of health status). The influence of system-specific variables (the second group of hypotheses) has been analysed, taking the difference between the actual number of admissions and the number of admissions expected on the basis of the number of beds and mortality as the dependent variable. In the Netherlands, none of the variables appears to have a clear influence on the level of this ratio, whereas in Belgium there is a greater number of admissions than expected in regions with a higher birthrate and a higher number of both general practitioners and specialists in the common disciplines (internal medicine, pediatrics, gynaecology) in relation to the total number of specialists.

Drug overdose in children

This paper reviews epidemiological factors, drugs taken, management and outcome of 478 children admitted to the Royal Children's Hospital with drug poisoning during the 5 years 1978-82. Accidental ingestion in young children is still common whilst self poisoning is increasing in the age group 8-17 years. Suicide attempts and self destructive ingestion accounted for 11.5% of all cases with two deaths. A significant number in this group were less than 10 years of age. Iatrogenic poisoning accounted for 11% of all cases with metoclopramide or prochlorperazine frequently involved. Benzodiazepines, major tranquillizers and antihistamines were the most commonly taken groups of drugs whilst the greatest number of admissions to Intensive Care Unit were due to tricyclic poisoning. Principles of management are discussed.