Higher Incidence Of Hospitalization Research Articles

The rate of viral transfer between upper and lower respiratory tracts determines RSV illness duration.

Respiratory syncytial virus can lead to serious lower respiratory infection (LRI), particularly in children and the elderly. LRI can cause longer infections, lingering respiratory problems, and higher incidence of hospitalization. In this paper, we use a simplified ordinary differential equation model of viral dynamics to study the role of transport mechanisms in the occurrence of LRI. Our model uses two compartments to simulate the upper respiratory tract and the lower respiratory tract (LRT) and assumes two distinct types of viral transfer between the two compartments: diffusion and advection. We find that a range of diffusion and advection values lead to long-lasting infections in the LRT, elucidating a possible mechanism for the severe LRI infections observed in humans.

INTERNAÇÕES POR ABUSO DE ÁLCOOL EM PRESIDENTE PRUDENTE NOS ÚLTIMOS TRÊS ANOS

Studies highlight alcoholism as a serious problem for Brazilian public health, as well as, it is understood that efficient interventions in this scenario need to take into account the specific and multidimensional context of this public. Therefore, the objective of this study is to describe the profile of hospitalizations due to alcohol abuse between 2015 and 2017 in the city of Presidente Prudente, through the health portal DATASUS (TABNET). It is a cross-sectional and descriptive investigation, of a quantitative nature. It was possible to identify male prevalence in relation to the number of hospitalizations at regional and state level. However, it was not possible to establish significant associations between periods of the year with the highest incidence of hospitalizations. It is concluded that new interinstitutional and interdisciplinary strategies need to be adopted in order to eradicate the pathology, as it promotes mental health, especially in men.

Cellular DNA quantification in respiratory samples for the normalization of viral load: a real need?

BackgroundRespiratory tract infections have an enormous social economic impact, with high incidence of hospitalization and high costs. Adequate specimen collection is the first crucial step for the correct diagnosis of viral respiratory infections. ObjectivesThe present retrospective study aimed: i) to verify the cell yield obtained from sampling the nasal respiratory tract using mid-turbinate flocked swabs; ii) to evaluate the normalization of viral load, based on cell number; and iii) to compare the kinetics of viral infection obtained with normalized vs non-normalized viral load. Study designThe number of cells were quantified by real-time PCR in residual extract of nasal swabs tested for respiratory viruses detection and stored at −80 °C in a universal transport medium (UTM™). ResultsA total of 513 virus-positive and 226 virus-negative samples were analyzed. Overall, a median of 4.42 log10 β2-microgolubin DNA copy number/ml of UTM™ (range 1.17–7.26) was detected. A significantly higher number of cells was observed in virus-positive as compared to virus-negative samples (4.75 vs 3.76; p < 0.001). Viral loads expressed as log10 RNA copies/ml of UTM™ and log10 RNA copies/median number of cells were compared in virus-positive samples and a strict correlation (r = 0.89, p < 0.001) and agreement (R2 = 0.82) were observed. In addition, infection kinetics were compared using the two methods with a follow-up series of eight episodes of viral infection and the mean difference was -0.57 log10 (range −1.99 to 0.40). ConclusionsThe normalization of viral load using cellular load compliments the validation of real-time PCR results in the diagnosis of respiratory viruses but is not strictly needed.

Determinants of long-term clinical outcomes in patients with angina but without obstructive coronary artery disease: a systematic review and meta-analysis.

The long-term prognosis of angina in patients without obstructive coronary artery disease (CAD) is uncertain. To assess the incidence of long-term adverse outcomes in such patients. We searched PubMed, Cochrane Library, the Embase database, and the Clinical Trials Registry for studies published in English until January 2017, assessing the composite primary outcome of all-cause death and non-fatal myocardial infarction using random-effects models to estimate pooled incidences. We identified 54 studies, reporting outcomes in overall 35039 patients (mean age 56, male/female ratio 0.51, 99770 person-years) with angina and no obstructive CAD. After a median follow-up of 5 years (interquartile range 3-7 years), the pooled incidence of the primary outcome was 0.98/100 person-years [95% confidence interval (CI) 0.77-1.19%], with considerable heterogeneity among studies (I2 = 91%, P < 0.001). The primary outcome was associated with prevalent dyslipidaemia (P = 0.016), diabetes (P = 0.035), and hypertension (P = 0.016). Studies enrolling patients with less-than-obstructive CAD showed a higher incidence of the primary outcome (1.32/100 person-years, 95% CI 1.02-1.62) compared with studies including only patients with 'entirely normal' coronary arteries (0.52/100 person-years, 95% CI 0.34-0.79, respectively; P < 0.01). The incidence of the primary outcome did not differ significantly between studies enrolling only patients with documented myocardial ischaemia and those studies enrolling patients regardless of presence of ischaemia. However, ischaemia documented by non-invasive imaging techniques was associated with a higher incidence of events (P = 0.02). Overall, these patients, however, suffered from a high incidence of recurrent hospitalization. Angina without obstructive CAD has a heterogeneous prognosis. A main determinant of major adverse events is the presence of 'some' coronary atherosclerosis, with unequivocal myocardial ischaemia being associated with worse clinical outcomes. Patients' quality of life is also worsened by the high incidence of hospitalization, angina recurrence, and repeated coronary angiography.

Year in review 2016: Interstitial lung disease, pulmonary vascular disease, pulmonary function, paediatric lung disease, cystic fibrosis and sleep.

Year in review 2016: Interstitial lung disease, pulmonary vascular disease, pulmonary function, paediatric lung disease, cystic fibrosis and sleep.

Women with atrial fibrillation and type 2 diabetes have a higher incidence of hospitalization and undergo ablation or pacemaker implantation less frequently than men

BackgroundWe reviewed trends from 2004 to 2013 in the incidence and outcomes for atrial fibrillation (AF) in Spanish patients with type 2 diabetes mellitus (T2DM) comparing women and men. MethodsWe used national hospital discharge data including all T2DM patients discharged from the hospital after AF. Patients with AF in the primary diagnosis field were selected. Discharges were grouped by sex. Incidence was calculated overall and stratified by sex. We analyzed diagnostic and therapeutic procedures, patient comorbidities, CHA2DS2-VASc score, length of hospital stay, readmission rates and in-hospital mortality (IHM). ResultsWe identified a total of 214,457 admissions for AF. Patients with T2DM accounted for 21.1% (19,505 men and 25,954 women). Women with T2DM had a significantly higher incidence of AF compared to men over the study period (IRR 1.33;95%CI 1.31–1.35). Women were significantly older (77.24±8.69years) than men (72.62±10.28years), had higher prevalences of obesity and hypertension, and higher CHA2DS2-VASc score. Women less frequently underwent ablation (3.21% vs. 1.54%; p<0.001) and received an implanted pacemaker (14.3% vs. 8.16%; p<0.001) than men. Crude IHM was 2.81% for women and 2.48% for men (p=0.030). Sex was not associated with a higher IHM after multivariable adjustment. ConclusionsOur study demonstrates an increase in hospitalization for AF in diabetic women. Women were older, had a higher comorbidity index and had CHAD2DS2-VASc score than men. Women with AF and T2DM undergo ablation or pacemaker implantation less frequently than their male counterparts. After multivariable adjustment sex did not predict mortality during admissions for AF.

Health Outcomes of Sarcopenia: A Systematic Review and Meta-Analysis.

ObjectiveThe purpose of this study was to perform a systematic review to assess the short-, middle- and long-term consequences of sarcopenia.MethodsProspective studies assessing the consequences of sarcopenia were searched across different electronic databases (MEDLINE, EMBASE, EBM Reviews, Cochrane Database of Systematic Reviews, EBM Reviews ACP Journal Club, EBM Reviews DARE and AMED). Only studies that used the definition of the European Working Group on Sarcopenia in Older People to diagnose sarcopenia were included. Study selection and data extraction were performed by two independent reviewers. For outcomes reported by three or more studies, a meta-analysis was performed. The study results are expressed as odds ratios (OR) with 95% CI.ResultsOf the 772 references identified through the database search, 17 were included in this systematic review. The number of participants in the included studies ranged from 99 to 6658, and the duration of follow-up varied from 3 months to 9.8 years. Eleven out of 12 studies assessed the impact of sarcopenia on mortality. The results showed a higher rate of mortality among sarcopenic subjects (pooled OR of 3.596 (95% CI 2.96–4.37)). The effect was higher in people aged 79 years or older compared with younger subjects (p = 0.02). Sarcopenia is also associated with functional decline (pooled OR of 6 studies 3.03 (95% CI 1.80–5.12)), a higher rate of falls (2/2 studies found a significant association) and a higher incidence of hospitalizations (1/1 study). The impact of sarcopenia on the incidence of fractures and the length of hospital stay was less clear (only 1/2 studies showed an association for both outcomes).ConclusionSarcopenia is associated with several harmful outcomes, making this geriatric syndrome a real public health burden.

Comparing the Effect of Acupressure and Cryotherapy on the Pain Caused by Removal of Chest Drain Tube in the Elderly Patients Undergoing Open Heart Surgery

Background Aging has a growing trend in the world. The elderly experience a high incidence of hospitalization and coronary bypass surgery compared with other age groups, and pain is the most common complaint in these patients. This research was conducted to compare the effect of acupressure and cryotherapy on the pain of removing drain tube from the chest of the elderly who have undergone open heart surgery.Methods In this quasi-experimental clinincal trial, 150 elderly people undergoing coronary artery bypass grafting with drain tube in their chests and hospitalized in the Intensive Care Unit of Shahid Rajaei Hospital (affiliated to Alborz University of Medical Sciences and Health and Treatment Services, Tehran, Iran) were selected through random sampling method. Then, they were divided into 3 groups of acupressure, cryotherapy, and control. The acupressure group received pressure on ST36, P6, LI4 points. The cryotherapy group received cold therapy through applying three packs of cooling gel, and the control group received routine postoperative cares. The pain intensity was measured 20 minutes before the insertion of the tube, during insertion, and 10 minutes after removal of the drain tube. The tools for collecting data were abbreviated mental test form, demographic questionnaire, and visual analoge scale. The obtained data were analyzed through descriptive and inferential statistics by SPSS version 20.Results In terms of demographic characteristics, the patients were homogenous. Before the intervention, there were no significant differences among three groups in terms of pain intensity (P=0.93). However, after the intervention, pain intensity, immediately after, and 10 minutes after removal of chest tube, significantly reduced in the experimental groups compared with the control group (P˂0.001). In general, reduction of pain intensity was higher in the acupressure group compared with the other two groups (P˂0.001).Conclusion Applying acupressure on ST36, LI4, and P6 points is effective in reducing the intensity of pain caused by removal of drain tube from the chest of the elderly patients. It is recommended as a safe and inexpensive drug-free approach to control pain caused by the removal of drain tube.

Systemic dysregulation of cellular immune responses to H1N1 infection during pregnancy

Abstract The 2009 H1N1 flu pandemic demonstrated that pregnant women infected with influenza were at risk for severe respiratory distress and premature-rupture-of-membranes (PROM), leading to high incidence of hospitalization, preterm births and small for gestation age (SGA) neonates. We utilize a syngeneic BALB/c pregnant mouse model which recapitulates clinical phenotypes shown during influenza infection of pregnant women. Pregnant mice sublethally infected (0.5xLD50) with pandemic H1N1 A/California/07/09 showed higher viral titers and delayed viral clearance relative to non-pregnant mice, and increased incidence of stillbirths and SGA offspring. Lymphocytes isolated at days 7 and 14 from lungs and spleens of infected pregnant and non-pregnant female mice were analyzed for H1N1 A/Ca/07/09 specific IL-4 and IFN-γ responses. Pregnancy delayed influenza-specific cytokine secretion at the site of infection, indicating systemic dysregulation of anti-viral responses. Lymphocytes from draining mediastinal lymph nodes, spleens and lungs were used to quantify activation of B cells in germinal centers (GC), maturation into antibody secreting cells and memory B cells, and mucosal homing to lung tissue following infection. Pregnancy decreased maturation of GC+ B cells in the spleen and migration of plasma cells from the spleen to the lungs. Infected pregnant mice generated equivalent serum influenza-specific neutralizing antibody titers and increased IgA antibody secreting cells (ASC) in the lungs 6 weeks post-infection relative to infected non-pregnant mice, indicating a potential role in pregnancy favoring the development of mucosal immunity in response to prolonged viral exposure.

Predictors of long-term clinical endpoints in patients with refractory angina.

BackgroundClinical outcomes in patients with refractory angina (RA) are poorly characterized and variably described. Using the Duke Database for Cardiovascular Disease (DDCD), we explored characteristics that drive clinical endpoints in patients with class II to IV angina stabilized on medical therapy.Methods and ResultsWe explored clinical endpoints and associated costs of patients who underwent catheterization at Duke University Medical Center from 1997 to 2010 for evaluation of coronary artery disease (CAD) and were found to have advanced CAD ineligible for additional revascularization, and were clinically stable for a minimum of 60 days. Of 77 257 cardiac catheterizations performed, 1908 patients met entry criteria. The 3‐year incidence of death; cardiac rehospitalization; and a composite of death, myocardial infarction, stroke, cardiac rehospitalization, and revascularization were 13.0%, 43.5%, and 52.2%, respectively. Predictors of mortality included age, ejection fraction (EF), low body mass index, multivessel CAD, low heart rate, diabetes, diastolic blood pressure, history of coronary artery bypass graft surgery, cigarette smoking, history of congestive heart failure (CHF), and race. Multivessel CAD, EF<45%, and history of CHF increased risk of mortality; angina class and prior revascularization did not. Total rehospitalization costs over a 3‐year period per patient were $10 185 (95% CI 8458, 11912) in 2012 US dollars.ConclusionsClinically stable patients with RA who are medically managed have a modest mortality, but a high incidence of hospitalization and resource use over 3 years. These findings point to the need for novel therapies aimed at symptom mitigation in this population and their potential impact on health care utilization and costs.

Abstract 18460: Asymmetric Septal Hypertrophy as a Prognostic Indicator During Progression of Aortic Valve Stenosis

Objective: Asymmetric septal hypertrophy (ASH) in patients with severe aortic stenosis (AS) has been associated with increased perioperative morbidity and mortality in smaller studies with severe aortic stenosis (AS). This association has not been tested in a large, longitudinal study. Methods: Clinical, echocardiographic and outcome data from 1730 patients with asymptomatic AS, participated in the Simvastatin Ezetimibe in Aortic Stenosis study (SEAS), a randomized placebo controlled study evaluating the effect of lipid lowering medications on progression of AS, were used. ASH was considered present if interventricular septal/posterior wall thickness ratio exceeded 1.5. The association of ASH with rate of major cardiovascular (CV) events was tested in time-dependent cox-regression analysis. Results: During a median of 4.3 years follow-up, ASH developed in 17.0 % of patients, and was associated with higher left ventricular mass (LVM) and body mass index (BMI) compared to non-ASH patients (all p&lt;0.05). In time-varying Cox regression analysis, ASH predicted a 50% greater incidence of ischemic CV events (ICE), a 63% greater incidence in the need for coronary artery bypass grafting (CABG) at the time of aortic valve replacement, and a 2-fold higher incidence of hospitalization for heart failure due to progression of AS (CHFAS) independent of important confounders (all p&lt;0.05) (Table). Conclusions: Development of ASH during progression of AS was a strong predictor of major CV events in patients participating in the SEAS-study. Table: Results are presented as Hazard ratio (95% Confidence Interval).

Disparities in health care utilization by race among teenagers and young adults with muscular dystrophy.

For people with muscular dystrophy (MD) health care access is crucial and utilization is expected to be high. A multidisciplinary approach is needed for optimal management of symptoms of this rare condition. Regular primary care, specialty care, therapy, and medicine use can improve quality of care and reduce need for emergency treatment and hospitalization. We analyzed health insurance and administrative data to test for racial disparities in regular care use among teenagers and young adults with MD. We used South Carolina Medicaid and other administrative data for individuals aged 15-24 years to determine annual health care utilization patterns for individuals with MD by race. We studied adolescents and young adults with MD because this age group represents a time when the condition is typically intensifying and the transition from pediatric to adult care is expected. We used Generalized Estimating Equation models to analyze longitudinal utilization data conditional on other factors that may lead to utilization differences. Race is correlated with health care utilization among adolescents and young adults with MD. Blacks have lower overall utilization, and less primary care, therapy, and specialist care use but higher incidence of hospitalization and emergency treatment use compared with whites and also to other races. The most striking disparity was the use of outpatient services. Blacks utilized these services 50% less compared with whites and 70% less compared with others. Even in regression analysis, where we take into account individual unobserved factors and allow clustering at the individual level, these differences remained and were in most cases statistically significant. Our results indicate that there are differences in health care utilization by race even when individuals have access to the same health care benefits. This means simply offering coverage to individuals with MD may not be sufficient in eliminating health disparities. Future studies will be needed to examine other possible sources of these racial disparities, such as resource awareness, health knowledge, or access barriers such as transportation.

Clinical significance of increased tricuspid valve incompetence following implantation of ventricular leads

Cardiac rhythm management devices (CRMD) require a ventricular lead to be placed across the tricuspid valve. Tricuspid regurgitation (TR) is an under-recognized clinical complication of lead implantation and its clinical significance is unknown. We studied the incidence of hospitalizations for congestive heart failure (CHF) exacerbation among patients with worsening TR after ventricular lead implantation. We reviewed 148 patients (age 68 ± 15) that received a CRMD. TR and pulmonary artery systolic pressure (PASP) measured by Doppler echocardiography before and after CRMD implantation were analyzed. Hospitalizations for CHF exacerbation post-implantation were counted. Follow-up was 32 ± 14 months. Ninety-nine (67%) patients had no change, 24 (16%) slight, and 9 (6%) significant increase in TR after CRMD implantation, while 13 (9%) patients had slight and 3 (2%) significant improvement. Patients with a significant increase in TR had higher incidence of hospitalizations (1.7 ± 0.5) compared to patients with slight (0.8 ± 1; p = 0.006) or no increase (0.5 ± 1; p = 0.0002) in TR. Patients with significant increase in TR had a greater change in PASP (25 mmHg; p = 0.002) after device implantation compared to those with a slight (10 mmHg; p = 0.002) or no increase (0.7 mmHg; p = 0.17). Increased TR following CRMD implantation is relatively common (33%) and correlated with subsequent risk of hospitalization for heart failure. A preventive strategy and close monitoring for development or worsening of CHF after CRMD implantation may help prevent hospital admissions.

Hospitalizations Associated with Disseminated Coccidioidomycosis, Arizona and California, USA

We analyzed hospitalization databases from Arizona and California for disseminated coccidioidomycosis–associated hospitalizations among immunocompetent persons. Racial/ethnic disease ratios were characterized by a higher incidence of hospitalization among blacks compared with other groups. This finding suggests that HIV infection, AIDS, and primary immune conditions are not a major factor in this disparity.

A case of difficult-to-treat eosinophilic asthma controlled with clarithromycin

Difficult-to-treat asthma is a major health problem that has been intensively researched. Patients with difficult-to-treat asthma have the highest incidence of hospitalizations and emergency department visits, [1] Dolan C.M. Fraher K.E. Bleecker E.R. et al. Design and baseline characteristics of the epidemiology and natural history of asthma: Outcomes and Treatment Regimens (TENOR) study: a large cohort of patients with severe or difficult-to-treat asthma. Ann Allergy Asthma Immunol. 2004; 92: 32-39 Abstract Full Text PDF PubMed Scopus (267) Google Scholar have the greatest risk of fatal asthma attacks, [2] Tough S.C. Hessel P.A. Ruff M. Green F.H. Mitchell I. Butt J.C. Features that distinguish those who die from asthma from community controls with asthma. J Asthma. 1998; 35: 657-665 Crossref PubMed Scopus (72) Google Scholar and use up to 3 times more resources. [3] Van Ganse E. Laforest L. Pietri G. et al. Persistent asthma: disease control, resource utilisation and direct costs. Eur Respir J. 2002; 20: 260-267 Crossref PubMed Scopus (116) Google Scholar Previous studies of patients using macrolides for 6 to 16 weeks have reported lung function and symptom improvement in asthma patients with evidence of Chlamydia pneumoniae or Mycoplasma pneumoniae infection in the upper or lower airways. [4] Friedlander A.L. Albert R.K. Chronic macrolide therapy in inflammatory airways diseases. Chest. 2010; 138: 1202-1212 Crossref PubMed Scopus (124) Google Scholar Besides antibiotic effects, macrolides have anti-inflammatory and immunomodulating properties. For instance, macrolides regulate the production of the proinflammatory cytokines tumor necrosis factor α and interleukin 8 (IL-8) by decreasing the binding of transcription factors NF-κB and AP-1. [5] Shinkai M. Henke M.O. Rubin B.K. Macrolide antibiotics as immunomodulatory medications: proposed mechanisms of action. Pharmacol Ther. 2008; 117: 393-405 Crossref PubMed Scopus (181) Google Scholar Macrolides effectively inhibit IL-8 release and induce apoptosis in eosinophils. 6 Kohyama T. Takizawa H. Kawasaki S. Akiyama N. Sato M. Ito K. Fourteen-member macrolides inhibit interleukin-8 release by human eosinophils from atopic donors. Antimicrob Agents Chemother. 1999; 43: 907-911 PubMed Google Scholar , 7 Adachi T. Motojima S. Hirata A. et al. Eosinophil apoptosis caused by theophylline, glucocorticoids, and macrolides after stimulation with IL-5. J Allergy Clin Immunol. 1996; 98: S207-S215 Abstract Full Text Full Text PDF PubMed Scopus (99) Google Scholar Long-term treatment with macrolides is recommended in a few lung diseases, such as diffuse panbronchiolitis, cystic fibrosis, posttransplantation bronchiolitis obliterans, and chronic obstructive pulmonary disease. 4 Friedlander A.L. Albert R.K. Chronic macrolide therapy in inflammatory airways diseases. Chest. 2010; 138: 1202-1212 Crossref PubMed Scopus (124) Google Scholar , 8 Albert R.K. Connett J. Bailey W.C. et al. Azithromycin for prevention of exacerbations of COPD. N Engl J Med. 2011; 365: 689-698 Crossref PubMed Scopus (917) Google Scholar Results from a recent randomized controlled trial demonstrated that azithromycin taken for 1 year decreased exacerbations of chronic obstructive pulmonary disease. [8] Albert R.K. Connett J. Bailey W.C. et al. Azithromycin for prevention of exacerbations of COPD. N Engl J Med. 2011; 365: 689-698 Crossref PubMed Scopus (917) Google Scholar The authors attributed these results to the antibacterial properties of this antibiotic; however, one must assume that the immunomodulatory effects of macrolides played an important role as well. Until now, evidence has been insufficient to support long-term macrolide use in asthma, but it might be beneficial in a subgroup of asthma patients.

Primary dose reduction (PDR) of chemotherapy (chemo) in patients (Pts) older than age 65 with advanced cancer (Ca) and toxicity outcomes.

9037 Background: Oncologists may empirically reduce chemo doses with the 1st cycle (PDR) presumably to minimize tox. We studied the factors associated with PDR in pts > age 65 with advanced CA receiving chemo with palliative intent and evaluated the association of PDR with tox outcomes. Methods: This is a secondary data analysis of a multi-site prospective study which identified risk factors for chemo tox in pts > age 65 (Hurria, ASCO 2010). Chemo dosing was per MD discretion and categorized as standard (SD) or PDR per NCCN guidelines. We studied clinical (sociodemographic, CA type), treatment (line of chemo, multi vs single agent) and geriatric assessment factors (functional status, comorbidity, social support, psychological, cognitive, and nutritional status) associated with PDR using bivariate and multivariate logistic regression. The association of PDR and tox was evaluated. Results: 319 pts (mean age 73; range 65-91) with advanced lung (35%) GI (25%), GYN (15%) and GU (12%) CA were included in this analysis. Of these, 92 pts (29%) received PDR. Factors associated with PDR are listed in the Table. In multivariate analysis, factors independently associated (p<0.05) with PDR include: older age (OR 1.09 CI 1.04-1.14), depression (OR 2.29 CI 1.08-4.86), liver/kidney disorders (OR 6.7 CI 2.1-21), prior CA (OR 2.41 CI 1.23- 4.75) and lung CA (OR 0.41 CI 0.19-0.89). Grade 3-5 tox occurred in 51% of PDR and 53% of SD pts. There was no significant difference between PDR and SD groups in grade 3-5 tox (overall, heme, non-heme), dose delays, or early chemo discontinuation. Despite PDR, pts had a higher incidence of hospitalization (30% PDR vs. 19% SD, p .03). Conclusions: PDR is common in pts > age 65. Predictors of PDR include age and comorbid conditions. Chemo tox is high despite PDR. Studies are needed to assess the implications of PDR on treatment efficacy vs toxicity and to develop evidence based guidelines for optimal patient selection. Variable PDR SD P value Age (mean) 76 72 <.0001 Widowed (%) 29 19 .041 GI/ GU cancer (%) 47 34 .032 Lung cancer (%) 23 40 .003 Comorbidity Depression (%) 25 10 .0006 Heart disease (%) 32 18 .008 Liver/kidney disease (%) 14 3 <.0001 Prior cancers (%) 30 15 .002 Stomach disorder (%) 30 16 .004

Epidemiology of Ocular Trauma Among the Elderly in a Developing Country

Purpose: To study the epidemiology of ocular trauma among the elderly in a developing country.Method: This is a multi-center retrospective clinical study of patients aged 65 years and above managed for ocular trauma between 2001 and 2007 at 4 hospitals in southwestern Nigeria. Age, sex, occupation, residential address, location at time of injury, activity preceding injury, agent of injury, treatment modalities offered and presenting visual acuity were recorded in a predesigned form. Type of injury was classified according to Birmingham Eye Trauma Terminology. Data were recorded and analyzed with descriptive statistics and Chi square using SPSS 11 (SPSS Inc., Chicago, IL) and statistical significance accepted at P < 0.05.Results: 78 patients with overall mean age of 70.1 ± 5.5 years and male to female ratio of 1.9: 1 (P = 0.007) were studied. Mean age for males was 70.0 ± 5.4 years and 70.1 ± 5.7 years for females. Eye injury occurred most commonly on the farm (37.2%), during farm related activities (35.9%) with sticks/twigs (41.1%) being commonest agent of ocular trauma among the elderly. However, injury occurred most frequently at home (51.9%) and during a fight/dispute (25.9%) with inciting agents being most frequently (33.3%) home related in elderly females. Eye injury was mainly of closed globe variety (85.9%); open globe injury was associated with higher incidence of hospitalization (P < 0.0001) and visual impairment (P = 0.004) at presentation.Conclusion: Although eye injury in elderly occurred more commonly on the farm during farm related activities, gender related differences are present with injury occurring more commonly in the home and during assaults/disputes.

Condutas no paciente com insuficiência cardíaca internado em enfermarias de medicina interna

A crescente prevalência da Insuficiência Cardíaca na população, e a constante má-aderência aos tratamentos propostos em nível ambulatorial, fazem com que o quadro de descompensação desta doença esteja entre as recordistas em número de internações, causando grande impacto na saúde pública do Brasil. O propósito deste estudo é o de estabelecer um protocolo de condutas a ser aplicado em pacientes com Insuficiência Cardíaca internados em enfermaria de Clínica Médica Geral, como o Hospital Estadual de Ribeirão Preto (SP, Brasil), com o objetivo de garantir a recuperação de um quadro de descompensação recente, assim como reorientar o paciente quanto à importância da aderência ao tratamento instituído. Para tanto, serão propostas a utilização e otimização de ferramentas farmacológicas, além de reintrodução de medidas não-farmacológicas, de modo que se reduza o tempo de internação,o número de recorrências, e favoreça o melhor seguimento ambulatorial destes pacientes.

Incidence, risk factors and consequences of falling injuries among the community-dwelling elderly in Shihpai, Taiwan

Falls causing injuries among older people and the consequences of those injuries are of increasing concern to public health practitioners. The aims of this study were to determine the incidence, characteristics and risk factors of fall injuries among the community-dwelling elderly in Shihpai, Taiwan; the impact on quality of life and health service utilization was also comprehensively studied. 1361 community-dwelling elderly who had been enrolled in the Shihpai eye study (1999-2000) were included. Subjects were interviewed and examined by trained interviewers, and data such as demographics, medical conditions, blood pressure, ophthalmic examination, fall history and quality of life (SF-36) were collected. Chi-square tests, analyses of covariance and multiple logistic regressions were performed as the main statistical methods. The mean age of the participants was 72.2 (range, 65-91) years old. 16.3% of the elderly persons interviewed had experienced at least one fall; among those, up to 50% had suffered mild injuries, and the incidence of remarkable injury was 27.6%. There were no significant differences in the location or time of falling, but there were different risk factors and consequences in injury severity. Fallers with remarkable injuries had a higher incidence of hospitalization and a greater fear of falling. No statistically significant decline in quality of life with increasing severity of falling injury was identified after a 12-month follow-up period. Gender, visual impairment and orthostatic hypotension were identified as the major risk factors of fall injuries in the elderly. These factors should be emphasized in order to reduce fall injuries in geriatrics.

Ingested foreign bodies causing complications and requiring hospitalization in European children: Results from the ESFBI study

In young children, particularly those aged 1-3 years, aerodigestive tract foreign bodies (FB) are a common pediatric problem. The aim of the present study was therefore to characterize the risk of complications and prolonged hospitalization due to FB in the upper digestive tract in terms of the characteristics of the injured patients (age, gender), typology and features of the FB, the circumstances of the accident and hospitalization details. A retrospective study was done in 19 hospitals in 19 corresponding European countries of 186 cases of injury due to the presence of an FB in the mouth, esophagus and stomach (ICD935), out of the 2103 overall cases of FB reported in other locations. Complications arose in 14 cases and hospitalization was required in 164 cases. No deaths were observed. A higher incidence of hospitalization in male patients (61%) was observed. Median age for children who experienced complications was 2 years old. The most common FB removal technique was esophagoscopy. In the majority of cases the children were treated by the ENT Department. The most common FB were coins, batteries and fish bones among food. Because batteries, as well as coins and fish bones among food were the most common type of FB encountered, and because recent development of technology has accelerated broad use of disk-type batteries, parents should be aware of this hazard, and an educational campaign for public education for this serious problem is advisable.