Incidence Of Hospital Admissions Research Articles

The relative clinical impact of 2009 pandemic influenza A (H1N1) in the community compared to seasonal influenza in the Netherlands was most marked among 5-14 year olds

Please cite this paper as: van Gageldonk‐Lafeber et al. (2011) The relative clinical impact of 2009 pandemic influenza A (H1N1) in the community compared to seasonal influenza in the Netherlands was most marked among 5–14 year olds. Influenza and Other Respiratory Viruses 5(6), e513–e520. Background So far, most pandemic influenza reports were based on case studies focusing on severe disease. For public health policy, it is essential to consider the overall impact of the pandemic, including mild diseases. Objectives The aim of our study is to gain insight into the epidemiology of 2009 pandemic influenza in the community and to estimate the relative impact of pandemic compared to seasonal influenza. Methods The relative impact of pandemic influenza in the general population was assessed as the influenza‐like illness (ILI) incidence during the pandemic season compared with that during regular seasons. Influenza‐like illness incidences and virus diagnostics were derived from continuous sentinel surveillance systems. The incidence of hospital admissions, based on the mandatory notification of pandemic influenza, was used to relate the impact of severe disease to that in the community. Results The overall incidence of general practitioners‐attended ILI was 96 consultations per 10 000 persons. Highest incidences were reported in children and lowest in persons aged ≥65 years. For 5–14 year olds, the incidence during the pandemic was higher than during all preceding seasons. Samples originating from 5 to 19 year olds were statistically significant more often positive for pandemic influenza A (H1N1) 2009 virus as compared with samples from 0 to 4 year olds. Moreover, the incidence of hospital admission owing to pandemic influenza was highest in the youngest children. Conclusions Our study showed that while the absolute incidences of 2009 pandemic influenza were highest in children aged 0–4 years, the relative clinical impact in the community compared to seasonal influenza in previous years was most noticeable in healthy children 5–14 years of age.

An epidemiological study of Henoch-Schönlein purpura

To describe the incidence of hospital admission among children in the Scottish population for Henoch-Schönlein purpura (HSP). The annual, quarterly and monthly incidences of HSP were derived from routinely collected data for Scotland from 1995 to 2007. Annual incidences of childhood cases of HSP in Scotland ranged from 20.3 to 26.7 per 100,000 of the child population over 1995-2007. Quarterly rates were highest in winter and lowest in summer. Monthly rates were highest in the months between December and March and consistently low in July and August. The annual incidence of childhood HSP in Scotland appears high compared with rates reported in other countries, and the results demonstrate a seasonal pattern. Health professionals should be aware of the symptoms, and of the best treatments and care available. Further research is needed to gain a better understanding of this disease, as the aetiology remains unknown and there are no clear evidence-based treatments or interventions.

Ivabradine improves coronary flow reserve in patients with stable coronary artery disease

ObjectivesAlthough treatment with ivabradine reduces the incidence of hospital admissions for myocardial infarction and coronary revascularisation, there are no data concerning its effect on coronary circulation. The purpose of this study was to assess the effects of ivabradine on coronary flow velocity and flow reserve (CFR) in patients with stable coronary artery disease (CAD). MethodsDuring diagnostic coronary angiography (baseline), twenty-one patients with stable CAD underwent coronary flow velocity measurements (APVcm/s) in a non-culprit vessel, using a Doppler guidewire, at rest (r) and after adenosine administration to achieve maximal hyperaemia (h). During programmed coronary intervention in the culprit vessel, the same measurements were repeated one week after treatment with ivabradine (5mg twice daily), both at the intrinsic heart rate and at a paced heart rate identical to that before treatment. CFR was defined as h-APV/r-APV. ResultsHeart rate was significantly lower after treatment with ivabradine (78±14bpm vs 65±9bpm, p<0.001). Also, a reduction of r-APV (17.0±5.5 vs 19.7±7.6, p=0.003) and augmentation of h-APV (57.9±17.8 vs 53.5±21.4, p=0.009) leading to CFR improvement (3.51±0.81 vs 2.78±0.61, p<0.001) were observed. During pacing, although r-APV reverted to values similar to those before treatment (20.0±6.5 vs 19.7±7.6, p=NS), a sustained improvement in h-APV was observed (59.5±19.7 vs 53.5±21.4, p=0.007) and CFR remained higher than before treatment (3.04±0.66 vs 2.78±0.61, p<0.001). ConclusionsIvabradine treatment significantly improves hyperaemic coronary flow velocity and CFR in patients with stable CAD. These effects remain even after heart rate correction indicating improved microvascular function.

Community-acquired Respiratory Infections in Young Children With Congenital Heart Diseases in the Palivizumab Era

To investigate the epidemiology of acute respiratory tract infections (ARIs) in children younger than 24 months old with hemodynamically significant congenital heart diseases. Primary aim: incidence of hospital admission due to ARI. Secondary aims: risk factors, etiologic agents, clinical outcomes, and usefulness of preventive measures. Prospective, multicenter, epidemiologic study conducted in 57 Spanish hospitals covering four 7-month seasons (2004-2008). A total of 2613 patients were eligible for the study. Three hundred fifty-four patients (13.5%) (95% confidence interval: 12.3-14.9) required a total of 453 hospital admissions. Clinical diagnoses: bronchiolitis (54.1%), upper respiratory tract infection (21%), pneumonia (19.9%), and others (17.4%). Median length of hospital stay: 7.0 days. No etiologic agent was identified in two-thirds of the patients. In the remaining patients either a single agent (26.8%) or polymicrobial infection (5%) was identified. Respiratory syncytial virus (RSV) was the agent that was most commonly found (3.8% specific hospitalization rate). Children receiving adequate RSV prophylaxis (90.5%) had a 58.2% (95% confidence interval: 37.6-78.3) reduction in RSV hospitalization. Risk factors for admission included malnourishment, infant age, male gender, chromosome alterations, wheezing, inadequate RSV prophylaxis fulfillment, and siblings <11 years of age. Pediatric intensive care unit care was required in 21.8% of the admissions and 9 patients (0.34%) died. Hospital admission rate and severity of ARI remain as important issues in hemodynamically significant congenital heart disease patients. The strict fulfillment of prophylactic recommendations against RSV is the only protective factor that can be modulated to decrease the ARI hospital admission rate.

Brunaslys barna: Innlagnir á Landspítala 2000-2008

Causes of burn injuries in children are universally associated with social and environmental factors. Epidemiological studies are therefore important in identifying risk factors and for planning preventive interventions. Children younger than 18 years with skin burns who were treated as inpatients at Landspitali University Hospital over a 9-year period, 2000 and 2008, were included in this retrospective descriptive study. Data was collected from medical records. Of 149 children included in the study 41.6% were four years old or younger. The average annual incidence of hospital admissions was 21/100,000. Cold water as first aid was applied in 78% of cases. Half of the accidents occurred in the home where a close family member was the caretaker. Risk factors were identified in 11.4% of the accidents and abuse or neglect was suspected in 3.4% of cases. Scalds were the most common type of burn injury (50.3%) followed by burns caused by fire (20.4%) including gas or petrol (14.9%) and fireworks (17.6%). The most common source of scalds was exposure to hot water from hot water mains (12,9%) and heated water (12,9%). The mean time from emergency room admission to the paediatric ward was two hours and 22 minutes. The mean length of stay was 13 days; median 9 days (range 1-97). Incidence of hospital admissions for burn injury has decreased when compared with earlier Icelandic studies. Children four years and younger and boys between 13-16 years old are most at risk for burn injuries. Stronger preventive measures as well as better documentation of burn accidents are imperative.

Incidence of Hospital Admissions With Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis Among South African Health Care Workers

Incidence of Hospital Admissions With Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis Among South African Health Care Workers

High Incidence of Hospital Admissions With Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis Among South African Health Care Workers

Nosocomial transmission has been described in extensively drug-resistant tuberculosis (XDR-TB) and HIV co-infected patients in South Africa. However, little is known about the rates of drug-resistant tuberculosis among health care workers in countries with high tuberculosis and HIV burden. To estimate rates of multidrug-resistant tuberculosis (MDR-TB) and XDR-TB hospitalizations among health care workers in KwaZulu-Natal, South Africa. Retrospective study of patients with drug-resistant tuberculosis who were admitted from 2003 to 2008 for the initiation of drug-resistant tuberculosis therapy. A public tuberculosis referral hospital in KwaZulu-Natal, South Africa. 231 health care workers and 4151 non-health care workers admitted for initiation of MDR-TB or XDR-TB treatment. Hospital admission rates and hospital admission incidence rate ratios. Estimated incidence of MDR-TB hospitalization was 64.8 per 100,000 health care workers versus 11.9 per 100,000 non-health care workers (incidence rate ratio, 5.46 [95% CI, 4.75 to 6.28]). Estimated incidence of XDR-TB hospitalizations was 7.2 per 100,000 health care workers versus 1.1 per 100,000 non-health care workers (incidence rate ratio, 6.69 [CI, 4.38 to 10.20]). A higher percentage of health care workers than non-health care workers with MDR-TB or XDR-TB were women (78% vs. 47%; P < 0.001), and health care workers were less likely to report previous tuberculosis treatment (41% vs. 92%; P < 0.001). HIV infection did not differ between health care workers and non-health care workers (55% vs. 57%); however, among HIV-infected patients, a higher percentage of health care workers were receiving antiretroviral medications (63% vs. 47%; P < 0.001). The study had an observational retrospective design, is subject to referral bias, and had no information on type of health care work or duration of occupational exposure to tuberculosis. Health care workers in this HIV-endemic area were substantially more likely to be hospitalized with either MDR-TB or XDR-TB than were non-health care workers. The increased risk may be explained by occupational exposure, underlining the urgent need for tuberculosis infection-control programs.

Trends of adverse drug reactions related-hospitalizations in Spain (2001-2006)

BackgroundAdverse drug reactions (ADR) are a substantial cause of hospital admissions. We conducted a nationwide study to estimate the burden of hospital admissions for ADRs in Spain during a six-year period (2001-2006) along with the associated total health cost.MethodsData were obtained from the national surveillance system for hospital data (Minimum Basic Data Set) maintained by the Ministry of Health and Consumer Affairs, and covering more than 95% of Spanish hospitals. From these admissions we selected all hospitalization that were code as drug-related (ICD-9-CM codes E), but intended forms of overdoses, errors in administration and therapeutics failure were excluded. The average number of hospitalizations per year, annual incidence of hospital admissions, average length of stay in the hospital, and case-fatality rate, were calculated.ResultsDuring the 2001-2006 periods, the total number of hospitalized patients with ADR diagnosis was 350,835 subjects, 1.69% of all acute hospital admissions in Spain. The estimated incidence of admissions due to ADR decreased during the period 2001-2006 (p < 0.05). More than five percent of patients (n = 19,734) died during an ADR-related hospitalization. The drugs most commonly associated with ADR-related hospitalization were antineoplastic and immunosuppressive drugs (n = 75,760), adrenal cortical steroids (n = 47,539), anticoagulants (n = 26,546) and antibiotics (n = 22,144). The costs generated by patients in our study increased by 19.05% between 2001 and 2006.ConclusionsApproximately 1.69% of all acute hospital admissions were associated with ADRs. The rates were much higher for elderly patients. The total cost of ADR-related hospitalization to the Spanish health system is high and has increased between 2001 and 2006. ADRs are an important cause of admission, resulting in considerable use of national health system beds and a significant number of deaths.

Hospital admissions from birth to early adolescence and early-life risk factors: the 11-year follow-up of the 1993 Pelotas (Brazil) birth cohort study

The aim of this prospective analysis was to describe the cumulative incidence of hospital admissions in the first year of life and between 1 and 11 years of age and to explore associated factors. Hospital admissions were collected through regular monitoring in the first year of life, and through maternal report on admissions between 1 and 11 years. Analyses were stratified by sex and adjusted for confounding factors. 18.1% of children were hospitalized in the first year of life, and 30.7% between ages 1 and 11 years. Among boys, hospital admission in the first year was associated with low family income, paternal smoking during pregnancy, preterm delivery, and low birthweight. Among girls, in addition to the variables described for boys, black/mixed skin color was also a risk factor for hospital admission. For admissions between 1 and 11 years of age, low family income and gestational age > 37 weeks were found to be significant risk factors.

The HealthNuts population‐based study of paediatric food allergy: validity, safety and acceptability

The incidence of hospital admissions for food allergy-related anaphylaxis in Australia has increased, in line with world-wide trends. However, a valid measure of food allergy prevalence and risk factor data from a population-based study is still lacking. To describe the study design and methods used to recruit infants from a population for skin prick testing and oral food challenges, and the use of preliminary data to investigate the extent to which the study sample is representative of the target population. The study sampling frame design comprises 12-month-old infants presenting for routine scheduled vaccination at immunization clinics in Melbourne, Australia. We compared demographic features of participating families to population summary statistics from the Victorian Perinatal census database, and administered a survey to those non-responders who chose not to participate in the study. Study design proved acceptable to the community with good uptake (response rate 73.4%), with 2171 participants recruited. Demographic information on the study population mirrored the Victorian population with most the population parameters measured falling within our confidence intervals (CI). Use of a non-responder questionnaire revealed that a higher proportion of infants who declined to participate (non-responders) were already eating and tolerating peanuts, than those agreeing to participate (54.4%; 95% CI 50.8, 58.0 vs. 27.4%; 95% CI 25.5, 29.3 among participants). A high proportion of individuals approached in a community setting participated in a food allergy study. The study population differed from the eligible sample in relation to family history of allergy and prior consumption and peanut tolerance, providing some insights into the internal validity of the sample. The study exhibited external validity on general demographics to all births in Victoria.

Enfermedades afectivas y actividad solar: Seguimiento a 16 años

Exposure to solar activity may be associated with incidence of depressive and manic disorders. To assess the link between solar activity and appearance of affective disorders. We examined 1862 clinical records of a psychiatric clinic located in Santiago, Chile. Patients with major depression and manic disorders were included in the study, only when they were admitted at the clinic for the first time. Solar activity was calculated using the Wolf number, which is given by the formula R = K(10g+f), where "g" stands for the groups of sunspots and "f" is the total number of sunspots. We examined the correlation between annual incidence of hospital admissions and average Wolf numbers for the period 1990-2005, which corresponds to approximately one and half solar cycles of 16 years. A total of 450 medical records corresponding to 299 patients (199 women) with depressive symptoms and 151 patients (73 women) with mania, were analyzed. There was a higher number of admissions for depression during the years with lower solar activity. Admissions due to mania tended to increase in the years with high solar activity. There was a negative correlation between the number of hospital admissions due to depression and solar activity (Spearman r = -0.812, p < 0.01). The association between the latter parameter and admissions due to mania did not reach statistical significance. There is a significant negative association between the rate of hospital admissions due to depressive disorders and solar activity.

Impact of outdoor biomass air pollution on hypertension hospital admissions

BackgroundThis study aimed to evaluate the association between the total suspended particles (TSP) generated from burning sugar cane plantations and the incidence of hospital admissions from hypertension in the city...

In-hospital mortality in 13,263 survivors of out-of-hospital cardiac arrest in Canada

There is a substantial mortality rate in patients admitted alive after out-of-hospital cardiac arrest. The primary objective of our study was to examine trends in in-hospital survival in out-of-hospital cardiac arrest survivors in Canada between 1994 and 2004. The secondary objective was to examine predictors of in-hospital survival in these patients. Data on hospital admissions from April 1, 1994, to March 31, 2004, were obtained from the Health Person-oriented Information Database, maintained by Statistics Canada. We included all patients with a primary diagnosis of cardiac arrest who survived to hospital admission. We assessed survival to hospital discharge in all patients admitted alive. In Canada, 13,263 patients survived community arrest between 1994 and 2004. The annual incidence of hospital admission after out-of-hospital cardiac arrest decreased by 33%, from 5.37 per 100,000 in 1994 to 3.63 per 100,000 in 2004 (P < .0001 for trend). Subsequently, 5,045 patients (38.03%) survived to hospital discharge. The survival rate did not change during the duration of the study. Invasive coronary artery disease management was associated with a greatly increased chance of survival (odds ratio 21.98, 95% CI 17.62-27.42). Also male gender, heart failure, and acute myocardial ischemia were independent positive predictors of survival to hospital discharge; greater age and comorbidities were negative predictors of survival. Finally, there were significant interprovincial variations in survival rates. Our study, the largest of its kind, has 4 main findings. Firstly, between 1993 and 2004, there was a significant and steady decline in admission rates after community cardiac arrest. Second, there was no change in the in-hospital survival rates. Thirdly, invasive management of coronary artery disease was associated with a greatly improved chance of survival, and finally, there were important regional variations in survival rates.

A Comparison Of Toxicity And Mobilization Efficacy Following Two Different Doses Of Cyclophosphamide For Mobilization Of Hematopoietic Stem Cells In Non-Hodgkin's Lymphoma Patients

A Comparison Of Toxicity And Mobilization Efficacy Following Two Different Doses Of Cyclophosphamide For Mobilization Of Hematopoietic Stem Cells In Non-Hodgkin's Lymphoma Patients

Trends in acute non-variceal bleeding in Israel in 1996–2007: A significant decrease in the rates of bleeding peptic ulcers

Background A decrease in the incidence of hospital admissions for acute non-variceal upper GI bleeding (AUGIB) has been reported in regions with a low prevalence of Helicobacter pylori (HP) infection. Aim To investigate trends in hospital admissions for AUGIB in Israel, where the prevalence of HP infection is intermediate. Methods We have searched the National Hospital Discharge Database of the Israeli Ministry of Health, where all admissions to acute care hospitals for the period January 1, 1996 through December 31, 2007 are compiled. Using a validated strategy, we identified all admissions for AUGIB according to ICD-9-CM codes. Incidence rates were calculated and adjusted to reflect the age and gender distribution of the Israeli population. Results The overall rates of hospital admissions for AUGIB decreased significantly from 29.3 to 16.8 cases/10 5 population/year ( p < 0.0001). The decreases were similar in both genders. This decrease was due to decreased rates of bleeding from duodenal ulcers (from 13.6 to 5 cases/10 5 population/year) and gastric ulcers (from 4.3 to 2.4 cases/10 5 population/year). The rates of bleeding from other causes remained unchanged. The rates of surgical interventions bleeding control decreased significantly (overall from 11 to 4%). The in-hospital mortality rate varied between 7.6 and 7%, did not change significantly in both genders but increased significantly with age during the study period. Conclusions A decline in the overall incidence of AUGIB during the study period was due to a significant decrease in the rate of bleeding peptic ulcers.

A Comparison of Toxicity and Mobilization Efficacy Following Two Different Doses of Cyclophosphamide for Mobilization of Hematopoietic Stem Cells in Multiple Myeloma Patients.

Abstract 4229 BackgroundCyclophosphamide (Cy) (2-7 g/m2) has been shown to be an effective regimen for hematopoietic stem cell (HSC) mobilization in multiple myeloma (MM) patients undergoing autologous stem cell transplantation (ASCT). However, the optimal dose to be used, which maximizes HSC collection yields while minimizing febrile neutropenia and other toxicities, remains controversial. Two historical cohorts of MM patients who received G-CSF and Cy at dose of either 4g/m2 (Cy4) or 2g/m2 (Cy2) were compared. MethodsA total of 72 patients undergoing first mobilization with Cy and G-CSF at a single institution between June 2006 and December 2008 were retrospectively analyzed. The initial Cy4 patient cohort (n=35) was mobilized with Cy 4gm/m2 starting on Day 1 followed by G-CSF 10ug/kg/day starting on Day 7 and continuing until completion of apheresis. Beginning in Feb 2008, the Cy dose was reduced to 2gm/m2 and the G-CSF start date was moved to day 4 (Cy2 n=37). Apheresis was initiated at physician discretion based on patient specific factors. Minimal and optimal yield was defined as collection of ≥2 × 106 and ≥6-10 × 106 CD34+ cells/kg respectively. Prophylactic antibiotics were given for ANC <500 to reduce risk of febrile neutropenia. ResultsMinimal cell dose required for ASCT (≥2 × 106 CD34+ cells/kg) was achieved in 97% vs. 86.5% of Cy4 and Cy2 patients, respectively. Of the 5 patients failing to mobilize on Cy2, four of these subsequently mobilized adequately following G-CSF and plerixafor. Median number of apheresis collections required was significantly lower in the Cy4 patients (1 vs.3, p=0.0065). The proportion of patients collecting the minimal and optimal cell dose in 2 or fewer days of apheresis was 94% vs. 86.5% (p= 0.4304) and 77% vs. 35% (p=0.0004), in the Cy4 and Cy2 patients respectively. However, mobilization with Cy4 was associated with a significantly higher incidence of hospital admissions due to febrile neutropenia (40% vs. 5%, p=0.0005), which is what prompted the change from Cy4 to Cy2. ConclusionsAlthough Cy4 and Cy2 are both effective HSC mobilizing regimens, mobilization efficacy and toxicity vary greatly. Cy4 results in higher HSC yields requiring fewer apheresis procedures, but this benefit is offset by increased morbidity and hospital utilization. Based on the suboptimal results with Cy 4g/m2 and Cy 2g/m2 mobilization, newer mobilization strategies are clearly needed for MM patients. We are currently exploring a chemotherapy-free approach utilizing G-CSF +/- plerixafor, with the aim of optimizing HSC yields while minimizing toxicity and costs (apheresis collections, hospital utilization, etc.). In our current algorithm, all MM patients receive G-CSF at a dose of 10ug/kg/day, with a day 4 peripheral CD34+ cell count determining requirement for plerixafor on the evening prior to apheresis collection(s).Cy 4gm/m2 + G-CSF n=35Cy 2gm/m2 + G-CSF n=37P Value% of Patients who achieved ≥ 2 ×106 CD34+ cells/kg in ≤ 2 days94% (33/35)86.5% (32/37)P=0.4304% of Patients who achieved ≥ 6 × 106 CD34+cells/kg in ≤ 2 days77% (27/35)35% (13/37)P=0.0004% of Patients who failed to collect ≥ 2 × 106 CD34+ cells/kg2.8%(1/35)13.5% (5/37)P=0.1998% of Patients who failed to achieve ≥ 6 ×106 CD34+cells/kg17% (6/35)37.8% (14/37)P=0.0668Median (range) days of collection in all patients1 (1-6)3 (1-6)P=0.0065% Patients hospitalized for febrile neutropenia40% (14/35)5% (2/37)P=0.0005 Disclosures:Off Label Use: Cyclophosphamide is being used as off label use for hematopoietic stem cell mobilization.

Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries

AimsPatient access to reperfusion therapy and the use of primary percutaneous coronary intervention (p-PCI) or thrombolysis (TL) varies considerably between European countries. The aim of this study was to obtain a realistic contemporary picture of how patients with ST elevation myocardial infarction (STEMI) are treated in different European countries.Methods and resultsThe chairpersons of the national working groups/societies of interventional cardiology in European countries and selected experts known to be involved in the national registries joined the writing group upon invitation. Data were collected about the country and any existing national STEMI or PCI registries, about STEMI epidemiology, and treatment in each given country and about PCI and p-PCI centres and procedures in each country. Results from the national and/or regional registries in 30 countries were included in this analysis. The annual incidence of hospital admission for any acute myocardial infarction (AMI) varied between 90–312/100 thousand/year, the incidence of STEMI alone ranging from 44 to 142. Primary PCI was the dominant reperfusion strategy in 16 countries and TL in 8 countries. The use of a p-PCI strategy varied between 5 and 92% (of all STEMI patients) and the use of TL between 0 and 55%. Any reperfusion treatment (p-PCI or TL) was used in 37–93% of STEMI patients. Significantly less reperfusion therapy was used in those countries where TL was the dominant strategy. The number of p-PCI procedures per million per year varied among countries between 20 and 970. The mean population served by a single p-PCI centre varied between 0.3 and 7.4 million inhabitants. In those countries offering p-PCI services to the majority of their STEMI patients, this population varied between 0.3 and 1.1 million per centre. In-hospital mortality of all consecutive STEMI patients varied between 4.2 and 13.5%, for patients treated by TL between 3.5 and 14% and for patients treated by p-PCI between 2.7 and 8%. The time reported from symptom onset to the first medical contact (FMC) varied between 60 and 210 min, FMC-needle time for TL between 30 and 110 min, and FMC-balloon time for p-PCI between 60 and 177 min.ConclusionMost North, West, and Central European countries used p-PCI for the majority of their STEMI patients. The lack of organized p-PCI networks was associated with fewer patients overall receiving some form of reperfusion therapy.

Efficacy and safety of intermittent preventive treatment with sulfadoxine-pyrimethamine for malaria in African infants: a pooled analysis of six randomised, placebo-controlled trials

Intermittent preventive treatment (IPT) is a promising strategy for malaria control in infants. We undertook a pooled analysis of the safety and efficacy of IPT in infants (IPTi) with sulfadoxine-pyrimethamine in Africa. We pooled data from six double-blind, randomised, placebo-controlled trials (undertaken one each in Tanzania, Mozambique, and Gabon, and three in Ghana) that assessed the efficacy of IPTi with sulfadoxine-pyrimethamine. In all trials, IPTi or placebo was given to infants at the time of routine vaccinations delivered by WHO's Expanded Program on Immunization. Data from the trials for incidence of clinical malaria, risk of anaemia (packed-cell volume <25% or haemoglobin <80 g/L), and incidence of hospital admissions and adverse events in infants up to 12 months of age were reanalysed by use of standard outcome definitions and time periods. Analysis was by modified intention to treat, including all infants who received at least one dose of IPTi or placebo. The six trials provided data for 7930 infants (IPTi, n=3958; placebo, n=3972). IPTi had a protective efficacy of 30.3% (95% CI 19.8-39.4, p<0.0001) against clinical malaria, 21.3% (8.2-32.5, p=0.002) against the risk of anaemia, 38.1% (12.5-56.2, p=0.007) against hospital admissions associated with malaria parasitaemia, and 22.9% (10.0-34.0, p=0.001) against all-cause hospital admissions. There were 56 deaths in the IPTi group compared with 53 in the placebo group (rate ratio 1.05, 95% CI 0.72-1.54, p=0.79). One death, judged as possibly related to IPTi because it occurred 19 days after a treatment dose, was subsequently attributed to probable sepsis. Four of 676 non-fatal hospital admissions in the IPTi group were deemed related to study treatment compared with five of 860 in the placebo group. None of three serious dermatological adverse events in the IPTi group were judged related to study treatment compared with one of 13 in the placebo group. IPTi with sulfadoxine-pyrimethamine was safe and efficacious across a range of malaria transmission settings, suggesting that this intervention is a useful contribution to malaria control. Bill & Melinda Gates Foundation.

Hospitalizations because of Adverse Drug Reactions in Elderly Patients Admitted through the Emergency Department

Several studies have been conducted to determine the frequency and characteristics of adverse drug reactions (ADRs) in elderly populations, focusing on those leading to hospital admission. However, most of these studies have been limited in their ability to assess risk factors, particularly the renal status of patients. Thus, the aim of this prospective study was to assess the incidence of ADRs and associated factors leading to hospital admissions in the elderly population. All patients aged > or =65 years admitted to the Toulouse University Hospital through the Emergency Department during four non-consecutive weeks in 2002-3 were included in this study except for patients in ambulatory care or admitted for intentional overdoses. The characteristics of patients admitted for a suspected ADR were compared with those of patients admitted for other reasons. The incidence of hospital admissions for ADRs was 8.37 per 100 admissions (95% CI 6.52, 10.52), corresponding to 66 patients with ADRs among 789 admissions. The most important factors associated with ADRs were the number of drugs being taken (odds ratio [OR] 1.18; 95% CI 1.08, 1.29), self-medication (OR 2.34; 95% CI 1.18, 4.66), use of antithrombotics (Anatomic Therapeutic and Chemical [ATC] classification B01; OR 2.26; 95% CI 1.33, 3.88) and use of antibacterial drugs (ATC J01; OR 4.04; 95% CI 1.50, 10.83). Surprisingly, exposure to drugs for acid-related disorders was associated with a low risk of ADRs (OR 0.26; 95% CI 0.09, 0.76). A significant incidence of ADRs leading to hospital admissions was found among elderly people. Our study showed that there is a need to increase the availability of information for the general public concerning potential ADRs due to self-medication and for prescribers concerning ADRs due to drug-drug interactions and polypharmacy.

Alcohol Consumption in the Country and Hospitalizations for Acute Alcohol Pancreatitis and Liver Cirrhosis during a 20-Year Period

Between 1970 and 1989 the incidence of pancreatitis increased in Finland in association with increased alcohol consumption. During the1990s there was a temporary decrease in alcohol consumption. We examined the trends in the amount of alcohol consumed in Finland and the incidence of hospital admissions for acute alcoholic pancreatitis and liver cirrhosis. The data on hospital admissions and annual alcohol consumption between 1987 and 2007 were obtained from the Finnish National Agency for Welfare and Health. Alcohol consumption increased from 8.2 litres of ethanol per inhabitant per year in 1987 to 10.5 litres in 2007, but during the economic recession in the country there was a temporary decrease in alcohol consumption between 1992 and 1994, with the lowest consumption of 8.0 litres in 1994. The incidence of hospitalizations for acute alcoholic pancreatitis in the whole population increased significantly during the study period among both men (from 57 to 69/100,000/year) and women (from 7 to 12/100,000/year). However, there was a significant decrease in hospitalizations in 1996 and 1997 correlating with alcohol consumption three years earlier. The incidence of hospitalizations due to liver cirrhosis increased in the age groups over 45 years in both genders throughout the study period. A temporary decrease was observed in 1994, when alcohol consumption was at its lowest. Interestingly, there was a trend from pancreatitis to cirrhosis during the last six years, when the hospitalizations for acute pancreatitis decreased, although the hospitalizations for liver cirrhosis increased following increased alcohol consumption. During the study period the female-to-male ratio for liver cirrhosis was twice as high as for acute alcoholic pancreatitis, but the relative portion of females increased by 50% in both diagnoses. In contrast to liver cirrhosis, the hospital admissions for which followed the national alcohol consumption, admissions for acute alcoholic pancreatitis ceased to show a connection with the national alcohol consumption during the past several years.