Significant Increase In Hospital Admissions Research Articles

Effect of heatwaves on daily hospital admissions in Portugal, 2000–18: an observational study

Climate change has increased the frequency, intensity, and duration of heatwaves, posing a serious threat to public health. Although the link between high temperatures and premature mortality has been extensively studied, the comprehensive quantification of heatwave effects on morbidity remains underexplored. In this observational study, we assessed the relationship between heatwaves and daily hospital admissions at a county level in Portugal. We considered all major diagnostic categories and age groups (<18 years, 18-64 years, and ≥65 years), over a 19-year period from 2000 to 2018, during the extended summer season, defined as May 1, to Sept 30. We did a comprehensive geospatial analysis, integrating over 12 million hospital admission records with heatwave events indexed by the Excess Heat Factor (EHF), covering all 278 mainland counties. We obtained data from the Hospital Morbidity Database and E-OBS daily gridded meteorological data for Europe from 1950 to present derived from in-situ observations. To estimate the effect of heatwaves on hospital admissions, we applied negative binomial regression models at both national and county levels. We found a statistically significant overall increase in daily hospital admissions during heatwave days (incidence rate ratio 1·189 [95% CI 1·179-1·198]; p<0·0001). All age groups were affected, with children younger than 18 years being the most affected (21·7% [20·6-22·7] increase in admissions; p<0·0001), followed by the working-age (19·7% [18·7-20·7]; p<0·0001) and elderly individuals (17·2% [16·2-18·2]; p<0·0001). All 25 major disease diagnostic categories showed significant increases in hospital admissions, particularly burns (34·3% [28·7-40·1]; p<0·0001), multiple significant trauma (26·8% [22·2-31·6]; p<0·0001), and infectious and parasitic diseases (25·4% [23·5-27·3]; p<0·0001). We also found notable increases in endocrine, nutritional, and metabolic diseases (25·1% [23·4-26·8]; p<0·0001), mental diseases and disorders (23·0% [21·1-24·8]; p<0·0001), respiratory diseases (22·4% [21·2-23·6]; p<0·0001), and circulatory system disorders (15·8% [14·7-16·9]; p<0·0001). Our results provide statistically significant evidence of the association between heatwaves and increased hospitalisations across all age groups and for all major causes of disease. To our knowledge, this is the first study to estimate the full extent of heatwaves' impact on hospitalisations using the EHF index over a 19-year period, encompassing an entire country, and spanning 25 disease categories during multiple heatwave events. Our data offer crucial information to guide policy makers in effectively and efficiently allocating resources to address the profound health-care consequences resulting from climate change. None.

The relationship between hot temperatures and hospital admissions for psychosis in adults diagnosed with schizophrenia: A case-crossover study in Quebec, Canada

IntroductionSome studies have found hot temperatures to be associated with exacerbations of schizophrenia, namely psychoses. As climate changes faster in Northern countries, our understanding of the association between temperature and hospital admissions (HA) for psychosis needs to be deepened. Objectives1) Among adults diagnosed with schizophrenia, measure the relationship between mean temperatures and HAs for psychosis during summer. 2) Determine the influence of individual and ecological characteristics on this relationship. MethodsA cohort of adults diagnosed with schizophrenia (n = 30,649) was assembled using Quebec's Integrated Chronic Disease Surveillance System (QICDSS). The follow-up spanned summers from 2001 to 2019, using hospital data from the QICDSS and meteorological data from the National Aeronautics and Space Administration's (NASA) Daymet database. In four geographic regions of the province of Quebec, a conditional logistic regression was used for the case-crossover analysis of the relationship between mean temperatures (at lags up to 6 days) and HAs for psychosis using a distributed lag non-linear model (DLNM). The analyses were adjusted for relative humidity, stratified according to individual (age, sex, and comorbidities) and ecological (material and social deprivation index and exposure to green space) factors, and then pooled through a meta-regression. ResultsThe statistical analyses revealed a statistically significant increase in HAs three days (lag 3) after elevated mean temperatures corresponding to the 90th percentile relative to a minimum morbidity temperature (MMT) (OR 1.040; 95% CI 1.008–1.074), while the cumulative effect over six days was not statistically significant (OR 1.052; 95% IC 0.993–1.114). Stratified analyses revealed non statistically significant gradients of increasing HAs relative to increasing material deprivation and decreasing green space levels. ConclusionsThe statistical analyses conducted in this project showed the pattern of admissions for psychosis after hot days. This finding could be useful to better plan health services in a rapidly changing climate.

Hospital admissions due to suicide attempts during the COVID-19 pandemic, a 3-year longitudinal study

The appearance of the SARS CoV-2 virus and the associated COVID-19 pandemic has been associated with the onset of mental disorders in healthy people and the worsening in those with pre-existing mental conditions. One of the areas that has raised the greatest concern is that of suicidality. Most of the published studies have been carried out cross-sectional or with small samples, without stratifying by age and gender. Thus, the aim of this longitudinal research is to study, in a large population sample of around 6,700,000 inhabitants belonging to the entire region of Madrid (Spain), the admissions in psychiatric hospitalization units due to suicidal attempts along 2019, 2020 and 2021. No clear increase in the number of admissions due to suicidality in the total population have been found. In addition, a higher prevalence in admissions among women is verified. Moreover, stratifying by age and gender, a striking and significant increase in hospital admissions due to suicidality has been observed in the group up to 17 years old, from September 2020 until the end of the study. These results highlight the special vulnerability of children and adolescents, specifically girls, and the need for preventive measures in the face of future pandemics.

Case-crossover study for the association between increased hospital admissions for respiratory diseases and the increase in atmospheric PM2.5 and PM2.5-bound trace elements in Pretoria, South Africa

ABSTRACT Outdoor PM2.5 was sampled in Pretoria, 18 April 2017 to 28 February 2020. A case-crossover epidemiology study was associated for increased PM2.5 and trace elements with increased hospital admissions for respiratory disorders (J00-J99). The results included a significant increase in hospital admissions, with total PM2.5 of 2.7% (95% CI: 0.6, 4.9) per 10 µg·m−3 increase. For the trace elements, Ca of 4.0% (95% CI: 1.4%−6.8%), Cl of 0.7% (95% CI: 0.0%−1.4%), Fe of 3.3% (95% CI: 0.5%−6.1%), K of 1.8% (95% CI: 0.2–3.5) and Si of 1.3% (95% CI: 0.1%−2.5%). When controlling for PM2.5, only Ca of 3.2% (95% CI: 0.3, 6.1) and within the 0–14 age group by 5.2% (95% CI: 1.5, 9.1). Controlling for a co-pollutant that is highly correlated with PM2.5 does reduce overestimation, but further studies should include deposition rates and parallel sampling analysis.

PD34-10 IMPACT OF SEPSIS ON ADMISSIONS, RE ADMISSIONS AND MORTALITY FOLLOWING URETEROSCOPY

You have accessJournal of UrologyCME1 Apr 2023PD34-10 IMPACT OF SEPSIS ON ADMISSIONS, RE ADMISSIONS AND MORTALITY FOLLOWING URETEROSCOPY Naeem Bhojani, Brian Eisner, Rutugandha Paranjpe, Benjamin Cutone, Manoj Monga, and Ben H. Chew Naeem BhojaniNaeem Bhojani More articles by this author , Brian EisnerBrian Eisner More articles by this author , Rutugandha ParanjpeRutugandha Paranjpe More articles by this author , Benjamin CutoneBenjamin Cutone More articles by this author , Manoj MongaManoj Monga More articles by this author , and Ben H. ChewBen H. Chew More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003327.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Post-ureteroscopy sepsis is a morbid condition that requires significant healthcare utilization. We investigated all-cause inpatient mortality, rates of intensive care unit (ICU) and inpatient admissions and readmissions. We also examine the yearly trends in sepsis and inpatient mortality in patients undergoing ureteroscopy (URS) in the United States (US). METHODS: Retrospective analyses were conducted using the IBM MarketScan Database to identify patients ≥18 years who underwent URS. Three cohorts were analyzed: non-sepsis (control), non-severe sepsis, and severe sepsis (sepsis + organ dysfunction). All-cause inpatient mortality and healthcare utilization including ICU admissions, inpatient admissions and readmissions were reported. Annual trends for sepsis events and inpatient mortality post-URS were examined from 2015-2019. RESULTS: 109,496 URS patients were identified. 5.6% developed sepsis within 30 days of URS. Of the 5.6%, 4.1% developed non-severe sepsis and 1.5% developed severe sepsis. The 30-day all-cause inpatient mortality for the non-sepsis, non-severe sepsis and severe sepsis cohorts was 0.03%, 0.27% and 2.5%, respectively (p<0.001). Severe sepsis substantially increased the risk of 30-day all-cause inpatient mortality compared to patients who did not develop sepsis (HR: 49.5; 95% CI: 28.9-84.7; p<0.001). ICU admission rates were 1.5%, 19.8% 52.4% for the non-sepsis, non-severe sepsis, and severe sepsis cohorts, respectively (p<0.001). Inpatient admissions were 18.3%, 74.9%, and 76.9% (p<0.001), while readmissions were 7.1%, 12.0%, and 15.9% (p<0.001), for the non-sepsis, non-severe sepsis, and severe sepsis cohorts, respectively. From 2015 to 2019, the annual prevalence of sepsis post URS increased significantly yearly from 4.7%, 5.1%, 5.7%, 6.0%, to 6.6% (p<0.001), however the rate of inpatient mortality remained stable (Figure 1). CONCLUSIONS: Sepsis post-URS significantly increases the risk of 30-day all cause inpatient mortality and leads to a significant increase in hospital admissions, ICU admissions, and readmissions. Over the 5-year study period, the prevalence of sepsis post-URS increased by 40%. Urologists should be aware of the increasing prevalence of this potentially deadly post-operative complication. Source of Funding: Boston Scientific © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e924 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Naeem Bhojani More articles by this author Brian Eisner More articles by this author Rutugandha Paranjpe More articles by this author Benjamin Cutone More articles by this author Manoj Monga More articles by this author Ben H. Chew More articles by this author Expand All Advertisement PDF downloadLoading ...

318: NONALCOHOLIC FATTY LIVER DISEASE ASSOCIATION WITH HOSPITAL AND ICU ADMISSION IN COVID-19

Introduction: Association between non-alcoholic fatty liver disease (NAFLD) and metabolic-associated fatty liver disease (MAFLD) with COVID-19 is still an ongoing debate. We aimed to conduct a systematic review and meta-analysis investigating the impact of NAFLD/ MAFLD on the duration of ICU and hospital stay in COVID-19 patients. Methods: A systematic review of literature from January 2019- to June 2022 on databases PubMed, Cochrane, Embase, Science Direct, and Web of science was conducted. Observational studies or clinical trials were included. Studies that assessed NAFLD/ MAFLD using lab assessment, non-invasive imaging, or liver biopsy were included. The protocol of the study was registered in Prospero and Prisma guidelines were followed (Figure 1). The meta-analysis was performed using Revman software. Mantel-Haenszel odds ratio was generated to describe the overall effect size using random effect models. Results: ICU Admission A total of 37,109 patients from fifteen studies were included in the qualitative analysis. A total of 5624 patients were in the NAFLD group and 31,485 patients were in the Non-NAFLD group, where 3148 patients with COVID-19 required ICU admission. Out of these, 1098 (19.5%) were in the NAFLD group and 2050 (6.5%) in the Non-NAFLD group. We observed a significantly increased ICU admission among COVID-19 patients with NAFLD compared to those without NAFLD (OR 1.67, 95%CI 1.02-2.72, p-value= 0.04). (Figure 2). Hospital Admission A total of 27,683 patients from three studies were included in the qualitative analysis. A total of 1128 patients in the NAFLD group and 26,555 patients in the Non-NAFLD group, where 4019 patients with COVID-19 required hospital admission. Out of these, 518 (45.9%) were in the NAFLD group and 3501(13.1%) in the Non-NAFLD group. We observed a significant increase in hospital admissions among COVID-19 patients with NAFLD compared to those without NAFLD (OR 2.71, 95%CI 1.10-6.70, p-Value=0.03). Conclusions: The NAFLD patients may have increased ICU and hospital admission compared to Non-NAFLD Patients. Fatty liver disease has an association with increased healthcare admission and critical care service utilization among COVID-19 patients.

Trends in Thoracic Aortic Aneurysm Hospital Admissions, Interventions, and Mortality in England between 1998 and 2020: An Observational Study

To assess trends in thoracic aortic aneurysm (TAA) hospital admissions, interventions, and aneurysm related mortality (ARM) in England, and examine the impact of endovascular repair on mortality for the years 1998 to 2020. Hospital admission and operative approach (thoracic endovascular aortic repair, [TEVAR] or open surgical repair) using Hospital Episodes Statistics, and ARM data from the Office for National Statistics for England standardised to the 2013 European Standard Population were analysed using linear regression and Joinpoint regression analyses. ARM was compared between the pre-endovascular era (1998 - 2008) and the endovascular era (2009 - 2019). A rising trend in hospital admission incidence has been observed, mainly due non-ruptured admissions (4.11 per 100 000 in 1998; 95% confidence interval (CI) 3.71 - 4.50 to 12.61 per 100 000 in 2020; 95% CI 12.00 - 13.21 in 2020; r2= .98; p < .001). Operative interventions increased mainly due to an increase in TEVAR (2.15 per 100 000; 95% CI 1.91 - 2.41 in 2020 vs. 0.26 per 100 000; 95% CI 0.16 - 0.36 in 2006; r2= .90; p < .001). Reductions in ARM from TAA were observed for males and females, irrespective of age and rupture status. The greatest reduction in ARM in the endovascular era was observed in females aged > 80 years with ruptured disease (15.26 deaths per 100 000 vs. 9.50 deaths per 100 000; p < .001). A significant increase in hospital admissions for non-ruptured TAA has been observed in the last 23 years in England, paralleled by a shift towards endovascular repair, and significant declining trends in ARM, irrespective of sex and age. The significant reductions in age standardised death rates from ruptured and non-ruptured TAA in the endovascular era, particularly for females aged > 80 years with ruptured disease, affirm the positive impact of an endovascular approach to TAA.

Impact of the earthquake during COVID-19 lockdown on fracture admission at a tertiary trauma centre in Croatia

PurposeTo determine the impact of an earthquake during COVID-19 lockdown on fracture admission at a tertiary trauma centre in Croatia. MethodsA case-control study was performed at the tertiary trauma centre registry. Two different periods were studied. The case group included a period during COVID-19 lockdown right after the earthquakes until the end of the confinement period in Croatia. And the control group corresponded to the equivalent period in 2019. We identified all consecutive patients who were admitted due to urgent care requirements for the musculoskeletal trauma. Patient's demographic data and admitting diagnoses were assessed. Data were analyzed by statistical procedures using the program MedCalc statistical software version 16.4.3. ResultsWe identified 178 emergency admissions due to musculoskeletal trauma. During the COVID-19 lockdown and post-earthquake period, there was a drastic reduction in total admissions (359 vs. 662; p < 0.0001) with an increased proportion of trauma admissions within the emergency admissions (34.9% vs. 26.5%; p = 0.02926, Z = −2.1825). Furthermore, in the case group there was a significant increase in hospital admissions due to ankle/foot trauma (11 vs. 2, p = 0.0126) and a trend towards a decrease in the admissions due to tibia fractures (5 vs. 12, p = 0.0896), however without statistical significance. Also, an increased proportion of women within the group of femoral fractures in both case group (81.6% vs. 52.6%, p = 0.00194, Z = 3.1033) and the control group (82.3% vs. 60.5%, p = 0.0232, Z = 2.2742) was observed. In both analyzed periods, the osteoporotic hip fracture was the most common independent admitting diagnosis. ConclusionIt is crucial to understand how natural disasters like earthquakes influence the pattern of trauma admissions during a coexisting pandemic. Accordingly, healthcare systems have to be prepared for an increased influx of certain pathology, like foot and ankle trauma.

Perception of food allergy among mothers of allergic children in Southwestern Saudi Arabia

Background: Food allergy (FA) is increasingly recognized with the highest prevalence in preschool children; there has been a significant increase in hospital admissions for systemic allergic diseases with anaphylaxis and food allergies. Hospital admissions for food allergy were noticed to rise from 6 to 41 per million between 1990 and 2000 worldwide . The prevalence of food allergy is increasing over time with significant geographic variations. It is estimated to affect 6% of children in the United States (USA); according to a study conducted in Makkah, by AL Mokarmah, the prevalence of FA among children attending the well-baby clinic was 22.5% and in Riyadh is 6% among children who visit the allergy clinic at King Khalid University Hospital. FA in children is usually caused by milk (2.5%), egg (1.3%), peanut (0.8%), tree nuts (0.2%), fish (0.1%), as well as shellfish (0.1%), with an overall prevalence of 6%. Methods: In this cross-sectional study, a self-administered questionnaire was used in the data collection. After data were collected, they were entered in the Statistical Software IBM SPSS version 22. Descriptive and inferential statistics were obtained. Results: Out of 980 mothers, 49% were suffering from food allergy, while 28.6% of their children were suffering from food allergy. Shellfish was the most common cause of food allergy (38%). Conclusion: The management of FA in children is improving through the acquisition of new knowledge in diagnosis and treatment. Education of physicians and food-allergic patients about FA and its treatment is becoming recognized as an unmet need. Key words: Food allergy, mother, children, knowledge, prevalence, factors

Acute effects of air pollution on hospital admissions for asthma COPD and bronchiectasis in Ahvaz Iran

Acute effects of air pollution on hospital admissions for asthma, COPD and bronchiectasis in Ahvaz, IranAbstractBackground and Aim: Although, air pollution is a serious problem in Ahvaz, the association between air pollution and respiratory diseases has not been studied enough in this area. The aim of this study was to determine the relation between short-term exposure to air pollutants and the risk of hospital admissions due to asthma, COPD and bronchiectasis in Ahvaz.Methods: Hospital admissions data and air pollutants including O3, NO, NO2, SO2, CO, PM10 and PM2.5 were obtained from 2008 to 2018. Adjusted Quasi-Poisson regression with a distributed lag model, controlled for trend, seasonality, weather, weekdays and holidays was used for data analysis.Results: The results showed a significant increase in hospital admissions for asthma (RR=1.004, 95% CI: 1.002-1.007) and COPD (RR=1.003, 95% CI: 1.001-1.005) associated with PM2.5. PM10 was associated with increased hospital admissions due to bronchiectasis in both genders (Men: RR=1.003, 95% CI: 1.001-1.006), (Female: RR=1.003, 95% CI: 1.000-1.006). NO2 was also associated with an increased risk of hospital admissions for asthma (RR=1.040, 95% CI: 1.008-1.074) and COPD (RR=1.049, 95% CI: 1.010-1.090). SO2 was associated with the risk of hospital admissions of asthma (RR=1.069, 95% CI: 1.017-1.124) and bronchiectasis (RR=1.030, 95% CI: 1.005-1.056). Finally, CO was associated with COPD (RR=1.643, 95% CI: 1.233-2.191) and bronchiectasis (RR=1.542, 95% CI: 1.035-2.298) hospital admissions.Conclusion: Short-term exposure to air pollutants significantly increases the risk of hospital admissions for asthma, COPD and bronchiectasis in the adult and elderly population.Keywords: Air pollution; particulate matter; Asthma; COPD; Bronchiectasis

Air pollution and hospital admissions due to deep vein thrombosis (DVT) in Ahvaz, Iran

There are limited studies on the relation between short-term exposure to air pollutants and the risk of deep venous thrombosis (DVT). The aim of this study was to determine the relation between the concentration of these pollutants and the risk of hospital admissions due to DVT in Ahvaz, which is one of the world's highly polluted cities. Daily data on pollutants including O3, NO, NO2, SO2, CO, PM10, and PM2.5and DVT hospital admissions were collected from2008until 2018. Quasi-Poisson regression combined with linear distributed lag models; adjusted for trend, seasonality, temperature, relative humidity, weekdays, and holidays were used to assess the relation between the daily average of air pollutants and hospital admission for DVT. The results showed that there was a significant increase in hospital admissions due to DVT in the total, men, women, and elderly populations in relation to NO and NO2. There was also a significant increase in DVT hospital admissions in the male and ≤60 years populations related to PM10; and among the female and ≤60 years old populations, related to PM2.5. Finally, the results showed that there were significant positive associations between SO2 and CO exposure and the incidence of DVT hospital admissions among men and women, respectively. The results of this study show the possible effect of short-term exposure to air pollution on the risk of DVT. Further studies are required to investigate whether direct interventions through industry and government policy may alter the impact of specific pollutants in order to alter the incidence of DVT and other identified health complications.

Hepatitis C-related cirrhosis will be a marginal cause of hospital admissions by 2025

Complications of cirrhosis are the main cause of hospital admissions in liver units. In areas where HCV is prevalent, most of these admissions are attributable to HCV-related cirrhosis (HCV-cirrhosis). This study assessed the impact of direct-acting antivirals (DAA) in the profile of patients with liver disease admitted to a referral liver unit from a university hospital. We registered hospital admissions resulting from cirrhosis to the Liver Unit of the Hospital Clinic of Barcelona, from 2011 to 2014 (pre-DAA period) and from 2015 to 2019 (post-DAA period). From a total of 14,865 hospital admissions, 10,053 resulted from cirrhosis (corresponding to 6,272 patients). The number and proportion of hospital admissions because of HCV-cirrhosis remained stable during the period 2011-2014 (525 per year, 48.8% of the total), but decreased progressively after 2015 (p <0.001), reaching <300 (27.1%) admissions in 2019. Similarly, HCV-cirrhosis accounted for 3,885 inpatient days per year (44.9%) during the pre-DAA period and decreased steadily after 2015 (p >0.001), reaching only 1,909 inpatient days (22%) in 2019. The figures for intensive care unit admissions followed a similar pattern. By means of a slope analysis (binomial regression model), we predicted that HCV-cirrhosis hospital admissions will be residual by 2025 (2.3%, 95% CI 0-10.9%). By contrast, we observed a significant increase in hospital admissions because of metabolic-associated fatty liver disease (5-fold) and autoimmune hepatitis (4-fold) during the study period. In summary, our data showed a profound reduction in HCV-cirrhosis hospitalisation burden since 2015, coincident with the wide use of DAAs in Spain. Our predictions suggest that, by 2025, HCV-cirrhosis will be a marginal cause of hospital admissions for patients with liver disease. Over the past few years, the wide use of antiviral drugs that cure HCV has had a significant effect on patients being admitted to hospital. Most patients with HCV and cirrhosis are treated (and often cured) in the community and, thus, the number of hospital admissions because of severe forms of HCV has decreased drastically. HCV is no longer the first cause of admission into liver units and, in only a few years from now, it is likely to be only a residual cause of hospitalisation.

How To Maximize Trainee Education During the Coronavirus Disease-2019 Pandemic: Perspectives From Around the World

How To Maximize Trainee Education During the Coronavirus Disease-2019 Pandemic: Perspectives From Around the World

Acute Effects of Air Pollution on Hospital Admissions for Asthma, COPD, and Bronchiectasis in Ahvaz, Iran.

Background and AimAlthough air pollution is a serious problem in Ahvaz, the association between air pollution and respiratory diseases has not been studied enough in this area. The aim of this study was to determine the relation between short-term exposure to air pollutants and the risk of hospital admissions due to asthma, COPD, and bronchiectasis in Ahvaz.MethodsHospital admissions data and air pollutants including O3, NO, NO2, SO2, CO, PM10, and PM2.5 were obtained from 2008 to 2018. Adjusted Quasi-Poisson regression with a distributed lag model, controlled for trend, seasonality, weather, weekdays, and holidays was used for data analysis.ResultsThe results showed a significant increase in hospital admissions for asthma (RR=1.004, 95% CI: 1.002–1.007) and COPD (RR=1.003, 95% CI: 1.001–1.005) associated with PM2.5. PM10 was associated with increased hospital admissions due to bronchiectasis in both genders (Men: RR=1.003, 95% CI: 1.001–1.006) (Female: RR=1.003, 95% CI: 1.000–1.006). NO2 was also associated with an increased risk of hospital admissions for asthma (RR=1.040, 95% CI: 1.008–1.074) and COPD (RR=1.049, 95% CI: 1.010–1.090). SO2 was associated with the risk of hospital admissions of asthma (RR=1.069, 95% CI: 1.017–1.124) and bronchiectasis (RR=1.030, 95% CI: 1.005–1.056). Finally, CO was associated with COPD (RR=1.643, 95% CI: 1.233–2.191) and bronchiectasis (RR=1.542, 95% CI: 1.035–2.298) hospital admissions.ConclusionShort-term exposure to air pollutants significantly increases the risk of hospital admissions for asthma, COPD, and bronchiectasis in the adult and elderly population.

Trends in adult asthma hospitalization: gender-age effect

&#x0D; &#x0D; &#x0D; Background: Hospital admissions due to asthma are a reliable source of information on the morbidity of the disease which, after the increase observed in the last quarter of the last centu- ry, shows a declining trend in the last few years. The aim of this study was to look at hospital admission trends due to asthma in our community and analyze some of its associated factors.&#x0D; Methods: Retrospective analysis of all hospital admissions involving adults aged 15 years and older with asthma as the primary or secondary diagnosis (if the first diagnosis was res- piratory failure or respiratory infection) in Public Health Service hospitals in the Galician region of Spain between the years 1995-2009 (total 24,766 admissions).&#x0D; Results: The majority of patients admitted were female (71%), over 60 years of age (64%), and admission occurred predomi- nantly in the winter months. The hospitalization rate due to asthma tripled over the period studied, this being mainly accounted for by women aged over 60 years. Mean hospital stay was 9.2 days, longer in older patients or those admitted over the weekend.&#x0D; Conclusions: A significant increase in hospital admissions due to asthma over the last few years has been observed in our community, mainly involving older women. The mean stay seems long, increasing with patients’ age and admission over the weekend.&#x0D; &#x0D; &#x0D;

Cerebral ischemic attack, epilepsy and hospital admitted patients with types of headaches attributed to PM10 mass concentration in Abadan, Iran

Abstract Air pollution related damage to the Central Nervous System (CNS) has been widely neglected in studies of air pollution and adverse health outcomes. The aim of this study was to evaluate hospital admissions in Abadan, Iran for several neurological diseases including cerebral ischemic attack, epilepsy, and various types of headache on days with polluted air compared with clean days. Abadan is a city in Khuzestan Province that is located in southwestern Iran and experiences many sand and dust storms. The sampling station was located on the roof of the Department of Environment (DoE) in Abadan. Sampling was conducted over four years (from March 2012 to July 2016). Hospital admissions of patients with cerebral ischemic attack, epilepsy, and headache types from March 2012 to July 2016 were obtained from the Hospital Information System (HIS). This study showed that hospital admissions for patients with cerebral ischemic attack, epilepsy, and patients with types of headaches on dusty days increased significantly compared to hospital admissions on clean days. Also hospital admissions of these patients significantly increased with increased concentrations of coarse particulate matter (PM10). Ambient PM10 concentrations in Abadan were relatively high. Significant increases in hospital admissions in this study were related to high PM10 concentrations. Elderly and women were susceptible subpopulations showing more sensitivity to dust compared with the rest of the population. Staying indoors and using facial respirators under these emergency conditions could be effective in protecting these sensitive subjects against dust.

Air pollution and hospital admissions for cardiovascular diseases in Ahvaz, Iran

Cardiovascular disease is one of the main causes of death in Iran. The aim of this study was to determine the relation between air pollution and cardiovascular hospital admissions in Ahwaz, Iran. Daily information about cardiovascular hospital admissions (based on the ICD-10) and data on air pollutants during 2008–2018 were inquired. A quasi-Poisson regression combined with linear distributed lag models; adjusted for trend, seasonality, temperature, relative humidity, weekdays and holidays was used to assess the relation between hospital admission for cardiovascular diseases and the average daily air pollution. The results of this study showed a significant increase in cardiovascular hospital admissions in the total population and women's population in relation to O3. There was a significant increase in hospital admissions for cardiovascular diseases in the whole population as well as gender and age groups associated with NO2 and NO. A significant increase was found in hospital admissions for cardiovascular diseases in relation to CO in the 65–74-year-old population. Finally, the results of this study showed that there was a significant increase in hospital admissions for cardiovascular disease associated with SO2. The main results of the present study confirm the deleterious short term impact of air pollution on cardiovascular morbidity in Ahvaz city. This evidence empasizes the need to implement policies for reducing air pollution.

A Statistical Analysis of the Relationship between Brown Haze and Surface Air Pollution Levels on Respiratory Hospital Admissions in Auckland, New Zealand

Eleven years of hospital admissions data for Auckland, New Zealand for respiratory conditions are analyzed using a Poisson regression modelling approach, incorporating a spline function to represent time, based on a detailed record of haze events and surface air pollution levels over an eleven-year period, taking into account the daily average temperature and humidity, the day of the week, holidays and trends over time. NO2 was the only pollutant to show a statistically significant increase (p = 0.009) on the day of the haze event for the general population. Ambient concentrations of CO, NO and NO2 were significantly associated with admissions with an 11-day lag period for the 0–14 year age group and a 5–7 day lag period for the 65+ year age group. A 3-day lag period was found for the 15–64 year age group for CO, NO and PM10. Finally, the incidence of brown haze was linked to significant increases in hospital admissions. A lag period of 5 days was recorded between haze and subsequent increases in admissions for the 0–14 year age group and the 65+ group and an 11-day lag for the 15–64 year age group. The results provide the first statistical link between Auckland brown haze events, surface air pollution and respiratory health. Medical institutions and practitioners could benefit from improved capacity to predict Auckland’s brown haze events in order prepare for the likely increases in respiratory admissions over the days ahead.

Operationsindikation der Sigmadivertikulitis in Deutschland: Sind alle Operationen gerechtfertigt?

Pathological changes of preexisting sigma diverticulosis into a state of sigma diverticulitis are possible. Treatment of sigma diverticulitis accounts for a significant proportion of emergency treatments in clinics. The number of patients treated for sigma diverticulitis has risen steadily in recent years. Although it can be observed that operated cases making 7 % compared with 14 % to all stationary admissions, there is a less marked increase. Nevertheless, the question should be clarified as to how high the proportion of complicated surgical cases is in relation to non-complicated cases. It is important to clarify, in this context, if each operation is justified or whether in some cases there is over-treatment. All data relating to Germany, were prospectively collected by the treating hospitals using the DRG and evaluated by the Federal Statistical Office. The treatment numbers from Erlangen were prospectively collected from the encrypted DRG and analysed retrospectively by the coding officer. The investigated period lasted from 2005 to 2010. To demonstrate some treatment options, the following possible forms of therapy were examined with reference to the Hansen/Stock classification. In Germany, about 40 % of stationary patients with sigma diverticulitis are treated surgically. It is striking that in about two thirds of all operated patients uncomplicated forms of diverticulitis were present. The remainder consisted of covered or free perforations. For these complicated forms, various treatment approaches have been established. Ultimately, in dependence of timing these are always surgically treated. In the milder forms the general indication for surgery has come into discussion as the recommendation for a surgical approach after the second relapse in the symptom-free interval is being questioned by several groups based on the age of the studies on which the recommendations are based. A significant increase in hospital admissions and surgically treated patients is demonstrated. Striking was that a closer analysis of data revealed that mainly non-complicated cases were surgically treated. This should be seen as a clear indication for an over-treatment. Therefore, possibly not all surgeries performed are justified. In the case of complicated forms, in consideration of various treatment paths, surgery is inevitable in most cases.

Patient Turnover and Nursing Employment in Massachusetts Hospitals Before and After Health Insurance Reform: Implications for the Patient Protection and Affordable Care Act

The Affordable Care Act is modeled after Massachusetts insurance reforms enacted in 2006. A linear mixed effect model examined trends in patient turnover and nurse employment in Massachusetts, New York, and California nonfederal hospitals from 2000 to 2011. The linear mixed effect analysis found that the rate of increase in hospital admissions was significantly higher in Massachusetts hospitals (p<.001) than that in California and New York (p=.007). The rate of change in registered nurses full-time equivalent hours per patient day was significantly less (p=.02) in Massachusetts than that in California and was not different from zero. The rate of change in admissions to registered nurses full-time equivalent hours per patient day was significantly greater in Massachusetts than California (p=.001) and New York (p<.01). Nurse staffing remained flat in Massachusetts, despite a significant increase in hospital admissions. The implications of the findings for nurse employment and hospital utilization following the implementation of national health insurance reform are discussed.