Seeking Hospital Care Research Articles

Request of hospital care dropped for TIA but remained stable for stroke during COVID-19 pandemic at a large Italian university hospital

Reduced incidence of stroke during COVID-19 pandemic was sometimes reported. While decrease in stroke incidence and fear of patients to go to the hospitals were sometimes invoked to explain this decrease, reduction in urban pollution was also hypothesized as a possible cause. We investigated statistically the incidence of ischemic and hemorrhagic stroke, and of transient ischemic attacks, at a large Italian tertiary stroke center during the pandemic. We analyzed statistically the number of transient ischemic attacks (TIA), ischemic strokes (IS) and hemorrhagic strokes (HS) between March 8 and May 2, 2020, the peak of the COVID-19 epidemic in Italy, and compared them with the identical period of 2019. We also analyzed the concentration of small particulate matter (PM10) in 2019 and 2020, to see if it could account for modified incidence of strokes or TIA. We found a large, significant drop in TIA (− 51%) during the pandemic compared to the same period of 2019. By contrast, the number of HS was identical, and IS showed a not significant − 24% decrease. PM10 concentration, already low in 2019, did not further decrease in 2020. Patients kept seeking hospital care when experiencing permanent neurological symptoms (stroke), but they tended not go to the hospital when their symptoms were transient (TIA). The fact that we did not observe a significant decrease in strokes may be explained by the fact that in our city the concentration of small particulate matter did not change compared to 2019.

Análise da ocorrência de acidentes envolvendo animais peçonhentos no Município de Caxias, estado do Maranhão, Brasil

O presente artigo teve como objetivo determinar a prevalência de acidentes envolvendo animais peçonhentos no município de Caxias-MA no período de 2016 a 2019. Trata-se de um estudo descritivo, documental, retrospectivo, com abordagem quantitativa, realizado no período de 2016 a 2019, tendo como universo de dados notificações de acidentes com animais peçonhentos no município de Caxias- MA. Os dados foram coletados por meio do sistema de informação de agravos e notificação (SINAN) disponibilizados pelo Ministério da Saúde. Quanto aos resultados, estudo avaliou 997 casos notificados de acidentes envolvendo animais peçonhentos no município de Caxias-MA, no período de 2016 a 2019, quanto ao perfil dos indivíduos identificados houve prevalência do sexo masculino (55,97%), faixa etária de 20 a 59 anos (59,88%), escolaridade dos acidentados era de ensino fundamental incompleto (37,41%), a maioria eram pardos (92,38%), com maior número de ocorrência em 2018 (32,60%), a maioria dos acidentes envolve escorpiões, (59,98%). Quanto às espécies de serpentes a Crotalus foi a mais prevalente (59,76%), o tempo de atendimento após a picada ocorreram entre uma a três horas após o acidente (50,65%) dos registros. O estudo permitiu analisar a prevalência de acidentes que envolveram animais peçonhentos durante um recorte temporal (2016 a 2019), em que foi observado um aumento no número de casos e uma pequena oscilação no decorrer dos anos. Neste aspecto, a enfermagem exerce um importante papel para a prevenção destes agravos, já que, está constantemente em contado com os pacientes que procuram atendimento hospitalar.

Covid-19: Estudo da infectividade no Município de Garanhuns - PE

A Covid-19 não é um problema local, mas um grave desafio para saúde pública, que afeta diferentes continentes e tem sido objeto de ações governamentais de diferentes esferas no município de Garanhuns. Este estudo objetivou analisar a taxa de infectividade de Covid-19, no município de Garanhuns, através do número reprodutivo efetivo do novo coronavírus. O número reprodutivo efetivo é usado frequentemente em modelos epidemiológicos. Para isso, foi necessário a utilização do gráfico de incidência e de uma distribuição paramétrica que representou a probabilidade de casos sucessivos no tempo transcorrido. Para garantir a consistência da estimativa usamos estimativas consistentes para a média e desvio-padrão da distribuição. Simulamos os parâmetros de acordo com a mais recente literatura sobre o assunto, garantindo estimativas mais adequadas para projeção em nossas análises. Ressaltamos que adaptamos os parâmetros de acordo com a realidade que um paciente infectado em média leva para procurar atendimento hospitalar após apresentar os primeiros sintomas de Covid-19. Os resultados demonstram que, até a data analisada, as medidas não foram suficientes para reduzir, de forma eficaz, a infectividade a um valor que permita afirmar que não há mais a propagação da doença. O estudo permitiu compreender a evolução da pandemia e a eficácia deas medidas públicas.

Determinants of healthcare use by homeless people with schizophrenia or bipolar disorder: results from the French Housing First Study

ObjectivesThere is limited evidence available on the health-seeking behaviours of individuals in relation to determinants of healthcare use. This study aimed to analyse the determinants of healthcare use (including both hospital and outpatient services) among homeless people with severe mental health illnesses. Study designThe study used data from a multicentre, randomised, controlled trial conducted in four large French cities (the French Housing First Study). MethodsData were drawn from 671 homeless people enrolled in the study between August 2011 and April 2014. Mobile mental health outreach teams recruited homeless individuals with severe mental health illnesses who were living on the street or in emergency shelters, hospitals or prisons. Data collection was performed during face-to-face interviews. Healthcare service use included hospitalisations, mental health and regular emergency department (ED) visits and outpatient visits to healthcare facilities or physicians’ offices over a 6-month follow-up period. The data were analysed with zero-inflated (ZI) two-part models. ResultsIn total, 61.1% of participants had at least one hospitalisation stay over the previous 6 months, with a mean of 25 (+/− 39.2) hospital days, and the majority (51%) had visited the ED (either for regular or mental health issues) during the same time period. The results confirmed the role of financial barriers (resources and health insurance) in seeking hospital care (P < 0.05). The main predictors for hospital use in the study population were a better social functioning score (odds ratio [OR]: 1.03; P < 0.001) and having schizophrenia (OR: 1.39; P < 0.01). Higher mental health scores (assessed by the Medical Outcomes Study 36-item Short Form Health Survey) (OR: 1.03, P < 0.01) and alcohol dependence (OR: 2.13; P < 0.01) were associated with not using ED healthcare services. Being ‘absolutely homeless’ predicted an increased use of the ED and a zero use of outpatient services. Inversely, no association with factors related to the homelessness trajectory was found in hospital ZI negative binomial models. ConclusionThis study is important because a comprehensive understanding of the determinants of healthcare use enables healthcare systems to adapt and develop. The efficiency of medicosocial interventions targeting the homeless population with mental health illnesses must also be assessed. Clinical trial numberNCT01570712.

Impact of Diabetes Foot Care Education on Amputation Rate in the University of Abuja Teaching Hospital, Nigeria.

Ulceration of the foot is a major problem for people with diabetes. In a developing country like Nigeria, huge challenge is caused by diabetes foot problems. The aim of this study was to determine the impact of diabetic foot care education of patients and health care staff on the outcome of diabetic foot complications in our hospital. This was a pre and post design carried out from April 2013 to March 2014 on 155 diabetes patients. Patient education was carried out by diabetes nurses and doctors, at diagnosis and re-enforced at follow-up clinics. At the end of 1 year, the impact of education was assessed. Descriptive statistics were generated as appropriate. A total of 155 patients, 64 (41%) males and 91 (59%) females, were studied with mean age of 49 ± 3 years and mean duration of diabetes 6 ± 2.6 years. At the onset of the program, 70% of the patients had no knowledge of foot care education. Only 13.5% knew that diabetes mellitus foot ulcer could be related to long duration of diabetes, nerve damage, blood vessel blockage, foot deformity, and uncontrolled blood glucose. Ninety-two percent of the patients preferred home remedies, herbal treatment, or chemist in the event of an ulcer. After the program, 77% would seek hospital care as first option, and amputation rate decreased from 50% in 2009 to 10% by 2017. Our experience has shown that education is the cheaper option for the prevention of lower limb amputation in a resource-poor setting like ours.

A study on clinical profile of acute undifferentiated febrile illness in a tertiary care hospital

Background: Acute febrile illness is very common among patients seeking hospital care in tropical country like India. This study was conducted to evaluate etiology and clinical profile of Acute Undifferentiated Febrile Illness (AUFI) in a tertiary care hospital.Methods: This study was conducted in 175 patients with acute febrile illness who were admitted in the medical wards and ICU from January 2018 to June 2019 in a tertiary care hospital. Clinical examination and investigations like complete hemogram, liver function test, renal function test, smear for malarial parasite, widal test, urine analysis blood and urine culture, antibody titters for dengue, Leptospirosis and imaging were done.Results: Out of 175, 94 (54%) were males and 81 (46%) were females. The commonest etiology was dengue (19%) followed by enteric fever (18%), scrub typhus (16%), malaria (14%), tuberculosis (6%) and leptospirosis (5%). 138 (79%) patients had less than 14 days of fever of which dengue was the most common and 37 (21%) patients had more than 14 days of fever with tuberculosis being predominate. Other common symptoms were chills/rigors, headache and myalgia seen in 77%, 71% and 42% respectively. Icterus was seen in malaria (42%) and leptospirosis (38%). Elevated transaminases levels were observed with dengue, leptospirosis, scrub typhus, enteric fever and malaria. ARDS was most common in scrub typhus.Conclusions: Among acute febrile illness, dengue and enteric fever were the most common in this study. A thorough and probing search for an eschar is very important in scrub typhus. The treating physician has to keep in mind the comprehensive list of differential diagnosis for patients with febrile illness and anticipating the complications.

Differential effects of distance decay on hospital inpatient visits among subpopulations in Florida, USA

Understanding patients’ travel behavior for seeking hospital care is fundamental for understanding healthcare market and planning for resource allocation. However, few studies examined the issue comprehensively across populations by geographical, demographic, and health insurance characteristics. Based on the 2011 State Inpatient Database in Florida, this study modeled patients’ travel patterns for hospital inpatient care across geographic areas (by average affluence, urbanicity) and calendar seasons, and across subpopulations (by age, gender, race/ethnicity, and health insurance status). Overall, travel patterns for all subpopulations were best captured by the log-logistic function. Patients in more affluent areas and rural areas tended to travel longer for hospital inpatient care, so did the younger, whites, and privately insured. Longer travel distances may be a necessity for rural patients to cope with lack of accessibility for local hospital care, but for the other population groups, it may indicate rather better mobility and more healthcare choices. The results can be used in various healthcare analyses such as accessibility assessment, hospital service area delineation, and healthcare resource planning.

The time is now: a call for action to translate recent momentum on tackling tropical snakebite into sustained benefit for victims.

Like the other WHO-listed Neglected Tropical Diseases (NTDs), snakebite primarily affects rural, impoverished tropical communities that lack adequate health resources. The annual 138 000 deaths and 400 000 disabilities suffered by these subsistence farming communities means that snakebite is an additional cause and consequence of tropical poverty. Unlike most of the NTDs, however, snakebite is a medical emergency, and requires rapid treatment in a hospital equipped with effective antivenom, beds and appropriately trained staff. The lack of such facilities in the remote areas most affected by snakebite, and the high treatment costs, explains why most victims, particularly in sub-Saharan Africa, consult traditional healers rather than seek hospital care. Whilst affordable, there is no evidence that traditional treatments are effective. The number of snakebite victims that die, unregistered, in the community is threefold higher than hospital-recorded deaths.After decades of inertia, WHO benefitted from advocacy interventions and the support of key agencies, including Médecins Sans Frontières, the Wellcome Trust, the Kofi Annan Foundation and the Global Snakebite Initiative, to recently institute transformative actions for reducing the public health burden of tropical snakebite. It is imperative that WHO and the other stakeholders now gain the support and investment of governments, research funders and donor agencies to ensure that this recent momentum for change is translated into sustained benefit to snakebite victims.

Clinical and demographic profile of patients with snakebite in a tertiary hospital in Ghana

Background: Snakebite is a public health problem affecting mainly rural populations. Objective: To determine the clinical pro le, manifestation, and outcome of snakebite cases presenting to the Tamale Teaching Hospital in Northern Ghana. Materials and Methods: This is a hospital record-based retrospective descriptive study of all confirmed snakebite cases recorded at the Tamale Teaching Hospital over a 2-year period from January 2016 to December 2017. Relevant demographic and clinical information were extracted from patient folders and analyzed. Results: One hundred and nineteen snakebite cases were recorded. The mean age of the victims was 26.38 years, 69.7% being male. Snakebites were recorded all year round with a slight peak in November. Most bites occurred in the interval between 4:00 PM and 8:00 PM and the lower extremity was the most common site of bite (71.4%). The major symptoms of envenomation included coagulopathies (86.5%) and local swelling/ulceration (78.2%); 68.9% had both coagulopathies and local cytotoxicity. Cellulitis/infected wounds (35.3%) and anemia (21.0%) were the major complications reported. 96.6% of the snakebite cases received antivenom on presentation. There was an average delay of 36.42 h from bite before seeking hospital care. No mortality was recorded. The causative snake species was identified in only 6.7% of cases. Conclusion: Snakebite is a potentially life-threatening disease in developing countries such as Ghana and disproportionately affects rural farmers who are mostly active young males. It occurs all year round. More accurate data on snakebites in Ghana are needed for planning purposes and to ensure the continuous availability of antivenom.

Factors Affecting Healthcare Access for Older Immigrants: A Qualitative Study with Service Users and Healthcare Social Workers in a Central Canadian City

Older immigrants are generally found to be less likely than their Canadian-born counterparts to seek hospital care and other healthcare services. This study provides insight into healthcare utilization patterns and barriers from the perspectives of older immigrants and their caregivers, and the healthcare social workers assisting them. The research examines five predisposing factors, nine enabling factors, and physical and mental need factors in Andersen’s behavioral model that affect healthcare access. While social workers and multidisciplinary professionals can make efforts to improve mutable factors, such as providing information through community networking and improving the quality and availability of translators in healthcare settings, the factors that acquire mixed levels of mutability-for example, health beliefs and perceived needs, and immigrant status and health insurancerequire long-term commitments of public education and policy change.

Le coût des soins obstétricaux et néonatals : étude des cas à la maternité de l’hôpital Jason Sendwe à Lubumbashi, République démocratique du Congo, en 2015

BackgroundThe aim of this study was to determine the user cost for obtaining obstetric and neonatal care during childbirth in the Jason Sendwe hospital in the city of Lubumbashi, Democratic Republic of Congo. MethodsWe conducted a cross-sectional study at the maternity of the Jason Sendwe hospital in Lubumbashi, reviewing charts and using a questionnaire given to 145 women who gave birth from 1st August to 30th September 2015. We calculated the cost based on the amounts paid by users for obtaining care, expressed in US dollars ($) at an exchange rate of 900 Congolese Francs (CDF) for $1. ResultsThe average age of parturients was 27±6 years (m±SD). Nearly 9 out of 10 women were married (84.8%), 24.1% had a primary school educational level. The majority (62.1%) had no occupational activity and the average monthly income of those employed was $28. Many of their spouses were self-employed (36.6%) with an average monthly income of $113. Hemorrhage was the most common complication (12.4%); perinatal mortality was 12.4%, and was only registered in cases of dystocia. Cost of care for eutocic delivery was 5 times greater than for complicated vaginal delivery that in turn had a 2-fold lower cost than caesarean section. It follows from this study that the cost of care for eutocic delivery, complicated vaginal delivery and cesarean section was, respectively: 1.4%, 7.5%, and 13.4% of annual household income. In general, in case of childbirth, 51%, 40.7%, and 34.4% of households devoted more than 5%, 10% and 20% respectively of their annual income to obtain obstetric and neonatal care. ConclusionThe cost of obstetric and neonatal care is catastrophically high for households in Lubumashi. Undoubtedly, those who seek hospital care for childbirth must cope with financial problems related to the incurred debt. The State should review its healthcare financial policy to ensure access to quality care for all.

Therapeutic Itinerary and Causes of Delay in Specialized Consultation of Patients Admitted for Diabetic Foot

Introduction: Amputation remains a common practice in patients admitted for diabetic foot. The delay in consultation is one of the main reasons. The objective of this work was to analyze patients’ itinerary care and to identify the causes of delay in consultation in patients admitted for diabetic foot. Method: This is a descriptive cross-sectional study, including all patients hospitalized for diabetic foot. A wait of at least seven (7) days before consulting the Endocrinology department of Hubert Koutoukou Maga Teaching Hospital (CNHU-HKM) after the foot injury occurred was considered as delay in consultation. The data were recorded and analyzed in the EPI INFO software. The description of the sample was made according to the usual statistics (frequency, average, standard deviation). Results: Seventy-six (76) diabetic foot cases were admitted during the period of the study. The mean age of the patients was 56.64 ± 10.71 years with extremes of 29 years and 84 years. Patients were most often received at an advanced stage of the foot injury, 3D stage of Texas classification in 87% of cases and Wagner grades 4 and 5 in 52% of cases. The amputation rate was 38.16%. An analysis of the first care places reveals that 90.8% of patients had consulted conventional medicine, 13.2% in traditional medicine; 1.2% had religious practices and 18.7% had declared self-medication at home. Consultation period at CNHU HKM was more than 7 days in 80% of cases and less than 7 days in 20% of cases. The average consultation time was 44.08 ± 26.43 days with extremes of 1 and 480 days. The main reasons for the delay in seeking hospital care cited by diabetic patients were fear of amputation (47.8% of cases), economic difficulties (32.5% of cases) and awareness lack of the situation seriousness (22.4%). Conclusion: The therapeutic itinerary of patients with diabetic foot was particularly long. The main reasons of late appeal to specialized care were fear of amputation and economic difficulties. The implementation of universal health insurance and an information, education and communication program could certainly reduce the periods allowed for recourse to care and therefore to reduce the amputation rate.

Determinants of Hand Washing Practices and Diarrhea Prevention among Mothers of Under-Five Children in Ibadan, Nigeria

Childhood diarrhea is the third-leading paediatric, diagnosed in hospitals and causes nearly one-quarter of under-five death in Nigeria. Morbidity and mortality for children through diarrhea are influenced by poor hygiene practices including poor hand washing. Thus this study examines the practice of hand ‘washing by mothers as a preventive mechanism against diarrhea experience among children under age five. A pretested standardized questionnaire was administered to 600 mothers of children under age five and complimented with eight sessions of in-depth interview (IDI) conducted among mothers in Ibadan metropolis. Overall, about 58% of the mothers were within 30-39 years of’ age range, 11% had no formal education, about 31% reported diarrhea experience for their children 2 weeks before the survey while 84.5% of them sought hospital care during diarrhea episodes. Respondents reportedly drank water from stream (8.7%) and used faecal disposals (91.5%) different front water closet. hand washing after toilet use was reportedly common to all the respondents: 24,3% washed their hands with water only, while 35% reportedly washed their hands occasionally. Only 33.5% reportedly got information on hand washing practices from health workers. Education and income of the respondents influenced adoption of frequent hand washing practices (p&lt;0.05), The study suggests focused health education for mothers through the media 011the importance of frequent hand washing practices.

‘Adulterant or contaminant in MT-45, or coingestion?’ Reply from the authors

In a commentary to our publication entitled “Acute skin and hair symptoms followed by severe, delayed eye complications in subjects using the synthetic opioid MT-45”,[1] Yip and Deng [2] argue that the lack of opioid symptoms would indicate involvement of another drug class, possibly arsenic or 2,4-dinitrophenol (DNP). In this respect, it should be emphasized that the patients did not seek hospital care for acute opioid overdose symptoms but for unexpected, late adverse side effects involving the skin, hair, and eyes. This article is protected by copyright. All rights reserved.

Gender differences in care-seeking behavior and healthcare consumption immediately after whiplash trauma.

ObjectiveThe aim was to study gender differences in care-seeking behavior and treatment provided immediately after whiplash trauma.MethodsParticipants were residents from a defined geographical area, Skaraborg County in the southwestern part of Sweden. A cohort of 3,368 persons exposed to whiplash trauma and attending a healthcare facility immediately after the trauma between 1999 and 2008 were identified in a database. Information about gender, age, time elapsed prior to seeking care, type of healthcare contact, initial treatment provided and eventual hospitalization time was retrieved.ResultsWomen sought care later than men (p = 0.00074). Women consulted primary healthcare first more often than men, who more often first sought hospital care (p = 0.0060). There were no gender differences regarding the type of treatment after trauma. Women had longer hospital admission than men (p = 0.022), indicating their injuries were at least similar to or worse than men’s.ConclusionWomen sought healthcare later than men after whiplash trauma. Although not directly investigated in this study, it raises the question if this may reduce their probability of getting financial compensation compared to men.

Update of Human Infections Caused by Cryptosporidium spp. and Cystoisospora belli, Honduras

Background: Cryptosporidium spp., and Cystoisospora belli are two intestinal apicomplexa protozoa associated with diarrhea and malnutrition in individuals of different ages and immune competency. Objectives: Update diagnosis of infection with either Apicomplexa species, twelve years cumulative results at the University Hospital, Honduras. Methodology: Observational, non-interventional revision of stool examination results, in the diagnosis of intestinal apicomplexa oocysts as identified in fixed and stained smears by the modified carbolfuchsin method (MAF). Results: Of 42,935 stool samples received during a 12 year period, 30.4% (13,041) were MAF stained and examined, of which 8,705 (20.3%) came from children 0 to 5 years old. For C. belli infections, 89 of a total of 109 (81.6%) cases were identified in patients 21 years old or older (p=0.001); 67.2% of the stools were diarrheic or liquid. In 19 individuals the excretion of C. belli oocytes persisted several months to a year despite treatment with trimetroprim sulfametoxazol. Age distribution of a total of 202 (1.5%) cryptosporidiasis cases showed two peaks: one in children 0 to 5 years old (56.4%) and the second in individuals 21 years old or older (35.1%) (p=0.001). The highest proportion of cryptosporidiasis cases was diagnosed in the age group 0 to 35 months old (91/114, 79.8%). No statistical differences were found in cryptosporidiasis and seasonality, stool consistency or sex. Strongyloides stercoralis larvae, Blastocystis spp., leukocytes and mucus were main additional findings. It appears that no other laboratory in the country diagnoses these parasite infections routinely. Conclusion: It was evident that these apicomplexa parasites are important etiologic agents of diarrheal disease, both in children and in immunocompromised individuals. Cryptosporidiasis burden of disease was evident in children seeking hospital care. Responsible commitment to tackling interdisciplinary research in Honduras regarding these parasites in particular is required.

Profile of pediatric eye trauma at Hospital de Base do Distrito Federal (HBDF), Brasília, Brazil.

To describe the epidemiological profile of ocular trauma in children at the HBDF emergency department. Descriptive, cross-sectional study. We evaluated 103 cases of ocular trauma in children less than 15 years between July 2012 and January 2013. The factors evaluated through semi-structured questionnaire available online were: age, gender, adult supervision, mechanism, type of trauma, time and place, site and nature of injury, visual acuity, need for hospitalization and/or surgery, type of surgery, mother's level of education, and family income. The average age of patients studied was 7.5 years. Boys (68%) predominate in all age groups. Blunt trauma prevailed (55.3%), followed by open (20%). Most of the cases occurred at home, 14 to 20 hours before seeking hospital care. The most common causes were: wood, stone, bicycle, broken glass, and falls. The cornea was affected in 54%. Visual acuity was ≥20/40 in 68.9%. Primary repair of the eye wall was indicated in 70.37% (p-value=0.022). Open traumas were more severe (p-value=0.005) and had more need for intervention (p-value=0.000). The injuries occurred despite the presence of adult supervision in 54% (p-value=0.002). The most severe injuries predominated in the age range 7-15 years (p=0.001). Ocular trauma was more frequent among boys. The mechanisms of injury are the most diverse, and prevail at home. Blunt trauma prevails, but the visual impact is due to open trauma. Programs of prevention and education on child ocular trauma are needed.

A key traumatic brain injury initiative in India

A key traumatic brain injury initiative in India

Awareness of Transmission, Complications and Protective Measures against Schistosomiasis among Paddy Cultivators

Background: Schistosomiasis infection is among the neglected tropical diseases seen in Sub-Saharan Africa causing acute and chronic infection by the trematode worms. Paddy farming and livestock keeping are major economic activities in Africa. Information is lacking on this target groups’ relationship to schistosomiasis infection. The aim was to assess the awareness of schistosomiasis transmission, complications, and protective measures among pad cultivators. Methods: A community based cross-sectional study done at Samuye, Singita and Manyada villages in Samuye ward, Shinyanga rural district, in the North West parts of Tanzania was conducted from September 2013 to January 2014. Subjects aged 10 years and above involved in paddy cultivation and livestock keeping were included. Three villages from Samuye district were randomly selected and interviews were done using structured questionnaires. Data obtained was analyzed using SPSS version 17.0 together with a series of tabulations. Results: Of the 350 respondents enrolled in the study, 70.5% (247/350) endorsed awareness of schistosomiasis infection, most of which 86.9% (304/350) had completed primary education. Over 50% endorsed previously suffering from schistosomiasis, males being more affected than females, 57.7% (188/350) vs. 42.3% (162/350), respectively. Majority of previously infected subjects, 72.8% (131/180), opted for herbal remedies as compared to 22.8% (41/180) seeking hospital care. Nearly all subjects, 93.5% (231/247), lacked awareness of preventive options. Conclusion: Schistosomiasis is one of the neglected tropical diseases, with significant knowledge gap among paddy cultivators in Samuye ward in disease treatment, complications and prevention in this high-risk group. Governmental emphasis on increasing awareness, education, and availability of prophylactic drugs to this high-risk group could prevent rates of transmission and establish infection control. Improving knowledge on schistosomiasis in this high-risk group would likely reduce disease burden significantly.

Predictors of Emergency Department Visits and Inpatient Admissions Among Homeless and Unstably Housed Adolescents and Young Adults.

Individuals under age 25 years are estimated to comprise one third of the homeless population nationally. Understanding the reasons for utilization of hospitals by homeless youth is important for optimizing disposition planning. Objectives of the present study were to: (1) report prevalence of emergency department (ED) and inpatient admissions among homeless and unstably housed youth; (2) describe demographic characteristics of those youth who seek hospital care; (3) describe their patterns of injury, illness, psychiatric, and substance use conditions; and (4) identify demographic and diagnostic predictors of ED visit or hospital readmission. Retrospective cohort study of 15-25-year-olds (N=402) who were admitted to the ED or inpatient floors of 2 urban teaching hospitals in King County, WA between July 1, 2009 and June 30, 2012 and whose address was "homeless" or "none" or a homeless shelter or service agency (ie, homeless or unstably housed), during any recorded encounter between July 1, 2009 and June 30, 2012. A total of 1151 ED visits and 227 inpatient admissions were documented. Fifty percent of patients had an ED visit or hospital readmission within 1 year, with 43.1% receiving care within 30 days of discharge. Cox regression showed that female individuals with an injury diagnosis (hazard ratio=1.74, 95% confidence interval=1.06, 2.85) and male individuals with an acute medical condition (hazard ratio=1.59, 95% confidence interval=1.09, 2.32) at index visit were more likely to have an ED visit or hospital readmission during the following year, as were patients who provided a private address at their index visit. Homeless young people who seek hospital care demonstrate a high rate of ED visits and hospital readmissions, with unique predictors of utilization associated with sex and housing status. Additional research is necessary to determine how best to transition these young people from hospital-based to community-based care.