Standardized Hospitalization Ratio Research Articles

Nurse Staffing and Patient Outcomes in Hemodialysis Units: A Literature Review

The hemodialysis unit manager must be able to ensure that the high-quality services are provided to ensure patient outcomes. Several previous studies have shown that nurse staffing is one of the components that needs to be considered to improve patient outcomes, but this has not been specifically proven in hemodialysis units. The study aims to determine the effect of nurse staffing and patient outcomes in hemodialysis units. This research is a literature review where the process of article searches is carried out through the Pubmed, Emerald, Science direct and Google Scholar electronic databases using certain some keyword combinations in articles published from 2012-2022. The review process used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and three research articles were analyzed. Results of study show that there is no significant relationship between the ratio of patient to nurses with various patient outcomes in assessed from the Standardized Hospitalization Ratio (SHR), Standardized Mortality Rate (SMR) and Standardized Readmission Ratio (SRR). Moreover, this study provides no evidence that the ratio of patients to nurses affects patient outcomes. Comparative studies with clear staffing parameters are needed to prove this issue.

Long term mortality and morbidity of Italian soldiers after deployment in Iraq as related to biomarkers assessment: Results of the SIGNUM study

IntroductionThe health profile of military veterans deployed in foreign operative theatres was assessed by several international studies because of potential exposure to depleted uranium and other pollutants. Here we reported results of 15-year epidemiological surveillance assessing long-term health effects in a cohort of Italian soldiers deployed in Iraq in 2004–2005 and participating in a biomonitoring campaign to identify potential genotoxic exposure to environmental xenobiotics before and after deployment (n = 981, SIGNUM cohort). MethodsWe evaluated mortality and hospitalization risks of the SIGNUM cohort retrospectively until 2016 and 2018 respectively. A wide cohort of military personnel never deployed abroad (n = 114,260) and the general Italian population were used as control populations in risk assessment. Causes of death and diagnoses of hospitalization were derived through deterministic record linkage with official national databases of mortality and hospital discharge. Standardized Mortality Ratio (SMR) and Standardized Hospitalization Ratio (SHR) were computed adjusting according to sex, age, area of birth, and calendar year. Differential pre-post deployment in xenobiotics concentrations and early effect biomarkers (oxidative DNA alterations and micronuclei) measured in blood serum were analysed in relation to cancer hospitalization. ResultsMortality risk due to pathologies was more than halved compared to the general population (SMR = 0.41, 95% CI 0.11–1.05) and not significantly different compared to soldiers never deployed abroad (SMR = 0.69, 95% CI 0.19–1.68).Similarly overall hospitalization risk due to pathologies was decreased with respect to the general population (SHR = 0.86, 95% CI 0.80–0.92) and comparable to the control military group (SHR = 0.99, 95% CI: 0.93–1.06). For haematological cancers a decreased hospitalization risk compared to the Italian general population was observed (SHR = 0.38, 95% CI 0–0.92). No statistically significant differences emerged in the patterns of biomarkers in association with cancer hospitalization. ConclusionThe study confirms the so called ‘healthy warrior’ effect for the SIGNUM veterans and showed no correlation between cancer occurrence and biomonitoring markers measured on field.

Occupational cohort study of asbestos-cement workers in a contaminated site in Sicily (Italy).

to analyse the asbestos-related diseases risk among the former workers of Sacelit asbestos-cement plant, operating in San Filippo del Mela (Sicily: 1958- 1993). cohort study. 228 subjects were employed in Sacelit from 1958 to 1993. Due to the available observation periods, the analyses of the different outcomes were performed for the subjects alive at the beginning of the respective follow up periods: mortality (1986-2018) was analysed for 204 subjects (177 men, 27 women), hospitalization (2001-2016) for 164 workers (139 men, 25 women) and the incidence of mesothelioma (1998-2016) was estimated for 178 subjects (153 men, 25 women). mortality (Standardized Mortality Ratio: SMR) and hospitalization (Standardized Hospitalization Ratio: SHR) from specific diseases were analysed. Incidence (Standardized Incidence Ratio: SIR) of mesothelioma cases was detected, also. SMR (1986-2014), SHR (2001-2016) and SIR (1998-2016), with 95% Confidence Intervals, were computed with respect to the regional rates, with STATA11. in the men cohort, mortality from lung (17 cases, SMR 2.83) and pleural cancers (5 cases, SMR 30) and from asbestosis (15 cases, SMR 1,930) was in excess. The risk of hospitalization was in excess, in both genders, from lung cancer (men: 6 cases, SHR 4.1; women: 2 cases, SHR 8.6) and asbestosis (men: 17 cases, SHR 1,304; women: 6 cases, SHR 2,455). The incidence of mesothelioma was in excess in men (5 cases, SIR 23.9); no female cases of mesothelioma were observed. a high occurrence of asbestos-related diseases in the cohort, particularly among men, was observed. The excess of hospitalization from asbestosis and lung cancer was highlighted also in women. The prosecution of the on-going health surveillance plan is particularly appropriated.

A National Hospital-Based Study of Hospitalized Patients With Primary Biliary Cholangitis.

Epidemiological studies on primary biliary cholangitis (PBC) have been based primarily on tertiary referral case series. We aimed to estimate the incidence and prevalence and describe comorbidities in hospitalized patients with PBC in Italy using a national hospital‐based data source. Data were extracted from the National Hospital Discharge Database, which includes all Italian individuals discharged from any hospital in the country. All adults diagnosed with biliary cirrhosis (International Classification of Diseases, Ninth Revision, Clinical Modification, 571.6) as the primary or secondary diagnosis from 2011 to 2015 were included. To determine whether a comorbidity was either more or less frequent in PBC patients compared with the general hospitalized Italian population, the standardized hospitalization ratio (SHR) was calculated. A total of 5,533 incident cases were identified from 2011 to 2015, 3,790 of whom were females (68.5%; female to male [F:M] ratio, 2.2:1). Prevalent cases were 9,664, of whom 7,209 were females (74.6%; F:M ratio, 2.9:1). The incident rate was 1.03 × 100,000 in males and 1.92 × 100,000 in females; prevalence was 1.89 × 100,000 in males and 4.75 × 100,000 in females. Extrahepatic autoimmune diseases, malignant neoplasms of liver and intrahepatic biliary ducts, and malignant neoplasms of gallbladder and extrahepatic bile ducts were found more frequently in PBC patients than in the general hospitalized population (SHR > 100), whereas cerebrovascular diseases and ischemic heart diseases were less frequent in PBC individuals (SHR < 100). Conclusion: This national study provides a survey of comorbidities associated with PBC. Hospitalized patients with PBC are more likely to have extrahepatic autoimmune diseases, hepatocellular carcinoma, and biliary tract cancers and a low risk of cardiovascular events.

Registered nurses are at increased risk of hospitalization for infectious diseases and perinatal complications: A population-based observational study

BackgroundNursing staff spend long periods in high-risk working environments. ObjectiveThe purpose of this study was to compare the hospitalization risk between nursing staff and the general population. DesignThis study adopted a retrospective observational design. SettingData from the Taiwan National Health Insurance Research Database from 2011 to 2013 were analyzed. MethodThe standardized hospitalization ratio model was used to analyze the relative risk of hospitalization for various diseases between nursing staff and the general population. ResultsA total of 33,267 numbers of nursing staff in Taiwan were hospitalized, an overall crude hospitalization rate of 21.5%. After controlling for gender, calendar year, and age of nursing staff, the standardized hospitalization ratio of female nursing staff was significantly higher compared to the general population for infectious and parasitic diseases (SHR = 121.05, 95% CI = 112.66–129.89), diseases of the respiratory system (SHR = 105.12, 95% CI = 100.60–109.80), complications of pregnancy, childbirth, and the puerperium (SHR = 102.59, 95% CI = 100.85–104.35), and diseases of the skin and subcutaneous tissue (SHR = 109.71, 95% CI = 101.10–118.86). ConclusionsNursing staff have a significantly higher hospitalization risk compared to the general population for infectious and parasitic diseases, diseases of the respiratory system, complications of pregnancy, childbirth, and puerperium, and diseases of the skin and subcutaneous tissue. This may be associated with the job characteristics and environment of nursing staff.

Facility Practice Variation to Help Understand the Effects of Public Policy: Insights from the Dialysis Outcomes and Practice Patterns Study (DOPPS).

Recent Centers for Medicare & Medicaid Services policies have used dialysis facility practice variation to develop public ratings and adjust payments. In the Dialysis Facility Compare star rating system (DFC SRS), facility-relative rates of performance-based clinical measures varied nearly two-fold for mortality (standardized mortality ratio; 10th/90th percentiles: 0.71, 1.34) and hospitalization (standardized hospitalization ratio; 10th/90th percentiles: 0.64, 1.37), and nearly four-fold for transfusion (standardized transfusion ratio; 10th/90th percentiles: 0.43, 1.65). Medicare claims data (from July of 2014) demonstrate that facility variation for the proportions of patients on hemodialysis hospitalized (10th/90th percentiles: 27%, 50%) and transfused (10th/90th percentiles: 3%, 17%) within 6 months that far exceeds relatively modest recent overall longitudinal trends. DFC SRS-rated facility variation is also substantial for fistula (10th/90th percentiles: 50%, 78%) and catheter use >90 days (10th/90th percentiles: 3%, 19%). By contrast, DFC SRS-rated facility distributions for adult hemodialysis Kt/V>1.2 (10th/90th percentiles: 84%, 97%) and total serum calcium >10.2 mg/dl (median, 1%; 75th/90th percentiles: 3%, 5%) are quite narrow and may be of questionable value. Likewise, variation in the US Dialysis Outcomes and Practice Patterns Study is over two-fold for facility median serum parathyroid hormone (10th/90th percentiles: 290 pg/ml, 629 pg/ml) and ferritin (10th/90th percentiles: 469 ng/ml, 1143 ng/ml) levels, and facility mean treatment time varies by 30 minutes (10th/90th percentiles: 204 minutes, 234 minutes). Rising serum parathyroid hormone and ferritin levels, and generally short dialysis treatment time, represent areas unchecked by existing policy; both overall trends and facility variation in these values may reflect unintended consequences of policy or reimbursement pressures and therefore raise concern. Additionally, outcomes in the transition period from advanced CKD to dialysis remain poor, and policy initiatives and performance accountability in this area remain insufficient. Innovative models of comprehensive care in advanced CKD and the early dialysis period which are more amenable to policy oversight are needed. In summary, facility variation is typically larger than prevailing longitudinal trends, and should not be overlooked. The combination of nationally representative observational databases (e.g., the Dialysis Outcomes and Practice Patterns Study) and ESRD registries can provide policy makers with additional tools to evaluate facility variation, develop policies, and monitor unintended effects.

Spatial distribution of renal disease in the contaminated site of Taranto (Italy)

Introduction: Environmental exposure to heavy metals, in particular to cadmium, arsenic and lead, has been associated with kidney disease. The aim of the present study is to investigate the occurrence of kidney disease in the Italian contaminated site (CS) of Taranto, characterized by an industrial area with the presence of various plants including a major steel mill. Methods: This is an exploratory ecological study. The cases were all subjects residing in the CS with a first hospital discharge diagnosis (primary or secondary) of kidney diseases (ICD-9-CM codes 580-586) in the years 2006-2010. Kidney disease cases associated with other disorders were excluded. Hospital discharge rates for kidney disease were compared to those of the regional population using the Standardized Hospitalization Ratio (SHR). All the subjects’ residences at the time of diagnosis were then geocoded, and SHRs were computed separately for areas at high and low exposure as per available environmental monitoring data. Moreover, the study took into account historical exposure levels and modelling for current levels of fine particulate matter (PM2.5) and cadmium. Results: SHRs for kidney disease of the CS, when compared to the regional population, showed a significant excess of 17% in males and of 8% in females. The excess was mainly explained by males (age group 60+). When focusing on the microgeographic study within the CS, the SHRs showed a significant excess of 28% in males (age group 20-59) and a non-significant excess of 25% in females (age group 20-59) residing at diagnosis in the areas at higher exposure. No correlation was found between residence and current spatial distribution of PM2.5 and cadmium. Conclusion: The excess of hospitalization for renal disease observed in the CS of Taranto does not affect children and adolescents, but rather mainly concerns adult males. This possibly suggest an occupational component, and correlates with historical patterns of atmospheric pollution.

Fluoro-edenite induced disease in the Sicilian site of Biancavilla (Italy).

Objectives Fluoro-edenite, a fibrous amphibole present in the soil and building materials of Biancavilla, (Sicily), was allocated in 2014 by the International Agency for Research on Cancer to the Group 1 as cause of mesothelioma. The aim of our research is to monitor the occurrence of mesothelioma and to evaluate data on non-malignant respiratory diseases among Biancavilla residents to better target prevention action. Methods Mesothelioma mortality and pleural cancer hospitalization (2006-2012) as well as incidence data (1998-2003) were analyzed. Standardized Mortality Ratio (SMR), Standardized Hospitalization Ratio (SHR), Standardized Incidence Ratio (SIR) were estimated with respect to regional rates. A descriptive research of the hospitalized pneumoconiosis cases in Biancavilla residents was undertaken (2006-2013). Results A statistically significant death excess from Pleural Mesothelioma (SMR 632) was observed; very high figures and 0.5 sex ratio (M/W) were shown in the younger age groups. Pleural cancer hospitalization showed significant excesses (SHR 399) in particular among younger persons. Mesothelioma incidence was increased in men (SIR 346) and in women (SIR 1221) with a sex ratio equal to one. Twenty-eight cases of pneumoconiosis (18 men and 10 women) were found. Conclusions The study confirms the role of exposure to fluoro-edenite fibres as source of mesothelioma, and the observed sex ratio, regarding mortality, hospitalization and incidence, corroborates the role of an environmental exposure. The higher excesses of death, hospitalizations, and incidence among young subjects suggest early exposure, in teenage/childhood years. The occurrence of unexpected hospitalization for pneumoconiosis in Biancavilla underlines the importance of further investigation on non malignant respiratory diseas

Excess mortality and hospitalized morbidity in newly treated epilepsy patients.

To assess the burden of mortality and hospitalized morbidity in newly treated epilepsy patients. We extracted relevant data of patients with newly treated epilepsy between September 16, 2005, and September 15, 2010, from the data repository covering all public hospitals in Hong Kong. Patients were followed up until September 15, 2011. Mortality and hospitalized morbidity were assessed, stratified by baseline comorbidities, number of antiepileptic drugs (AEDs) used, and treatment with enzyme-inducing AEDs (EIAEDs). Mortality was compared to the age- and sex-specific general population in Hong Kong. Of the 7,461 newly treated epilepsy patients (55% male; median age 60 years), 2,166 (29%) died during the study period. The standardized mortality ratio was 5.09 (95% confidence interval [CI] 4.88-5.31), and was higher among those with physical or psychiatric baseline comorbidity (5.46; 95% CI 5.22-5.71) than those without (3.28; 95% CI 2.87-3.73). Standardized hospitalization ratio was 6.76 (95% CI 6.70-6.82). Baseline physical comorbidity-free patients (n = 3,514) exhibited higher risk of developing stroke (standardized incidence ratio [SIR] 4.96; 95% CI 4.19-5.84) and ischemic heart disease (SIR 4.18; 95% CI 3.54-4.91), and male patients had elevated risk of developing cancer (SIR 2.30; 95% CI 1.75-2.97). Patients treated with EIAEDs had higher risk of being subsequently recorded with new physical comorbidities than those with non-EIAEDs (relative risk [RR] 1.48; 95% CI 1.19-1.85), especially for cerebrovascular disease (RR 1.78; 95% CI 1.14-2.77). Newly treated epilepsy patients bear excess mortality and hospitalization risks. They have higher risk of developing stroke, ischemic heart disease, and cancer. Treatment with EIAEDs was associated with increased overall morbidity.

Spatial Patterns of Ischemic Heart Disease in Shenzhen, China: A Bayesian Multi-Disease Modelling Approach to Inform Health Planning Policies.

Incorporating the information of hypertension, this paper applies Bayesian multi-disease analysis to model the spatial patterns of Ischemic Heart Disease (IHD) risks. Patterns of harmful alcohol intake (HAI) and overweight/obesity are also modelled as they are common risk factors contributing to both IHD and hypertension. The hospitalization data of IHD and hypertension in 2012 were analyzed with three Bayesian multi-disease models at the sub-district level of Shenzhen. Results revealed that the IHD high-risk cluster shifted slightly north-eastward compared with the IHD Standardized Hospitalization Ratio (SHR). Spatial variations of overweight/obesity and HAI were found to contribute most to the IHD patterns. Identified patterns of IHD risk would benefit IHD integrated prevention. Spatial patterns of overweight/obesity and HAI could supplement the current disease surveillance system by providing information about small-area level risk factors, and thus benefit integrated prevention of related chronic diseases. Middle southern Shenzhen, where high risk of IHD, overweight/obesity, and HAI are present, should be prioritized for interventions, including alcohol control, innovative healthy diet toolkit distribution, insurance system revision, and community-based chronic disease intervention. Related health resource planning is also suggested to focus on these areas first.

Hemodialysis Facility Variation in Hospitalization and Transfusions Using Medicare Claims: The DOPPS Practice Monitor for US Dialysis Care

Hemodialysis Facility Variation in Hospitalization and Transfusions Using Medicare Claims: The DOPPS Practice Monitor for US Dialysis Care

Hospitalization due to cancer among German seafarers.

To evaluate the relative risk of cancer among male German seafarers employed on German vessels in respect of various shipboard ranks and types of vessel. The seafarers' cancer discharge diagnoses from hospital were compared with those discharge diagnoses from the German general population and expressed as a standardized hospitalization ratio (SHR). The examined seafarers (on average 23,436 per year) showed a higher SHR for malignant neoplasms at all sites, in decreasing order for leukemia, non-Hodgkin lymphoma (NHL), respiratory cancer, and non-melanoma skin cancer. Seafarers employed on tankers showed a considerably elevated SHR for malignant neoplasms at all sites, which was mainly attributable to their high SHR for leukemia and respiratory cancer. Seafaring occupations pose an elevated risk of certain cancers. Further studies are required to evaluate to what extent occupational exposure to carcinogenic substances and lifestyle-related unhealthy behaviours contribute to the increased risk of cancer in seafarers.

Comparison of hospitalization among German coastal and deep sea fishermen

This study aims to compare the hospitalization of German fishermen employed on German-flagged fishing vessels with that of the general German population in consideration of differences between coastal and deep sea fishery. By means of a database from the health insurance company for seafarers, diagnoses of German fishermen treated in German hospitals were determined from January 1997 to December 2007. Compared with the general German population, the fishermen's risk for specific diseases leading to hospitalization was calculated as standardized hospitalization ratio (SHR). Compared with the German reference population, German fishermen showed a considerably high SHR for malignant neoplasms at all sites (SHR 1.46; 95% CI 1.37-1.56), for respiratory cancer, and for non-Hodgkin lymphoma (NHL). Furthermore, they had more often been hospitalized due to diabetes mellitus, diseases of the respiratory and digestive systems as well as due to injury and poisoning. The risk for respiratory cancer and NHL among coastal fishermen exceeded that of deep sea fishermen, whereas the latter displayed a considerably higher SHR for diabetes mellitus, diseases of the respiratory system and metabolic and nutritional disorders. In contrast, the SHR for hypertensive and ischemic heart diseases was decreased among deep sea fishermen. Less qualified deep sea fishermen displayed a considerably higher SHR for malignant neoplasms at all sites than more highly qualified ones. Fishery is still an occupation which poses a high risk for malignant neoplasms and injuries. This is likely due to lifestyle and work-related factors. Further studies are needed to evaluate the different working and living conditions of coastal and deep sea fishermen.

Variabilidad geográfica de las hospitalizaciones por infarto agudo al miocardio en Costa Rica

This research shows the geographic pattern of hospitalizations due to acute myocardial infarction in the public health care system in Costa Rica from 2010 to 2012. For the geographical analysis we used the geographic representation of the Bayesian smoothed standardized hospitalization ratio and the areas with hospitalization rate significantly different from the national average. Spatial autocorrelation was determined by Moran's I indicator. Amplitude between variations was performed using inter percentile ratio (percentile 95/percentile 5) and the variation coefficient. The gross rate is 5.8 hospitalizations per 10 000 population in men and 2.6/10 000 in women. The range of variation between areas with higher and lower hospitalizations is more than double. The most complex national hospitals are in the metropolitan areas. We found a pattern of low rates of hospitalization for acute myocardial infarction outside of metropolitan areas. This could be related to difficulties in accessing hospital services.

Long-term follow-up of kidney transplant recipients: comparison of hospitalization rates to the general population

BackgroundKidney transplant recipients are recognized as a vulnerable population that is at increased risk of adverse health outcomes. However, there have been few studies that have compared hospital-related morbidity of these patients to the general population, and how this differs with respect to time since transplantation. Such analyses are useful in estimating the health burden in this patient population.MethodsWe assembled a population-based Canadian cohort (excluding Quebec) of 6,116 kidney transplant recipients who underwent transplantation between 1 April 2001 and 31 December 2008. Record linkage was used to identify hospital discharge records of these patients from 1 April 2001 through 31 March 2009. Hospital discharges were tabulated across the main disease chapters of the ICD10, and person-years of follow-up were calculated across age and sex strata. Comparisons of hospital-related morbidity to the general population were made by using a standardized hospitalization ratio (SHR). For those who underwent transplantation in 2004, stratified analyses were performed to explore differences in hospital discharge rates both before and after transplantation.ResultsAfter excluding hospitalizations due to complications from transplantation, when compared to the general population, transplant recipients were approximately 6.4 (95% CI: 6.3, 6.5) times more likely to be hospitalized during follow-up. The SHRs were highest during the time periods proximate to transplantation, and then decreased to approximately a five-fold increase from 3 years post transplantation onwards. The largest disease-specific excesses were observed with infectious diseases and diseases of the endocrine system. Among those who underwent transplantation in 2004, the SHR decreased from 11.2 to 5.0 in the periods before and after surgery, respectively.ConclusionsOur results indicate that, even more than 5-years post transplantation, there remains a more than six-fold difference in hospitalization rates relative to the general population. Additional work is needed to confirm these findings, and to develop strategies to reduce long-term morbidity in this patient population.

Risk of neurological diseases among survivors of electric shocks: A nationwide cohort study, Denmark, 1968–2008

Several studies suggest a link between electric injuries and neurological diseases, where electric shocks may explain elevated risks for neuronal degeneration and, subsequently, neurological diseases. We conducted a retrospective cohort study on the risk of neurological diseases among people in Denmark who had survived an electric accident in 1968-2008. The cohort included 3,133 people and occurrences of neurological diseases were determined by linkage to the nationwide population-based Danish National Register of Patients. The numbers of cases observed at first hospital contact in the cohort were compared with the respective rates of first hospital contacts for neurological diseases in the general population. We observed significantly increased risks for peripheral nerve diseases (standardized hospitalization ratio (SHR), 1.66; 95% confidence interval (CI), 1.22-2.22), for migraine (SHR, 1.80; 95% CI, 1.23-2.54), for vertigo (SHR, 1.60; 95% CI, 1.22-2.05), and for epilepsy (SHR, 1.45; 95% CI, 1.11-1.85). Only small numbers of cases of other neurological diseases were found, making the risk estimates unstable. These findings suggest an association between a single electric shock and increased risks for peripheral nerve diseases, migraines, vertigo, and epilepsy, but confirmation of these observations is needed.

Predicting Hospitalization and Mortality in End-Stage Renal Disease (ESRD) Patients Using an Index of Coexisting Disease (ICED)–Based Risk Stratification Model

We evaluated the use of an additive Index of Coexisting Diseases (ICED)-based stratification schema to determine subsequent hospitalization and mortality in a hemodialysis population. Patients from five commercial health plans were stratified into low-, medium-, and high-risk groups and followed for up to 1 year. Patients were reassessed and restratified at 90-day intervals and censored when disease management ceased. Outcome measures collected through selfreports and health plan records were captured in an active database. Survival to first hospitalization/ mortality was compared by Kaplan Meier curves, survivor function differences by the Wilcoxon test, and group comparisons by ANOVA and chi square. Population characteristics included mean age of 63.0, 57.7% male, and 58.8% diabetic. Mortality was 13.0% per patient year (standardized mortality ratio 0.43) and the hospitalization rate was 0.59 per patient year (standardized hospitalization ratio 0.24). Survival curves demonstrated differences in mortality and hospitalization between the patients in different initial risk categories (p < 0.01). Mean hospitalizations were 0.81 +/- 1.53 per patient year (high risk), 0.45 +/- 0.99 (medium risk), and 0.15 +/- 0.51 for the low-risk group (p < 0.001). Stratification was dynamic; 47.3% decreased and 4.7% increased risk level between the first and second assessment. These changes were associated with survival differences for initial low (p = 0.06) or medium patients (p < 0.01), and hospital-free survival for initial medium (p = 0.08) or high patients (p < 0.05). In conclusion, this ICED-based stratification schema predicted mortality and hospitalization for hemodialysis patients participating in our disease management program.

A Cohort Study of Parkinson???s Disease and Other Neurodegenerative Disorders in Danish Welders

We sought to evaluate rates of hospitalizations for neurodegenerative disorders in a cohort of Danish metal manufacturing employees. A retrospective cohort study was conducted from 1977 to 2002 among 27,839 male Danish metal-manufacturing employees, with 9,817 of those employed in departments engaged in mild or stainless-steel welding and 6,163 welders. The standardized hospitalization ratio and 95% confidence intervals (CI) for Parkinson's disease were 0.9 (CI = 0.7-1.2) for men in steel-manufacturing companies, 1.0 (CI = 0.7-1.5) for men in welding departments, and 0.9 (CI = 0.4-1.5) for welders. Observed numbers for other neurological conditions were small and not above population expectations. Analyses for time period worked, age, and duration of welding were unremarkable. This relatively large cohort study with long-term follow-up provides no support for the hypothesis that rates of hospitalization for Parkinson's disease or other neurological conditions are elevated under the exposure circumstances of these Danish workers.

Psychiatric hospitalizations among survivors of cancer in childhood or adolescence.

We investigated whether children and adolescents who survive cancer are at increased risk for psychiatric hospitalization. In a nationwide, population-based, retrospective cohort study, 3710 persons who survived at least three years after a diagnosis of cancer in childhood or adolescence in the period from 1943 to 1990, and who were alive on January 1, 1970, or were born after that date, were identified in the Danish Cancer Registry. This population was followed up for psychiatric hospitalization from January 1, 1970, through 1993 by linkage with the Danish national Psychiatric Central Register. The number of expected cases was based on the national rates of hospitalization for psychiatric disease. Among the 3710 survivors of cancer in childhood or adolescence, there was a total of 88 psychiatric hospitalizations. The risk of hospitalization for any psychiatric disease was higher among the survivors than in the general population, but the excess risk was restricted to survivors of brain tumor (the standardized hospitalization ratio [SHR], corresponding to the ratio of observed to expected cases of hospitalization for psychiatric disease, was 1.8; 95 percent confidence interval, 1.5 to 2.2). An increased risk of psychoses of somatic, cerebral causes (SHR, 7.7; 95 percent confidence interval, 4.1 to 13.2), psychiatric disorders in somatic disease (SHR, 5.1; 95 percent confidence interval, 2.5 to 9.1), and schizophrenia and related disorders (SHR, 2.4; 95 percent confidence interval, 1.2 to 4.4) was observed among survivors of brain tumor. There was no evidence of a significantly increased risk of major depression. The risk of hospitalization for a psychiatric disorder is not increased among survivors of cancer in childhood or adolescence, except among survivors of brain tumor.

Gender differences in children's hospitalization in Catalonia: another inequality?

The aim of this study was to describe children's hospitalization and to analyse gender differences by selected diagnostic and procedure groups. Using the Clinical Classification for Health Policy Research Version 2 (CCHPR), 81 888 hospitalizations from the Minimum Basic Data Set of Hospital Discharge (CMBDAH) of 1995 related to children under 15 y of age in Catalonia, Spain, were studied. Hospitalization rates, number of days in hospital, average length of stay (d) in hospital and the standardized hospitalization ratio (SHR) (hospitalization rate in boys/hospitalization rate in girls) were computed. Two independent approaches were taken: (i) gender‐specific categories were excluded in order to compare hospitalizations by sex; (ii) a selected group of 17 diagnostic and procedure categories were chosen in order to carry out the specific gender comparison. In both approaches, the selected indicators were compared by age groups, and totals were standardized by age using the direct method. An excess of hospitalization in boys was observed (SHR= 1.18; 95% CI: 1.17–1.19). The number of days spent in hospital and hospitalization rates were higher in infants and were also higher for boys than for girls. The average length of stay in hospital was higher in infants and in girls at all ages. These differences were systematic when stratified by health region, admission and discharge circumstances and hospital category. Except for urinary infection, which was higher in girls (SHR: 0.65; CI 95%: 0.54—0.76), the SHR was higher in boys in all diagnostic and procedure categories analysed (all SHR &gt; 1). Specific sex categories, injuries and poisonings cannot on their own explain a higher level of hospitalization among boys. More specific studies are needed to explain the role of the family and the healthcare system in gender inequalities in children's hospitalization. □Catalonia, children, differences, hospitalization, inequalities, sex