Total Annual Days Research Articles

Pharmacologically treated diabetes and hospitalization among older Norwegians receiving homecare services from 2009 to 2014: a nationwide register study

IntroductionThe aim was to assess whether annual hospitalization (admissions, length of stay and total days hospitalized) among persons >65 years receiving home care services in Norway were higher for persons...

Assessment of Prescription Analgesic Use in Older Adults With and Without Chronic Kidney Disease and Outcomes

Pain is a common symptom among patients with kidney disease. However, little is known about use of analgesics among patients aged 65 years or older with chronic kidney disease (CKD) who do not receive dialysis treatment. To assess national trends and geographic variations in use of opioids and prescription nonsteroidal anti-inflammatory drugs (NSAIDs) in older adults with and without CKD in the US (2006-2015) and examine associations between use of opioids and patient outcomes. This cohort study used the 5% Medicare claims data (2005-2015) to select 10 retrospective annual cohorts of Medicare Part D beneficiaries aged 65 years and older from 2006 to 2015 and a retrospective longitudinal cohort. Data were analyzed in August 2019. CKD status and other comorbidities identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes. Analgesic use was measured by overall use (proportion of ever used opioids/NSAIDs), long-term use (prescribed >90 days), and cumulative use (total annual days' supply). Patient outcomes included progression to end-stage kidney disease (ESKD) and all-cause mortality. A total of 6 260 454 beneficiaries (9.6% identified with CKD by claims) were selected in the annual cohorts and 649 339 beneficiaries (8.3% identified with CKD) were selected in the longitudinal cohort. There was significant growth in opioid use (31.2%-42.4%) and NSAID use (10.7%-16.6%) among patients aged 65 years and older with CKD from 2006 to 2015. Long-term use of opioids increased during 2006 to 2014 (25.8%-36.7%) but decreased through 2015 at 35.6%, while long-term use of NSAIDs remained stable. Opioid use was higher in patients with CKD, particularly CKD stages 4 to 5 (odds ratio [OR], 1.35; 95% CI, 1.33-1.37; P < .001) compared with non-CKD. NSAID use was lower in patients with CKD stages 4 to 5 (OR, 0.55; 95% CI, 0.54-0.56; P < .001). Substantial geographic variations in analgesic use were observed across states (opioid use in CKD: 24.7%-54.3%; NSAID use in CKD: 11.2%-20.8%, 2012-2015). Opioid use was associated with progression to ESKD (hazard ratio [HR], 1.10; 95% CI, 1.04-1.16; P = .001) and death (HR, 1.19; 95% CI, 1.18-1.20; P < .001) independent of CKD status and other covariates. There was an inverse association between NSAID use and death (HR, 0.84; 95% CI, 0.83-0.85; P < .001). Among Medicare patients with CKD, use of prescription analgesics, both opioid and NSAID, increased from 2006 to 2015. Optimizing pain management in a complex condition such as kidney disease should remain a priority for clinicians and researchers alike.

Relationship of American Spinal Injury Association Impairment Scale Grade to Post-injury Hospitalization and Costs in Thoracic Spinal Cord Injury.

BACKGROUNDThe lifetime economic burden of thoracic spinal cord injury (SCI) is known to be high, but evidence of variability of costs in relation to the American Spinal Injury Association Impairment Scale (AIS) grade is limited.OBJECTIVETo estimate lifetime economic costs of hospitalization by AIS grade in thoracic SCI.METHODSUsing SCI Model Systems data from January 2000 to March 2016 from the National Spinal Cord Injury Statistical Center, we estimated mean total annual days of all-cause hospitalization by AIS grade among persons with thoracic SCI, based on assessments 1, 5, and 10 yr post-injury. We combined this information with secondary cost data and projections of life expectancy to estimate lifetime economic costs of hospitalization by AIS grade in persons aged 35 yr at time of thoracic SCI. Future costs were discounted to present value at 3% annually.RESULTSOne year post-injury, mean total annual days of hospitalization ranged from 2.1 for persons with AIS-D injuries to 5.9 for those who were AIS-A. Similar differences were noted 5 and 10 yr post-SCI. The estimated net present value of expected lifetime costs of hospitalization following thoracic SCI at age 35 yr was $321 534, $249 514, $188 989, and $68 120 (2015 US$) for AIS-A, AIS-B, AIS-C, and AIS-D injuries, respectively.CONCLUSIONPersons with less severe thoracic SCI, as reflected in AIS grade, spend fewer days in hospital over their lifetimes, leading to lower costs of inpatient care. Therapies improving AIS grade following thoracic SCI may provide cost savings in addition to addressing substantial unmet need.

Examining Relationships Between Legislative and Presidential Influences and Organizational Probity: Evidence from South Korean Central Government Agencies

ABSTRACTIn public management, few empirical studies have been conducted on the effects of the most influential political authorities—the legislature and the president—on government organizations, despite the theoretical and practical significance of these effects. This study tests the relationships between legislative and presidential influences and organizational probity in South Korean central government agencies, on the basis of political transaction-cost and principal–agent theories. We use three measures of legislative influence—inspectional influence (total annual days of legislative inspection), statutory influence (rules-to-laws ratio), and budgetary influence (ratio of reprogramming budget to total budget), and one measure of presidential influence (annual number of substantive meetings with the president). Then, these independent variables are linked to the organizational probity measure from audited archival data. The two-time-point panel data analysis reveals a positive link between legislative inspectional influence and probity but a negative relationship between the presidential influence measure and probity; the results support theoretical arguments for control over administrative agencies. Thus, the evidence suggests that governments should be cautious of implementing reforms that increase organizational or managerial autonomy.

General practitioner characteristics and sickness absence—a register-based study of 348 054 employed Norwegians

Background: Sickness certification is currently of increased interest in general practice research. Sickness absence certification is a key medical task for general practitioners (GPs), but the knowledge of GPs’ certification practices and the GPs’ role in sickness absence is limited and partly contradictory. Objective: The objective of this study was to analyse whether rates of sickness absence vary in relation to characteristics of the GP and their list-population. Methods: The data set consisted of matched GP–patient data, including 627 GPs and 348 054 people in employment in the two largest cities in Norway in 2006. Sickness absence rates (total annual days) were estimated using descriptive statistics and analysis of variation. Results: Of the population at risk of sick leave, 23.3% of the women had at least one sickness episode in 2006, compared with 12.7% of the men. Mean total annual days of sick leave was 12.1 for the women and 6.4 for the men. Characteristics of the GPs’ list population, especially the socio-economic status of those on the list, were associated with variations in sickness absence rates. GP gender and age showed association only in one subgroup of list patients.Conclusion: Our findings support previous studies concluding that individual patient factors are the most important variables explaining with sickness absence patterns. The study also showed that some GP-factors, and especially factors linked to the composition of the list population, are associated with variations in sickness absence rates and thus important when studying certification practices.

Iberian–Balearic fern regions and their explanatory variables

This article delineates the compositional regions present in the Iberian–Balearic fern flora and compares these regions to previously proposed biogeographic units. It also assesses the extent to which environmental variables could explain the regions and the fern species richness gradients found within them. A combination of 40 previously published and new maps were used to compile the distribution of 123 pteridophytes on a 50 × 50 km UTM grid. Cluster analysis of the resulting 257 squares was used to classify 10 regions based on fern species assemblages. Discriminant function analysis identified the environmental variables that best explained these fern composition regions. Using generalized linear models; the number of species in each square was regressed against topography, climate, geology, environmental diversity, land use and spatial variables within each region. Two main latitudinal pteridophyte zones can be recognized in the Iberian Peninsula. These two zones are longitudinally subdivided into two sub zones. The 10 regions established significantly differ both in species richness and influential environmental variables. Climatic variables discriminate the most among regions, followed by topography, heterogeneity and geology. Pteridophyte richness varies, with richer areas being located along the coast and the main mountain ranges and the poorest areas being in the central plateaus and some north eastern and south western river basins. Species richness variation in Iberia is positively correlated with altitude range, precipitation, maximum altitude and area with siliceous soils. It is negatively correlated with the total annual days of sun, however. The fact that species richness is explained by different variables within each of the 10 regions indicates that the specific factors determining the spatial distribution of species richness vary from region to region. Some coastal regions are poorly explained by the model, and display a negative correlation with the selected causal factors. This finding suggests that persistent historic effects might play a local role in determining species assemblages in these regions.

Changes in the Number and Timing of Days of Ice-Affected Flow on Northern New England Rivers, 1930–2000

Historical dates of ice-affected flows for 16 rural, unregulated rivers in northern New England, USA were analyzed. The total annual days of ice-affected flow decreased significantly (p < 0.1) over the 20th century at 12 of the 16 rivers. On average, for the nine longest-record rivers, the total annual days of ice-affected flow decreased by 20 days from 1936 to 2000, with most of the decrease occurring from the 1960s to 2000. Four of the 16 rivers had significantly later first dates of ice-affected flow in the fall. Twelve of the 16 rivers had significantly earlier last dates of ice-affected flow in the spring. On average, the last dates became earlier by 11 days from 1936 to 2000 with most of the change occurring from the 1960s to 2000. The total annual days of ice-affected flow were significantly correlated with November through April air temperatures (r = −0.70) and with November through April precipitation (r = −0.52). The last spring dates were significantly correlated with March through April air temperatures (r = −0.73) and with January through April precipitation (r = −0.37). March mean river flows increased significantly at 13 of the 16 rivers in this study.