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Liu, Xianchen, John Thompson, Hemant Phatak, Jack Mardekian, Anthony Porcari, Margot Johnson e Alexander T. Cohen. "Extended anticoagulation with apixaban reduces hospitalisations in patients with venous thromboembolism". Thrombosis and Haemostasis 115, n.º 01 (janeiro de 2016): 161–68. http://dx.doi.org/10.1160/th15-07-0606.
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SummaryTreatment with apixaban versus placebo for 12 months significantly reduced symptomatic recurrent venous thromboembolism (VTE) or all-cause death without increasing the rate of major bleeding in the AMPLIFY-EXT trial. This analysis examined the effects of apixaban versus placebo on the rate of all-cause hospitalisations, time to first hospitalisation, and predictors of first hospitalisation in patients with VTE enrolled in AMPLIFY-EXT. Treatment with apixaban 2.5 mg and 5 mg twice daily significantly reduced the rate of all-cause hospitalisations versus placebo (hazard ratio [95 % confidence interval], 0.64 [0.43, 0.95]; p=0.026 and 0.54 [0.36, 0.82]; p=0.004, respectively). Apixaban prolonged mean time to first hospitalisation versus placebo by 43 and 49 days for the 2.5-mg and 5-mg twice-daily groups, respectively. Median length of hospital stay during the first hospitalisation was longer for placebo than for apixaban 2.5 mg or 5 mg twice daily (7.0, 5.0, and 4.5 days, respectively). Treatment with apixaban was a significant predictor of lower rates of hospitalisations versus placebo, and severe/moderate renal impairment was a significant predictor of an increased rate. This study supports extended use of apixaban for reducing all-cause hospitalisations and extending time to first hospitalisation in patients with VTE enrolled in AMPLIFY-EXT (www.clinical trials.gov registration: #NCT00633893).
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Wedderburn, Catherine J., Julia Bondar, Marilyn T. Lake, Raymond Nhapi, Whitney Barnett, Mark P. Nicol, Liz Goddard e Heather J. Zar. "Risk and rates of hospitalisation in young children: A prospective study of a South African birth cohort". PLOS Global Public Health 4, n.º 1 (17 de janeiro de 2024): e0002754. http://dx.doi.org/10.1371/journal.pgph.0002754.
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Children in sub-Saharan Africa (SSA) are disproportionately affected by morbidity and mortality. There is also a growing vulnerable population of children who are HIV-exposed uninfected (HEU). Understanding reasons and risk factors for early-life child hospitalisation will help optimise interventions to improve health outcomes. We investigated hospitalisations from birth to two years in a South African birth cohort study. Mother-child pairs in the Drakenstein Child Health Study were followed from birth to two years with active surveillance for hospital admission and investigation of aetiology and outcome. Incidence, duration, cause, and factors associated with child hospitalisation were investigated, and compared between HEU and HIV-unexposed uninfected (HUU) children. Of 1136 children (247 HEU; 889 HUU), 314 (28%) children were hospitalised in 430 episodes despite >98% childhood vaccination coverage. The highest hospitalisation rate was from 0–6 months, decreasing thereafter; 20% (84/430) of hospitalisations occurred in neonates at birth. Amongst hospitalisations subsequent to discharge after birth, 83% (288/346) had an infectious cause; lower respiratory tract infection (LRTI) was the most common cause (49%;169/346) with respiratory syncytial virus (RSV) responsible for 31% of LRTIs; from 0–6 months, RSV-LRTI accounted for 22% (36/164) of all-cause hospitalisations. HIV exposure was associated with increased incidence rates of hospitalisation in infants (IRR 1.63 [95% CI 1.29–2.05]) and longer hospital admission (p = 0.004). Prematurity (HR 2.82 [95% CI 2.28–3.49]), delayed infant vaccinations (HR 1.43 [95% CI 1.12–1.82]), or raised maternal HIV viral load in HEU infants were risk factors for hospitalisation; breastfeeding was protective (HR 0.69 [95% CI 0.53–0.90]). In conclusion, children in SSA experience high rates of hospitalisation in early life. Infectious causes, especially RSV-LRTI, underly most hospital admissions. HEU children are at greater risk of hospitalisation in infancy compared to HUU children. Available strategies such as promoting breastfeeding, timely vaccination, and optimising antenatal maternal HIV care should be strengthened. New interventions to prevent RSV may have additional impact in reducing hospitalisation.
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Malik, Anam, Ellis Garland, Michael Drozd, Victoria Palin, Marilena Giannoudi, Sam Straw, Nick Jex et al. "Diabetes mellitus and the causes of hospitalisation in people with heart failure". Diabetes and Vascular Disease Research 19, n.º 1 (janeiro de 2022): 147916412110739. http://dx.doi.org/10.1177/14791641211073943.
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Introduction Diabetes mellitus (DM) is associated with increased risk of hospitalisation in people with heart failure and reduced ejection fraction (HFrEF). However, little is known about the causes of these events. Methods Prospective cohort study of 711 people with stable HFrEF. Hospitalisations were categorised by cause as: decompensated heart failure; other cardiovascular; infection or other non-cardiovascular. Rates of hospitalisation and burden of hospitalisation (percentage of follow-up time in hospital) were compared in people with and without DM. Results After a mean follow-up of 4.0 years, 1568 hospitalisations occurred in the entire cohort. DM (present in 32% [ n=224]) was associated with a higher rate (mean 1.07 vs 0.78 per 100 patient-years; p<0.001) and burden (3.4 vs 2.2% of follow-up time; p<0.001) of hospitalisation. Cause-specific analyses revealed increased rate and burden of hospitalisation due to decompensated heart failure, other cardiovascular causes and infection in people with DM, whereas other non-cardiovascular causes were comparable. Infection made the largest contribution to the burden of hospitalisation in people with and without DM. Conclusions In people with HFrEF, DM is associated with a greater burden of hospitalisation due to decompensated heart failure, other cardiovascular events and infection, with infection making the largest contribution.
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Komagamine, Junpei, e Masaki Kobayashi. "Prevalence of hospitalisation caused by adverse drug reactions at an internal medicine ward of a single centre in Japan: a cross-sectional study". BMJ Open 9, n.º 8 (agosto de 2019): e030515. http://dx.doi.org/10.1136/bmjopen-2019-030515.
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ObjectivesFew studies have investigated the prevalence of adverse drug reactions (ADRs) leading to hospitalisation in Japan. The aim of this study was to determine the prevalence of ADRs leading to hospitalisation and to evaluate the preventability of these ADRs in Japan.DesignA single-centre cross-sectional study using electronic medical records.SettingAcute care hospital.ParticipantsAll 1545 consecutive hospital admissions to an internal medicine ward due to acute medical illnesses from April 2017 to May 2018. The median patient age was 79 years (IQR 66–87), and the proportion of women was 47.9%.Outcome measuresThe primary outcome was the proportion of hospitalisations caused by ADRs among all hospitalisations. All suspected cases of ADRs were independently evaluated by two reviewers, and disagreements were resolved by discussion. The causality assessment for ADRs was performed by using the WHO-Uppsala Monitoring Committee criteria. The contribution of ADRs to hospitalisation and their preventability were evaluated based on the Hallas criteria.ResultsOf the 1545 hospitalisations, 153 hospitalisations (9.9%, 95% CI 8.4% to 11.4%) were caused by 200 ADRs. Cardiovascular agents (n=46, 23.0%), antithrombic agents (n=33, 16.5%), psychotropic agents (n=29, 14.5%) and non-steroidal anti-inflammatory drugs (n=24, 12.0%) accounted for approximately two-thirds of all ADRs leading to hospitalisation. Of 153 hospitalisations caused by ADRs, 102 (66.7%) were judged to be preventable.ConclusionsSimilar to other countries, one in every ten hospitalisations is caused by ADRs according to data from an internal medicine ward of a Japanese hospital. Most of these hospitalisations are preventable. Some efforts to minimise hospitalisations caused by ADRs are needed.
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Moore, Hannah C., Graham L. Hall e Nicholas de Klerk. "Infant respiratory infections and later respiratory hospitalisation in childhood". European Respiratory Journal 46, n.º 5 (20 de agosto de 2015): 1334–41. http://dx.doi.org/10.1183/13993003.00587-2015.
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Acute respiratory infections (ARI) cause significant morbidity in infancy. We sought to quantify the relationship between ARI and development of respiratory morbidity in early childhood.Population-based longitudinal hospitalisation data were linked to perinatal, birth and death records for 145 580 Western Australian children from 1997 to 2002. We conducted Cox regression with sensitivity analyses to quantify the risk of recurrent ARI in infancy for respiratory hospitalisation after the age of 3 years.ARI in infancy was significantly related to respiratory hospitalisation before (hazard ratio (HR) 3.5, 95% CI 3.1–3.8) and after (HR 3.0, 95% CI 2.6–3.4) adjusting for known risk factors including maternal smoking during pregnancy, season of birth, delivery mode and gestational age. We noted a dose response with the number and length of infant ARI hospitalisations and increasing risk with no effect modification by gestational age. Results were similar when later respiratory hospitalisations were restricted to asthma hospitalisations only.Recurrent hospitalisations for ARI in infancy significantly increase the risk of respiratory morbidity and asthma requiring hospitalisation after the age of 3 years in a dose-response fashion. The increase in relative risk is not modified by gestational age. Efforts to reduce the occurrence of infant ARI are likely to have significant public health benefits.
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Scherrenberg, Martijn, Jobbe PL Leenen, Astrid E. van der Velde, Josiane Boyne, Wendy Bruins, Julie Vranken, Hans-Peter Brunner-La Rocca, Ed P. De Kluiver e Paul Dendale. "Bringing the hospital to home: Patient-reported outcome measures of a digital health-supported home hospitalisation platform to support hospital care at home for heart failure patients". DIGITAL HEALTH 9 (janeiro de 2023): 205520762311521. http://dx.doi.org/10.1177/20552076231152178.
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Background Hospitalisations for heart failure are frequent and costly, linked with a lower quality of life, and lead to higher morbidity and mortality. Home hospitalisation interventions could be a substitute for in-hospital stays to reduce the burden on patients. The current study aims to investigate patient-reported satisfaction and usability in combination with the safety of a digital health-supported home hospitalisation intervention for heart failure patients. Methods We conducted an international, multicentre, single-arm, interventional study to investigate the feasibility and safety of a digital health-supported home hospitalisation platform. Patients with acute decompensation of known and well-assessed chronic heart failure with an indication for hospital admission were included. The primary outcome was patient satisfaction. Secondary outcomes were usability, adherence, and safety. Results A total number of 66 patients were included, of which the data of 65 patients (98.5%) was analysed. A total of 86.1% of patients reported being very satisfied or totally satisfied. No patients reported to be not satisfied with the home hospitalisation intervention. The patients reported a sufficient usability score (mean score: 75.8% of 100%) for the digital health-supported home hospitalisation platform. The adherence to the daily measurements of blood pressure and weight was very high, whereas the adherence to the daily interaction with the eCoach was lower (69.3%). In 7 patients (10.8%), a conversion from home hospitalisation to regular hospitalisation was needed. Furthermore, 6 patients (9.2%) had rehospitalisation within 30 days after the end of the home hospitalisation intervention. Conclusion A digitally supported home hospitalisation intervention is feasible. This study demonstrates high patient satisfaction and sufficiently high usability scores. The safety outcomes are comparable with traditional heart failure hospitalisations. This indicates that digitally supported home hospitalisation could be an alternative to in-hospital care for all age groups, yet further research is needed to prove the (cost-) effectiveness.
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Jansa, Pavel, David Ambrož, Michael Aschermann, Vladimír Černý, Vladimír Dytrych, Samuel Heller, Jan Kunstýř et al. "Hospitalisation Is Prognostic of Survival in Chronic Thromboembolic Pulmonary Hypertension". Journal of Clinical Medicine 11, n.º 20 (20 de outubro de 2022): 6189. http://dx.doi.org/10.3390/jcm11206189.
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This analysis investigated the prognostic value of hospitalisation in chronic thromboembolic pulmonary hypertension (CTEPH) using data from the Czech Republic, wherein pulmonary endarterectomy (PEA) was the only targeted treatment option until 2015. Using a landmark method, this analysis quantified the association between a first CTEPH-related hospitalisation event occurring before 3-, 6-, 9-, and 12-month landmark timepoints and subsequent all-cause mortality in adult CTEPH patients diagnosed between 2003 and 2016 in the Czech Republic. Patients were stratified into operable and inoperable, according to PEA eligibility. CTEPH-related hospitalisations were defined as non-elective. Hospitalisations related to CTEPH diagnosis, PEA, balloon pulmonary angioplasty, or clinical trial participation were excluded. Of 436 patients who survived to ≥3 months post diagnosis, 309 were operable, and 127 were inoperable. Sex- and age-adjusted hazard ratios (HRs) showed CTEPH-related hospitalisation was a statistically significant prognostic indicator of mortality at 3, 9, and 12 months in inoperable patients, with an approximately 2-fold increased risk of death in the hospitalisation group (HRs [95% CI] ranging from 1.98 [1.06–3.70] to 2.17 [1.01–4.63]). There was also a trend of worse survival probabilities in the hospitalisation groups for operable patients, with the difference most pronounced at 3 months, with a 76% increased risk of death (adjusted HR [95% CI] 1.76 [1.15–2.68]). This first analysis on the prognostic value of CTEPH-related hospitalisations demonstrates that a first CTEPH-related hospitalisation is prognostic of mortality in CTEPH, particularly for inoperable patients. These patients may benefit from medical and/or interventional therapy.
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Kerr, Steven, Tristan Millington, Igor Rudan, Colin McCowan, Holly Tibble, Karen Jeffrey, Adeniyi Francis Fagbamigbe et al. "External validation of the QCovid 2 and 3 risk prediction algorithms for risk of COVID-19 hospitalisation and mortality in adults: a national cohort study in Scotland". BMJ Open 13, n.º 12 (dezembro de 2023): e075958. http://dx.doi.org/10.1136/bmjopen-2023-075958.
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ObjectiveThe QCovid 2 and 3 algorithms are risk prediction tools developed during the second wave of the COVID-19 pandemic that can be used to predict the risk of COVID-19 hospitalisation and mortality, taking vaccination status into account. In this study, we assess their performance in Scotland.MethodsWe used the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 national data platform consisting of individual-level data for the population of Scotland (5.4 million residents). Primary care data were linked to reverse-transcription PCR virology testing, hospitalisation and mortality data. We assessed the discrimination and calibration of the QCovid 2 and 3 algorithms in predicting COVID-19 hospitalisations and deaths between 8 December 2020 and 15 June 2021.ResultsOur validation dataset comprised 465 058 individuals, aged 19–100. We found the following performance metrics (95% CIs) for QCovid 2 and 3: Harrell’s C 0.84 (0.82 to 0.86) for hospitalisation, and 0.92 (0.90 to 0.94) for death, observed-expected ratio of 0.24 for hospitalisation and 0.26 for death (ie, both the number of hospitalisations and the number of deaths were overestimated), and a Brier score of 0.0009 (0.00084 to 0.00096) for hospitalisation and 0.00036 (0.00032 to 0.0004) for death.ConclusionsWe found good discrimination of the QCovid 2 and 3 algorithms in Scotland, although performance was worse in higher age groups. Both the number of hospitalisations and the number of deaths were overestimated.
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Phung, Dung T., Joshua L. Warren, Cordia Ming-Yeuk Chu e Robert Dubrow. "Relationship between flood severity and risk of hospitalisation in the Mekong River Delta of Vietnam". Occupational and Environmental Medicine 78, n.º 9 (19 de julho de 2021): 676–78. http://dx.doi.org/10.1136/oemed-2021-107768.
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ObjectiveTo examine the relationship between flood severity and risk of hospitalisation in the Vietnam Mekong River Delta (MRD).MethodsWe obtained data on hospitalisations and hydro-meteorological factors during 2011–2014 for seven MRD provinces. We classified each day into a flood-season exposure period: the 2011 extreme annual flood (EAF); 2012–2014 routine annual floods (RAF); dry season and non-flood wet season (reference period). We used province-specific Poisson regression models to calculate hospitalisation incidence rate ratios (IRRs). We pooled IRRs across provinces using random-effects meta-analysis.ResultsDuring the EAF, non-external cause hospitalisations increased 7.2% (95% CI 3.2% to 11.4%); infectious disease hospitalisations increased 16.4% (4.3% to 29.8%) and respiratory disease hospitalisations increased 25.5% (15.5% to 36.4%). During the RAF, respiratory disease hospitalisations increased 8.2% (3.2% to 13.5%). During the dry season, hospitalisations decreased for non-external causes and for each specific cause except injuries.ConclusionsWe observed a gradient of decreasing risk of hospitalisation from EAF to RAF/non-flood wet season to dry season. Adaptation measures should be strengthened to prepare for the increased probability of more frequent extreme floods in the future, driven by climate change.
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Amadou, Coralie, Pierre Denis, Kristel Cosker e Anne Fagot-Campagna. "Less amputations for diabetic foot ulcer from 2008 to 2014, hospital management improved but substantial progress is still possible: A French nationwide study". PLOS ONE 15, n.º 11 (30 de novembro de 2020): e0242524. http://dx.doi.org/10.1371/journal.pone.0242524.
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Objective To assess the improvement in the management of diabetes and its complications based on the evolution of hospitalisation rates for diabetic foot ulcer (DFU) and lower extremity amputation (LEA) in individuals with diabetes in France. Methods Data were provided by the French national health insurance general scheme from 2008 to 2014. Hospitalisations for DFU and LEA were extracted from the SNIIRAM/SNDS French medical and administrative database. Results In 2014, 22,347 hospitalisations for DFU and 8,342 hospitalisations for LEA in patients with diabetes were recorded. Between 2008 and 2014, the standardised rate of hospitalisation for DFU raised from 508 to 701/100,000 patients with diabetes. In the same period, the standardised rate of LEA decreased from 301 to 262/100,000 patients with diabetes. The level of amputation tended to become more distal. The proportion of men (69% versus 73%) and the frequency of revascularization procedures (39% versus 46%) increased. In 2013, the one-year mortality rate was 23% after hospitalisation for DFU and 26% after hospitalisation for LEA. Conclusions For the first time in France, the incidence of a serious complication of diabetes, i.e. amputations, has decreased in relation with a marked improvement in hospital management.
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Drazdienė, Nijolė, Rasa Tamelienė, Daiga Kviluna, Pille Saik, Ervin Saik e Jolanta Zaikauskienė. "Hospitalisation of late preterm infants due to lower respiratory tract infections in Lithuania, Latvia, and Estonia: incidence, disease severity, and risk factors". Acta medica Lituanica 25, n.º 2 (30 de agosto de 2018): 76–85. http://dx.doi.org/10.6001/actamedica.v25i2.3760.
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Background. By two years of age, almost all children experience at least one episode of respiratory syncytial virus (RSV) infection, the most common viral cause of hospitalisation due to lower respiratory tract infection (LRTI). We present data on LRTI hospitalisations (with a special focus on RSV), the course of illness, and LRTI hospitalisation risk factors in Lithuania, Latvia, and Estonia. Materials and methods. The analysed data were part of a large multinational study conducted in 23 countries (PONI). LRTI-related hospitalisations were observed during one RSV season for late premature infants (born between 33 weeks and 0 days and 35 weeks and 6 days of gestation) ≤6 months of age, who did not receive RSV prophylaxis. The potential risk factors and demographics were recorded at study enrolment and at the end of the RSV season. The primary endpoint was hospitalisation due to RSV LRTI; the secondary endpoints included severity, the course and the outcome of LRTI hospitalisations. Results. Out of the 291 infants enrolled in three Baltic states, 19 were hospitalised due to LRTI (6.5%). RSV testing was performed for 14 hospitalised infants; five infants had a positive test for RSV (1.7%). The majority of the hospitalised infants (94.7%) had mild or moderate respiratory illness. Male sex, O2 dependency after birth, younger maternal age, and furred pets at home were significantly associated with an increased risk for LRTI hospitalisation. Conclusions. During one RSV season, the incidence of LRTI hospitalisations among late preterm infants was 6.5% and the incidence of RSV LRTI hospitalisations was 1.7%.
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Levartovsky, A., Y. Barash, S. Ben-Horin, B. Ungar, E. Klang, S. Soffer e U. Kopylov. "P221 Thromboembolic events in hospitalised patients with inflammatory bowel disease – a large tertiary hospital experience". Journal of Crohn's and Colitis 14, Supplement_1 (janeiro de 2020): S253. http://dx.doi.org/10.1093/ecco-jcc/jjz203.350.
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Abstract Background Patients with inflammatory bowel disease (IBD) have a greater risk of venous thromboembolism (VTE) events compared with the general population especially during flares, in both hospitalised and ambulatory patients. Although VTE prophylaxis (thromboprophylaxis) is recommended in hospitalised IBD patients, the implementation is not universal, especially for non-IBD-related hospitalisations. In this study, we aimed to present the rates of VTEs and thromboprophylaxis among hospitalised IBD patients. Methods We created an electronic data repository of all IBD patients who visited the emergency department (ED) of our tertiary medical centre between 2012 and 2018. Data included tabular demographic and clinical variables (reason for referral, VTEs, clinical characteristics, hospitalisation, lab results, treatment and outcome) as well as free-text physician records. For this study, we searched the data repository for VTE cases, using ICD10 coding. Results Overall, there were 7009 ED visits of 2405 patients with IBD, 1556 (64.7%) Crohn's disease and 849 (35.3%) Ulcerative colitis patients. Thromboprophylaxis was administered in 463 hospitalisations (12.4% of IBD-related and 10.9% of non-IBD-related hospitalisations). 1.5% of patients (36/2405) who visited the ED had a new VTE. Thirty patients were diagnosed with a deep vein thrombosis (DVT), two patients with a pulmonary embolism (PE) and six additional patients were diagnosed with both a DVT and PE in the same hospitalisation. Eleven patients had a VTE during a non-IBD-related hospitalisation and six patients during an IBD-related hospitalisation (0.6% vs. 0.3%, respectively, pv = 0.12). Five patients (29.4%) developed VTEs after receiving thromboprophylaxis during hospitalisation. The majority (72.7%) of VTEs diagnosed during a non-IBD-related hospitalisation did not have additional thrombosis-related risk factors. One patient died during hospitalisation and two more patients died in the upcoming 30 days (unrelated to VTEs). Conclusion The rate of thromboprophylaxis in hospitalised IBD patients is low, despite posing life-threatening implications. Thromboprophylaxis should be implemented in IBD patients hospitalised for all indications.
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Huang, Rong, Lin Xiao, Jane Zhu, Justin Cheng, Jill Torrie, Nancy Gros-Louis McHugh, Nathalie Auger e Zhong-Cheng Luo. "Population-based birth cohort study on diabetes in pregnancy and infant hospitalisations in Cree, other First Nations and non-Indigenous communities in Quebec". BMJ Open 13, n.º 12 (dezembro de 2023): e074518. http://dx.doi.org/10.1136/bmjopen-2023-074518.
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ObjectivesDiabetes in pregnancy, whether pre-gestational (chronic) or gestational (de novo hyperglycaemia), increases the risk of adverse birth outcomes. It is unclear whether gestational diabetes increases the risk of postnatal morbidity in infants. Cree First Nations in Quebec are at high risk for diabetes in pregnancy. We assessed whether pre-gestational or gestational diabetes may increase infant hospitalisation (an infant morbidity indicator) incidence, and whether this may be related to more frequent infant hospitalisations in Cree and other First Nations in Quebec.DesignPopulation-based birth cohort study through administrative health data linkage.Setting and participantsSingleton infants (≤1 year) born to mothers in Cree (n=5070), other First Nations (9910) and non-Indigenous (48 200) communities in rural Quebec.ResultsBoth diabetes in pregnancy and infant hospitalisation rates were much higher comparing Cree (23.7% and 29.0%) and other First Nations (12.4% and 34.1%) to non-Indigenous (5.9% and 15.5%) communities. Compared with non-diabetes, pre-gestational diabetes was associated with an increased risk of any infant hospitalisation to a greater extent in Cree and other First Nations (relative risk (RR) 1.56 (95% CI 1.28 to 1.91)) than non-Indigenous (RR 1.26 (1.15 to 1.39)) communities. Pre-gestational diabetes was associated with increased risks of infant hospitalisation due to diseases of multiple systems in all communities. There were no significant associations between gestational diabetes and risks of infant hospitalisation in all communities. The population attributable risk fraction of infant hospitalisations (overall) for pre-gestational diabetes was 6.2% in Cree, 1.6% in other First Nations and 0.3% in non-Indigenous communities.ConclusionsThe study is the first to demonstrate that pre-gestational diabetes increases the risk of infant hospitalisation overall and due to diseases of multiple systems, but gestational diabetes does not. High prevalence of pre-gestational diabetes may partly account for the excess infant hospitalisations in Cree and other First Nations communities in Quebec.
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Galego, M. A., J. V. Santos, J. Viana, A. Freitas e R. Duarte. "To be or not to be hospitalised with tuberculosis in Portugal". International Journal of Tuberculosis and Lung Disease 23, n.º 9 (1 de setembro de 2019): 1029–34. http://dx.doi.org/10.5588/ijtld.18.0617.
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SETTING: In Portugal, as in other countries, tuberculosis (TB) is considered a disease that should be managed on an ambulatory basis. However, hospitalisation remains important to manage some at-risk groups and complications.OBJECTIVE: To identify the possible risk factors associated with hospitalisations in TB patients in Portugal.DESIGN: Data extraction through two national databases (one for registration of TB cases and the other with hospitalisation information in public health facilities) between 2007 and 2013. Univariate and multivariate analysis of demographic and clinical variables was performed.RESULTS: We identified 4421 hospitalisations. Chronic diseases, cancer, substance abuse, a higher social/economic risk, extra-pulmonary TB, lung cavitary disease and previous uncompleted treatment were more frequent among hospitalised patients. Human immunodeficiency virus coinfection, cancer, alcohol abuse, extra-pulmonary TB and uncompleted previous TB treatment were the most important predictors of hospitalisation with TB. The hospitalisation rate among TB patients in Portugal was lower when compared with other countries with lower and higher incidences.CONCLUSION: Immune dysfunctions and progression of chronic diseases are associated with more severe forms of TB and frequent adverse effects which can be sufficiently severe to necessitate hospital admission. Despite having an intermediate TB incidence, the hospitalisation rate in Portugal is not higher than that of other countries.
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Mahadea, D., P. Kotecki, I. Miechowicz, A. Dobrowolska e P. Eder. "P1138 Long-term Epidemiological Trends in Emergency Hospital Admissions and Hospitalizations of Patients with Inflammatory Bowel Diseases in one of the biggest metropolises in western Poland in years 2010 to 2021". Journal of Crohn's and Colitis 18, Supplement_1 (1 de janeiro de 2024): i2037—i2038. http://dx.doi.org/10.1093/ecco-jcc/jjad212.1268.
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Abstract Background A worldwide significant dynamic shift in the incidence and clinical course of Inflammatory Bowel Diseases (IBD) has been observed in the past years. One key indicator that embodies this variability is the necessity for urgent hospitalisation due to exacerbations of Crohn's Disease (CD) and Ulcerative Colitis (UC). The objective of this study was to assess this phenomenon in the Poznan Metropolis, one of the biggest metropolises in western Poland, over a 12-year timeframe. Methods Using the National Health Fund's database, urgent hospitalisations of patients with CD or UC from 2010-2021 were identified, and defined as unplanned admissions to emergency departments and inpatient units in Poznan Metropolis hospitals, which required hospitalisation. The ratio of emergency to planned hospitalisations were compared in two identical timeframes: 2010-2015 vs. 2016-2021 and, additionally, during the COVID-19 pandemic years 2020-2021 vs. 2018-2019. The data were analysed and compared according to diagnosis, age, gender and length of hospitalisation. Results The numbers of urgent and planned hospitalisations in regard to predefined time periods are shown in Table 1. The rate of acute to planned hospitalisations from 2010-2015 vs. 2016-2021 was 27% (809/3006) vs. 44.5% (1131/2540) (p <0.0001). It increased significantly in all defined categories, except for patients over 60 years of age, where an insignificant decrease from 79% to 71% (p=0.4) was noted. Lower hospitalisation rates were observed among men compared to women (2010-2015: 28% vs. 46%; 2016-2021: 25% vs. 43%). The COVID-19 pandemic posed a paramount challenge to global healthcare systems. However, a statistically significant decrease in the rate of urgent to planned hospitalisations was only found in CD patients (47% vs. 34%; p=0.02; Figure 1). No impact on hospitalisation duration was observed during the COVID-19 pandemic as compared to 2018-2019. Conclusion Despite ongoing therapeutic advances, IBD remains a substantial challenge to healthcare systems, as evidenced by the increasing trend in urgent hospitalisations over time, regardless of the diagnosis, particularly among women. The COVID-19 pandemic significantly triggered global economic and healthcare crisis. However, the repercussions on the treatment of IBD patients in our Metropolis were inconsequential.
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Vuik, Sabine I., Gianluca Fontana, Erik Mayer e Ara Darzi. "Do hospitalisations for ambulatory care sensitive conditions reflect low access to primary care? An observational cohort study of primary care usage prior to hospitalisation". BMJ Open 7, n.º 8 (agosto de 2017): e015704. http://dx.doi.org/10.1136/bmjopen-2016-015704.
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ObjectivesTo explore whether hospitalisations for ambulatory care sensitive conditions (ACSCs) are associated with low access to primary care.DesignObservational cohort study over 2008 to 2012 using the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases.SettingEnglish primary and secondary care.ParticipantsA random sample of 300 000 patients.Main outcome measuresEmergency hospitalisation for an ACSC.ResultsOver the long term, patients with ACSC hospitalisations had on average 2.33 (2.17 to 2.49) more general practice contacts per 6 months than patients with similar conditions who did not require hospitalisation. When accounting for the number of diagnosed ACSCs, age, gender and GP practice through a nested case–control method, the difference was smaller (0.64 contacts), but still significant (p<0.001).In the short-term analysis, measured over the 6 months prior to hospitalisation, patients used more GP services than on average over the 5 years. Cases had significantly (p<0.001) more primary care contacts in the 6 months before ACSC hospitalisations (7.12, 95% CI 6.95 to 7.30) than their controls during the same 6 months (5.57, 95% CI 5.43 to 5.72). The use of GP services increased closer to the time of hospitalisation, with a peak of 1.79 (1.74 to 1.83) contacts in the last 30 days before hospitalisation.ConclusionsThis study found no evidence to support the hypothesis that low access to primary care is the main driver of ACSC hospitalisations. Other causes should also be explored to understand how to use ACSC admission rates as quality metrics, and to develop the appropriate interventions.
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Batul, Rameesa, Ritika Choudhary e Ouber Qayoom. "Comparison of Demographic Profile, Clinical Features and Comorbidities in Complicated Vs Uncomplicated Young Patients of Community Acquired Pneumonia Presenting to a Tertiary Care Centre". International Journal of Research and Review 10, n.º 2 (7 de fevereiro de 2023): 17–24. http://dx.doi.org/10.52403/ijrr.20230204.
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INTRODUCTION: Much research has been conducted in recent decades to determine prognostic factors for adverse outcome in patients hospitalized for CAP, including concomitant diseases and clinical parameters on admission. There is a large body of evidence in this field in the general population, less focus was put in younger group of patients, even though several recent studies showed that there is an increasing number of hospital admissions due to CAP among patients less than 60 years old. AIMS & OBJECTIVES: To compare demographic profile, clinical features and comorbidities in uncomplicated vs complicated young patients of community acquired pneumonia. RESULTS:In our study mean age of hospitalisation was 48.61% as compared to 52.39% in uncomplicated hospitalisation. Our study had more females constituting 59% of total patients. Comorbidities were significantly associated with complicated hospitalisation. Chest pain (p value=0.001), fever and breathlessness was significantly present in patients with complicated hospitalisations than uncomplicated hospitalisation. CONCLUSION: Complicated hospitalisations in young patients of community acquired pneumonia is associated with certain specific demographic and clinical parameters and comorbidities which are different from those in uncomplicated patients Keywords: Community Acquired Pneumonia, CAP, demographic profile.
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Setayeshgar, Solmaz, James Wilton, Hind Sbihi, Moe Zandy, Naveed Janjua, Alexandra Choi e Kate Smolina. "Comparison of influenza and COVID-19 hospitalisations in British Columbia, Canada: a population-based study". BMJ Open Respiratory Research 10, n.º 1 (fevereiro de 2023): e001567. http://dx.doi.org/10.1136/bmjresp-2022-001567.
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IntroductionWe compared the population rate of COVID-19 and influenza hospitalisations by age, COVID-19 vaccine status and pandemic phase, which was lacking in other studies.MethodWe conducted a population-based study using hospital data from the province of British Columbia (population 5.3 million) in Canada with universal healthcare coverage. We created two cohorts of COVID-19 hospitalisations based on date of admission: annual cohort (March 2020 to February 2021) and peak cohort (Omicron era; first 10 weeks of 2022). For comparison, we created influenza annual and peak cohorts using three historical periods years to capture varying severity and circulating strains: 2009/2010, 2015/2016 and 2016/2017. We estimated hospitalisation rates per 100 000 population.ResultsCOVID-19 and influenza hospitalisation rates by age group were ‘J’ shaped. The population rate of COVID-19 hospital admissions in the annual cohort (mostly unvaccinated; public health restrictions in place) was significantly higher than influenza among individuals aged 30–69 years, and comparable to the severe influenza year (2016/2017) among 70+. In the peak COVID-19 cohort (mostly vaccinated; few restrictions in place), the hospitalisation rate was comparable with influenza 2016/2017 in all age groups, although rates among the unvaccinated population were still higher than influenza among 18+. Among people aged 5–17 years, COVID-19 hospitalisation rates were lower than/comparable to influenza years in both cohorts. The COVID-19 hospitalisation rate among 0–4 years old, during Omicron, was higher than influenza 2015/2016 and 2016/2017 and lower than 2009/2010 pandemic.ConclusionsDuring first Omicron wave, COVID-19 hospitalisation rates were significantly higher than historical influenza hospitalisation rates for unvaccinated adults but were comparable to influenza for vaccinated adults. For children, in the context of high infection levels, hospitalisation rates for COVID-19 were lower than 2009/2010 H1N1 influenza and comparable (higher for 0–4) to non-pandemic years, regardless of the vaccine status.
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Raphael, Eva, R. Gaynes e Rita Hamad. "Cross-sectional analysis of place-based and racial disparities in hospitalisation rates by disease category in California in 2001 and 2011". BMJ Open 9, n.º 10 (outubro de 2019): e031556. http://dx.doi.org/10.1136/bmjopen-2019-031556.
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ObjectivesTo study the association of place-based socioeconomic factors with disease distribution by comparing hospitalisation rates in California in 2001 and 2011 by zip code median household income.DesignSerial cross-sectional study testing the association between hospitalisation rates and zip code-level median income, with subgroup analyses by zip code income and race.Participants/settingOur study included all hospitalised adults over 18 years old living in California in 2001 and 2011 who were not pregnant or incarcerated. This included all acute-care hospitalisations in California including 1632 zip codes in 2001 and 1672 zip codes in 2011.Primary and secondary outcomesWe compared age-standardised hospitalisations per 100 000 persons, overall and for several disease categories.ResultsThere were 1.58 and 1.78 million hospitalisations in California in 2001 and 2011, respectively. Spatial analysis showed the highest hospitalisation rates in urban inner cities and rural areas, with more than 5000 hospitalisations per 100 000 persons. Hospitalisations per 100 000 persons were consistently highest in the lowest zip code income quintile and particularly among black patients.ConclusionHospitalisation rates rose from 2001 to 2011 among Californians living in low-income and middle-income zip codes. Integrating spatially defined state hospital discharge and federal zip code income data provided a granular description of disease burden. This method may help identify high-risk areas and evaluate public health interventions targeting health disparities.
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Zafeiridi, Evi, Alan McMichael e Bernadette McGuinness. "58 Hospitalisation Rates and Causes for People with Dementia in Northern Ireland". Age and Ageing 48, Supplement_3 (setembro de 2019): iii1—iii16. http://dx.doi.org/10.1093/ageing/afz102.11.
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Abstract Background People with dementia are almost 50% more likely to have an acute hospital admission due to a common age-related illnesses, such as urinary tract infection. They also have an 18% higher rate of readmission following discharge and approximately one quarter of hospital beds are occupied by people with dementia. Furthermore, people with dementia have an increased mortality rate in hospital and for six months after discharge compared to age-matched controls. This study assessed the hospitalisation and re-hospitalisation rates for people with dementia in Northern Ireland, as well as exploring whether mortality rates increase during or following these hospitalisations. A secondary aim was to explore the causes of hospitalisations between people with dementia and a representative age-matched control group. Methods Data from over 50,000 people with dementia and the control group from national databases in Northern Ireland were retrospectively analysed. Results The results showed that dementia does not affect hospitalisations; however, the number of hospitalisations can predict mortality in people with dementia. The most common causes for hospitalisation did not differ between the dementia and the control groups and included pneumonia, urinary tract infection and fractures. Conclusion The results will inform health care professionals on whether a reduced number of hospitalisations increases life expectancy and may result in relieving some of the financial strain currently being experienced by the National Health Service.
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Shantakumar, Sumitra, Pieter W. Kamphuisen, Fernie J. A. Penning-van Beest, Ron M. C. Herings e Myrthe P. P. van Herk-Sukel. "Myocardial infarction, ischaemic stroke and pulmonary embolism before and after breast cancer hospitalisation". Thrombosis and Haemostasis 106, n.º 07 (2011): 149–55. http://dx.doi.org/10.1160/th10-12-0778.
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SummaryWe studied the occurrence of myocardial infarction (MI), ischaemic stroke (IS) and pulmonary embolism (PE) before and after breast cancer hospitalisation compared with cancer-free controls. For this, women with a first breast cancer hospitalisation during 2000–2007 were selected from the PHARMO Record Linkage System, including drug use and hospitalisations of three million inhabitants in the Netherlands, and matched 1:10 by age to cancer-free women. The occurrence of MI, IS and PE were assessed in the 12 months before and after breast cancer hospitalisation. The study included 11,473 breast cancer patients, with a mean (± SD) age of 59 (± 14) years. Breast cancer patients were two to three times as likely as their cancer-free controls to have had a hospitalisation for PE, MI or IS in the 12 months before diagnosis, though prevalence was <1% in all groups. Breast cancer patients experienced an extreme high risk of PE in the first six months after diag- nosis (hazard ratio [HR] 23.5, 95% confidence interval [CI] 11.1–49.7 compared to controls), which declined gradually to a four times increased risk (HR 3.6, 95%CI 2.4–5.5) more than 12 months after breast cancer hospitalisation. However, incidence was low: less than five events per 1,000 person years during all time periods. For MI and IS we did not observe significant increased HRs after breast cancer hospitalisation compared to controls. Breast cancer patients seem to have a higher risk profile to develop MI and IS, and receive treatment that increases the risk of PE compared to cancer-free controls, although the frequency of hospitalisations was low.
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Barker, Ruth E., Samantha SC Kon, Stuart F. Clarke, Jenni Wenneberg, Claire M. Nolan, Suhani Patel, Jessica A. Walsh et al. "COPD discharge bundle and pulmonary rehabilitation referral and uptake following hospitalisation for acute exacerbation of COPD". Thorax 76, n.º 8 (2 de março de 2021): 829–31. http://dx.doi.org/10.1136/thoraxjnl-2020-215464.
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Pulmonary rehabilitation (PR) following hospitalisations for acute exacerbation of COPD (AECOPD) is associated with improved exercise capacity and quality of life, and reduced readmissions. However, referral for, and uptake of, post-hospitalisation PR are low. In this prospective cohort study of 291 consecutive hospitalisations for AECOPD, COPD discharge bundles delivered by PR practitioners compared with non-PR practitioners were associated with increased PR referral (60% vs 12%, p<0.001; adjusted OR: 14.46, 95% CI: 5.28 to 39.57) and uptake (40% vs 32%, p=0.001; adjusted OR: 8.60, 95% CI: 2.51 to 29.50). Closer integration between hospital and PR services may increase post-hospitalisation PR referral and uptake.
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Li, You, Ena Batinović, Petra Milić e Joško Markić. "The role of birth month in the burden of hospitalisations for acute lower respiratory infections due to respiratory syncytial virus in young children in Croatia". PLOS ONE 17, n.º 9 (2 de setembro de 2022): e0273962. http://dx.doi.org/10.1371/journal.pone.0273962.
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Background Birth month was an important risk factor for respiratory syncytial virus (RSV) hospitalisation in infants. However, little is known about the role of birth month in RSV hospitalisation in finer age bands during infancy, which is relevant to strategies for RSV passive immunisations for infants. We aimed to understand the role of birth month in the burden of RSV-associated acute lower respiratory infection (ALRI) hospitalisation in finer age bands of the first year of life. Methods In this retrospective study, we analysed the hospitalisation records during 2014–19 at the University Hospital of Split, Split-Dalmatia County, Croatia. We estimated all-cause and RSV associated ALRI hospitalisation rates among children under five years, with a focus on infants by finer age band and birth month. Results We included 1897 ALRI hospitalisations during the study period. Overall in children under five years, annual hospitalisation rate was 14.66/1000 (95% CI: 14.01–15.34) for all-cause ALRI, and was 7.56/1000 (95% CI: 6.83–8.34) for RSV-ALRI. RSV-ALRI hospitalisation rate was highest in infants aged 28 days–<3 months (61.15/1000, 95% CI: 52.91–70.31). Infants born in November, December and January (2–3 months before RSV peak) had the highest hospitalisation rates during infancy. Depending on the birth month of infants, the risk of RSV-ALRI hospitalisation peaked at different months of age; infants who were born in September had the highest RSV-ALRI hospitalisation rate at the age of 3–<6 months. Conclusions Our study underlines the importance of birth month in planning RSV immunisation strategies for infants, and provides useful baseline data for effectiveness analysis of novel RSV prophylactic products.
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Pietiläinen, Olli, Mikko Laaksonen, Eero Lahelma, Aino Salonsalmi e Ossi Rahkonen. "Occupational class inequalities in disability retirement after hospitalisation". Scandinavian Journal of Public Health 46, n.º 3 (21 de agosto de 2017): 331–39. http://dx.doi.org/10.1177/1403494817726618.
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Aims: This study aimed to investigate whether hospitalisation is associated with increased risk of disability retirement differently across four occupational classes. Methods: 170,510 employees of the City of Helsinki, Finland were followed from 1990 to 2013 using national registers for hospitalisations and disability retirement. Increases in the risk of disability retirement after hospitalisation for any cause, cardiovascular diseases, musculoskeletal disorders, mental disorders, malignant neoplasms, respiratory diseases and injuries were assessed across four occupational classes: professional, semi-professional, routine non-manual and manual, using competing risks models. Results: In general, hospitalisation showed a slightly more increased risk of disability retirement in the lower ranking occupational classes. Hospitalisation among women for mental disorders showed a more increased risk in the professional class (hazard ratio 14.73, 95% confidence interval 12.67 to 17.12) compared to the routine manual class (hazard ratio 7.27, 95% confidence interval 6.60 to 8.02). Occupational class differences were similar for men and women. The risk of disability retirement among women increased most in the routine non-manual class after hospitalisation for musculoskeletal disorders and injuries, and most in the professional class after hospitalisation for cardiovascular diseases. The corresponding risks among men increased most in the two lowest ranking classes after hospitalisation for injuries. Conclusions: Ill-health as measured by hospitalisation affected disability retirement in four occupational classes differently, and the effects also varied by the diagnostic group of hospitalisation. Interventions that tackle work disability should consider the impact of ill-health on functioning while taking into account working conditions in each occupational class.
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Britton, Philip N., Lynette Khoury, Robert Booy, Nicholas Wood e Cheryl A. Jones. "Encephalitis in Australian children: contemporary trends in hospitalisation". Archives of Disease in Childhood 101, n.º 1 (16 de outubro de 2015): 51–56. http://dx.doi.org/10.1136/archdischild-2015-308468.
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ObjectiveThe clinical epidemiology of childhood encephalitis in Australia is inadequately understood. We aimed to describe recent trends in childhood encephalitis-related hospitalisation.Study designWe identified encephalitis-related hospital admissions (2000–2012) in national datasets among children ≤14 years using ICD encephalitis codes. We calculated hospitalisation rates and analysed trends by year, age, gender, location, indigenous status and aetiology.ResultsRates of childhood encephalitis hospitalisations significantly declined over an 11-year period (2000–2012; average hospitalisation rate 3.2/100 000). Varicella encephalitis hospitalisations decreased significantly, associated with high levels of varicella vaccine coverage since 2006. Acute disseminated encephalomyelitis (ADEM) was the most common ‘specified’ cause of encephalitis hospitalisation (15%–17%), and its rate has significantly increased. The highest hospitalisation rates occurred in the <1 year age group (5.8/100 000) and varied by location (highest in Northern Territory). The majority (58.9%) of hospitalised encephalitis had no cause identified; this proportion was highest in the <1 year age group (77%). The most common specified infectious causes included: herpes simplex virus, enterovirus, bacterial meningoencephalitis and varicella. When aggregated, the proportion of childhood encephalitis coded as viral was 21.2%.ConclusionHospitalisation of childhood encephalitis has slightly decreased in Australia. High rates of childhood immunisation have been associated with a reduction of varicella-associated encephalitis in Australian children. ADEM, an immune-mediated encephalitis, is the most common recognised cause of encephalitis in children. Young children (<1 year) have the highest admission rates. The high proportion of ‘unspecified’ encephalitis deaths and hospitalisations is an ongoing challenge.
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Russo, Letícia Xander, Timothy Powell-Jackson, Jorge Otavio Maia Barreto, Josephine Borghi, Roxanne Kovacs, Garibaldi Dantas Gurgel Junior, Luciano Bezerra Gomes et al. "Pay for performance in primary care: the contribution of the Programme for Improving Access and Quality of Primary Care (PMAQ) on avoidable hospitalisations in Brazil, 2009–2018". BMJ Global Health 6, n.º 7 (julho de 2021): e005429. http://dx.doi.org/10.1136/bmjgh-2021-005429.
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BackgroundEvidence on the effect of pay-for-performance (P4P) schemes on provider performance is mixed in low-income and middle-income countries. Brazil introduced its first national-level P4P scheme in 2011 (PMAQ-Brazilian National Programme for Improving Primary Care Access and Quality). PMAQ is likely one of the largest P4P schemes in the world. We estimate the association between PMAQ and hospitalisations for ambulatory care sensitive conditions (ACSCs) based on a panel of 5564 municipalities.MethodsWe conducted a fixed effect panel data analysis over the period of 2009–2018, controlling for coverage of primary healthcare, hospital beds per 10 000 population, education, real gross domestic product per capita and population density. The outcome is the hospitalisation rate for ACSCs among people aged 64 years and under per 10 000 population. Our exposure variable is defined as the percentage of family health teams participating in PMAQ, which captures the roll-out of PMAQ over time. We also provided several sensitivity analyses, by using alternative measures of the exposure and outcome variables, and a placebo test using transport accident hospitalisations instead of ACSCs.ResultsThe results show a negative and statistically significant association between the rollout of PMAQ and ACSC rates for all age groups. An increase in PMAQ participating of one percentage point decreased the hospitalisation rate for ACSC by 0.0356 (SE 0.0123, p=0.004) per 10 000 population (aged 0–64 years). This corresponds to a reduction of approximately 60 829 hospitalisations in 2018. The impact is stronger for children under 5 years (−0.0940, SE 0.0375, p=0.012), representing a reduction of around 11 936 hospitalisations. Our placebo test shows that the association of PMAQ on the hospitalisation rate for transport accidents is not statistically significant, as expected.ConclusionWe find that PMAQ was associated with a modest reduction in hospitalisation for ACSCs.
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Stensballe, Lone Graff, Signe Sørup, Peter Aaby, Christine Stabell Benn, Gorm Greisen, Dorthe Lisbeth Jeppesen, Nina Marie Birk et al. "BCG vaccination at birth and early childhood hospitalisation: a randomised clinical multicentre trial". Archives of Disease in Childhood 102, n.º 3 (21 de julho de 2016): 224–31. http://dx.doi.org/10.1136/archdischild-2016-310760.
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BackgroundThe BCG vaccine is administered to protect against tuberculosis, but studies suggest there may also be non-specific beneficial effects upon the infant immune system, reducing early non-targeted infections and atopic diseases. The present randomised trial tested the hypothesis that BCG vaccination at birth would reduce early childhood hospitalisation in Denmark, a high-income setting.MethodsPregnant women planning to give birth at three Danish hospitals were invited to participate. After parental consent, newborn children were allocated to BCG or no intervention within 7 days of age. Randomisation was stratified by prematurity. The primary study outcome was number of all-cause hospitalisations analysed as repeated events. Hospitalisations were identified using The Danish National Patient Register. Data were analysed by Cox proportional hazards models in intention-to-treat and per-protocol analyses.Results4184 pregnant women were randomised and their 4262 children allocated to BCG or no intervention. There was no difference in risk of hospitalisation up to 15 months of age; 2129 children randomised to BCG experienced 1047 hospitalisations with a mean of 0.49 hospitalisation per child compared with 1003 hospitalisations among 2133 control children (mean 0.47), resulting in a HR comparing BCG versus no BCG of 1.05 (95% CI 0.93 to 1.18) (intention-to-treat analysis). The effect of BCG was the same in children born at term (1.05 (0.92 to 1.18)) and prematurely (1.07 (0.63 to 1.81), p=0.94). The effect was also similar in the two sexes and across study sites. The results were essentially identical in the per-protocol analysis and after adjustment for baseline characteristics.ConclusionsBCG vaccination at birth did not reduce the risk of hospitalisation for somatic acquired disease until 15 months of age in this Danish study population.Trial registration numberNCT01694108, results.
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Mitchell, Rebecca J., Kate Curtis e Kim Foster. "A 10-year review of child injury hospitalisations, health outcomes and treatment costs in Australia". Injury Prevention 24, n.º 5 (27 de julho de 2017): 344–50. http://dx.doi.org/10.1136/injuryprev-2017-042451.
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BackgroundChildhood injury is a leading cause of hospitalisation, yet there has been no comprehensive examination of child injury and survival over time in Australia. To examine the characteristics, temporal trend and survival for children who were hospitalised as a result of injury in Australia.MethodA retrospective examination of linked hospitalisation and mortality data for injured children aged 16 years or less during 1 July 2001 to 30 June 2012. Negative binomial regression examined change in injury hospitalisation trends. Cox proportional hazard regression examined the association of risk factors on 30-day survival.ResultsThere were 6 86 409 injury hospitalisations, with an age-standardised rate of 1489 per 1 00 000 population (95% CI 1485.3 to 1492.4) in Australia. Child injury hospitalisation rates did not change over the 10-year period. For every severely injured child, there are at least 13 children hospitalised with minor or moderate injuries. The total cost of child injury hospitalisations was $A2.1 billion (annually $A212 million). Falls (38.4%) were the most common injury mechanism. Factors associated with a higher risk of 30-day mortality were: child was aged ≤10 years, higher injury severity, head injury, injured in a transport incident or following drowning and submersion or other threats to breathing, during self-harm and usual residence was regional/remote Australia.ConclusionsChildhood injury hospitalisation rates have not reduced in 10 years. Children’s patterns of injury change with age, and priorities for injury prevention alter according to developmental stages. The development of a national multisectorial childhood injury monitoring and prevention strategy in Australia is long overdue.
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Roy, Brita, Carley Riley, Jeph Herrin, Erica Spatz, Brent Hamar, Kenneth P. Kell, Elizabeth Y. Rula e Harlan Krumholz. "Associations between community well-being and hospitalisation rates: results from a cross-sectional study within six US states". BMJ Open 9, n.º 11 (novembro de 2019): e030017. http://dx.doi.org/10.1136/bmjopen-2019-030017.
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ObjectiveTo evaluate the association between community well-being, a positively framed, multidimensional assessment of the health and quality of life of a geographic community, and hospitalisation rates.DesignCross-sectional studySettingZip codes within six US states (Florida, Iowa, Nebraska, New York, Pennsylvania and Utah)Main outcome measuresOur primary outcome was age-adjusted, all-cause hospitalisation rates in 2010; secondary outcomes included potentially preventable disease-specific hospitalisation rates, including cardiovascular-related, respiratory-related and cancer-related admissions. Our main independent variable was the Gallup-Sharecare Well-Being Index (WBI) and its domains (life evaluation, emotional health, work environment, physical health, healthy behaviours and basic access).ResultsZip codes with the highest quintile of well-being had 223 fewer hospitalisations per 100 000 (100k) residents than zip codes with the lowest well-being. In our final model, adjusted for WBI respondent age, sex, race/ethnicity and income, and zip code number of hospital beds, primary care physician density, hospital density and admission rates for two low-variation conditions, a 1 SD increase in WBI was associated with 5 fewer admissions/100k (95% CI 4.0 to 5.8; p<0.001). Results were similar for cardiovascular-related and respiratory-related admissions, but no association remained for cancer-related hospitalisation after adjustment. Patterns were similar for each of the WBI domains and all-cause hospitalisations.Conclusion and relevanceCommunity well-being is inversely associated with local hospitalisation rates. In addition to health and quality-of-life benefits, higher community well-being may also result in fewer unnecessary hospitalisations.
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Orlando, Joseph F., Matthew Beard, Michelle Guerin e Saravana Kumar. "Systematic review of predictors of hospitalisation for non-specific low back pain with or without referred leg pain". PLOS ONE 18, n.º 10 (10 de outubro de 2023): e0292648. http://dx.doi.org/10.1371/journal.pone.0292648.
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Significant costs and utilisation of healthcare resources are associated with hospitalisations for non-specific low back pain despite clinical guidelines recommending community-based care. The aim of this systematic review was to investigate the predictors of hospitalisation for low back pain. A protocol was registered with PROSPERO international prospective register of systematic reviews (#CRD42021281827) and conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Database search of Ovid Medline, Emcare, Embase, PsycINFO, Cochrane Library, PEDro and OTSeeker was conducted. Studies were included if they examined a predictor of hospitalisation for non-specific low back pain with or without referred leg pain. Data was extracted and descriptively synthesised. Risk of bias of included studies was assessed using the Critical Appraisal Skills Programme Checklists. There were 23 studies published over 29 articles which identified 52 predictor variables of hospitalisation for low back pain. The risk of hospitalisation was grouped into themes: personal, health and lifestyle, psychology, socioeconomic, occupational, clinical, and health systems and processes. There was moderate level evidence that arrival to an emergency department via ambulance with low back pain, and older age increase the risk of hospitalisations for low back pain. There was low level evidence that high pain intensity, past history of low back pain, opioid use, and occupation type increase the risk of hospitalisation for low back pain. Further research into psychological and social factors is warranted given the paucity of available studies. Hospital avoidance strategies, improved patient screening and resource utilisation in emergency departments are considerations for practice.
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Mariotti, Pascal. "Hospitalisation". Pratiques en santé mentale 68, n.º 1 (15 de fevereiro de 2022): 35–38. http://dx.doi.org/10.3917/psm.221.0035.
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Moreland, Briana L., Elizabeth R. Burns e Yara K. Haddad. "National rates of non-fatal emergency department visits and hospitalisations due to fall-related injuries in older adults 2010–2014 and 2016: transitioning from ICD-9-CM to ICD-10-CM". Injury Prevention 27, Suppl 1 (março de 2021): i75—i78. http://dx.doi.org/10.1136/injuryprev-2019-043516.
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BackgroundThis study describes rates of non-fatal fall-injury emergency department (ED) visits and hospitalisations before and after the US 2015 transition from the 9th to 10th revision of the International Classification of Diseases, Clinical Modification (ICD-9-CM to ICD-10-CM).MethodsED visit and hospitalisation data for adults aged 65+ years were obtained from the 2010–2016 Healthcare Cost and Utilisation Project. Differences in fall injury rates between 2010 and 2014 (before transition), and 2014 and 2016 (before and after transition) were analysed using t-tests.ResultsFor ED visits, rates did not differ significantly between 2014 and 2016 (4288 vs 4318 per 100 000, respectively). Hospitalisation rates were lower in 2014 (1232 per 100 000) compared with 2016 (1281 per 100 000).ConclusionIncreased rates of fall-related hospitalisations could be an artefact of the transition or may reflect an increase in the rate of fall-related hospitalisations. Analyses of fall-related hospitalisations across the transition should be interpreted cautiously.
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Wang, K., K. K. W. Yau e A. H. Lee. "Factors Influencing Hospitalisation of Infants for Recurrent Gastroenteritis in Western Australia". Methods of Information in Medicine 42, n.º 03 (2003): 251–54. http://dx.doi.org/10.1055/s-0038-1634357.
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Summary Objective: To determine factors affecting length of hospitalisation of infants for recurrent gastroenteritis using linked data records from the Western Australia heath information system. Methods: A seven-year retrospective cohort study was undertaken on all infants born in Western Australia in 1995 who were admitted for gastroenteritis during their first year of life (n = 519). Linked hospitalisation records were retrieved to derive the outcome measure and other demographic variables for the cohort. Unlike previous studies that focused mainly on a single episode of gastroenteritis, the durations of successive hospitalisations were analysed using a proportional hazards model with correlated frailty to determine the prognostic factors influencing recurrent gastroenteritis. Results: Older children experienced a shorter stay with an increased discharge rate of 1.9% for each month increase in admission age. An additional comorbidity recorded in the hospital discharge summary slowed the adjusted discharge rate by 46.5%. Aboriginal infants were readmitted to hospital more frequently, and had an adjusted hazard ratio of 0.253, implying a much higher risk of prolonged hospitalisation compared to non-Aborigines. Conclusions: The use of linked hospitalisation records has the advantage of providing access to hospital-based population information in the context of medical informatics. The analysis of linked data has enabled the assessment of prognostic factors influencing length of hospitalisations for recurrent gastroenteritis with high statistical power.
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Xu, Rongbin, Caroline X. Gao, Christina Dimitriadis, Catherine L. Smith, Matthew T. C. Carroll, Jillian F. Ikin, Fay H. Johnston, Malcolm R. Sim, Michael J. Abramson e Yuming Guo. "Long-term impacts of coal mine fire-emitted PM2.5 on hospitalisation: a longitudinal analysis of the Hazelwood Health Study". International Journal of Epidemiology 51, n.º 1 (6 de dezembro de 2021): 179–90. http://dx.doi.org/10.1093/ije/dyab249.
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Abstract Background Little is known about the long-term health impacts of exposures to landscape fire smoke. We aimed to evaluate the association between exposure to coal mine fire-related particulate matter 2.5 μm or less in diameter (PM2.5) and hospitalisation in the 5 years following the 6-week Hazelwood coal mine fire in Australia in 2014. Methods We surveyed 2725 residents (mean age: 58.3 years; 54.3% female) from an exposed and a comparison town. Individual PM2.5 exposures during the event were estimated using modelled PM2.5 concentrations related to the coal mine fire and self-reported location data. The individual exposure and survey data were linked with hospitalisation records between January 2009 and February 2019. Recurrent event survival analysis was used to evaluate relationships between PM2.5 exposure and hospitalisation following mine fire, adjusting for important covariates. Results Each 10-µg/m3 increase in mine fire-related PM2.5 was associated with a 9% increased hazard [hazard ratio (HR) = 1.09; 95% confidence interval (CI): 1.01, 1.17] of respiratory hospitalisation over the next 5 years, with stronger associations observed for females (HR = 1.16; 95% CI: 1.06, 1.27) than males (HR = 0.99; 95% CI: 0.89, 1.11). In particular, increased hazards were observed for hospitalisations for asthma (HR = 1.43; 95% CI: 1.19, 1.73) and chronic obstructive pulmonary disease (HR = 1.14; 95% CI: 1.02, 1.28). No such association was found for hospitalisations for cardiovascular diseases, mental illness, injuries, type 2 diabetes, renal diseases or neoplasms. Conclusions A 6-week exposure to coal mine fire-related PM2.5 was associated with increased hazard of respiratory hospitalisations over the following 5 years, particularly for females.
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Wilk, Piotr, Shehzad Ali, Kelly K. Anderson, Andrew F. Clark, Martin Cooke, Stephanie J. Frisbee, Jason Gilliland et al. "Geographic variation in preventable hospitalisations across Canada: a cross-sectional study". BMJ Open 10, n.º 5 (maio de 2020): e037195. http://dx.doi.org/10.1136/bmjopen-2020-037195.
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ObjectiveThe objective of this study is to examine the magnitude and pattern of small-area geographic variation in rates of preventable hospitalisations for ambulatory care-sensitive conditions (ACSC) across Canada (excluding Québec).Design and settingA cross-sectional study conducted in Canada (excluding Québec) using data from the 2006 Canadian Census Health and Environment Cohort (CanCHEC) linked prospectively to hospitalisation records from the Discharge Abstract Database (DAD) for the three fiscal years: 2006–2007, 2007–2008 and 2008–2009.Primary outcome measurePreventable hospitalisations (ACSC).ParticipantsThe 2006 CanCHEC represents a population of 22 562 120 individuals in Canada (excluding Québec). Of this number, 2 940 150 (13.03%) individuals were estimated to be hospitalised at least once during the 2006–2009 fiscal years.MethodsAge-standardised annualised ACSC hospitalisation rates per 100 000 population were computed for each of the 190 Census Divisions. To assess the magnitude of Census Division-level geographic variation in rates of preventable hospitalisations, the global Moran’s I statistic was computed. ‘Hot spot’ analysis was used to identify the pattern of geographic variation.ResultsOf all the hospitalisation events reported in Canada during the 2006–2009 fiscal years, 337 995 (7.10%) events were ACSC-related hospitalisations. The Moran’s I statistic (Moran’s I=0.355) suggests non-randomness in the spatial distribution of preventable hospitalisations. The findings from the ‘hot spot’ analysis indicate a cluster of Census Divisions located in predominantly rural and remote parts of Ontario, Manitoba and Saskatchewan and in eastern and northern parts of Nunavut with significantly higher than average rates of preventable hospitalisation.ConclusionThe knowledge generated on the small-area geographic variation in preventable hospitalisations can inform regional, provincial and national decision makers on planning, allocation of resources and monitoring performance of health service providers.
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Inacio, Maria C., Robert N. Jorissen, Steve Wesselingh, Janet K. Sluggett, Craig Whitehead, John Maddison, John Forward, Alice Bourke, Gillian Harvey e Maria Crotty. "Predictors of hospitalisations and emergency department presentations shortly after entering a residential aged care facility in Australia: a retrospective cohort study". BMJ Open 11, n.º 11 (novembro de 2021): e057247. http://dx.doi.org/10.1136/bmjopen-2021-057247.
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ObjectivesTo: (1) examine the 90-day incidence of unplanned hospitalisation and emergency department (ED) presentations after residential aged care facility (RACF) entry, (2) examine individual-related, facility-related, medication-related, system-related and healthcare-related predictors of these outcomes and (3) create individual risk profiles.DesignRetrospective cohort study using the Registry of Senior Australians. Fine-Gray models estimated subdistribution HRs and 95% CIs. Harrell’s C-index assessed risk models’ predictive ability.Setting and participantsIndividuals aged ≥65 years old entering a RACF as permanent residents in three Australian states between 1 January 2013 and 31 December 2016 (N=116 192 individuals in 1967 RACFs).Predictors examinedIndividual-related, facility-related, medication-related, system and healthcare-related predictors ascertained at assessments or within 90 days, 6 months or 1 year prior to RACF entry.Outcome measures90-day unplanned hospitalisation and ED presentation post-RACF entry.ResultsThe cohort median age was 85 years old (IQR 80–89), 62% (N=71 861) were women, and 50.5% (N=58 714) had dementia. The 90-day incidence of unplanned hospitalisations was 18.0% (N=20 919) and 22.6% (N=26 242) had ED presentations. There were 34 predictors of unplanned hospitalisations and 34 predictors of ED presentations identified, 27 common to both outcomes and 7 were unique to each. The hospitalisation and ED presentation models out-of-sample Harrell’s C-index was 0.664 (95% CI 0.657 to 0.672) and 0.655 (95% CI 0.648 to 0.662), respectively. Some common predictors of high risk of unplanned hospitalisation and ED presentations included: being a man, age, delirium history, higher activity of daily living, behavioural and complex care needs, as well as history, number and recency of healthcare use (including hospital, general practitioners attendances), experience of a high sedative load and several medications.ConclusionsWithin 90 days of RACF entry, 18.0% of individuals had unplanned hospitalisations and 22.6% had ED presentations. Several predictors, including modifiable factors, were identified at the time of care entry. This is an actionable period for targeting individuals at risk of hospitalisations.
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Ezpeleta, Guillermo, Ana Navascués, Natividad Viguria, Mercedes Herranz-Aguirre, Sergio Enrique Juan Belloc, Juan Gimeno Ballester, Juan Carlos Muruzábal et al. "Effectiveness of Nirsevimab Immunoprophylaxis Administered at Birth to Prevent Infant Hospitalisation for Respiratory Syncytial Virus Infection: A Population-Based Cohort Study". Vaccines 12, n.º 4 (4 de abril de 2024): 383. http://dx.doi.org/10.3390/vaccines12040383.
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Respiratory syncytial virus (RSV) infection is a frequent cause of hospitalisation in the first few months of life; however, this risk rapidly decreases with age. Nirsevimab immunoprophylaxis was approved in the European Union for the prevention of RSV-associated lower respiratory tract disease in infants during their first RSV season. We evaluated the effectiveness of nirsevimab in preventing hospitalisations for confirmed RSV infection and the impact of a strategy of immunisation at birth. A population-based cohort study was performed in Navarre, Spain, where nirsevimab was offered at birth to all children born from October to December 2023. Cox regression was used to estimate the hazard ratio of hospitalisation for PCR-confirmed RSV infection between infants who received and did not receive nirsevimab. Of 1177 infants studied, 1083 (92.0%) received nirsevimab. The risk of hospitalisation for RSV was 8.5% (8/94) among non-immunised infants versus 0.7% (8/1083) in those that were immunised. The estimated effectiveness of nirsevimab was 88.7% (95% confidence interval, 69.6–95.8). Immunisation at birth of infants born between October and December 2023 prevented one hospitalisation for every 15.3 immunised infants. Immunisation of children born from September to January might prevent 77.5% of preventable hospitalisations for RSV in infants born in 2023–2024. These results support the recommendation of nirsevimab immunisation at birth to children born during the RSV epidemic or in the months immediately before to prevent severe RSV infections and alleviate the overload of paediatric hospital resources.
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Xu, Dongjuan, Robert Kane e Greg Arling. "Relationship between nursing home quality indicators and potentially preventable hospitalisation". BMJ Quality & Safety 28, n.º 7 (13 de março de 2019): 524–33. http://dx.doi.org/10.1136/bmjqs-2018-008924.
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BackgroundHospitalisations are very common among nursing home residents and many of these are deemed inappropriate or preventable. Little is known about whether clinical care quality is related to hospitalisation, especially potentially preventable hospitalisations (PPHs). Among the few studies that have been conducted, the findings have been inconsistent. The objective of this study was to examine the relationship between quality indicators and overall and PPHs among Medicaid beneficiaries aged 65 years and older receiving care at nursing homes in Minnesota.Methods23 risk-adjusted quality indicators were used to assess nursing home quality of care. Quality indicators and other facility-level variables from the Minnesota Nursing Home Report Card were merged with resident-level variables from the Minimum Data Set. These merged data were linked with Medicaid claims to obtain hospitalisation rates during the 2011–2012 period. The sample consisted of a cohort of 20 518 Medicaid beneficiaries aged 65 years and older who resided in 345 Minnesota nursing homes. The analyses controlled for resident and facility characteristics using the generalised linear mixed model.ResultsThe results showed that about 44 % of hospitalisations were PPHs. Available quality indicators were not strongly or consistently associated with the risk of hospitalisation (neither overall nor PPH). Among these 23 quality indicators, five quality indicators (antipsychotics without a diagnosis of psychosis, unexplained weight loss, pressures sores, bladder continence and activities of daily living [ADL] dependence) were related significantly to hospitalisation and only four quality indicators (antipsychotics without a diagnosis of psychosis, unexplained weight loss, ADL dependence and urinary tract infections) were related to PPH.ConclusionAlthough general quality indicators can be informative about overall nursing home performance, only selected quality indicators appear to tap dimensions of clinical quality directly related to hospitalisations.
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Louis, Magali, Jonathan Cottenet, Arnaud Salmon-Rousseau, Mathieu Blot, Pierre-Henri Bonnot, Jean-Michel Rebibou, Pascal Chavanet, Christiane Mousson, Catherine Quantin e Lionel Piroth. "Prevalence and incidence of kidney diseases leading to hospital admission in people living with HIV in France: an observational nationwide study". BMJ Open 9, n.º 5 (maio de 2019): e029211. http://dx.doi.org/10.1136/bmjopen-2019-029211.
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ObjectivesTo describe hospitalisations for kidney disease (KD) among people living with HIV (PLHIV) in France and to identify the factors associated with such hospitalisations since data on the epidemiology of KD leading to hospitalisation are globally scarce.DesignObservational nationwide study using the French Programme de Médicalisation des Systèmes d’Information database.SettingFrance 2008–2013.ParticipantsAround 10 862 PLHIV out of a mean of 5 210 856 patients hospitalised each year. All hospital admissions with a main diagnosis code indicating KD (International Classification of Diseases, 10th revision codes, N00 to –N39) were collected.Main outcome measuresThe prevalence and incidence of KD leading to hospital admission in PLHIV and the associated risk factors.ResultsThe prevalence of patients hospitalised for KD was 1.5 higher in PLHIV than in the general population, and increased significantly from 3.0% in 2008 to 3.7% in 2013 (p<0.01). The main cause of hospitalisation for KD was acute renal failure (ARF, 25.4%). Glomerular diseases remained stable (6.4%) throughout the study period, focal segmental glomerulosclerosis being the main diagnosis (37.6%). Only 41.3% of patients hospitalised for glomerular disease were biopsied. The other common motives for admission were nephrolithiasis (22.1%) and pyelonephritis (22.6%).The 5-year cumulative incidence of KD requiring hospitalisation was 5.9% in HIV patients newly diagnosed for HIV in 2009. Factors associated with a higher risk of incident KD requiring hospitalisation were cardiovascular disease (HR 3.30, 95% CI 1.46 to 7.49), and, for female patients, AIDS (HR 2.45, 95% CI 1.07 to 5.58). Two-thirds of hospitalisations for incident ARF occurred in the first 2 years of follow-up.ConclusionsHospital admission for KD is more frequent in PLHIV than in the general population and increases over time. ARF remains the leading cause. Glomerular diseases are infrequently documented by renal biopsies. Older patients and those with cardiovascular disease are particularly concerned.
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Dickins, Marissa, Angela Joe e Judy A. Lowthian. "Ten-Year Trends and Predictors of Unplanned Hospitalisation in Community-Dwelling Older People Receiving Home-Based Care". Health & Social Care in the Community 2023 (9 de fevereiro de 2023): 1–13. http://dx.doi.org/10.1155/2023/9332777.
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Older people prefer to remain living in their own home for as long as possible; however, many require support to do so through health and other care services provided in the home. This study aimed to explore the trends in usage of a home-based care service by older people in metropolitan Melbourne and factors associated with unplanned hospitalisations. This longitudinal study analysed episodes of home-based care for people aged ≥65 years between 2006 and 2015. An episode of care was defined as the period of time during which the home care services were provided to the client. Care episodes culminated in a planned discharge from the service or an unplanned hospitalisation. Descriptive statistics and multivariable logistic regression were utilised to investigate the characteristics associated with unplanned hospitalisations. Utilisation of home-based care services over the 10-year period showed an increasing rate of use by people aged ≥85 years and a reduced usage rate by females aged 70–84 years and males 75–79 years old. Of 170,001 episodes of care, 43,608 (25.7%) resulted in an unplanned hospitalisation. Home-based care delivered to people aged ≥85 years showed an increasing rate of episodes ending in an unplanned transfer to the hospital. Between 2006 and 2015, individuals aged 85–89 years displayed a rate increase of 18.7% in episodes ending in an unplanned hospitalisation; for those aged ≥90 years, the rate rise was 43.6%. Factors associated with an unplanned hospitalisation included advancing age, male gender, living alone, cognitive dysfunction, and the complexity of medical issues. Health policy has focussed on providing services to enable older people to remain in their own home. The increasing rate of unplanned hospitalisations for community-dwellers aged ≥85 years suggests more support is required to enable ageing in place.
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Olié, J. P., e E. Lévy. "Manic episodes: the direct cost of a three-month period following hospitalisation". European Psychiatry 17, n.º 5 (setembro de 2002): 278–86. http://dx.doi.org/10.1016/s0924-9338(02)00680-6.
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SummaryIntroduction.Few data exist to estimate the burden of manic episodes on healthcare systems or the therapeutic strategies used. This study was undertaken to identify treatment strategies chosen, and to assess the “real-world” direct medical cost of treating manic episodes necessitating hospitalisation.Method.Case record data were reviewed during the three months following hospitalisation for a manic episode in France. Healthcare resource utilisation was assessed, direct costs calculated, and treatment strategies analysed. A total of 137 patients files (51.8% female; mean age: 35 years) were reviewed and data on 185 hospitalisations collected.Results.The mean duration of hospitalisation was 47 days over the study period. The most common treatment strategy during hospitalisation was the combination of a mood stabiliser with a neuroleptic drug (64% of patients at day 30). Anticonvulsants including valproate (39%) and carbamazepine (20%) were more common than lithium (42%). Treatment received during hospitalisation was generally continued after discharge, with a trend away from neuroleptics and towards mood stabilisers. The mean direct costs incurred over the three-month study period was Euro 22 297, with 98.6% of those costs due to hospitalisation.Conclusion.These results confirm that the costs of treating a manic episode are high, and overwhelmingly due to the cost of hospitalisation.
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Trotskyy, Hryhoriy M., Andriy Y. Lisnyy, Yuliya V. Pakulova-Trotska e Nataliya V. Kamut. "Analysis of the Respiratory Tract Morbidity in Children Living in Big Cities". International Journal of Child Health and Nutrition 10, n.º 2 (30 de abril de 2021): 74–79. http://dx.doi.org/10.6000/1929-4247.2021.10.02.4.
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Upper and lower respiratory tract pathology is an urgent problem of modern paediatrics since it is the most common paediatric disease. The aim was to conduct a retrospective analysis of the structure of respiratory diseases in children. Materials and methods: We conducted a retrospective analysis of 5,615 medical records of patients undergoing inpatient treatment at the non-profit municipal enterprise City Children's Clinical Hospital in 2018 for respiratory system pathology. Retrospective analysis is performed using the electronic program "Doctor Eleks", which allows us to search and form a group of case histories by keyword. The age characteristics and the structure of the respiratory tract morbidity were defined, seasonal prevalence and duration of treatment, and the medical conditions requiring the longest inpatient treatment were determined. A judicious approach is required to the question of hospitalisation of a patient with respiratory pathology - it must be timely and well-founded because the presence of a respiratory pathology does not always require hospitalisation. There is a necessity in studying the causes of hospitalisation of children for respiratory pathology and retrospectively study the history and causes of re-hospitalisations to develop recommendations for reducing the incidence of hospitalisation. It is also planned to study the structure of hospitalised patients according to other nosologies (pathology of the digestive tract, urinary system, etc.) in the nearest future in order to propose an algorithm for optimising the processes of hospitalisation by differentiating visitors who actually need hospitalisation and those who may be in outpatient treatment.
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Donaire-Gonzalez, David, Elena Gimeno-Santos, Eva Balcells, Jordi de Batlle, Maria A. Ramon, Esther Rodriguez, Eva Farrero et al. "Benefits of physical activity on COPD hospitalisation depend on intensity". European Respiratory Journal 46, n.º 5 (23 de julho de 2015): 1281–89. http://dx.doi.org/10.1183/13993003.01699-2014.
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The present study aims to disentangle the independent effects of the quantity and the intensity of physical activity on the risk reduction of chronic obstructive pulmonary disease (COPD) hospitalisations.177 patients from the Phenotype Characterization and Course of COPD (PAC-COPD) cohort (mean±sd age 71±8 years, forced expiratory volume in 1 s 52±16% predicted) wore the SenseWear Pro 2 Armband accelerometer (BodyMedia, Pittsburgh, PA, USA) for eight consecutive days, providing data on quantity (steps per day, physically active days and daily active time) and intensity (average metabolic equivalent tasks) of physical activity. Information on COPD hospitalisations during follow-up (2.5±0.8 years) was obtained from validated centralised datasets.During follow-up 67 (38%) patients were hospitalised. There was an interaction between quantity and intensity of physical activity in their effects on COPD hospitalisation risk. After adjusting for potential confounders in the Cox regression model, the risk of COPD hospitalisation was reduced by 20% (hazard ratio (HR) 0.79, 95% CI 0.67–0.93; p=0.005) for every additional 1000 daily steps at low average intensity. A greater quantity of daily steps at high average intensity did not influence the risk of COPD hospitalisations (HR 1.01, p=0.919). Similar results were found for the other measures of quantity of physical activity.Greater quantity of low-intensity physical activity reduces the risk of COPD hospitalisation, but high-intensity physical activity does not produce any risk reduction.
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Mitchell, Rebecca J., e Cate M. Cameron. "Self-harm hospitalised morbidity and mortality risk using a matched population-based cohort design". Australian & New Zealand Journal of Psychiatry 52, n.º 3 (4 de julho de 2017): 262–70. http://dx.doi.org/10.1177/0004867417717797.
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Objective: Prior and repeated self-harm hospitalisations are common risk factors for suicide. However, few studies have accounted for pre-existing comorbidities and prior hospital use when quantifying the burden of self-harm. The aim is to quantify hospitalisation in the 12 months preceding and re-hospitalisation and mortality risk in the 12 months post a self-harm hospitalisation. Method: A population-based matched cohort using linked hospital and mortality data for individuals ⩾18 years from four Australian jurisdictions. A non-injured comparison cohort was matched on age, gender and residential postcode. Twelve-month pre- and post-index self-harm hospitalisations and mortality were examined. Results: The 11,597 individuals who were hospitalised following self-harm in 2009 experienced 21% higher health service use in the 12 months pre and post the index admission and a higher mortality rate (2.9% vs 0.3%) than their matched counterparts. There were 133 (39.0%) deaths within 2 weeks of hospital discharge and 342 deaths within 12 months of the index hospitalisation in the self-harm cohort. Adjusted rate ratios for hospital readmission were highest for females (2.86; 95% confidence interval: [2.33, 2.52]) and individuals aged 55–64 years (3.96; 95% confidence interval: [2.79, 5.64]). Conclusion: Improved quantification of the burden of self-harm-related hospital use can inform resource allocation for intervention and after-care services for individuals at risk of repeated self-harm. Better assessment of at-risk self-harm behaviour, appropriate referrals and improved post-discharge care, focusing on care continuity, are needed.
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Chu, Patricia Y., Christoph P. Hornik, Jennifer S. Li, Michael J. Campbell e Kevin D. Hill. "Respiratory syncytial virus hospitalisation trends in children with haemodynamically significant heart disease, 1997–2012". Cardiology in the Young 27, n.º 1 (10 de maio de 2016): 16–25. http://dx.doi.org/10.1017/s1047951116000470.
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AbstractObjectiveThe aim of the study was to evaluate the trends in respiratory syncytial virus-related hospitalisations and associated outcomes in children with haemodynamically significant heart disease in the United States of America.Study designThe Kids’ Inpatient Databases (1997–2012) were used to estimate the incidence of respiratory syncytial virus hospitalisation among children ⩽24 months with or without haemodynamically significant heart disease. Weighted multivariable logistic regression and chi-square tests were used to evaluate the trends over time and factors associated with hospitalisation, comparing eras before and after publication of the 2003 American Academy of Pediatrics palivizumab immunoprophylaxis guidelines. Secondary outcomes included in-hospital mortality, morbidity, length of stay, and cost.ResultsOverall, 549,265 respiratory syncytial virus-related hospitalisations were evaluated, including 2518 (0.5%) in children with haemodynamically significant heart disease. The incidence of respiratory syncytial virus hospitalisation in children with haemodynamically significant heart disease decreased by 36% when comparing pre- and post-palivizumab guideline eras versus an 8% decline in children without haemodynamically significant heart disease (p<0.001). Children with haemodynamically significant heart disease had higher rates of respiratory syncytial virus-associated mortality (4.9 versus 0.1%, p<0.001) and morbidity (31.5 versus 3.5%, p<0.001) and longer hospital length of stay (17.9 versus 3.9 days, p<0.001) compared with children without haemodynamically significant heart disease. The mean cost of respiratory syncytial virus hospitalisation in 2009 was $58,166 (95% CI:$46,017, $70,315).ConclusionsThese data provide stakeholders with a means to evaluate the cost–utility of various immunoprophylaxis strategies.
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Raghu, Ganesh, Brett Ley, Kevin K. Brown, Vincent Cottin, Kevin F. Gibson, Robert J. Kaner, David J. Lederer et al. "Risk factors for disease progression in idiopathic pulmonary fibrosis". Thorax 75, n.º 1 (14 de outubro de 2019): 78–80. http://dx.doi.org/10.1136/thoraxjnl-2019-213620.
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In this retrospective study of a randomised trial of simtuzumab in idiopathic pulmonary fibrosis (IPF), prodromal decline in forced vital capacity (FVC) was significantly associated with increased risk of mortality, respiratory and all-cause hospitalisations, and categorical disease progression. Predictive modelling of progression-free survival event risk was used to assess the effect of population enrichment for patients at risk of rapid progression of IPF; C-index values were 0.64 (death), 0.69 (disease progression), and 0.72 (adjudicated respiratory hospitalisation) and 0.76 (all-cause hospitalisation). Predictive modelling may be a useful tool for improving efficiency of clinical trials with categorical end points.
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Ma, Rui, Lizhong Liang, Yunfeng Kong, Mingyang Chen, Shiyan Zhai, Hongquan Song, Yane Hou e Guangli Zhang. "Spatiotemporal variations of asthma admission rates and their relationship with environmental factors in Guangxi, China". BMJ Open 10, n.º 10 (outubro de 2020): e038117. http://dx.doi.org/10.1136/bmjopen-2020-038117.
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ObjectiveThe study aimed to determine if and how environmental factors correlated with asthma admission rates in geographically different parts of Guangxi province in China.SettingGuangxi, China.ParticipantsThis study was done among 7804 asthma patients.Primary and secondary outcome measuresSpearman correlation coefficient was used to estimate correlation between environmental factors and asthma hospitalisation rates in multiple regions. Generalised additive model (GAM) with Poisson regression was used to estimate effects of environmental factors on asthma hospitalisation rates in 14 regions of Guangxi.ResultsThe strongest effect of carbon monoxide (CO) was found on lag1 in Hechi, and every 10 µg/m3 increase of CO caused an increase of 25.6% in asthma hospitalisation rate (RR 1.26, 95% CI 1.02 to 1.55). According to the correlation analysis, asthma hospitalisations were related to the daily temperature, daily range of temperature, CO, nitrogen dioxide (NO2) and particulate matter (PM2.5) in multiple regions. According to the result of GAM, the adjusted R2 was high in Beihai and Nanning, with values of 0.29 and 0.21, which means that environmental factors are powerful in explaining changes of asthma hospitalisation rates in Beihai and Nanning.ConclusionAsthma hospitalisation rate was significantly and more strongly associated with CO than with NO2, SO2 or PM2.5 in Guangxi. The risk factors of asthma exacerbations were not consistent in different regions, indicating that targeted measures should differ between regions.
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Kampman, O., A. Illi, P. Poutanen e E. Leinonen. "Four-year outcome in non-compliant schizophrenia patients treated with or without home-based ambulatory outpatient care". European Psychiatry 18, n.º 1 (fevereiro de 2003): 1–5. http://dx.doi.org/10.1016/s0924-9338(02)00006-8.
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AbstractNon-compliance in neuroleptic maintenance treatment is a major concern in schizophrenia. Home-based outpatient care has been shown both to improve medication compliance and reduce relapse frequency. We analysed the need for hospitalisation, levels of functioning and mortality rate during the de-institutionalisation process in 41 schizophrenia patients with repeated hospitalisations and prolonged history of non-compliance. Eighteen of the patients received ambulatory outpatient care (AOC) after discharge. This treatment procedure focuses on enduring neuroleptic maintenance treatment. One of the hospital nurses takes care of home visits every 2–4 weeks. In the 4-year follow-up, half of the patients in the AOC group did not need hospitalisation at all and the number of days of hospitalisation in the whole group diminished by almost four-fifths compared with the previous 4 years. In the non-AOC group, there was a more limited decrease in the number of days of hospitalisation during the corresponding follow-up period. The mortality rates showed a slight tendency towards a better outcome in the AOC group. There was no change in the levels of functioning in the AOC group. This treatment can be carried out with limited resources. It clearly reduces the need for hospitalisation in a subgroup of schizophrenia patients having problems with compliance and recurrent relapse. The effectiveness of AOC on the mortality rates of schizophrenia patients needs further examination.
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Falster, Michael O., Alastair H. Leyland e Louisa R. Jorm. "Do hospitals influence geographic variation in admission for preventable hospitalisation? A data linkage study in New South Wales, Australia". BMJ Open 9, n.º 2 (fevereiro de 2019): e027639. http://dx.doi.org/10.1136/bmjopen-2018-027639.
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ObjectivePreventable hospitalisations are used internationally as a performance indicator for primary care, but the influence of other health system factors remains poorly understood. This study investigated between-hospital variation in rates of preventable hospitalisation.SettingLinked health survey and hospital admissions data for a cohort study of 266 826 people aged over 45 years in the state of New South Wales, Australia.MethodBetween-hospital variation in preventable hospitalisation was quantified using cross-classified multiple-membership multilevel Poisson models, adjusted for personal sociodemographic, health and area-level contextual characteristics. Variation was also explored for two conditions unlikely to be influenced by discretionary admission practice: emergency admissions for acute myocardial infarction (AMI) and hip fracture.ResultsWe found significant between-hospital variation in adjusted rates of preventable hospitalisation, with hospitals varying on average 26% from the state mean. Patients served more by community and multipurpose facilities (smaller facilities primarily in rural areas) had higher rates of preventable hospitalisation. Community hospitals had the greatest between-hospital variation, and included the facilities with the highest rates of preventable hospitalisation. There was comparatively little between-hospital variation in rates of admission for AMI and hip fracture.ConclusionsGeographic variation in preventable hospitalisation is determined in part by hospitals, reflecting different roles played by community and multipurpose facilities, compared with major and principal referral hospitals, within the community. Care should be taken when interpreting the indicator simply as a performance measure for primary care.
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Buschulte, Katharina, Hans-Joachim Kabitz, Lars Hagmeyer, Peter Hammerl, Albert Esselmann, Conrad Wiederhold, Dirk Skowasch et al. "Hospitalisation patterns in interstitial lung diseases: data from the EXCITING-ILD registry". Respiratory Research 25, n.º 1 (4 de janeiro de 2024). http://dx.doi.org/10.1186/s12931-023-02588-y.
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Abstract Background Interstitial lung diseases (ILD) comprise a heterogeneous group of mainly chronic lung diseases with more than 200 entities and relevant differences in disease course and prognosis. Little data is available on hospitalisation patterns in ILD. Methods The EXCITING-ILD (Exploring Clinical and Epidemiological Characteristics of Interstitial Lung Diseases) registry was analysed for hospitalisations. Reasons for hospitalisation were classified as all cause, ILD-related and respiratory hospitalisations, and patients were analysed for frequency of hospitalisations, time to first non-elective hospitalisation, mortality and progression-free survival. Additionally, the risk for hospitalisation according to GAP index and ILD subtype was calculated by Cox proportional-hazard models as well as influencing factors on prediction of hospitalisation by logistic regression with forward selection. Results In total, 601 patients were included. 1210 hospitalisations were recorded during the 6 months prior to registry inclusion until the last study visit. 800 (66.1%) were ILD-related, 59.3% of admissions were registered in the first year after inclusion. Mortality was associated with all cause, ILD-related and respiratory-related hospitalisation. Risk factors for hospitalisation were advanced disease (GAP Index stages II and III) and CTD (connective tissue disease)-ILDs. All cause hospitalisations were associated with pulmonary hypertension (OR 2.53, p = 0.005). ILD-related hospitalisations were associated with unclassifiable ILD and concomitant emphysema (OR = 2.133, p = 0.001) as well as with other granulomatous ILDs and a positive smoking status (OR = 3.082, p = 0.005). Conclusion Our results represent a crucial contribution in understanding predisposing factors for hospitalisation in ILD and its major impact on mortality. Further studies to characterize the most vulnerable patient group as well as approaches to prevent hospitalisations are warranted.