Potentially preventable hospitalisations for physical health conditions in community mental health service users: a population-wide linkage study

AIMS

Mental health (MH) service users have increased prevalence of chronic physical conditions such as cardio-respiratory diseases and diabetes. Potentially Preventable Hospitalisations (PPH) for physical health conditions are an indicator of health service access, integration and effectiveness, and are elevated in long term studies of people with MH conditions. We aimed to examine whether PPH rates were elevated in MH service users over a 12-month follow-up period more suitable for routine health indicator reporting. We also examined whether MH service users had increased PPH rates at a younger age, potentially reflecting the younger onset of chronic physical conditions.

METHODS

A population-wide data linkage in New South Wales (NSW), Australia, population 7.8 million. PPH rates in 178 009 people using community MH services in 2016-2017 were compared to population rates. Primary outcomes were crude and age- and disadvantage-standardised annual PPH episode rate (episodes per 100 000 population), PPH day rate (hospital days per 100 000) and adjusted incidence rate ratios (AIRR).

RESULTS

MH service users had higher rates of PPH admission (AIRR 3.6, 95% CI 3.5-3.6) and a larger number of hospital days (AIRR 5.2, 95% CI 5.2-5.3) than other NSW residents due to increased likelihood of admission, more admissions per person and longer length of stay. Increases were greatest for vaccine-preventable conditions (AIRR 4.7, 95% CI 4.5-5.0), and chronic conditions (AIRR 3.7, 95% CI 3.6-3.7). The highest number of admissions and relative risks were for respiratory and metabolic conditions, including chronic obstructive airways disease (AIRR 5.8, 95% CI 5.5-6.0) and diabetic complications (AIRR 5.4, 95% CI 5.1-5.8). One-quarter of excess potentially preventable bed days in MH service users were due to vaccine-related conditions, including vaccine-preventable respiratory illness. Age-related increases in risk occurred earlier in MH service users, particularly for chronic and vaccine-preventable conditions. PPH rates in MH service users aged 20-29 were similar to population rates of people aged 60 and over. These substantial differences were not explained by socio-economic disadvantage.

CONCLUSIONS

PPHs for physical health conditions are substantially increased in people with MH conditions. Short term (12-month) PPH rates may be a useful lead indicator of increased physical morbidity and less accessible, integrated or effective health care. High hospitalisation rates for vaccine-preventable respiratory infections and hepatitis underline the importance of vaccination in MH service users and suggests potential benefits of prioritising this group for COVID-19 vaccination.

Haemoglobin Le Lamentin (alpha 20 (B1) His-->Gln) in a British family: identification by electrospray mass spectrometry

The first identification of haemoglobin Le Lamentin (alpha 20 (B1) His-->Gln) in a British patient is described. The patient was a 69 year old asymptomatic white male being screened for diabetes, whose blood was undergoing its first ever analysis for glycated haemoglobin using a Glycomat II analyser. Identification of the haemoglobin variant was by electrospray mass spectrometry.

The in-vitro assessment of a collagen/vicryl (polyglactin) composite film together with candidate suture materials for potential use in urinary tract surgery. III. Adherence of bacteria to the material surface

A Collagen/Vicryl (Polyglactin) composite membrane (developed for use in urinary tract surgery) has been incubated in cultures of radioactively labelled urinary tract pathogens vis Escherichia coli, Staphylococcus epidermidis, and Proteus mirabilis for up to 1 h. For comparison, collagen film, Vicryl mesh, and a number of absorbable and non-absorbable sutures were similarly tested. Following incubation, samples were also examined by scanning electron microscopy. Under the experimental conditions employed, only minimal adherence of the micro-organisms to the collagen coated Vicryl mesh, its two individual components, as well as Vicryl and nylon sutures was observed. Significantly greater numbers of bacteria, however, adhered to silk and Chromic Catgut. The results suggest that adherence of microorganisms to the prosthesis even in infected urine is unlikely to develop into a microcolony of bacteria. However, it should be emphasised that great care must be exercised when extrapolating from the in-vitro to the in-vivo situation.

Comparison of MacKay-Marg, Goldmann, and Perkins tonometers in abnormal corneas

Intraocular pressure was determined manometrically in owl monkey eyes with normal and edematous corneas. The pressure was measured with Perkins hand-held, Goldmann, and MacKay-Marg tonometers to compare relative accuracy. At monometric levels of 20, 30, and 40 mm Hg, a statistically significant difference in readings was found between normal and edematous corneas with use of the Perkins and Goldmann applanators, whereas no such difference was found with the MacKay-Marg tonometer. The MacKay-Marg tonometer most closely approximated the true intraocular pressure in edematous corneas.