1
|
Moger TA, Holte JH, Amundsen O, Haavaag SB, Edvardsen A, Bragstad LK, Hellesø R, Tjerbo T, Vøllestad NK. Associations between outpatient care and later hospital admissions for patients with chronic obstructive pulmonary disease - a registry study from Norway. BMC Health Serv Res 2024; 24:500. [PMID: 38649963 PMCID: PMC11036724 DOI: 10.1186/s12913-024-10975-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Although chronic obstructive pulmonary disease (COPD) admissions put a substantial burden on hospitals, most of the patients' contacts with health services are in outpatient care. Traditionally, outpatient care has been difficult to capture in population-based samples. In this study we describe outpatient service use in COPD patients and assess associations between outpatient care (contact frequency and specific factors) and next-year COPD hospital admissions or 90-day readmissions. METHODS Patients over 40 years of age residing in Oslo or Trondheim at the time of contact in the period 2009-2018 were identified from the Norwegian Patient Registry (in- and outpatient hospital contacts, rehabilitation) and the KUHR registry (contacts with GPs, contract specialists and physiotherapists). These were linked to the Regular General Practitioner registry (characteristics of the GP practice), long-term care data (home and institutional care, need for assistance), socioeconomic and-demographic data from Statistics Norway and the Cause of Death registry. Negative binomial models were applied to study associations between combinations of outpatient care, specific care factors and next-year COPD hospital admissions and 90-day readmissions. The sample consisted of 24,074 individuals. RESULTS A large variation in the frequency and combination of outpatient service use for respiratory diagnoses (GP, emergency room, physiotherapy, contract specialist and outpatient hospital contacts) was apparent. GP and outpatient hospital contact frequency were strongly associated to an increased number of next-year hospital admissions (1.2-3.2 times higher by increasing GP frequency when no outpatient hospital contacts, 2.4-5 times higher in combination with outpatient hospital contacts). Adjusted for healthcare use, comorbidities and sociodemographics, outpatient care factors associated with lower numbers of next-year hospitalisations were fees indicating interaction between providers (7% reduction), spirometry with GP or specialist (7%), continuity of care with GP (15%), and GP follow-up (8%) or rehabilitation (18%) within 30 days vs. later following any current year hospitalisations. For 90-day readmissions results were less evident, and most variables were non-significant. CONCLUSION As increased use of outpatient care was strongly associated with future hospitalisations, this further stresses the need for good communication between providers when coordinating care for COPD patients. The results indicated possible benefits of care continuity within and interaction between providers.
Collapse
Affiliation(s)
- Tron Anders Moger
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Jon Helgheim Holte
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Olav Amundsen
- Department for Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Silje Bjørnsen Haavaag
- Department of Public Health Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Anne Edvardsen
- Department of Pulmonary Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Line Kildal Bragstad
- Department of Public Health Science, Institute of Health and Society, University of Oslo, Oslo, Norway
- Faculty of Health Sciences, Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Ragnhild Hellesø
- Department of Public Health Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Trond Tjerbo
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Nina Køpke Vøllestad
- Department for Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway
| |
Collapse
|
2
|
Enríquez-Vázquez D, Gómez-Martín C, Barge-Caballero G, Barge-Caballero E, López-Pérez M, Bilbao-Quesada R, González-Babarro E, Gómez-Otero I, López-López A, Gutiérrez-Feijoo M, Varela-Román A, Crespo-Leiro MG. [Incidence and causes of hospitalization in patients with transthyretin (ATTR-CA) and light chain (AL-CA) cardiac amyloidosis]. Med Clin (Barc) 2024; 162:e1-e7. [PMID: 38423944 DOI: 10.1016/j.medcli.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/24/2023] [Accepted: 01/11/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION AND OBJETIVES Cardiac amyloidosis (CA) is a disorder associated with high number of hospital admissions. Given the scarce information available, we propose an analysis of the incidence and causes of hospitalization in this disease. MATERIAL AND METHODS One hundred and forty-three patients [128 by transthyretin (ATTR-CA) and 15 by light chains (AL-CA)] included in Registro de Amiloidosis Cardiaca de Galicia (AMIGAL) were evaluated, including all hospitalizations. RESULTS During a median follow-up of 959 days there were 179 unscheduled hospitalizations [incidence rate (IR) 512.6 admissions per 1000 patients-year], most common due to cardiovascular reasons (n=109, IR 312.2). Most frequent individual cause of hospitalization was heart failure (n=87, TI 249.2). AL-CA was associated with a higher IR of unscheduled hospitalizations than ATTR-CA (IR 781 vs. 483.2; HR 1.62; p=0,029) due to non-cardiovascular admissions (IR 376 vs. 181.2; HR 2.07; p=0.027). Unscheduled admission-free survival at 1 and 3 years in AL-CA was inferior than in ATTR-CA (46.7% and 20.0% vs. 73.4% and 35.2%, respectively; p=0.021). CONCLUSIONS CA was associated with high incidence of hospitalizations, being heart failure the most frequent individual cause; unscheduled admission-free survival in AL-CA was lower than in ATTR-CA due mostly to non-cardiovascular admissions.
Collapse
Affiliation(s)
- Daniel Enríquez-Vázquez
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Servicio de Cardiología. Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España
| | | | - Gonzalo Barge-Caballero
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Servicio de Cardiología. Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España.
| | - Eduardo Barge-Caballero
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Servicio de Cardiología. Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España
| | - Manuel López-Pérez
- Servicio de Cardiología. Complexo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, España
| | - Raquel Bilbao-Quesada
- Servicio de Cardiología. Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Pontevedra, España
| | - Eva González-Babarro
- Servicio de Cardiología. Complexo Hospitalario de Pontevedra (CHOP), Pontevedra, España
| | - Inés Gómez-Otero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España; Servicio de Cardiología. Complexo Hospitalario Universitario de Santiago de Compostela (CHUS)l Santiago de Compostela, A Coruña, España
| | - Andrea López-López
- Servicio de Cardiología. Hospital Universitario Lucus Augusti (HULA). Lugo, España
| | - Mario Gutiérrez-Feijoo
- Servicio de Cardiología, Complexo Hospitalario Universitario de Ourense (CHUOU), Ourense, España
| | - Alfonso Varela-Román
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España; Servicio de Cardiología. Complexo Hospitalario Universitario de Santiago de Compostela (CHUS)l Santiago de Compostela, A Coruña, España
| | - María G Crespo-Leiro
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Servicio de Cardiología. Complexo Hospitalario Universitario A Coruña (CHUAC), A Coruña, España; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, España
| |
Collapse
|
3
|
Gilliam LK, Parker MM, Moffet HH, Lee AK, Karter AJ. Continuous Glucose Monitor Metrics Are Associated with Emergency Department Visits and Hospitalizations for Hypoglycemia and Hyperglycemia, But Have Low Predictive Value. Diabetes Technol Ther 2024. [PMID: 38277155 DOI: 10.1089/dia.2023.0493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Objective: Determine whether continuous glucose monitor (CGM) metrics can provide actionable advance warning of an emergency department (ED) visit or hospitalization for hypoglycemic or hyperglycemic (dysglycemic) events. Research Design and Methods: Two nested case-control studies were conducted among insulin-treated diabetes patients at Kaiser Permanente, who shared their CGM data with their providers. Cases included dysglycemic events identified from ED and hospital records (2016-2021). Controls were selected using incidence density sampling. Multiple CGM metrics were calculated among patients using CGM >70% of the time, using CGM data from two lookback periods (0-7 and 8-14 days) before each event. Generalized estimating equations were specified to estimate odds ratios and C-statistics. Results: Among 3626 CGM users, 108 patients had 154 hypoglycemic events and 165 patients had 335 hyperglycemic events. Approximately 25% of patients had no CGM data during either lookback; these patients had >2 × the odds of a hypoglycemic event and 3-4 × the odds of a hyperglycemic event. While several metrics were strongly associated with a dysglycemic event, none had good discrimination. Conclusion: Several CGM metrics were strongly associated with risk of dysglycemic events, and these can be used to identify higher risk patients. Also, patients who are not using their CGM device may be at elevated risk of adverse outcomes. However, no CGM metric or absence of CGM data had adequate discrimination to reliably provide actionable advance warning of an event and thus justify a rapid intervention.
Collapse
Affiliation(s)
- Lisa K Gilliam
- Kaiser Northern California Diabetes Program, Endocrinology and Internal Medicine, Kaiser Permanente, South San Francisco Medical Center, South San Francisco, California, USA
| | - Melissa M Parker
- Division of Research, Kaiser Permanente, Oakland, California, USA
| | - Howard H Moffet
- Division of Research, Kaiser Permanente, Oakland, California, USA
| | - Alexandra K Lee
- Division of Geriatrics, University of California, San Francisco, San Francisco, California, USA
| | - Andrew J Karter
- Division of Research, Kaiser Permanente, Oakland, California, USA
- Department of General Internal Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| |
Collapse
|
4
|
Luque-García L, Muxika-Legorburu J, Mendia-Berasategui O, Lertxundi A, García-Baquero G, Ibarluzea J. Green and blue space exposure and non-communicable disease related hospitalizations: A systematic review. Environ Res 2024; 245:118059. [PMID: 38157973 DOI: 10.1016/j.envres.2023.118059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/05/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024]
Abstract
The global increase in non-communicable diseases (NCDs) presents a critical public health concern. Emerging evidence suggests that exposure to natural environments may reduce the risk of developing NCDs through multiple pathways. The present systematic review aims to synthesize and evaluate the observational evidence regarding associations between exposure to green and blue spaces and hospital admissions related to NCDs. A comprehensive literature search strategy was conducted in Embase (Ovid), PubMed, and Web of Science. The risk of bias and quality of the evidence were assessed using The Navigation Guide methodology, an approach specifically designed for environmental health research. Of 3060 search results, 17 articles were included. Notably, the majority of the studies (n = 14; 82.4%) were published from 2020 onwards. Most studies were conducted in the United States (n = 6; 35.3%) and China (n = 4; 23.5%). Exposure to green spaces was assessed through all studies, while only three included blue spaces. In terms of study design, cohort design was employed in nearly half of the studies (n = 8; 47.1%), followed by case-crossover design (n = 3, 17.6%). Over 75% of the included studies (n = 13) had a high or probably high rating in the risk of bias assessment. The studies encompassed diverse NCD outcome domains; cardiovascular diseases (CVDs) (n = 10), respiratory diseases (RSDs) (n = 2), heat-related diseases (n = 1), metabolic diseases (n = 2), cancer (n = 1), neurodegenerative diseases (NDDs) (n = 2), and mental health disorders (n = 2). The present review suggests that a clear link between blue space exposure and NCD hospital admissions is not evident. However, exposure to green spaces appears to predominantly have a protective effect, although the direction of the association varies across different outcome domains. The heterogeneity among the outcome domains together with the limited number of studies, emphasizes the need for more robust evidence.
Collapse
Affiliation(s)
- L Luque-García
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country (UPV/EHU), Leioa, 48940, Spain; Biogipuzkoa Health Research Institute, Group of Environmental Epidemiology and Child Development, Paseo Doctor Begiristain S/n, 20014, Donostia- San Sebastián, Spain; Osakidetza Basque Health Service, Goierri Alto-Urola Integrated Health Organisation, Zumarraga Hospital, Zumarraga, 20700, Spain.
| | - J Muxika-Legorburu
- Osakidetza Basque Health Service, Goierri Alto-Urola Integrated Health Organisation, Zumarraga Hospital, Zumarraga, 20700, Spain
| | - O Mendia-Berasategui
- Osakidetza Basque Health Service, Goierri Alto-Urola Integrated Health Organisation, Zumarraga Hospital, Zumarraga, 20700, Spain
| | - A Lertxundi
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country (UPV/EHU), Leioa, 48940, Spain; Biogipuzkoa Health Research Institute, Group of Environmental Epidemiology and Child Development, Paseo Doctor Begiristain S/n, 20014, Donostia- San Sebastián, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), 28029, Madrid, Spain
| | - G García-Baquero
- Biogipuzkoa Health Research Institute, Group of Environmental Epidemiology and Child Development, Paseo Doctor Begiristain S/n, 20014, Donostia- San Sebastián, Spain; Faculty of Biology, University of Salamanca, Avda Licenciado Méndez Nieto S/n, 37007, Salamanca, Spain
| | - J Ibarluzea
- Biogipuzkoa Health Research Institute, Group of Environmental Epidemiology and Child Development, Paseo Doctor Begiristain S/n, 20014, Donostia- San Sebastián, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), 28029, Madrid, Spain; Ministry of Health of the Basque Government, Sub-Directorate for Public Health and Addictions of Gipuzkoa, 20013, San Sebastián, Spain; Faculty of Psychology of the University of the Basque Country, 20018, San Sebastian, Spain
| |
Collapse
|
5
|
Wattal V, Checkland K, Sutton M, Morciano M. What remains after the money ends? Evidence on whether admission reductions continued following the largest health and social care integration programme in England. Eur J Health Econ 2024:10.1007/s10198-024-01676-0. [PMID: 38460069 DOI: 10.1007/s10198-024-01676-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/18/2024] [Indexed: 03/11/2024]
Abstract
We study the long-term effects on hospital activity of a three-year national integration programme. We use administrative data spanning from 24 months before to 22 months after the programme, to estimate the effect of programme discontinuation using difference-in-differences method. Our results show that after programme discontinuation, emergency admissions were slower to increase in Vanguard compared to non-Vanguard sites. These effects were heterogeneous across sites, with greater reductions in care home Vanguard sites and concentrated among the older population. Care home Vanguards showed significant reductions beginning early in the programme but falling away more rapidly after programme discontinuation. Moreover, there were greater reductions for sites performing poorly before the programme. Overall, this suggests the effects of the integration programme might have been lagged but transitory, and more reliant on continued programme support.
Collapse
Affiliation(s)
- Vasudha Wattal
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, UK.
| | - Katherine Checkland
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, UK
| | - Matt Sutton
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, UK
| | - Marcello Morciano
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, UK
- Department of Economics "Marco Biagi", University of Modena and Reggio Emilia, Modena, Italy
- Visiting Research Associate, Care Policy and Evaluation Centre (CPEC), London School of Economics, London, UK
| |
Collapse
|
6
|
Gao D, Friedman S, Hosler AS, Sheridan S, Zhang W, Yu F, Lin S. Ambient heat and diabetes hospitalizations: Does the timing of heat exposure matter? Sci Total Environ 2024; 912:169011. [PMID: 38040382 DOI: 10.1016/j.scitotenv.2023.169011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Although ambient heat exposure is linked with diabetes mortality, the impacts of heat exposure on diabetes-related hospitalizations remain controversial. Previous research did not examine the timing of heat-diabetes associations and relation with comorbidities/risk factors. OBJECTIVE We examined the association between heat exposure and diabetes-related hospitalizations in the transitional and summer months and identified populations vulnerable to heat. METHODS We conducted a time-stratified case-crossover study. Data on diabetes hospital admissions (primary diagnosis of type 1 and type 2 diabetes, 2013-2020) were collected by the New York State (NYS) Department of Health under the state legislative mandate. We treated temperature and air pollutants as continuous variables and defined the heat exposure as per interquartile range (IQR, a measure between the 25th and 75th percentiles) increase of daily mean temperature. Conditional logistic regressions were performed to quantify the heat-diabetes associations after controlling for air pollutants and time variant variables. Multiplicative-scale interactions between heat and demographics/comorbidities/risk factors on diabetes hospitalizations were investigated. RESULTS Each IQR increase in temperature was associated with significantly increased risks for diabetes admissions that occurred immediately and lasted for an entire week during multi-day lags in the transitional month of May (ranges of excess risk: 3.1 %-4.8 %) but not in the summer (June-August) (ranges of excess risk: -0.3 %-1.3 %). The significant increases in the excess risk of diabetes were also found among diabetes patients with complications of neuronopathy (excess risk: 27.7 %) and hypoglycemia (excess risk: 19.1 %). Furthermore, the modification effects on the heat-diabetes association were significantly stronger in females, Medicaid enrollees, non-compliant patients, and individuals with comorbidities of atherosclerotic heart disease and old myocardial infarction. CONCLUSIONS Ambient heat exposure significantly increased the burden of hospital admissions for diabetes in transitional rather than summer months indicating the importance of exposure timing. Vulnerability to heat varied by demographics and heart comorbidity.
Collapse
Affiliation(s)
- Donghong Gao
- Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, USA
| | | | - Akiko S Hosler
- Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, USA
| | - Scott Sheridan
- Department of Geography, Kent State University, Kent, OH, USA
| | - Wangjian Zhang
- Department of Medical Statistics, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Fangqun Yu
- Atmospheric Sciences Research Center, University at Albany, Albany, NY, USA
| | - Shao Lin
- Department of Epidemiology and Biostatistics, University at Albany, Rensselaer, NY, USA; Department of Environmental Health Sciences, University at Albany, Rensselaer, NY, USA.
| |
Collapse
|
7
|
Zhang R, Liu M, Zhang W, Ling J, Dong J, Ruan Y. Short-term association between air pollution and daily genitourinary disorder admissions in Lanzhou, China. Environ Geochem Health 2024; 46:74. [PMID: 38367071 DOI: 10.1007/s10653-023-01821-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/27/2023] [Indexed: 02/19/2024]
Abstract
The aim of this study was to determine the relationship between short-term exposure to ambient air pollution and the number of daily hospital admissions for genitourinary disorders in Lanzhou. Hospital admission data and air pollutants, including PM2.5, PM10, SO2, NO2, O38h and CO, were obtained from the period 2013 to 2020. A generalized additive model (GAM) combined with distribution lag nonlinear model (DLNM) based on quasi-Poisson distribution was used by the controlling for trends, weather, weekdays and holidays. Short-term exposure to PM2.5, NO2 and CO increased the risk of genitourinary disorder admissions with RR of 1.0096 (95% CI 1.0002-1.0190), 1.0255 (95% CI 1.0123-1.0389) and 1.0686 (95% CI 1.0083-1.1326), respectively. PM10, O38h and SO2 have no significant effect on genitourinary disorders. PM2.5 and NO2 are more strongly correlated in female and ≥ 65 years patients. CO is more strongly correlated in male and < 65 years patients. PM2.5, NO2 and CO are risk factors for genitourinary morbidity, and public health interventions should be strengthened to protect vulnerable populations.
Collapse
Affiliation(s)
- Runping Zhang
- School of Public Health, Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Miaoxin Liu
- School of Public Health, Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Wancheng Zhang
- School of Public Health, Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Jianglong Ling
- School of Public Health, Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Jiyuan Dong
- School of Public Health, Lanzhou University, Lanzhou, 730000, People's Republic of China
| | - Ye Ruan
- School of Public Health, Lanzhou University, Lanzhou, 730000, People's Republic of China.
| |
Collapse
|
8
|
Kaier K, Brühmann BA, Fetzer S, von der Warth R, Farin-Glattacker E. Impact of a complex health services intervention in long-term care nursing homes on 3-year overall survival: results from the CoCare study. BMC Health Serv Res 2024; 24:203. [PMID: 38355493 PMCID: PMC10868086 DOI: 10.1186/s12913-024-10635-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/24/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND The Coordinated medical Care (CoCare) project aimed to improve the quality of medical care in nursing homes by optimizing collaboration between nurses and physicians. We analyze the impact of the CoCare intervention on overall survival. METHODS The effect of time-varying treatment on 3-year overall survival was analyzed with treatment as time-varying covariate within the entire cohort. To reduce bias due to non-random assignment to treatment groups, regression adjustment was applied. Therefore, age, sex, and level of care were used as potential confounders. RESULTS The study population consisted of 8,893 nursing home residents (NHRs), of which 1,330 participated in the CoCare intervention. The three-year overall survival was 49.8% in the entire cohort. NHRs receiving the intervention were associated with a higher survival probability compared to NHRs of the control group. In a univariable cox model with time-dependent treatment, the intervention was associated with a hazard ratio of 0.70 [95%CI 0.56-0.87, p = 0.002]. After adjustment for age, sex and level of care, the hazard ratio increased to 0.82 but was still significant [95%CI 0.71-0.96, p = 0.011]. CONCLUSION The analysis shows that optimizing collaboration between nurses and physicians leads to better survival of NHRs in Germany. This adds to the already published favorable cost-benefit ratio of the CoCare intervention and shows that a routine implementation of optimized collaboration between nurses and physicians is highly recommended.
Collapse
Affiliation(s)
- Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.
| | - Boris A Brühmann
- Section of Health Care Research and Rehabilitation Research (SEVERA), Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Stefan Fetzer
- Faculty of Economics, Aalen University, Aalen, Germany
| | - Rieka von der Warth
- Section of Health Care Research and Rehabilitation Research (SEVERA), Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research (SEVERA), Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| |
Collapse
|
9
|
López-Bueno JA, Padrón-Monedero A, Díaz J, Navas-Martín MA, Linares C. Short-term impact of air pollution, noise and temperature on emergency hospital admissions in Madrid (Spain) due to liver and gallbladder diseases. Environ Res 2024; 249:118439. [PMID: 38346485 DOI: 10.1016/j.envres.2024.118439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Very few epidemiological studies have explored the environmental and meteorological risk factors that influence liver diseases and gallbladder disorders, and no studies have addressed the specific case of Spain. METHODS This is a retrospective ecological study conducted during 2013-2018. We analysed emergency admissions in the central area of the Region of Madrid for the following causes: Liver and gallbladder diseases (L&GB) (ICD-10: K70-K81); disorders of gallbladder (DGB) (ICD 10: K80-K81); liver disease (LD) (ICD 10: K70-K77); alcoholic liver disease (ALD) (ICD-10: K70); viral hepatitis (VH) (ICD10:B15-B19); and hepatic failure, not elsewhere classified (HFNS) (ICD-10: K72). Independent variables used: meteorological (maximum daily temperature (Tmax in ⁰C), minimum daily temperature (Tmin in ⁰C), and relative humidity (RH in %)); chemical air pollution (8-hO3, NO2, PM10, PM2.5 in μg/m3); and noise pollution (equivalent level of daily noise (Ld in dB(A)). Transformed variables: extreme heat in degrees (Theat); wet cold (WC); and high ozone. We fitted Poisson models, negative binomials and zero-inflated Poisson controlled for seasonality, day of the week, holidays, trend, and autoregressive trend. Based on these models, the percentage of cases attributable to statistically significant risk factors was then estimated. RESULTS In L&GB emergency admissions daily noise is related to 4.4% (CI95%: 0.8 7.9) of admissions; NO2 to 2.9% (CI95%: 0.1 5.7) and wet cold to 0.2% (CI95%: 0.8 7.9). Heat wave temperature was only related to ALD. In addition, the wet cold association with L&GB is also related to HFNS attributing 1.0% (CI95%: 0.3 1.8) of admissions for this cause. CONCLUSIONS Daily noise and NO2 are associated with more than 7% of urgent L&GB admissions. Both pollutants, are mainly emitted by road traffic. A reduction of traffic in cities would result in a reduction of emergency admissions due to this cause.
Collapse
Affiliation(s)
- J A López-Bueno
- Climate Change, Health and Urban Environment Reference Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - A Padrón-Monedero
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - J Díaz
- Climate Change, Health and Urban Environment Reference Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain.
| | - M A Navas-Martín
- Climate Change, Health and Urban Environment Reference Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - C Linares
- Climate Change, Health and Urban Environment Reference Unit, National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| |
Collapse
|
10
|
Vgontzas AN, Paschalidou A, Simos PG, Anastasaki M, Zografaki A, Volikos E, Koutra K, Basta M. Impact of long-acting injectable antipsychotics vs. oral medication on relapses of patients with psychosis and bipolar disorder. Psychiatry Res 2024; 332:115676. [PMID: 38176166 DOI: 10.1016/j.psychres.2023.115676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 12/07/2023] [Accepted: 12/14/2023] [Indexed: 01/06/2024]
Abstract
Relapse associated with multiple hospital readmissions of patients with chronic and severe mental disorders, such as psychosis and bipolar disorder, is frequently associated with non-adherence to treatment. The primary aim of the study was to compare the effectiveness of long-acting injectable (LAI) treatment, vs. oral medication in reducing readmissions of patients with psychotic or bipolar disorder in a community sample of 164 patients with psychosis and 29 patients with bipolar disorder (n = 193), with poor adherence to oral medication. The mean follow up period was 5.6 years and the number of readmissions were compared for an equal-length period of oral treatment preceding the onset of LAI administration. We observed a significant decrease of 45.2 % in total hospital readmissions after receiving LAIs treatment. The effect was significant both for patients with a pre-LAI treatment history of predominantly voluntary hospitalizations and with predominantly involuntary admissions. In addition, we observed equal effectiveness of first- vs. second-generation LAIs in reducing total hospital readmissions regardless of type of pre-treatment admission history (voluntary vs. involuntary). LAIs appear to be effective in reducing both voluntary and involuntary hospital readmissions in patients with psychosis and bipolar disorder with a history of poor adherence to treatment.
Collapse
Affiliation(s)
- Alexandros N Vgontzas
- Mobile Mental Health Unit of Heraklion, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece; Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece; Sleep Research and Treatment Center Department of Psychiatry, Pennsylvania State University College of Medicine, Hershey, PA 17033, USA.
| | - Anna Paschalidou
- Mobile Mental Health Unit of Heraklion, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece
| | - Panagiotis G Simos
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece; Department of Psychiatry, University Hospital of Heraklion, Heraklion, Crete 71110, Greece; Institute of Computer Science, Foundation of Research and Technology, Heraklion, Greece
| | - Maria Anastasaki
- Mobile Mental Health Unit of Heraklion, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece
| | - Avgi Zografaki
- Mobile Mental Health Unit of Heraklion, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece
| | - Emmanouil Volikos
- Mobile Mental Health Unit of Heraklion, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece; Department of Psychiatry, University Hospital of Heraklion, Heraklion, Crete 71110, Greece
| | - Katerina Koutra
- Department of Psychology, School of Social Sciences, University of Crete, Gallos Campus, Rethymnon, Crete 74100, Greece
| | - Maria Basta
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Crete, Voutes, Heraklion, Crete 71003, Greece; Department of Psychiatry, University Hospital of Heraklion, Heraklion, Crete 71110, Greece
| |
Collapse
|
11
|
Kanchan S, Ogden E, Kesheri M, Skinner A, Miliken E, Lyman D, Armstrong J, Sciglitano L, Hampikian G. COVID-19 hospitalizations and deaths predicted by SARS-CoV-2 levels in Boise, Idaho wastewater. Sci Total Environ 2024; 907:167742. [PMID: 37852488 DOI: 10.1016/j.scitotenv.2023.167742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/22/2023] [Accepted: 10/09/2023] [Indexed: 10/20/2023]
Abstract
The viral load of COVID-19 in untreated wastewater from Idaho's capital city Boise, ID (Ada County) has been used to predict changes in hospital admissions (statewide in Idaho) and deaths (Ada County) using distributed fixed lag modeling and artificial neural networks (ANN). The wastewater viral counts were used to determine the lag time between peaks in wastewater viral counts and COVID-19 hospitalizations as well as deaths (14 and 23 days, respectively). Quantitative measurement of SARS-CoV-2 viral RNA counts in the untreated wastewater was determined three times a week using RT-qPCR over a span of 13 months. To mitigate the effects of PCR inhibitors in wastewater, a series of dilution tests were conducted, and the 1/4 dilution was used to generate the most successful model. Wastewater SARS-CoV-2 viral RNA counts and hospitalization from June 7, 2021 to December 29, 2021 were used as training data to predict hospitalizations; and wastewater SARS-CoV-2 viral RNA counts and deaths from June 7, 2021 to December 20, 2021 were used as training data to predict deaths. These training data were used to make predictive ANN models for future hospitalizations and deaths. To the best of our knowledge, this is the first report of prediction of deaths from COVID-19 based on wastewater SARS-CoV-2 viral RNA counts using machine learning-based multilayered ANN. The applied modeling demonstrates that wastewater surveillance data can be combined with hospitalizations and death data to generate machine learning-based ANN models that predict future COVID-19 hospital admissions and deaths, providing an early warning for medical response teams and healthcare policymakers.
Collapse
Affiliation(s)
- Swarna Kanchan
- Department of Biological Sciences, Boise State University, Boise, Idaho, 83725, United States of America; Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, 25701, United States of America
| | - Ernie Ogden
- Department of Biological Sciences, Boise State University, Boise, Idaho, 83725, United States of America
| | - Minu Kesheri
- Department of Biological Sciences, Boise State University, Boise, Idaho, 83725, United States of America; Department of Biomedical Sciences, Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, 25701, United States of America
| | - Alexis Skinner
- Department of Biological Sciences, Boise State University, Boise, Idaho, 83725, United States of America
| | - Erin Miliken
- Department of Biological Sciences, Boise State University, Boise, Idaho, 83725, United States of America
| | - Devyn Lyman
- Department of Biological Sciences, Boise State University, Boise, Idaho, 83725, United States of America
| | - Jacob Armstrong
- Department of Biological Sciences, Boise State University, Boise, Idaho, 83725, United States of America
| | - Lawrence Sciglitano
- Department of Biological Sciences, Boise State University, Boise, Idaho, 83725, United States of America
| | - Greg Hampikian
- Department of Biological Sciences, Boise State University, Boise, Idaho, 83725, United States of America.
| |
Collapse
|
12
|
Joiner KA, Lin J, Pantano J. Upcoding in medicare: where does it matter most? Health Econ Rev 2024; 14:1. [PMID: 38165452 PMCID: PMC10759668 DOI: 10.1186/s13561-023-00465-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/11/2023] [Indexed: 01/03/2024]
Abstract
Upcoding in Medicare has been a topic of interest to economists and policy makers for nearly 40 years. While upcoding is generally understood as "billing for services at higher level of complexity than the service actually pro- vided or documented," it has a wide range of definitions within the literature. This is largely because the financial incentives across programs and aspects under the coding control of billing specialists and providers are different, and have evolved substantially over time, as has the published literature. Arguably, the primary importance of analyzing upcoding in different parts of Medicare is to inform policy makers on the magnitude of the process and to suggest approaches to mitigate the level of upcoding. Financial estimates for upcoding in traditional Medicare (Medicare Parts A and B), are highly variable, in part reflecting differences in methodology for each of the services covered. To resolve this variability, we used summaries of audit data from the Comprehensive Error Rate Testing program for the period 2010-2019. This program uses the same methodology across all forms of service in Medicare Parts A and B, allowing direct comparisons of upcoding magnitude. On average, upcoding for hospitalization under Part A represents $656 million annually (or 0.53% of total Part A annual expenditures) during our sample period, while up- coding for physician services under Part B is $2.38 billion annually (or 2.43% of Part B annual expenditures). These numbers compare to the recent consistent estimates from multiple different entities putting upcoding in Medicare Part C at $10-15 billion annually (or approximately 2.8-4.2% of Part C annual expenditures). Upcoding for hospitalization under Medicare Part A is small, relative to overall upcoding expenditures.
Collapse
Affiliation(s)
| | - Jianjing Lin
- Russell Sage Lab 3203, Rensselaer Polytechnic Institute, 110 8Th St, Troy, NY, 12180, USA.
| | | |
Collapse
|
13
|
de-Miguel-Diez J, Gutierrez-Albaladejo N, Caballero-Segura FJ, Lopez-de-Andres A, Jimenez-Garcia R, Zamorano-Leon JJ, Carabantes-Alarcon D, Omaña-Palanco R, Hernández-Barrera V, Cuadrado-Corrales N. Trends and sex differences in atrial fibrillation among patients hospitalized due to asthma: Insights from a nationwide population-based discharge database in Spain, 2016-2021. Respir Med 2024; 221:107508. [PMID: 38135195 DOI: 10.1016/j.rmed.2023.107508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/16/2023] [Accepted: 12/19/2023] [Indexed: 12/24/2023]
Abstract
AIMS To analyze changes in the prevalence of atrial fibrillation (AF) in patients hospitalized due to asthma; to compare hospital outcomes in asthma patients with and without AF, assessing sex differences; to identify variables associated with the presence of AF; and to analyze the factors associated with in-hospital mortality (IHM) among asthma patients with AF. METHODS We used data from the Registry of Specialized Care Activity-Basic Minimum Data Set to select all patients aged ≥40 years with an asthma diagnosis in Spain, from 2016 to 2021. We stratified the study population according to the presence of AF and sex. RESULTS We identified 65,233 hospitalizations that met the inclusion criteria (14.85 % with AF). The prevalence of AF significantly increased over time, with the male sex being a protective factor for its presentation. IHM were significantly higher in patients with AF. Older age, being a woman, congestive heart failure, renal disease, obstructive sleep apnea, hypertension, and hyperthyroidism were associated with the presence of AF. Advanced age and the presence of cancer and COVID-19 were factors associated with a higher IHM, as well as admission to an intensive care unit and the use of invasive mechanical ventilation. There were no association of sex with the IHM. CONCLUSIONS AF is highly prevalent among subjects hospitalized due to asthma, with this prevalence having increased significantly in Spain over time. The presence of AF in patients with asthma was associated significantly with a higher LOHS and IHM. Sex was not associated with IHM in these patients.
Collapse
Affiliation(s)
- Javier de-Miguel-Diez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | | | - Francisco J Caballero-Segura
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Ana Lopez-de-Andres
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
| | - Rodrigo Jimenez-Garcia
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - José J Zamorano-Leon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - David Carabantes-Alarcon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Ricardo Omaña-Palanco
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Natividad Cuadrado-Corrales
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
14
|
Hu T, Xu ZY, Wang J, Su Y, Guo BB. Meteorological factors, ambient air pollution, and daily hospital admissions for depressive disorder in Harbin: A time-series study. World J Psychiatry 2023; 13:1061-1078. [PMID: 38186723 PMCID: PMC10768489 DOI: 10.5498/wjp.v13.i12.1061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND The literature has discussed the relationship between environmental factors and depressive disorders; however, the results are inconsistent in different studies and regions, as are the interaction effects between environmental factors. We hypothesized that meteorological factors and ambient air pollution individually affect and interact to affect depressive disorder morbidity. AIM To investigate the effects of meteorological factors and air pollution on depressive disorders, including their lagged effects and interactions. METHODS The samples were obtained from a class 3 hospital in Harbin, China. Daily hospital admission data for depressive disorders from January 1, 2015 to December 31, 2022 were obtained. Meteorological and air pollution data were also collected during the same period. Generalized additive models with quasi-Poisson regression were used for time-series modeling to measure the non-linear and delayed effects of environmental factors. We further incorporated each pair of environmental factors into a bivariate response surface model to examine the interaction effects on hospital admissions for depressive disorders. RESULTS Data for 2922 d were included in the study, with no missing values. The total number of depressive admissions was 83905. Medium to high correlations existed between environmental factors. Air temperature (AT) and wind speed (WS) significantly affected the number of admissions for depression. An extremely low temperature (-29.0 ℃) at lag 0 caused a 53% [relative risk (RR)= 1.53, 95% confidence interval (CI): 1.23-1.89] increase in daily hospital admissions relative to the median temperature. Extremely low WSs (0.4 m/s) at lag 7 increased the number of admissions by 58% (RR = 1.58, 95%CI: 1.07-2.31). In contrast, atmospheric pressure and relative humidity had smaller effects. Among the six air pollutants considered in the time-series model, nitrogen dioxide (NO2) was the only pollutant that showed significant effects over non-cumulative, cumulative, immediate, and lagged conditions. The cumulative effect of NO2 at lag 7 was 0.47% (RR = 1.0047, 95%CI: 1.0024-1.0071). Interaction effects were found between AT and the five air pollutants, atmospheric temperature and the four air pollutants, WS and sulfur dioxide. CONCLUSION Meteorological factors and the air pollutant NO2 affect daily hospital admissions for depressive disorders, and interactions exist between meteorological factors and ambient air pollution.
Collapse
Affiliation(s)
- Ting Hu
- Department of Five Therapy, The First Psychiatric Hospital of Harbin, Harbin 150026, Heilongjiang Province, China
| | - Zhao-Yuan Xu
- Medical Section, The First Psychiatric Hospital of Harbin, Harbin 150026, Heilongjiang Province, China
| | - Jian Wang
- Department of Out-Patient, The First Psychiatric Hospital of Harbin, Harbin 150026, Heilongjiang Province, China
| | - Yao Su
- Science and Education, The First Psychiatric Hospital of Harbin, Harbin 150026, Heilongjiang Province, China
| | - Bing-Bing Guo
- Department of 22 Therapy, Harbin Psychiatric Baiyupao Hospital, Harbin 150000, Heilongjiang Province, China
| |
Collapse
|
15
|
Lodh R, Hou B, Hough A, Oddie S, Mason D, Wright J. Health care utilisation and education outcomes of children with rare diseases: a born in Bradford cohort study. Eur J Pediatr 2023; 182:5511-5517. [PMID: 37782349 DOI: 10.1007/s00431-023-05225-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/13/2023] [Accepted: 09/17/2023] [Indexed: 10/03/2023]
Abstract
The purpose of this study is to describe the burden of health care utilisation and early education outcomes of children with and without rare diseases. Using the Born in Bradford birth cohort and its linked routine health care and education data, we looked at cumulative primary care episodes, hospital admissions and medication prescriptions. We assessed education outcomes using Early Years Foundation Stage Profile and the National Curriculum Tests-Key Stage 1 results. Among analytical sample of 13,858, 1711 or 12.3% children were identified with a rare disease by an average age of 14 years. Children with rare diseases were twice more likely to be admitted to hospital compared to children without. Average length of stay was around 5 days in those with rare diseases group compared to less than 1 day in those without. The average number of primary care episodes was 45.4 in children with rare diseases and 28.2 visits in those without. These children were over three times more likely to be on multiple medications. Children with rare diseases had 30% higher risk of being below academic expectations at Foundation Year and, depending on subject, between 50 and 60% higher risks at KS1 tests. Conclusions: Children with rare diseases are significantly more likely to have increased primary care episodes and to have more regular medications. They are likely to have more hospital admissions with a longer stay also. Educationally, they are at higher risk of failing to achieve expected standards in early-year settings. What is Known: • Existing studies of rare diseases have used cross sectional data to describe secondary care data. Previous research has not explored the impact of rare diseases on academic outcomes in children. What is New: • Using Born in Bradford birth cohort and its linked primary and secondary care data, this study provides the most comprehensive estimate of prevalence of rare diseases in any study to date. Children with rare diseases were not only significantly more likely to have contact with primary care and to be admitted to hospitals; they were also more like to be on more regular medications and had higher risk of not achieving expected standards in early-year education outcomes. • Our study is unusual in being able to access linked health and education data and reinforces the importance of adopting a whole system approach to children's health and wellbeing that recognises the close links between health and education.
Collapse
Affiliation(s)
- Rajib Lodh
- Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Bo Hou
- Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK.
- Leicester Medical School, University of Leicester, Lancaster Rd, George Davies Centre Leicester, LE1 7HA, UK.
| | - Amy Hough
- Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Sam Oddie
- Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Dan Mason
- Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - John Wright
- Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, BD9 6RJ, UK
| |
Collapse
|
16
|
Lewtak K, Poznańska A, Kanecki K, Tyszko P, Goryński P, Jankowski K, Nitsch-Osuch A. Ukrainian migrants' and war refugees' admissions to hospital: evidence from the Polish Nationwide General Hospital Morbidity Study, 2014-2022. BMC Public Health 2023; 23:2336. [PMID: 38001432 PMCID: PMC10675912 DOI: 10.1186/s12889-023-17202-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Considering the rapid influx of Ukrainian migrants and war refugees into Poland, the knowledge of their health condition is becoming increasingly important for health system policy and planning. The aim of the study was to assess war-related changes in the frequency and structure of hospitalizations among Ukrainian migrants and refugees in Poland. METHODS The study is based on the analysis of hospital admission records of Ukrainian patients, which were collected in the Nationwide General Hospital Morbidity Study from 01.01.2014 to 31.12.2022. RESULTS In the study period, 13,024 Ukrainians were hospitalized in Poland, 51.7% of whom had been admitted to hospital after February 24, 2022. After the war broke out, the average daily hospital admissions augmented from 2.1 to 21.6 person/day. A noticeable increase in the share of women (from 50% to 62%) and children (from 14% to 51%) was also observed. The average age of patients fell from 33.6 ± 0.2 years to 24.6 ± 0.3 years. The most frequently reported hospital events among the migrants until 23.02.2022 were injuries (S00-T98) - 26.1%, pregnancy, childbirth and the puerperium (O00-O99) - 18.4%, and factors influencing health status and contact with health services (Z00-Z99) - 8.4%. After the war started, the incidence of health problems among migrants and war refugees changed, with pregnancy, childbirth and the puerperium (O00-O99) being the most common - 14.9%, followed by abnormal clinical and lab findings (R00-R99) - 11.9%, and infectious and parasitic diseases (A00-B99) - 11.0%. CONCLUSIONS Our findings may support health policy planning and delivering adequate healthcare in refugee-hosting countries.
Collapse
Affiliation(s)
- Katarzyna Lewtak
- Department of Health Promotion and Prevention of Chronic Diseases, National Institute of Public Health NIH - National Research Institute, 24 Chocimska Street, 00-791, Warsaw, Poland.
- Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland.
| | - Anna Poznańska
- Department of Population Health Monitoring and Analysis, National Institute of Public Health NIH - National Research Institute, Warsaw, Poland
| | - Krzysztof Kanecki
- Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Tyszko
- Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland
- Institute of Rural Health in Lublin, Lublin, Poland
| | - Paweł Goryński
- Department of Population Health Monitoring and Analysis, National Institute of Public Health NIH - National Research Institute, Warsaw, Poland
| | - Krzysztof Jankowski
- Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland
- National Geriatrics, Rheumatology and Rehabilitation Institute, Warsaw, Poland
| | - Aneta Nitsch-Osuch
- Department of Social Medicine and Public Health, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
17
|
Pipitò L, Zinna G, Trizzino M, Gioè C, Tolomeo M, Di Carlo P, Colomba C, Gibaldi L, Iaria C, Almasio P, Cascio A. Causes of hospitalization and predictors of in-hospital mortality among people living with HIV in Sicily-Italy between 2010 and 2021. J Infect Public Health 2023; 16:1703-1708. [PMID: 37729685 DOI: 10.1016/j.jiph.2023.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Despite the rising number of people living with human immunodeficiency virus (HIV), there is a lack of knowledge about the factors that lead to PLWHs being hospitalized in worldwide literature. Our study aimed to investigate PLWH admissions in Sicily (Italy) between January 2010 and September 2021 and to analyze the characteristics and risk factors for in-hospital mortality and differences between Italians and foreigners. METHODS Data from the hospital discharge forms of all people living with HIV (PLWH) hospitalized in Sicilian hospitals were retrospectively collected. Age, sex, nationality, length of stay, acquired immunodeficiency syndrome (AIDS), and non-AIDS-related diseases were evaluated using univariate analysis according to in-hospital mortality rates. The factors associated with mortality were included in the logistic regression model. RESULTS In total, 5281 admissions from 2726 PLWHs occurred, most of which were related to non-AIDS diseases. Approximately 20 % regarded foreign patients, mainly from Africa. Logistic regression analysis revealed an association between in-hospital mortality and some AIDS- and non-AIDS-related diseases (wasting syndrome, lymphomas, Kaposi sarcomas, progressive multifocal leukoencephalopathy, cryptococcosis, abscesses, sepsis, cardiovascular disease, nephropathy, and respiratory diseases). African patient admissions were significantly associated with tuberculosis, toxoplasmosis, Burkitt lymphoma, and hepatitis B diagnoses. CONCLUSIONS Our study showed that most hospitalizations were related to non-AIDS-defining diseases, with differences between Italian and foreign patients, mainly from Africa.
Collapse
Affiliation(s)
- Luca Pipitò
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro," University of Palermo, Palermo, Italy; Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the fight against AIDS, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy; Palermo Fast-Track City, Casa dei Diritti, Via Libertà 45, 90143 Palermo, Italy
| | - Giuseppe Zinna
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro," University of Palermo, Palermo, Italy
| | - Marcello Trizzino
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the fight against AIDS, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy; Palermo Fast-Track City, Casa dei Diritti, Via Libertà 45, 90143 Palermo, Italy
| | - Claudia Gioè
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the fight against AIDS, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy; Palermo Fast-Track City, Casa dei Diritti, Via Libertà 45, 90143 Palermo, Italy
| | - Manlio Tolomeo
- Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the fight against AIDS, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy; Palermo Fast-Track City, Casa dei Diritti, Via Libertà 45, 90143 Palermo, Italy
| | - Paola Di Carlo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro," University of Palermo, Palermo, Italy; Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the fight against AIDS, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy; Palermo Fast-Track City, Casa dei Diritti, Via Libertà 45, 90143 Palermo, Italy
| | - Claudia Colomba
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro," University of Palermo, Palermo, Italy; Palermo Fast-Track City, Casa dei Diritti, Via Libertà 45, 90143 Palermo, Italy; Pediatric Infectious Diseases Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, 90127 Palermo, Italy
| | - Lidia Gibaldi
- Dipartimento per la pianificazione strategica, Assessorato della Salute Regione Siciliana, Palermo, Italy
| | - Chiara Iaria
- Palermo Fast-Track City, Casa dei Diritti, Via Libertà 45, 90143 Palermo, Italy; Infectious Diseases Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, 90127 Palermo, Italy
| | - Piero Almasio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro," University of Palermo, Palermo, Italy
| | - Antonio Cascio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G D'Alessandro," University of Palermo, Palermo, Italy; Infectious and Tropical Disease Unit and Sicilian Regional Reference Center for the fight against AIDS, AOU Policlinico "P. Giaccone", 90127 Palermo, Italy; Palermo Fast-Track City, Casa dei Diritti, Via Libertà 45, 90143 Palermo, Italy.
| |
Collapse
|
18
|
Esteban C, Antón-Ladislao A, Aramburu A, Chasco L, Orive M, Sobradillo P, López-Roldan L, Jiménez-Puente A, de Miguel J, García-Talavera I, Quintana JM. Physical activity and sedentary behaviour in patients admitted with COPD: Associated factors. Respir Med Res 2023; 84:101052. [PMID: 37897880 DOI: 10.1016/j.resmer.2023.101052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 07/22/2023] [Accepted: 09/26/2023] [Indexed: 10/30/2023]
Abstract
AIM To establish amongst a cohort of patients admitted with Chronic Obstructive Pulmonary Disease which factors were associated with their level of Physical Activity and Sedentary Behavior prior to the admission event. METHODS Prospective observational cohort study. Nine Spanish hospitals participated. Patients were recruited consecutively. Variables relating to the patients' clinical baseline status were recorded, including the COPD Assessment test, the HADS anxiety-depression test, comorbidities and the Yale Physical Activity Survey. Data relating to admission and up to two months after discharge were also recorded. RESULTS 1638 COPD patients were studied, with a mean age of 72.39 (SD 10.33), 76.56 % male, FEV1 49.41 % (SD19.19), Charlson index 2. The level of PA at baseline was 30.79 points (SD 22.43). Multivariable linear regression analysis identified the following as being associated with low PA: older age, obesity, higher level of hemoglobin, lower score of Barthel index, which means disability, health related quality of life (EuroQoL-5d and CAT) and dyspnea. Variables associated with sedentary behavior were: older age, presence of obstructive apnea syndrome, higher disability, presence of depressive symptoms and dyspnea. CONCLUSIONS In a cohort of hospitalized COPD patients, we have found several variables, some of them modifiable, associated with physical activity/inactivity and sedentary behavior.
Collapse
Affiliation(s)
- Cristóbal Esteban
- Respiratory Department, Hospital Galdakao, Galdakao, Bizkaia, Spain; BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain.
| | - Ane Antón-Ladislao
- Research Unit, Hospital Galdakao, Galdakao, Bizkaia, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain
| | - Amaia Aramburu
- Respiratory Department, Hospital Galdakao, Galdakao, Bizkaia, Spain; BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain
| | - Leyre Chasco
- Respiratory Department, Hospital Galdakao, Galdakao, Bizkaia, Spain; BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain
| | - Miren Orive
- Departamento Psicología Social, Facultad Farmacia, UPV/EHU, Vitoria-Gasteiz, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain
| | - Patricia Sobradillo
- Servicio de Respiratorio, Hospital Cruces, Barakaldo, Spain; BioCruces-Bizkaia Health Research Institute, Barakaldo, Spain
| | | | - Alberto Jiménez-Puente
- Unidad de Evaluación, Hospital Costa del Sol, Marbella, Malaga, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain
| | - Javier de Miguel
- Servicio de Respiratorio, Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)., Madrid, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain
| | - Ignacio García-Talavera
- Servicio de Respiratorio, Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain
| | - José M Quintana
- Research Unit, Hospital Galdakao, Galdakao, Bizkaia, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain; Kronikgune Research Institute, Barakaldo, Spain; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain
| |
Collapse
|
19
|
Foley JA, Willis C. Prevalence and impact of mental health issues in Parkinson's disease unplanned hospital admissions. Parkinsonism Relat Disord 2023; 115:105805. [PMID: 37607451 DOI: 10.1016/j.parkreldis.2023.105805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/13/2023] [Indexed: 08/24/2023]
Affiliation(s)
- Jennifer A Foley
- UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK; Department of Neuropsychology, Box 37, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK.
| | - Charlotte Willis
- UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK; Department of Neuropsychology, Box 37, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK
| |
Collapse
|
20
|
Krüger EL, Nedel AS, Dos Santos Gomes AC, Lúcio PS. Analyzing the relationship between air temperature and respiratory morbidity in children and the elderly in Porto Alegre, Brazil, before and during the COVID-19 pandemic. Int J Biometeorol 2023; 67:1461-1475. [PMID: 37438577 DOI: 10.1007/s00484-023-02516-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/07/2023] [Accepted: 06/29/2023] [Indexed: 07/14/2023]
Abstract
The aim of the study was to analyze the relationship between air temperature data against hospital admissions due to respiratory diseases of children (under five years of age) and the elderly (over 65) in subtropical Porto Alegre, Brazil, comparing outcomes for 3 sequential years, 2018-2020, pre- and post-COVID 19 pandemic. Meteorological and hospital admission (HA) data for Porto Alegre, marked by a Koeppen-Geiger's Cfa climate type with well-defined seasons, were used in the analyses. HA was obtained for respiratory diseases (J00-99, according to the International Classification of Diseases, ICD-10) from the Brazilian DATASUS (Unified Health System database). We performed correlation analysis between variables (HA versus air temperature and heat stress) in order to identify existing relationships and lag effects (between meteorological condition and morbidity). Relative risk (RR) was also obtained for the two age groups during the three years. Results showed that the pandemic year disrupted observed patterns of association between analyzed variables, with either very low or non-existent correlations.
Collapse
Affiliation(s)
- Eduardo L Krüger
- Departamento de Construção Civil, Universidade Tecnológica Federal do Paraná - UTFPR/Campus Curitiba - Sede Ecoville, Rua Deputado Heitor Alencar Furtado, 4900, Curitiba, 81280-340, Brazil.
| | - Anderson Spohr Nedel
- Faculdade de Agronomia, Universidade Federal da Fronteira Sul (UFFS), Cerro Largo, Rio Grande do Sul, Brazil
| | | | - Paulo S Lúcio
- Departamento de Ciências Atmosféricas e Climáticas, Universidade Federal do Rio Grande do Norte (UFRN), Natal, Brazil
| |
Collapse
|
21
|
Rodriguez-Jimenez R, García-Fernández L, Baón-Pérez B, Ansede-Cascudo JC, Arroba CMA, Sendra-Gutierrez JM, Romero-Ferreiro V, Sánchez-Cabezudo Á, Alvarez-Mon MA, Navío-Acosta M. Hospital admissions due to suicide attempts during the COVID-19 pandemic, a 3-year longitudinal study. Psychiatry Res 2023; 327:115346. [PMID: 37523887 DOI: 10.1016/j.psychres.2023.115346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/12/2023] [Accepted: 07/15/2023] [Indexed: 08/02/2023]
Abstract
The appearance of the SARS CoV-2 virus and the associated COVID-19 pandemic has been associated with the onset of mental disorders in healthy people and the worsening in those with pre-existing mental conditions. One of the areas that has raised the greatest concern is that of suicidality. Most of the published studies have been carried out cross-sectional or with small samples, without stratifying by age and gender. Thus, the aim of this longitudinal research is to study, in a large population sample of around 6,700,000 inhabitants belonging to the entire region of Madrid (Spain), the admissions in psychiatric hospitalization units due to suicidal attempts along 2019, 2020 and 2021. No clear increase in the number of admissions due to suicidality in the total population have been found. In addition, a higher prevalence in admissions among women is verified. Moreover, stratifying by age and gender, a striking and significant increase in hospital admissions due to suicidality has been observed in the group up to 17 years old, from September 2020 until the end of the study. These results highlight the special vulnerability of children and adolescents, specifically girls, and the need for preventive measures in the face of future pandemics.
Collapse
Affiliation(s)
- Roberto Rodriguez-Jimenez
- Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación 12 de Octubre (imas12), Hospital Universitario 12 de Octubre, Madrid, Spain; CIBERSAM-ISCIII (Biomedical Research Networking Centre in Mental Health), Spain
| | - Lorena García-Fernández
- CIBERSAM-ISCIII (Biomedical Research Networking Centre in Mental Health), Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, San Juan, Alicante, Spain; Servicio de Psiquiatría, Hospital Universitario de San Juan, San Juan, Alicante, Spain.
| | - Beatriz Baón-Pérez
- Oficina Regional de Coordinación de Salud Mental y Adicciones, Servicio Madrileño de Salud, Madrid, Spain
| | - Juan Carlos Ansede-Cascudo
- Oficina Regional de Coordinación de Salud Mental y Adicciones, Servicio Madrileño de Salud, Madrid, Spain
| | | | | | - Verónica Romero-Ferreiro
- Instituto de Investigación 12 de Octubre (imas12), Hospital Universitario 12 de Octubre, Madrid, Spain; CIBERSAM-ISCIII (Biomedical Research Networking Centre in Mental Health), Spain; Departmento de Psicología, Universidad Europea de Madrid, Madrid, Spain
| | - Ángeles Sánchez-Cabezudo
- Instituto de Investigación 12 de Octubre (imas12), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Miguel A Alvarez-Mon
- Departmento de Medicina y Especialidades Médicas, Universidad de Alcala, Alcala de Henares, Madrid 28801, Spain; Instituto Ramón y Cajal de INvestigación Sanitaria (IRYCIS), Madrid 28034, Spain; Departmento de Psiquiatría y Salud Mental, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Mercedes Navío-Acosta
- Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación 12 de Octubre (imas12), Hospital Universitario 12 de Octubre, Madrid, Spain; CIBERSAM-ISCIII (Biomedical Research Networking Centre in Mental Health), Spain; Oficina Regional de Coordinación de Salud Mental y Adicciones, Servicio Madrileño de Salud, Madrid, Spain
| |
Collapse
|
22
|
López-Cuadrado T, Szmulewicz A, Öngür D, Martínez-Alés G. Clinical characteristics and outcomes of people with severe mental disorders hospitalized due to COVID-19: A nationwide population-based study. Gen Hosp Psychiatry 2023; 84:234-240. [PMID: 37633121 DOI: 10.1016/j.genhosppsych.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/28/2023]
Abstract
OBJETIVE Hospitalized COVID-19 patients with severe mental illness (SMI) have worse outcomes than counterparts without SMI. Barriers in access to acute care medical procedures among SMI patients may partially explain this phenomenon. Here, we examined differences in critical care admission and in-hospital mortality between hospitalized COVID-19 patients with and without SMI. METHODS This population-based study used Spain's nationwide electronic health records. Based on International Classification Diseases, Tenth Revision, ICD-10-CM codes, we identified all patients aged ≥15 years hospitalized due to COVID-19 between July 1st-December 31st, 2020, and compared patients with and without SMI in terms of (i) critical care admission and (ii) in-hospital mortality - overall and stratified by age. We used logistic regression models including sex, age, and comorbidity burden as measured by Charlson Comorbidity Index Score as covariates. RESULTS Of 118,691 hospital admissions due to COVID-19 of people aged ≥15 years, 1512 (1.3%) included a diagnosis of SMI. Compared to non-SMI patients, SMI patients had higher in-hospital mortality (OR,95%CI: 1.63,1.42-1.88) and were less frequently admitted to critical care (OR,95%CI: 0.70,0.58-0.85). Admission to critical care in SMI patients was lower than for non-SMI counterparts only among individuals aged ≥60 years. The magnitude of the difference in in-hospital mortality between SMI and non-SMI patients decreased as age increased. CONCLUSIONS Individuals with SMI had reduced critical care admission and increased in-hospital mortality compared non-SMI counterparts, suggesting that differences in delivery of acute care medical procedures may partially explain higher risk of negative outcomes among COVID-19 patients with SMI.
Collapse
Affiliation(s)
- Teresa López-Cuadrado
- Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain.
| | - Alejandro Szmulewicz
- CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Dost Öngür
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Psychotic Disorders Division, McLean Hospital, Belmont, MA, USA
| | - Gonzalo Martínez-Alés
- CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Mental Health Network Biomedical Research Center (CIBERSAM), Madrid, Spain; Hospital La Paz Institute for Health Research (IDIPaz), Madrid, Spain
| |
Collapse
|
23
|
Panteli D, Mauer N, Tille F, Nimptsch U. How did the COVID-19 pandemic affect inpatient care for children in Germany? An exploratory analysis based on national hospital discharge data. BMC Health Serv Res 2023; 23:938. [PMID: 37653471 PMCID: PMC10472716 DOI: 10.1186/s12913-023-09929-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/16/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The delivery of health services around the world faced considerable disruptions during the COVID-19 pandemic. While this has been discussed for a number of conditions in the adult population, related patterns have been studied less for children. In light of the detrimental effects of the pandemic, particularly for children and young people under the age of 18, it is pivotal to explore this issue further. METHODS Based on complete national hospital discharge data available via the German National Institute for the Reimbursement of Hospitals (InEK) data browser, we compare the top 30 diagnoses for which children were hospitalised in 2019, 2020, 2021 and 2022. We analyse the development of monthly admissions between January 2019 and December 2022 for three tracers of variable time-sensitivity: acute lymphoblastic leukaemia (ALL), appendicitis/appendectomy and tonsillectomy/adenoidectomy. RESULTS Compared to 2019, total admissions were approximately 20% lower in 2020 and 2021, and 13% lower in 2022. The composition of the most frequent principal diagnoses remained similar across years, although changes in rank were observed. Decreases were observed in 2020 for respiratory and gastrointestinal infections, with cases increasing again in 2021. The number of ALL admissions showed an upward trend and a periodicity prima vista unrelated to pandemic factors. Appendicitis admissions decreased by about 9% in 2020 and a further 8% in 2021 and 4% in 2022, while tonsillectomies/adenoidectomies decreased by more than 40% in 2020 and a further 32% in 2021 before increasing in 2022; for these tracers, monthly changes are in line with pandemic waves. CONCLUSIONS Hospital care for critical and urgent conditions among patients under the age of 18 was largely upheld in Germany during the COVID-19 pandemic, potentially at the expense of elective treatments. There is an alignment between observed variations in hospitalisations and pandemic mitigation measures, possibly also reflecting changes in demand. This study highlights the need for comprehensive, intersectoral data that would be necessary to better understand changing demand, unmet need/foregone care and shifts from inpatient to outpatient care, as well as their link to patient outcomes and health care efficiency.
Collapse
Affiliation(s)
- Dimitra Panteli
- Department of Health Care Management, Technische Universität Berlin, Strasse des 17. Juni 135, 10623, Berlin, Germany.
- European Observatory on Health Systems and Policies, Place Victor Horta 40/30, Brussels, 1060, Belgium.
| | - Nicole Mauer
- European Observatory on Health Systems and Policies, Place Victor Horta 40/30, Brussels, 1060, Belgium
| | - Florian Tille
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, Cowdray House, London, WC2A 2AE, UK
| | - Ulrike Nimptsch
- Department of Health Care Management, Technische Universität Berlin, Strasse des 17. Juni 135, 10623, Berlin, Germany
| |
Collapse
|
24
|
Zhang X, Yu S, Zhang F, Zhu S, Zhao G, Zhang X, Li T, Yu B, Zhu W, Li D. Association between traffic-related air pollution and osteoporotic fracture hospitalizations in inland and coastal areas: evidences from the central areas of two cities in Shandong Province, China. Arch Osteoporos 2023; 18:96. [PMID: 37452267 DOI: 10.1007/s11657-023-01308-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
Our result showed that short-term exposure to traffic-related air pollutants (TRAPs) might increase the risk of hospitalizations for osteoporotic fractures. It was suggested that government should formulate emission reduction policies to protect the health of citizens. INTRODUCTION As the main source of urban air pollution in China, exhaust emissions of motor vehicles have been linked to adverse health outcomes, but evidence of the relationship between short-term exposure to TRAPs and osteoporotic fractures is still relatively rare. METHODS In this study, a total of 5044 inpatients from an inland city (Jinan) and a coastal city (Qingdao), two cities with developed transportation in Shandong Province, were included. A generalized additive model (GAM) was used to investigate the association between TRAPs and hospitalizations for osteoporotic fractures. The stratified analyses were performed by gender and age. RESULTS Positive associations between TRAPs and osteoporotic fracture hospitalizations were observed. We found that short-term exposure to TRAPs was associated with increased numbers of hospitalizations for osteoporotic fractures. PM2.5 and PM10 were statistically significant associated with hospitalizations for osteoporotic fractures at both single-day and multiday lag structures only in Qingdao, with the strongest associations at lag06 and lag07 [RR=1.0446(95%CI: 1.0018,1.0891) for PM2.5, RR=1.0328(95%CI: 1.0084,1.0578) for PM10]. For NO2 and CO, we found significant associations at lag4 in the single lag structure in Jinan [RR=1.0354 (95%CI: 1.0071, 1.0646) for NO2, RR=1.0014 (95%CI: 1.0002, 1.0025) for CO], while only CO at lag4 was significantly associated with hospitalizations for osteoporotic fractures in Qingdao [1.0038 (1.0012, 1.0063)]. Stratified analyses indicated that the associations were stronger in females and older individuals (65 + years). CONCLUSION This study implied that short-term exposure to TRAPs pollution was associated with an increased risk of hospitalizations for osteoporotic fractures. Female patients and patients aged 65 + years appeared to be more vulnerable to TRAPs, suggesting that poor air quality is a modifiable risk factor for osteoporotic fractures.
Collapse
Affiliation(s)
- Xupeng Zhang
- Department of Public Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Shengwen Yu
- Department of Orthopedics, Qingdao Hospital of Traditional Chinese Medicine (Qingdao Hiser hospital), Qingdao, 266033, China
| | - Faxue Zhang
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Shijie Zhu
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Gaichan Zhao
- Department of Public Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Xiaowei Zhang
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Tianzhou Li
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China
| | - Bo Yu
- Department of Orthopedics, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250014, China
| | - Wei Zhu
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China.
| | - Dejia Li
- Department of Public Health, School of Public Health, Wuhan University, Wuhan, 430071, China.
- Department of Occupational and Environmental Health, School of Public Health, Wuhan University, Wuhan, 430071, China.
| |
Collapse
|
25
|
Arrospide A, Sagardui MG, Larizgoitia I, Iturralde A, Moreda A, Mar J. Effectiveness of the booster dose of COVID-19 vaccine in the Basque Country during the sixth wave: A nationwide cohort study. Vaccine 2023:S0264-410X(23)00622-9. [PMID: 37271704 DOI: 10.1016/j.vaccine.2023.05.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 05/02/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
The aim of the study was to assess the effect of a booster dose of COVID-19 vaccine on the rates of hospital ward and intensive care unit (ICU) admissions around the time of emergence of the Omicron variant in the Basque Country. A retrospective cohort population-based study was conducted. The population with any records related to COVID-19 vaccination up to 28 February 2022 was classified into four cohorts by vaccination status. For every cohort, the hospital ward and ICU admission rates were calculated for each day between November 2021 and February 2022. Generalized linear models with a negative binomial distribution were used to estimate the age-adjusted hospitalization rate ratio of the cohort of individuals who had received a booster compared to the other cohorts. The age-adjusted rates of hospital ward and ICU admissions were 70.4 % and 72.0 % lower, respectively, in the fully vaccinated plus booster group compared to the fully vaccinated but no booster group. Analysing changes in the 14-day admission incidence rates showed that as the prevalence of the Omicron variant increased, the corresponding rate ratios decreased. The immunity acquired with the booster dose allowed the hospital network to meet all the demand for hospitalization during a period of high incidence of COVID-19, despite the fact that vaccine protection decreased as the prevalence of the Omicron variant increased.
Collapse
Affiliation(s)
- A Arrospide
- Ministry of Health of the Basque Government, Vitoria-Gasteiz, Spain; Biodonostia Health Research Institute, Economic Evaluation of Chronic Diseases Research Group, San Sebastián, Spain.
| | - M G Sagardui
- Ministry of Health of the Basque Government, Vitoria-Gasteiz, Spain
| | - I Larizgoitia
- Ministry of Health of the Basque Government, Vitoria-Gasteiz, Spain
| | - A Iturralde
- Ministry of Health of the Basque Government, Vitoria-Gasteiz, Spain; Osakidetza Basque Health Service, Directorate General, Vitoria-Gasteiz, Spain
| | - A Moreda
- Ministry of Health of the Basque Government, Vitoria-Gasteiz, Spain
| | - J Mar
- Biodonostia Health Research Institute, Economic Evaluation of Chronic Diseases Research Group, San Sebastián, Spain; Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Arrasate, Spain; Kronikgune Institute for Health Services Research, Barakaldo, Spain
| |
Collapse
|
26
|
Pan R, Okada A, Yamana H, Yasunaga H, Kumazawa R, Matsui H, Fushimi K, Honda Y, Kim Y. Association between ambient temperature and cause-specific cardiovascular disease admissions in Japan: A nationwide study. Environ Res 2023; 225:115610. [PMID: 36871945 DOI: 10.1016/j.envres.2023.115610] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/06/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Substantial evidence suggests that non-optimal temperatures can increase the risk of cardiovascular disease (CVD) mortality and morbidity; however, limited studies have reported inconsistent results for hospital admissions depending on study locations, which also lack national-level investigations on cause-specific CVDs. METHODS We performed a two-stage meta-regression analysis to examine the short-term associations between temperature and acute CVD hospital admissions by specific categories [i.e., ischemic heart disease (IHD), heart failure (HF), and stroke] in 47 prefectures of Japan from 2011 to 2018. First, we estimated the prefecture-specific associations using a time-stratified case-crossover design with a distributed lag nonlinear model. We then used a multivariate meta-regression model to obtain national average associations. RESULTS During the study period, a total of 4,611,984 CVD admissions were reported. We found cold temperatures significantly increased the risk of total CVD admissions and cause-specific categories. Compared with the minimum hospitalization temperature (MHT) at the 98th percentile of temperature (29.9 °C), the cumulative relative risks (RRs) for cold (5th percentile, 1.7 °C) and heat (99th percentile, 30.5 °C) on total CVD were 1.226 [95% confidence interval (CI): 1.195, 1.258] and 1.000 (95% CI: 0.998, 1.002), respectively. The RR for cold on HF [RR = 1.571 (95% CI: 1.487, 1.660)] was higher than those of IHD [RR = 1.119 (95% CI: 1.040, 1.204)] and stroke [RR = 1.107 (95% CI: 1.062, 1.155)], comparing to their cause-specific MHTs. We also observed that extreme heat increased the risk of HF with RR of 1.030 (95% CI: 1.007, 1.054). Subgroup analysis showed that the age group ≥85 years was more vulnerable to these non-optimal temperature risks. CONCLUSIONS This study indicated that cold and heat exposure could increase the risk of hospital admissions for CVD, varying depending on the cause-specific categories, which may provide new evidence to reduce the burden of CVD.
Collapse
Affiliation(s)
- Rui Pan
- Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hayato Yamana
- Data Science Center, Jichi Medical University, Shimotsuke, Japan; Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasushi Honda
- Faculty of Health and Sport Sciences, University of Tsukuba, Japan; Center for Climate Change Adaptation, National Institute for Environmental Studies, Japan; School of Tropical Medicine and Global Health, Nagasaki University, Japan
| | - Yoonhee Kim
- Department of Global Environmental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| |
Collapse
|
27
|
Gómez González L, Linares C, Díaz J, Egea A, Calle-Martínez A, Luna MY, Navas MA, Ascaso-Sánchez MS, Ruiz-Páez R, Asensio C, Padrón-Monedero A, López-Bueno JA. Short-term impact of noise, other air pollutants and meteorological factors on emergency hospital mental health admissions in the Madrid region. Environ Res 2023; 224:115505. [PMID: 36805353 DOI: 10.1016/j.envres.2023.115505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND A number of environmental factors, such as air pollution, noise in urbanised settings and meteorological-type variables, may give rise to important effects on human health. In recent years, many studies have confirmed the relation between various mental disorders and these factors, with a possible impact on the increase in emergency hospital admissions due to these causes. The aim of this study was to analyse the impact of a range of environmental factors on daily emergency hospital admissions due to mental disorders in the Madrid Autonomous Region (MAR), across the period 2013-2018. METHODOLOGY Longitudinal ecological time series study analysed by Generalised Linear Models with Poisson regression, with the dependent variable being daily Emergency Hospital Mental Health Admissions (EHMHA) in the MAR, and the independent variable being mean daily concentrations of chemical pollutants, noise levels and meteorological variables. RESULTS EHMHA were related statistically significantly in the short term with diurnal noise levels. Relative risks (RRs) for total admissions due to mental disorders and self-inflicted injuries, in the case of diurnal noise was RR: 1.008 95%CI (1.003 1.013). Admissions attributable to diurnal noise account for 5.5% of total admissions across the study period. There was no association between hospital admissions and chemical air pollution. CONCLUSION Noise is a variable that shows a statistically significant short-term association with EHMHA across all age groups in the MAR region. The results of this study may serve as a basis for drawing up public health guidelines and plans, which regard these variables as risk factors for mental disorders, especially in the case of noise, since this fundamentally depends on anthropogenic activities in highly urbanised areas with high levels of traffic density.
Collapse
Affiliation(s)
- L Gómez González
- Climate Change, Health and Urban Environment Reference Unit, Carlos III Institute of Health Instituto de Salud Carlos III/ISCIII, Madrid, Spain
| | - C Linares
- Climate Change, Health and Urban Environment Reference Unit, Carlos III Institute of Health Instituto de Salud Carlos III/ISCIII, Madrid, Spain
| | - J Díaz
- Climate Change, Health and Urban Environment Reference Unit, Carlos III Institute of Health Instituto de Salud Carlos III/ISCIII, Madrid, Spain.
| | - A Egea
- Residente de Medicina Preventiva y Salud Pública Hospital General Universitario de Albacete, Madrid, Spain
| | - A Calle-Martínez
- Residente de Medicina Preventiva y Salud Pública, Hospital Universitario, Móstoles, Madrid, Spain
| | - M Y Luna
- State Meteorological Agency Agencia Estatal de Meteorología/AEMET, Madrid, Spain
| | - M A Navas
- Climate Change, Health and Urban Environment Reference Unit, Carlos III Institute of Health Instituto de Salud Carlos III/ISCIII, Madrid, Spain
| | - M S Ascaso-Sánchez
- Climate Change, Health and Urban Environment Reference Unit, Carlos III Institute of Health Instituto de Salud Carlos III/ISCIII, Madrid, Spain
| | | | - C Asensio
- Universidad Politéctnica de Madrid. Grupo de Investigación en Instrumentación y Acústica Aplicada Ctra. Valencia km 7 - Campus sur - 28031, Madrid, Spain
| | - A Padrón-Monedero
- National School of Public Health, National Institute of Health Carlos III, Madrid, Spain
| | - J A López-Bueno
- Climate Change, Health and Urban Environment Reference Unit, Carlos III Institute of Health Instituto de Salud Carlos III/ISCIII, Madrid, Spain
| |
Collapse
|
28
|
Egea A, Linares C, Díaz J, Gómez L, Calle A, Navas MA, Ruiz-Páez R, Asensio C, Padrón-Monedero A, López-Bueno JA. How heat waves, ozone and sunlight hours affect endocrine and metabolic diseases emergency admissions? A case study in the region of Madrid (Spain). Environ Res 2023; 229:116022. [PMID: 37121348 DOI: 10.1016/j.envres.2023.116022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/11/2023] [Accepted: 04/28/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Studies which analyse the joint effect of acoustic or chemical air pollution variables and different meteorological variables on neuroendocrine disease are practically nonexistent. This study therefore sought to analyse the impact of air pollutants and environmental meteorological variables on daily unscheduled admissions due to endocrine and metabolic diseases in the Madrid Region from January 01, 2013 to December 31, 2018. MATERIAL AND METHODS We conducted a longitudinal, retrospective, ecological study of daily time series analysed by Poisson regression, with emergency neuroendocrine-disease admissions in the Madrid Region as the dependent variable. The independent variables were: mean daily concentrations of PM10, PM2.5, NO2 and O3; acoustic pollution; maximum and minimum daily temperatures; hours of sunlight; relative humidity; wind speed; and air pressure above sea level. Estimators of the statistically significant variables were used to calculate the relative risks (RRs). RESULTS A statistically significant association was found between the increase in temperatures in heat waves, RR: 1.123 95% CI (1.001-1.018), and the number of emergency admissions, making it the main risk factor. An association between a decrease in sunlight and an increase in hospital admissions, RR: 1.005 95% CI (1.002 1.008), was likewise observed. Similarly, ozone, in the form of mean daily concentrations in excess of 44 μg/m3, had an impact on admissions due to neuroendocrine disease, RR: 1.010 95% CI (1.007-1.035). The breakdown by sex showed that in the case of women, NO2 was also a risk factor, RR: 1.021 95% CI (1.007-1.035). CONCLUSION The results obtained in this study serve to identify risk factors for this disease, such as extreme temperatures in heat waves, O3 or NO2. The robust association found between the decrease in sunlight and increase in hospital admissions due to neuroendocrine disease serves to spotlight an environmental factor which has received scant attention in public health until now.
Collapse
Affiliation(s)
- A Egea
- Preventive Medicine and Public Health Resident, Albacete General University Teaching Hospital, Spain
| | - C Linares
- Climate Change, Health and Urban Environment Reference Unit, Carlos III Institute of Health (Instituto de Salud Carlos III/ISCIII), Madrid, Spain
| | - J Díaz
- Climate Change, Health and Urban Environment Reference Unit, Carlos III Institute of Health (Instituto de Salud Carlos III/ISCIII), Madrid, Spain.
| | - L Gómez
- Climate Change, Health and Urban Environment Reference Unit, Carlos III Institute of Health (Instituto de Salud Carlos III/ISCIII), Madrid, Spain
| | - A Calle
- Preventive Medicine Department, Hospital Universitario de Móstoles, Móstoles, Spain
| | - M A Navas
- Climate Change, Health and Urban Environment Reference Unit, Carlos III Institute of Health (Instituto de Salud Carlos III/ISCIII), Madrid, Spain
| | | | - C Asensio
- Madrid Polytechnic University, Instrumentation and Applied Acoustics Research Group, Ctra. Valencia km 7 - Campus sur, 28031, Madrid, Spain
| | - A Padrón-Monedero
- National School of Public Health, Carlos III Institute of Health, Madrid, Spain
| | - J A López-Bueno
- Climate Change, Health and Urban Environment Reference Unit, Carlos III Institute of Health (Instituto de Salud Carlos III/ISCIII), Madrid, Spain
| |
Collapse
|
29
|
Ruvira G, Ruvira-Durante J, Cosín-Sales J, Marín-García PJ, Llobat L. Environmental gaseous pollutants are related to increase of acute coronary syndrome in Valencia region. Med Clin (Barc) 2023:S0025-7753(23)00160-4. [PMID: 37088610 DOI: 10.1016/j.medcli.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/11/2023] [Accepted: 03/15/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION AND AIMS Environmental pollution are one of the most relevant risk factors to atherosclerosis. To know awareness about the importance of urban air pollution as a trigger for hospital admission due to acute coronary syndrome (ACS), this study analyzed levels of different gaseous air pollutants in the air and its correlation with number of ACS. METHODS Epidemiological data of patients admitted for ACS in five towns during the years 2006-2008 were recovered. Clinical data regarding admissions for ACS were obtained from the hospital admission services. Measures of seven air contaminants were recovered from the environmental stations. Mixed model including sex, age, location, and the average levels of air pollutants contaminants as fixed effects and its interaction were performed. RESULTS The incidence rate of ACS is higher in man than woman, and higher in older people than young. The maximum ACS were in the last trimester of the year, was the most elevated levels of gaseous pollutants have been found. Levels of NO2, NO, and CO are positively correlated between them, and negatively correlated with O3 levels. All air pollutants analyzed increase the number of ACS hospital admission in the five locations evaluated. CONCLUSIONS Levels of gaseous pollutants are related between them, being the levels of NO2, NO, and CO, positively correlated, and negatively correlated with levels of O3. Number of ACS hospital admission increases with levels of five air gaseous pollutants studied.
Collapse
Affiliation(s)
- Guillem Ruvira
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | | | - Juan Cosín-Sales
- Servicio de Cardiología, Hospital Arnau de Vilanova, Valencia, Spain
| | - Pablo Jesús Marín-García
- Departamento de Producción y Sanidad Animal, Salud Pública y Ciencia y Tecnología de los Alimentos, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - Lola Llobat
- Departamento de Producción y Sanidad Animal, Salud Pública y Ciencia y Tecnología de los Alimentos, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain.
| |
Collapse
|
30
|
Kindstedt J, Andersson P, Westberg A, Glader EL, Lövheim H, Gustafsson M. Exploring medication-related hospital admissions and their association with cognitive impairment among acutely admitted older people. Res Social Adm Pharm 2023; 19:1048-1053. [PMID: 37105774 DOI: 10.1016/j.sapharm.2023.04.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/05/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Medication-related hospital admissions (MRAs) are common among older people. Persons with cognitive impairment are especially vulnerable to adverse drug effects. At the same time, increased home health care and social support could theoretically prevent medication-related problems. This study aims to estimate the proportion of MRAs and explore their relationship with cognitive impairment in a population of acutely admitted older people. METHODS This cross-sectional study comprised 300 individuals aged 75 years or older admitted to an acute medical ward. Two assessors identified possibly MRAs using the Assessment Tool for Hospital Admissions Related to Medications 10 (AT-HARM10). Screening for cognitive impairment was performed during ward stay using a 4-item test related to time orientation. Prevalence odds ratios between cognitive test scores and MRAs were analysed through logistic regression. RESULTS Using AT-HARM10, 108 out of 300 admissions (36%) were classified as possibly MRAs by both assessors. Moreover, MRAs were least common among patients with the lowest cognitive test scores. There was an association regarding MRAs when the lowest test score was treated as a cut-off and compared against a reference category comprising all other scores (OR, 0.31 [95% CI 0.10-0.93]; p = 0.037) in a logistic regression model adjusted for cohabitation and home health care. CONCLUSION Approximately one-third of the hospital admissions among acutely admitted older people were considered at least possibly medication-related. Hence, there is still a great need to manage medication-related problems and reduce MRAs in this vulnerable population. Using a 4-item instrument to screen for cognitive impairment, there was a negative association between MRA and lowest cognitive test score. Further exploration of the relationship between MRAs and cognitive impairment may indicate appropriate components and target populations for interventions that aims to reduce the risk of MRA.
Collapse
Affiliation(s)
- Jonas Kindstedt
- Department of Integrative Medical Biology, Umeå University, SE-901 87, Umeå, Sweden.
| | - Pernilla Andersson
- Department of Integrative Medical Biology, Umeå University, SE-901 87, Umeå, Sweden.
| | - Annica Westberg
- Department of Integrative Medical Biology, Umeå University, SE-901 87, Umeå, Sweden.
| | - Eva-Lotta Glader
- Department of Public Health and Clinical Medicine, Umeå University, SE-901 87, Umeå, Sweden.
| | - Hugo Lövheim
- Department of Community Medicine and Rehabilitation, Umeå University, SE-901 87, Umeå, Sweden.
| | - Maria Gustafsson
- Department of Integrative Medical Biology, Umeå University, SE-901 87, Umeå, Sweden.
| |
Collapse
|
31
|
Lu X, Qiu H. Explainable prediction of daily hospitalizations for cerebrovascular disease using stacked ensemble learning. BMC Med Inform Decis Mak 2023; 23:59. [PMID: 37024922 PMCID: PMC10080841 DOI: 10.1186/s12911-023-02159-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 03/23/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND With the prevalence of cerebrovascular disease (CD) and the increasing strain on healthcare resources, forecasting the healthcare demands of cerebrovascular patients has significant implications for optimizing medical resources. METHODS In this study, a stacking ensemble model comprised of four base learners (ridge regression, random forest, gradient boosting decision tree, and artificial neural network) and a meta learner (elastic net) was proposed for predicting the daily number of hospital admissions (HAs) for CD using the historical HAs data, air quality data, and meteorological data in Chengdu, China from 2015 to 2018. To solve the label imbalance problem, a re-weighting method based on label distribution smoothing was integrated into the meta learner. We trained the model using the data from 2015 to 2017 and evaluated its predictive ability using the data in 2018 based on four metrics, including mean absolute error (MAE), root mean square error (RMSE), mean absolute percentage error (MAPE), and coefficient of determination (R2). In addition, the SHapley Additive exPlanations (SHAP) framework was applied to provide explanation for the prediction of our stacking model. RESULTS Our proposed model outperformed all the base learners and long short-term memory (LSTM) on two datasets. Particularly, compared with the optimal results obtained by individual models, the MAE, RMSE, and MAPE of the stacking model decreased by 13.9%, 12.7%, and 5.8%, respectively, and the R2 improved by 6.8% on CD dataset. The model explanation demonstrated that environmental features played a role in further improving the model performance and identified that high temperature and high concentrations of gaseous air pollutants might strongly associate with an increased risk of CD. CONCLUSIONS Our stacking model considering environmental exposure is efficient in predicting daily HAs for CD and has practical value in early warning and healthcare resource allocation.
Collapse
Affiliation(s)
- Xiaoya Lu
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, No.2006, Xiyuan Ave, West Hi-Tech Zone, 611731, Chengdu, Sichuan, People's Republic of China
| | - Hang Qiu
- School of Computer Science and Engineering, University of Electronic Science and Technology of China, No.2006, Xiyuan Ave, West Hi-Tech Zone, 611731, Chengdu, Sichuan, People's Republic of China.
- Big Data Research Center, University of Electronic Science and Technology of China, Chengdu, China.
| |
Collapse
|
32
|
Gannon MR, Park MH, Miller K, Dodwell D, Horgan K, Clements K, Medina J, Cromwell DA. Concordance of cancer drug therapy information derived from routinely collected hospital admissions data and the Systemic Anti-Cancer Therapy (SACT) dataset, for older women diagnosed with early invasive breast cancer in England. Cancer Epidemiol 2023; 83:102337. [PMID: 36774694 DOI: 10.1016/j.canep.2023.102337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/06/2023] [Accepted: 02/05/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND Evaluating uptake of oncological treatments, and subsequent outcomes, depends on data sources containing accurate and complete information about cancer drug therapy (CDT). This study aimed to evaluate the consistency of CDT information in the Hospital Episode Statistics Admitted Patient Care (HES-APC) and Systemic Anti-Cancer Therapy (SACT) datasets for early invasive breast cancer (EIBC). METHODS The study included women (50 + years) diagnosed with EIBC in England from 2014 to 2019 who had surgery within six months of diagnosis. Concordance of CDT recorded in HES-APC (identified using OPCS codes) and SACT was evaluated at both patient-level and cycle-level. Factors associated with CDT use captured only in HES-APC were assessed using statistical models. RESULTS The cohort contained 129,326 women with EIBC. Overall concordance between SACT and HES-APC on CDT use was 94 %. Concordance increased over the study period (91-96 %), and there was wide variation across NHS trusts (lowest decile of trusts had concordance≤77 %; highest decile≥99 %). Among women receiving CDT, 9 % (n = 2781/31693) of use was not captured in SACT; incompleteness was worst (18 %=47/259) among women aged 80 + and those diagnosed in 2014 (21%=1121/5401). OPCS codes in HES-APC were good at identifying patient-level and cycle-level use of trastuzumab or FEC chemotherapy (fluorouracil, epirubicin, cyclophosphamide), with 89 % and 93 % concordance with SACT respectively (patient-level agreement). Among cycles of solely oral CDT recorded in SACT, only 24 % were captured in HES-APC, compared to 71 % for intravenous/subcutaneous CDT. CONCLUSIONS Combining information in HES-APC and SACT provides a more complete picture of CDT treatment in women aged 50 + receiving surgery for EIBC than using either data source alone. HES-APC may have particular value in identifying CDT use among older women, those diagnosed less recently, and in NHS trusts with low SACT data returns.
Collapse
Affiliation(s)
- Melissa Ruth Gannon
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
| | - Min Hae Park
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - Katie Miller
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kieran Horgan
- Department of Breast Surgery, St James's University Hospital, Leeds, UK
| | - Karen Clements
- National Cancer Registration and Analysis Service, NHS Digital, 2nd Floor, 23 Stephenson Street, Birmingham, UK
| | - Jibby Medina
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - David Alan Cromwell
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK; Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| |
Collapse
|
33
|
Dong TF, Zha ZQ, Sun L, Liu LL, Li XY, Wang Y, Meng XL, Li HB, Wang HL, Nie HH, Yang LS. Ambient nitrogen dioxide and cardiovascular diseases in rural regions: a time-series analyses using data from the new rural cooperative medical scheme in Fuyang, East China. Environ Sci Pollut Res Int 2023; 30:51412-51421. [PMID: 36809617 DOI: 10.1007/s11356-023-25922-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Abstract
Most of studies relating ambient nitrogen dioxide (NO2) exposure to hospital admissions for cardiovascular diseases (CVDs) were conducted among urban population. Whether and to what extent these results could be generalizable to rural population remains unknown. We addressed this question using data from the New Rural Cooperative Medical Scheme (NRCMS) in Fuyang, Anhui, China. Daily hospital admissions for total CVDs, ischaemic heart disease, heart failure, heart rhythm disturbances, ischaemic stroke, and haemorrhagic stroke in rural regions of Fuyang, China, were extracted from NRCMS between January 2015 and June 2017. A two-stage time-series analysis method was used to assess the associations between NO2 and CVD hospital admissions and the disease burden fractions attributable to NO2. In our study period, the average number (standard deviation) of hospital admissions per day were 488.2 (117.1) for total CVDs, 179.8 (45.6) for ischaemic heart disease, 7.0 (3.3) for heart rhythm disturbances, 13.2 (7.2) for heart failure, 267.9 (67.7) for ischaemic stroke, and 20.2 (6.4) for haemorrhagic stroke. The 10-μg/m3 increase of NO2 was related to an elevated risk of 1.9% (RR: 1.019, 95% CI: 1.005 to 1.032) for hospital admissions of total CVDs at lag0-2 days, 2.1% (1.021, 1.006 to 1.036) for ischaemic heart disease, and 2.1% (1.021, 1.006 to 1.035) for ischaemic stroke, respectively, while no significant association was observed between NO2 and hospital admissions for heart rhythm disturbances, heart failure, and haemorrhagic stroke. The attributable fractions of total CVDs, ischaemic heart disease, and ischaemic stroke to NO2 were 6.52% (1.87 to 10.94%), 7.31% (2.19 to 12.17%), and 7.12% (2.14 to 11.85%), respectively. Our findings suggest that CVD burdens in rural population are also partly attributed to short-term exposure to NO2. More studies across rural regions are required to replicate our findings.
Collapse
Affiliation(s)
- Teng-Fei Dong
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, China
| | - Zhen-Qiu Zha
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, China
- Anhui Provincial Center for Disease Control and Prevention, Hefei, 230601, Anhui, China
| | - Liang Sun
- Fuyang Center for Disease Control and Prevention, Fuyang, 236069, Anhui, China
| | - Ling-Li Liu
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, China
| | - Xing-Yang Li
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, China
| | - Yuan Wang
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, China
| | - Xiang-Long Meng
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, China
| | - Huai-Biao Li
- Fuyang Center for Disease Control and Prevention, Fuyang, 236069, Anhui, China
| | - Hong-Li Wang
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, China
| | - Huan-Huan Nie
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, China
| | - Lin-Sheng Yang
- School of Public Health, Department of Epidemiology and Health Statistics, Anhui Medical University, Meishan Road 81, Hefei, 230032, Anhui, China.
| |
Collapse
|
34
|
Iro MA, Goldacre MJ, Goldacre R. Central nervous system abscesses and empyemas in England: epidemiological trends over five decades. J Infect 2023; 86:309-315. [PMID: 36764391 DOI: 10.1016/j.jinf.2023.01.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/11/2023]
Abstract
OBJECTIVES To report on population-based epidemiological trends in central nervous system (CNS) abscesses and empyemas in England over five decades. METHODS Trend analyses of age-sex-specific hospital admission and death rates using routinely collected English national hospital discharge records, mortality records, and annual population denominators from 1968 to 2019. RESULTS Hospital admission rates for CNS abscesses and empyemas were stable in England until the late 1980s. In the last two decades of the study period (1999-2019), first-time admissions increased from 1.24 per 100,000 population in 1999 (95% confidence interval [CI] 1.14-1.35) to 2.86 in 2019 (95% CI 2.72-3.01). Admission rates were highest among infants and older adults, and were higher for males than females. There were small but significant increases in annual mortality rates for CNS abscesses and empyemas over the last two decades of the study period after accounting for population ageing, but mortality remained low at around 0.1-0.2 per 100,000 population. Mortality increased with advancing age; deaths in childhood were extremely rare. Case fatality rates where a relevant diagnosis was recorded as either the underlying or contributing cause were 4.3% and 9.7% respectively. CONCLUSIONS The increase in CNS abscesses and empyemas in England might reflect improved case ascertainment, but the likelihood of a true rise in incidence should be considered.
Collapse
Affiliation(s)
- M A Iro
- Faculty of Medicine and Institute of Life Sciences, University of Southampton, UK; Department of Paediatric Infectious Diseases, Southampton Children's Hospital, Southampton NHS Foundation Trust, Southampton, UK.
| | - M J Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - R Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| |
Collapse
|
35
|
Angelini M, Teglia F, Casolari G, Astolfi L, Boffetta P. Decrease of visits and hospital admissions for cancer patients during the COVID-19 pandemic. A systematic review and meta-analysis. Z Gesundh Wiss 2023:1-7. [PMID: 37361300 PMCID: PMC10018603 DOI: 10.1007/s10389-023-01857-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/16/2023] [Indexed: 03/28/2023]
Abstract
Background During the COVID-19 pandemic, many nonurgent oncologic services were postponed. The aim of the present study was to estimate the impact of the pandemic on visits and hospital admissions for cancer patients worldwide. Methods In our systematic review and meta-analysis, databases such as Pubmed, Proquest, and Scopus were searched comprehensively for articles published between January 1, 2020, and December 12, 2021. We included articles reporting data comparing the number of visits and hospital admissions for oncologic patients performed before and during the pandemic. Two pairs of independent reviewers extracted data from the selected studies. The weighted average of the percentage change was calculated and compared between pandemic and pre-pandemic periods. Stratified analysis was performed by geographic area, time interval, and study setting. Findings We found a mean relative change throughout January-October 2020 of -37.8% (95% CI -42.6; -32.9) and -26.3% (95% CI -31.4; -21.1) compared to pre-pandemic periods for oncologic visits and hospital admission, respectively. The temporal trend showed a U-shaped curve with nadir in April for cancer visits and in May 2020 for hospital admissions. All geographic areas showed a similar pattern and the same was observed when stratifying the studies as clinic-based and population-based. Interpretation Our results showed a decrease in the number of visits and hospital admission during the January-October 2020 period after the outbreak of the COVID-19 pandemic. The postponement or cancellation of these oncologic services may negatively affect the patient's outcome and the future burden of disease. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-023-01857-w.
Collapse
Affiliation(s)
- Marco Angelini
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Federica Teglia
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Giulia Casolari
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Laura Astolfi
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Paolo Boffetta
- Department of Medical and Surgical Sciences, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
- Stony Brook Cancer Center, Stony Brook University, New York, NY USA
| |
Collapse
|
36
|
Junaid M, Slack-Smith L, Wong K, Hewitt T, Bourke J, Baynam G, Calache H, Leonard H. Patterns, trends, and factors influencing hospitalizations for craniosynostosis in Western Australia. A population-based study. Eur J Pediatr 2023; 182:2379-2392. [PMID: 36899143 PMCID: PMC10175457 DOI: 10.1007/s00431-023-04922-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/12/2023]
Abstract
Understanding hospital service use among children with a diagnosis of craniosynostosis (CS) is important to improve services and outcomes. This study aimed to describe population-level trends, patterns, and factors influencing hospitalizations for craniosynostosis in Western Australia. Data on live births (1990-2010; n = 554,624) including craniosynostosis, episodes of death, demographic, and perinatal factors were identified from the midwives, birth defects, hospitalizations, and death datasets. Information on craniosynostosis and non-craniosynostosis-related admissions, cumulative length of hospital stay (cLoS), intensive care unit, and emergency department-related admissions were extracted from the hospitalization dataset and linked to other data sources. These associations were examined using negative binomial regression presented as annual percent change and associations of hospitalizations by age groups, demographic, and perinatal factors were expressed as incidence rate ratio (IRR). We found an increasing trend in incident hospitalizations but a marginal decline in cLoS for craniosynostosis over the observed study period. Perinatal conditions, feeding difficulties, nervous system anomalies, respiratory, and other infections contributed to majority of infant non-CS-related admissions.Respiratory infections accounted for about twice the number of admissions for individuals with CS (IRRs 1.94-2.34) across all observed age groups. Higher incidence of non-CS hospitalizations was observed among females, with associated anomalies, to families with highest socioeconomic disadvantage and living in remote areas of the state. Conclusion: Marginal reduction in the cLoS for CS-related admissions observed over the 21-year period are potentially indicative of improved peri-operative care. However, higher incidence of respiratory infection-related admissions for syndromic synostosis is concerning and requires investigation.
Collapse
Affiliation(s)
- Mohammed Junaid
- School of Population and Global Health, The University of Western Australia, Clifton Street Building, Clifton Street, Nedlands, 6009, WA, Australia. .,Telethon Kids Institute, The University of Western Australia, Northern Entrance, 15 Hospital Avenue, Nedlands, WA, Australia.
| | - Linda Slack-Smith
- School of Population and Global Health, The University of Western Australia, Clifton Street Building, Clifton Street, Nedlands, 6009, WA, Australia.,Telethon Kids Institute, The University of Western Australia, Northern Entrance, 15 Hospital Avenue, Nedlands, WA, Australia
| | - Kingsley Wong
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, 15 Hospital Avenue, Nedlands, WA, Australia
| | - Timothy Hewitt
- Department of Plastic and Reconstructive Surgery, Perth Children's Hospital, Nedlands, WA, Australia
| | - Jenny Bourke
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, 15 Hospital Avenue, Nedlands, WA, Australia
| | - Gareth Baynam
- Western Australian Register of Developmental Anomalies, Department of Health, Government of Western Australia, Perth, WA, Australia
| | - Hanny Calache
- Deakin Health Economics, Institute of Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, 15 Hospital Avenue, Nedlands, WA, Australia
| |
Collapse
|
37
|
Abstract
In 2010, Ireland found itself at the eye of an international storm as a network of head shops emerged selling new psychoactive substances (NPS) and Irish youth rapidly became the heaviest users of NPS in Europe. Within months, the Irish government enacted novel legislation, which has since been copied by other countries, which effectively stopped the head shops selling NPS. Critics of this policy argued that it could cause harms to escalate. A number of separate studies indicate that a range of drug-related harms increased amongst Irish youth during the period of head shop expansion. Within months of their closure, health harms began to decline. NPS-related addiction treatment episodes reduced and admissions to both psychiatric and general hospitals related to any drug problem began to fall. Population use underwent sustained decline. Consequently, the closure of head shops can be viewed as a success in terms of public health.
Collapse
Affiliation(s)
- B P Smyth
- Clinical Senior Lecturer, Department of Public Health & Primary Care, Trinity College Dublin, Dublin, Ireland
- Consultant Child & Adolescent Psychiatrist, Youth Drug & Alcohol Service, HSE Addiction Service, Airton Pk, Tallaght, Dublin, Ireland
| |
Collapse
|
38
|
Jin L, Zhou T, Fang S, Zhou X, Bai Y. Association of air pollutants and hospital admissions for respiratory diseases in Lanzhou, China, 2014-2019. Environ Geochem Health 2023; 45:941-959. [PMID: 35384572 PMCID: PMC8985563 DOI: 10.1007/s10653-022-01256-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/07/2022] [Indexed: 05/10/2023]
Abstract
The aim of this study was to assess the effects of air pollutants on hospital admissions for respiratory disease (RD) by using distributed lag nonlinear model (DLNM) in Lanzhou during 2014-2019. In this study, the dataset of air pollutants, meteorological, and daily hospital admissions for RD in Lanzhou, from January 1st, 2014 to December 31st, 2019, were collected from three national environmental monitoring stations, China meteorological data service center, and three large general hospitals, respectively. A time-series analysis with DLNM was used to estimate the associations between air pollutants and hospital admissions for RD including the stratified analysis of age, gender, and season. The key findings were expressed as the relative risk (RR) with a 95% confidence interval (CI) for single-day and cumulative lag effects (0-7). A total of 90, 942 RD hospitalization cases were identified during the study period. The highest association (RR, 95% CI) of hospital admissions for RD and PM2.5 (1.030, 1.012-1.049), and PM10 (1.009, 1.001-1.015), and NO2 (1.047, 1.024-1.071) were observed at lag 07 for an increase of 10 μg/m3 in the concentrations, and CO at lag07 (1.140, 1.052-1.236) for an increase of 1 mg/m3 in the concentration. We observed that the RR estimates for gaseous pollutants (e.g., CO and NO2) were larger than those of particulate matter (e.g., PM2.5 and PM10). The harmful effects of PM2.5, PM10, NO2, and CO were greater in male, people aged 0-14 group and in the cold season. However, no significant association was observed for SO2, O38h, and total hospital admissions for RD. Therefore, some effective intervention strategies should be taken to strengthen the treatment of the ambient air pollutants, especially gaseous pollutants (e.g., CO and NO2), thereby, reducing the burden of respiratory diseases.
Collapse
Affiliation(s)
- Limei Jin
- College of Earth and Environmental Sciences, Lanzhou University, Lanzhou, 73000 China
- School of Public Health, Gansu University of Chinese Medicine, Lanzhou, 73000 China
| | - Tian Zhou
- College of Atmospheric Sciences, Lanzhou University, Lanzhou, 73000 China
| | - Shuya Fang
- College of Atmospheric Sciences, Lanzhou University, Lanzhou, 73000 China
| | - Xiaowen Zhou
- College of Atmospheric Sciences, Lanzhou University, Lanzhou, 73000 China
| | - Yana Bai
- School of Public Health, Lanzhou University, Lanzhou, 73000 China
| |
Collapse
|
39
|
Ruiz-Páez R, Díaz J, López-Bueno JA, Asensio C, Ascaso MS, Saez M, Luna MY, Barceló MA, Navas MA, Linares C. Short-term effects of air pollution and noise on emergency hospital admissions in Madrid and economic assessment. Environ Res 2023; 219:115147. [PMID: 36580986 DOI: 10.1016/j.envres.2022.115147] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/07/2022] [Accepted: 12/22/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION The aim of this study was to study the effect of air pollution and noise has on the population in Madrid Community (MAR) in the period 2013-2018, and its economic impact. METHODS Time series study analysing emergency hospital admissions in the MAR due to all causes (ICD-10: A00-R99), respiratory causes (ICD-10: J00-J99) and circulatory causes (ICD-10: I00-I99) across the period 2013-2018. The main independent variables were mean daily PM2.5, PM10, NO2, 8-h ozone concentrations, and noise. We controlled for meteorological variables, Public Holidays, seasonality, and the trend and autoregressive nature of the series, and fitted generalised linear models with a Poisson regression link to ascertain the relative risks and attributable risks. In addition, we made an economic assessment of these hospitalisations. RESULTS The following associations were found: NO2 with admissions due to natural (RR: 1.007, 95% CI: 1.004-1.011) and respiratory causes (RR: 1.012, 95% CI: 1.005-1.019); 8-h ozone with admissions due to natural (RR: 1.049, 95% CI: 1.014-1.046) and circulatory causes (RR: 1.088, 95% CI: 1.039-1.140); and diurnal noise (LAeq7-23h) with admissions due to natural (RR: 1.001, 95% CI: 1.001-1.002), respiratory (RR: 1.002, 95% CI: 1.001-1.003) and circulatory causes (RR: 1.003, 95% CI: 1.002-1.005). Every year, a total of 8246 (95% CI: 4580-11,905) natural-cause admissions are attributable to NO2, with an estimated cost of close on €120 million and 5685 (95% CI: 2533-8835) attributed to LAeq7-23h with an estimated cost of close on €82 million. CONCLUSIONS Nitrogen dioxide, ozone and noise are the main pollutants to which a large number of hospitalisations in the MAR are attributed, and are thus responsible for a marked deterioration in population health and high related economic impact.
Collapse
Affiliation(s)
| | - J Díaz
- Climate Change, Health and Urban Environment Reference Unit, Carlos III Institute of Health (Instituto de Salud Carlos III/ISCIII), Madrid, Spain.
| | | | - C Asensio
- Universidad Politéctnica de Madrid. Grupo de Investigación en Instrumentación y Acústica Aplicada, Ctra. Valencia Km 7, Campus sur, 28031, Madrid, Spain
| | - M S Ascaso
- Climate Change, Health and Urban Environment Reference Unit, Carlos III Institute of Health (Instituto de Salud Carlos III/ISCIII), Madrid, Spain
| | - M Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - M Y Luna
- Meteorological Statal Agency. (AEMET), Madrid, Spain
| | - M A Barceló
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - M A Navas
- Climate Change, Health and Urban Environment Reference Unit, Carlos III Institute of Health (Instituto de Salud Carlos III/ISCIII), Madrid, Spain
| | - C Linares
- Climate Change, Health and Urban Environment Reference Unit, Carlos III Institute of Health (Instituto de Salud Carlos III/ISCIII), Madrid, Spain
| |
Collapse
|
40
|
Aranburu-Imatz A, Jiménez-Hornero JE, Morales-Cané I, López-Soto PJ. Environmental pollution in North-Eastern Italy and its influence on chronic obstructive pulmonary disease: time series modelling and analysis using visibility graphs. Air Qual Atmos Health 2023; 16:793-804. [PMID: 36714016 PMCID: PMC9875196 DOI: 10.1007/s11869-023-01310-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/16/2023] [Indexed: 06/01/2023]
Abstract
The impact on human health from environmental pollution is receiving increasing attention. In the case of respiratory diseases such as chronic obstructive pulmonary disease (COPD), the relationship is now well documented. However, few studies have been carried out in areas with low population density and low industrial production, such as the province of Belluno (North-Eastern Italy). The aim of the study was to analyze the effect of exposure to certain pollutants on the temporal dynamics of hospital admissions for COPD in the province of Belluno. Daily air pollution concentration, humidity, precipitations, and temperature were collected from the air monitoring stations in Belluno. Generalized additive mixed models (GAMM) and visibility graphs were used to determine the effects of the short-term exposure to environmental agents on hospital admissions associated to COPD. In the case of the city of Belluno, the GAMM showed that hospital admissions were associated with NO2, PM10, date, and temperature, while for the city of Feltre, GAMM produced no associated variables. Several visibility graph indices (average edge overlap and interlayer mutual information) showed a significant overlap between environmental agents and hospital admission for both cities. Our study has shown that visibility graphs can be useful in establishing associations between environmental agents and COPD hospitalization in sparsely populated areas.
Collapse
Affiliation(s)
- Alejandra Aranburu-Imatz
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menéndez Pidal S/N., 14004 Córdoba, Spain
- Department of Nursing, Pharmacology and Physiotherapy, University of Cordoba, Córdoba, Spain
- Outpatient Clinic, Hospital Giovanni Paolo II, ULSS1 Dolomiti, Veneto, Italy
| | | | - Ignacio Morales-Cané
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menéndez Pidal S/N., 14004 Córdoba, Spain
- Department of Nursing, Pharmacology and Physiotherapy, University of Cordoba, Córdoba, Spain
- Department of Nursing, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| | - Pablo Jesús López-Soto
- Department of Nursing, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Av. Menéndez Pidal S/N., 14004 Córdoba, Spain
- Department of Nursing, Pharmacology and Physiotherapy, University of Cordoba, Córdoba, Spain
- Department of Nursing, Hospital Universitario Reina Sofía de Córdoba, Córdoba, Spain
| |
Collapse
|
41
|
Requia WJ, Vicedo-Cabrera AM, Amini H, da Silva GL, Schwartz JD, Koutrakis P. Short-term air pollution exposure and hospital admissions for cardiorespiratory diseases in Brazil: A nationwide time-series study between 2008 and 2018. Environ Res 2023; 217:114794. [PMID: 36410458 DOI: 10.1016/j.envres.2022.114794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 06/16/2023]
Abstract
The established evidence associating air pollution with health is limited to populations from specific regions. Further large-scale studies in several regions worldwide are needed to support the literature to date and encourage national governments to act. Brazil is an example of these regions where little research has been performed on a large scale. To address this gap, we conducted a study looking at the relationship between daily PM2.5, NO2, and O3, and hospital admissions for circulatory and respiratory diseases across Brazil between 2008 and 2018. A time-series analytic approach was applied with a distributed lag modeling framework. We used a generalized conditional quasi-Poisson regression model to estimate relative risks (RRs) of the association of each air pollutant with the hospitalization for circulatory and respiratory diseases by sex, age group, and Brazilian regions. Our study population includes 23, 791, 093 hospital admissions for cardiorespiratory diseases in Brazil between 2008 and 2018. Among those, 53.1% are respiratory diseases, and 46.9% are circulatory diseases. Our findings suggest significant associations of ambient air pollution (PM2.5, NO2, and O3) with respiratory and circulatory hospital admissions in Brazil. The national meta-analysis for the whole population showed that for every increase of PM2.5 by 10 μg/m3, there is a 3.28% (95%CI: 2.61; 3.94) increase in the risk of hospital admission for respiratory diseases. For O3, we found positive associations only for some sub-group analyses by age and sex. For NO2, our findings suggest that a 10 ppb increase in this pollutant, there was a 35.26% (95%CI: 24.07; 46.44) increase in the risk of hospital admission for respiratory diseases. This study may better support policymakers to improve the air quality and public health in Brazil.
Collapse
Affiliation(s)
- Weeberb J Requia
- School of Public Policy and Government, Fundação Getúlio Vargas, Brasília, Distrito Federal, Brazil.
| | - Ana Maria Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Heresh Amini
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Joel D Schwartz
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, United States
| | - Petros Koutrakis
- Department of Environmental Health, Harvard TH Chan School of Public Health, Boston, MA, United States
| |
Collapse
|
42
|
He Y, Jiang W, Gao X, Lin C, Li J, Yang L. Short-term effects and economic burden of air pollutants on acute lower respiratory tract infections in children in Southwest China: a time-series study. Environ Health 2023; 22:6. [PMID: 36641448 PMCID: PMC9840265 DOI: 10.1186/s12940-023-00962-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/07/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND There are few studies on the effects of air pollutants on acute lower respiratory tract infections (ALRI) in children. Here, we investigated the relationship of fine particulate matter (PM2.5), inhalable particulate matter (PM10), sulfur dioxide (SO2), and nitrogen dioxide (NO2) with the daily number of hospitalizations for ALRI in children in Sichuan Province, China, and to estimate the economic burden of disease due to exposure to air pollutants. METHODS We collected records of 192,079 cases of childhood ALRI hospitalization between January 1, 2017 and December 31, 2018 from nine municipal/prefecture medical institutions as well as the simultaneous meteorological and air pollution data from 183 monitoring sites in Sichuan Province. A time series-generalized additive model was used to analyze exposure responses and lagged effects while assessing the economic burden caused by air pollutant exposure after controlling for long-term trends, seasonality, day of the week, and meteorological factors. RESULTS Our single-pollutant model shows that for each 10 μg/m3 increase in air pollutant concentration (1 μg/m3 for SO2), the effect estimates of PM2.5, PM10, SO2, and NO2 for pneumonia reached their maximum at lag4, lag010, lag010, and lag07, respectively, with relative risk (RR) values of 1.0064 (95% CI, 1.0004-1.0124), 1.0168(95% CI 1.0089-1.0248), 1.0278 (95% CI 1.0157-1.0400), and 1.0378 (95% CI, 1.0072-1.0692). By contrast, the effect estimates of PM2.5, PM10, SO2, and NO2 for bronchitis all reached their maximum at lag010, with RRs of 1.0133 (95% CI 1.0025-1.0242), 1.0161(95% CI 1.0085-1.0238), 1.0135 (95% CI 1.0025-1.0247), and 1.1133(95% CI 1.0739-1.1541). In addition, children aged 5-14 years were more vulnerable to air pollutants than those aged 0-4 years (p < 0.05). According to the World Health Organization's air quality guidelines, the number of ALRI hospitalizations attributed to PM2.5, PM10, and NO2 pollution during the study period was 7551, 10,151, and 7575, respectively, while the incurring economic burden was CNY 2847.06, 3827.27, and 2855.91 million. CONCLUSION This study shows that in Sichuan Province, elevated daily average concentrations of four air pollutants lead to increases in numbers of childhood ALRI hospitalizations and cause a serious economic burden.
Collapse
Affiliation(s)
- Yi He
- HEOA Group, School of Public Health, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Road, Chengdu, China
| | - Wanyanhan Jiang
- HEOA Group, School of Public Health, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Road, Chengdu, China
| | - Xi Gao
- HEOA Group, School of Public Health, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Road, Chengdu, China
| | - Chengwei Lin
- HEOA Group, School of Public Health, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Road, Chengdu, China
| | - Jia Li
- HEOA Group, School of Management, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Road, Chengdu, China
| | - Lian Yang
- HEOA Group, School of Public Health, Chengdu University of Traditional Chinese Medicine, No. 1166 Liutai Road, Chengdu, China
| |
Collapse
|
43
|
Ruiz-Páez R, Díaz J, López-Bueno JA, Navas MA, Mirón IJ, Martínez GS, Luna MY, Linares C. Does the meteorological origin of heat waves influence their impact on health? A 6-year morbidity and mortality study in Madrid (Spain). Sci Total Environ 2023; 855:158900. [PMID: 36155828 DOI: 10.1016/j.scitotenv.2022.158900] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/08/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In Spain, two synoptic-scale conditions influence heat wave formation. The first involves advection of warm and dry air masses carrying dust of Saharan origin (North African Dust (NAF) = 1). The second entails anticyclonic stagnation with high insolation and stability (NAF) = 0). Some studies show that the meteorological origin of these heat waves may affect their impact on morbidity and mortality. OBJECTIVE To determine whether the impact of heat waves on health outcomes in Madrid (Spain) during 2013-2018 varied by synoptic-scale condition. METHODOLOGY Outcome data consist of daily mortality and daily hospital emergency admissions (morbidity) for natural, circulatory, and respiratory causes. Predictors include daily maximum and minimum temperatures and daily mean concentrations of NO2, PM10, PM2.5, NO2, and O3. Analyses adjust for insolation, relative humidity, and wind speed. Generalized linear models were performed with Poisson link between the variables controlling for trend, seasonality, and auto-regression in the series. Relative Risks (RR) and Attributable Risks (AR) were determined. The RRs for mortality attributable to high temperatures were similar regardless of NAF status. For hospital admissions, however, the RRs for hot days with NAF = 0 are higher than for days with NAF = 1. We also found that atmospheric pollutants worsen morbidity and mortality, especially PM10 concentrations when NAF = 1 and O3 concentrations when NAF = 0. RESULTS The effect of heat waves on morbidity and mortality depends on the synoptic situation. The impact is greater under anticyclonic stagnation conditions than under Saharan dust advection. Further, the health impact of pollutants such as PM10 and O3 varies according to the synoptic situation. CONCLUSIONS Based on these findings, we strongly recommend prevention plans to include data on the meteorological situation originating the heat wave, on a synoptic-scale, as well as comprehensive preventive measures against the compounding effect of high temperatures and pollution.
Collapse
Affiliation(s)
| | - J Díaz
- Reference Unit on Climate Change, Health and Urban Environment, National Institute of Health Carlos III, Madrid, Spain.
| | | | - M A Navas
- Reference Unit on Climate Change, Health and Urban Environment, National Institute of Health Carlos III, Madrid, Spain
| | - I J Mirón
- Department of Health, Community Board of Castile La Mancha, Toledo, Spain
| | | | - M Y Luna
- State Meteorological Agency (AEMET), Madrid, Spain
| | - C Linares
- Reference Unit on Climate Change, Health and Urban Environment, National Institute of Health Carlos III, Madrid, Spain
| |
Collapse
|
44
|
Cobb S, Bazargan M, Assari S, Barkley L, Bazargan-Hejazi S. Emergency Department Utilization, Hospital Admissions, and Office-Based Physician Visits Among Under-Resourced African American and Latino Older Adults. J Racial Ethn Health Disparities 2023; 10:205-18. [PMID: 35006585 DOI: 10.1007/s40615-021-01211-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This study uses a theoretical model to explore (a) emergency department (ED) utilization, (b) hospital admissions, and (c) office-based physician visits among sample of under-resourced African American and Latino older adults. METHODS Nine hundred five African American and Latino older adults from an under-resourced urban community of South Los Angeles participated in this study. Data was collected using face-to-face interviews. Poisson and logistic regression analysis were used to estimate the parameters specified in the Andersen behavioral model. Predictors included predisposing factors, defined as demographic and other personal characteristics that influence the likelihood of obtaining care, and enabling factors defined as personal, family, and community resources that support or encourage efforts to access health services. RESULTS African American older adults have a greater frequency of hospital admissions, ED, and physician visits than their Latino counterparts. About 25%, 45%, and 59% of the variance of the hospital admissions, ED utilization, and physician visits could be explained by predisposing and enabling characteristics. Lower health-related quality of life was associated with a higher number of hospital admissions, ED, and physician visits. Financial strain and difficulty accessing medical care were associated with a higher number of hospital admissions. Being covered by Medicare and particularly Medi-Cal were positively associated with higher hospital admissions, ED, and physician visits. DISCUSSION Compared to African American older adults, Latino older adults show higher utilization of (a) emergency department (ED) utilization, (b) hospital admissions, and (c) office-based physician visits. A wide range of predisposing and enabling factors such as insurance and financial difficulties correlate with some but not other types of health care use. Multi-disciplinary, culturally sensitive, clinic- and community-based interventions are needed to address enabling and predisposing factors that influence ED utilization and hospital admission among African American and Latino older adults in under-resourced communities.
Collapse
|
45
|
Jestrzemski D, Athanasiadou M, Scoutellas V, Ghezellou P, Spengler B, Gessler F, Kuch U. Hospital admissions due to snake envenomation in the Republic of Cyprus: a 7-year retrospective review. J Occup Med Toxicol 2022; 17:25. [PMID: 36544155 PMCID: PMC9768951 DOI: 10.1186/s12995-022-00363-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/02/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Snake envenomation is a major neglected tropical disease, lacking data in many countries including Cyprus, a Mediterranean island inhabited by the medically important blunt-nosed viper (Macrovipera lebetina). Reviewing the 2013-2019 period, we present first-time epidemiological snakebite data in the Republic of Cyprus. METHODS We obtained data on snake envenomation-related hospital admissions from the Ministry of Health, and population and rainfall data from the Statistical Service of Cyprus and Department of Meteorology websites. Human-viper conflict information was acquired from interviews with 12 representatives of Cypriot institutions. RESULTS Between 2013 and 2019, 288 snake envenomation cases were admitted to public hospitals, averaging 41 people annually. The minimum was 29 cases (2017) and the maximum was 58 (2015). Snake envenomation incidence increased from 4.55 per 100,000 population (2013) to 6.84 (2015), but remained low since 2017 (3.49 in 2019). Between 2000 and 2018, the deaths of one man (73 years), and indirectly, one woman (77 years), were related to snake envenomation. While 266 cases (92%) happened between April and October (the blunt-nosed viper activity period), most envenomations occurred in September (cumulative for 2013-2019), with 88 cases (31%). Snakebite incidence peaked in the 60-69 years age group (9.19 per 100,000 population), and was higher in males (6.85) than in females (2.82). Of all admitted patients, 242 (84%) were discharged within 4 days. Mean hospital stay duration was 2.65 days, with one case of 13 days. Most patients were admitted to the general hospitals in Paphos (51%), Limassol (30%) and Nicosia (11%), which provide secondary healthcare, with the last one providing tertiary healthcare. CONCLUSIONS Snakebite-related deaths are very rare in the Republic of Cyprus. Most envenomation cases happened in late summer (September). Short hospital stays indicate mostly non-severe clinical courses. The hospital admission data suggest that snake envenomation risk is highest in Paphos district. The statistical data hint at males and middle- to older-aged people being at highest risk, whereas from our interview data we assume that outdoor workers are at higher risk than other occupational groups.
Collapse
Affiliation(s)
- Daniel Jestrzemski
- grid.7450.60000 0001 2364 4210Faculty of Forest Sciences and Forest Ecology, Department of Forest Zoology and Forest Conservation, University of Göttingen, Göttingen, Germany ,grid.7839.50000 0004 1936 9721Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany
| | - Maria Athanasiadou
- grid.426504.1Health Monitoring Unit, Ministry of Health, Nicosia, Republic of Cyprus
| | - Vasos Scoutellas
- grid.426504.1Health Monitoring Unit, Ministry of Health, Nicosia, Republic of Cyprus
| | - Parviz Ghezellou
- grid.8664.c0000 0001 2165 8627Institute of Inorganic and Analytical Chemistry, Justus Liebig University Giessen, Giessen, Germany
| | - Bernhard Spengler
- grid.8664.c0000 0001 2165 8627Institute of Inorganic and Analytical Chemistry, Justus Liebig University Giessen, Giessen, Germany
| | - Frank Gessler
- miprolab Mikrobiologische Diagnostik GmbH, Göttingen, Germany ,grid.7450.60000 0001 2364 4210Institut für angewandte Biotechnologie der Tropen e.V., University of Göttingen, Göttingen, Germany
| | - Ulrich Kuch
- grid.7839.50000 0004 1936 9721Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany
| |
Collapse
|
46
|
Hegazy N, Cowan A, D'Aoust PM, Mercier É, Towhid ST, Jia JJ, Wan S, Zhang Z, Kabir MP, Fang W, Graber TE, MacKenzie AE, Guilherme S, Delatolla R. Understanding the dynamic relation between wastewater SARS-CoV-2 signal and clinical metrics throughout the pandemic. Sci Total Environ 2022; 853:158458. [PMID: 36075428 PMCID: PMC9444583 DOI: 10.1016/j.scitotenv.2022.158458] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 05/27/2023]
Abstract
Wastewater surveillance (WWS) of SARS-CoV-2 was proven to be a reliable and complementary tool for population-wide monitoring of COVID-19 disease incidence but was not as rigorously explored as an indicator for disease burden throughout the pandemic. Prior to global mass immunization campaigns and during the spread of the wildtype COVID-19 and the Alpha variant of concern (VOC), viral measurement of SARS-CoV-2 in wastewater was a leading indicator for both COVID-19 incidence and disease burden in communities. As the two-dose vaccination rates escalated during the spread of the Delta VOC in Jul. 2021 through Dec. 2021, relations weakened between wastewater signal and community COVID-19 disease incidence and maintained a strong relationship with clinical metrics indicative of disease burden (new hospital admissions, ICU admissions, and deaths). Further, with the onset of the vaccine-resistant Omicron BA.1 VOC in Dec. 2021 through Mar. 2022, wastewater again became a strong indicator of both disease incidence and burden during a period of limited natural immunization (no recent infection), vaccine escape, and waned vaccine effectiveness. Lastly, with the populations regaining enhanced natural and vaccination immunization shortly prior to the onset of the Omicron BA.2 VOC in mid-Mar 2022, wastewater is shown to be a strong indicator for both disease incidence and burden. Hospitalization-to-wastewater ratio is further shown to be a good indicator of VOC virulence when widespread clinical testing is limited. In the future, WWS is expected to show moderate indication of incidence and strong indication of disease burden in the community during future potential seasonal vaccination campaigns.
Collapse
Affiliation(s)
- Nada Hegazy
- Department of Civil Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Aaron Cowan
- Department of Civil Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Patrick M D'Aoust
- Department of Civil Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Élisabeth Mercier
- Department of Civil Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Jian-Jun Jia
- Department of Civil Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Shen Wan
- Department of Civil Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Zhihao Zhang
- Department of Civil Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Md Pervez Kabir
- Department of Civil Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Wanting Fang
- Department of Civil Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Tyson E Graber
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Alex E MacKenzie
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Stéphanie Guilherme
- Department of Civil Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert Delatolla
- Department of Civil Engineering, University of Ottawa, Ottawa, Ontario, Canada.
| |
Collapse
|
47
|
Fernández-García A, Pérez-Ríos M, Fernández-Villar A, Candal-Pedreira C, Naveira-Barbeito G, Santiago-Pérez MI, Rey-Brandariz J, Represas-Represas C, Malvar-Pintos A, Ruano-Ravina A. Hospitalizations due to and with chronic obstructive pulmonary disease in Galicia: 20 years of evolution. Rev Clin Esp 2022; 222:569-577. [PMID: 35882597 DOI: 10.1016/j.rceng.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/26/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This work aims to analyze the evolution of COPD-related hospitalizations in Galicia from 1996 to 2018 both as main cause of admission (DUE TO COPD) or when coded in any diagnostic order (WITH COPD), assessing the influence of age, sex, seasonality, and other main causes of the hospitalization. METHODS An analysis was conducted of administrative healthcare database (CMBD) data on index COPD-related hospitalizations in Galicia from 1996 to 2018. Crude, specific, and standardized rates were calculated for the entire sample and according to age and sex groups. RESULTS In the period from 1996 to 2018, there were 310,883 index admissions WITH COPD in Galicia, of which 29.6% were DUE TO COPD. Both WITH COPD and DUE TO COPD admission rates increased, mainly in men. There was a clear seasonality that was especially relevant in the DUE TO COPD group. The mean male-to-female ratio was approximately 4:1 in both groups, although it was lower in the extreme age groups, with no change over time. The mean age at admission increased three years in men during this period; there were no changes among women. The main causes of admission in those not hospitalized DUE TO COPD were heart failure and pneumonia. CONCLUSION The combined evaluation of records of hospital admissions WITH COPD and DUE TO COPD offers additional information for a better understanding of the trends of this disease and allows for establishing hypotheses that explain the results described, providing information for better healthcare planning.
Collapse
Affiliation(s)
- A Fernández-García
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain; Hospital POVISA, Vigo, Pontevedra, Spain
| | - M Pérez-Ríos
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, La Coruña, Spain.
| | - A Fernández-Villar
- Servicio de Neumología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain; Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - C Candal-Pedreira
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
| | - G Naveira-Barbeito
- Servicio de Epidemiología, Dirección General de Salud Pública, Xunta de Galicia, Santiago de Compostela, La Coruña, Spain
| | - M I Santiago-Pérez
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain; Servicio de Epidemiología, Dirección General de Salud Pública, Xunta de Galicia, Santiago de Compostela, La Coruña, Spain
| | - J Rey-Brandariz
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
| | - C Represas-Represas
- Servicio de Neumología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain; Grupo NeumoVigo I+i, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Servicio de Neumología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - A Malvar-Pintos
- Servicio de Epidemiología, Dirección General de Salud Pública, Xunta de Galicia, Santiago de Compostela, La Coruña, Spain
| | - A Ruano-Ravina
- Área de Medicina Preventiva y Salud Pública, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, La Coruña, Spain
| |
Collapse
|
48
|
Mason KE, Pearce N, Cummins S. Neighborhood environment and socioeconomic inequalities in cancer admissions: a prospective study using UK Biobank and linked hospital records. Cancer Causes Control 2022; 33:1431-1444. [PMID: 36116076 PMCID: PMC9630224 DOI: 10.1007/s10552-022-01626-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 08/31/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE Neighborhood environments may influence cancer risk. Average population effect estimates might mask differential effects by socioeconomic position. Improving neighborhood environments could inadvertently widen health inequalities if important differences are overlooked. METHODS Using linked records of hospital admissions in UK Biobank, we assessed associations between admission with a primary diagnosis of cancer (any/breast/colorectal), and exposure to neighborhood greenspace, physical activity facilities, and takeaway food stores, and whether household income and area deprivation modify these associations. We used adjusted Cox proportional hazards models, and estimated relative excess risks due to interaction (RERI) to assess effect modification. RESULTS Associations between neighborhood exposures and cancer-related hospitalizations were weak to null overall, but with some evidence of effect modification. Most notably, more greenspace near home was associated with 16% lower hazard of cancer-related hospital admission in deprived areas (95% CI 2-29%). This was further pronounced for people in low-income households in deprived areas, and for breast cancer. CONCLUSION In deprived neighborhoods, increasing the amount of greenspace may help reduce cancer-related hospitalizations. Examining effect modification by multiple socioeconomic indicators can yield greater insight into how social and environmental factors interact to influence cancer incidence. This may help avoid perpetuating cancer inequalities when designing neighborhood environment interventions.
Collapse
Affiliation(s)
- Kate E Mason
- Department of Public Health Policy and Systems, University of Liverpool, Liverpool, UK. .,Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Steven Cummins
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
49
|
Guo YT, Bernard Goggins W, Chan EYY, Ho KF. Individual socioeconomic status as a modifier of the association between high ambient temperature and hospital admissions: a time series study in Hong Kong, 2010-2019. Environ Sci Pollut Res Int 2022; 29:67353-67361. [PMID: 35524101 PMCID: PMC9492594 DOI: 10.1007/s11356-022-20512-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/25/2022] [Indexed: 06/14/2023]
Abstract
Few studies have examined individual socioeconomic status (SES) as a potential modifier of ambient temperature-health associations, especially for temperature-related hospitalizations. We fit penalized distributed lag non-linear models within generalized additive models to study the short-term associations (0-3 days) between temperature and hospital admissions stratified by common causes, age, and individual SES, as determined by whether patients received public assistance (PA) to cover their medical fee at the time of hospitalizations, during the hot season (May 15 to October 15) in Hong Kong for the years 2010-2019. We calculated the ratio of relative risk (RRR) and corresponding 95% confidence interval (CI) to statistically test the difference of the associations between PA groups. For 75 + patients, the PA group had significantly increased risks of hospitalizations at higher temperature for most causes, with relative risks (RR, 99th %ile vs. 25%ile) and 95% CIs of 1.138 (1.099, 1.179), 1.057 (1.008, 1.109), and 1.163 (1.094, 1.236) estimated for all non-cancer non-external, circulatory, and respiratory admissions, respectively. There were slight decreases of RRs with higher temperature for 75 + patients without PA. The strengths of temperature-hospitalization associations were strongly and significantly different between PA groups for all examined causes for 75 + patients, with the most considerable discrepancy found for ischemic heart disease (RRR = 1.266; 95% CI, 1.137, 1.410). Hospitalizations for patients aged 15-74 were less affected by heat, and the difference of the associations between groups was small. Individual SES is a significant modifier of high temperature-hospitalization associations in Hong Kong among the elderly. Public health interventions are needed to better protect this subpopulation from adverse health impacts of high temperature.
Collapse
Affiliation(s)
- Yi Tong Guo
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - William Bernard Goggins
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Emily Ying Yang Chan
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
- Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response (CCOUC), The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kin Fai Ho
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| |
Collapse
|
50
|
de Vocht F, McQuire C, Ferraro C, Williams P, Henney M, Angus C, Egan M, Mohan A, Purves R, Maani N, Shortt N, Mahon L, Crompton G, O'Donnell R, Nicholls J, Bauld L, Fitzgerald N. Impact of public health team engagement in alcohol licensing on health and crime outcomes in England and Scotland: A comparative timeseries study between 2012 and 2019. Lancet Reg Health Eur 2022; 20:100450. [PMID: 35799613 PMCID: PMC9253894 DOI: 10.1016/j.lanepe.2022.100450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Public health teams (PHTs) in England and Scotland engage to varying degrees in local alcohol licensing systems to try to reduce alcohol-related harms. No previous quantitative evidence is available on the effectiveness of this engagement. We aimed to quantify the effects of PHT engagement in alcohol licensing on selected health and crime outcomes. METHODS 39 PHTs in England (n = 27) and Scotland (n = 12) were recruited (of 40 contacted) for diversity in licensing engagement level and region, with higher activity areas matched to lower activity areas. Each PHT's engagement in licensing for each 6 month period from April 2012 to March 2019 was quantified using a new measure (PHIAL) developed using structured interviews, documentary analyses, and expert consultation. Outcomes examined were ambulance callouts, alcohol-related hospital admissions, alcohol-related and alcohol-specific mortality and violent, sexual and public order offences. Timeseries were analysed using multivariable negative binomial mixed-effects models. Correlations were assessed between each outcome and 18-month average PHIAL score (primary metric), cumulative PHIAL scores and change in PHIAL scores. Additionally, 6-month lagged correlations were also assessed. FINDINGS There was no clear evidence of any associations between the primary exposure metric and the public health or crime outcomes examined, nor between cumulative PHIAL scores or change in PHIAL score and any outcomes. There were no significant associations in England or Scotland when analysed separately or between outcomes and lagged exposure metrics. INTERPRETATION There is no clear evidence that allocating PHT resources to engaging in alcohol licensing is associated with downstream reductions in alcohol-related health harms or crimes, in the short term or over a seven year follow-up period. Such engagement likely has benefits in shaping the licensing system to take account of health issues longer term, but as current systems cannot reduce alcohol availability or contain online sales, their potential benefits are somewhat constrained. FUNDING The ExILEnS project is funded by the NIHR Public Health Research Programme (project number 15/129/11). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
Collapse
Affiliation(s)
- Frank de Vocht
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
- NIHR School for Public Health Research, UK
- NIHR Applied Research Collaboration West, UK
| | - Cheryl McQuire
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
- NIHR School for Public Health Research, UK
| | - Claire Ferraro
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Philippa Williams
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - Madeleine Henney
- School of Health and Related Research, University of Sheffield, UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, UK
- SPECTRUM Consortium, UK
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, UK
| | - Andrea Mohan
- School of Health Sciences, University of Dundee, UK
| | - Richard Purves
- Institute for Social Marketing & Health, University of Stirling, UK
| | - Nason Maani
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, UK
- Boston University School of Public Health, USA
| | - Niamh Shortt
- SPECTRUM Consortium, UK
- School of GeoSciences, University of Edinburgh, UK
| | - Laura Mahon
- SPECTRUM Consortium, UK
- Institute for Social Marketing & Health, University of Stirling, UK
- Alcohol Focus Scotland, UK
| | | | - Rachel O'Donnell
- Institute for Social Marketing & Health, University of Stirling, UK
| | - James Nicholls
- Institute for Social Marketing & Health, University of Stirling, UK
| | - Linda Bauld
- SPECTRUM Consortium, UK
- Usher Institute, University of Edinburgh, UK
| | - Niamh Fitzgerald
- SPECTRUM Consortium, UK
- Institute for Social Marketing & Health, University of Stirling, UK
| |
Collapse
|