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Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Road traffic injuries are the fifth leading cause of years of life lost, with pedestrians comprising 39% of all road deaths (Global Burden of Disease Mortality and Causes of Death Collaborators [1]). Programs that use injury surveillance data to identify high-risk targets for intervention are known to be effective for reducing injury. This study aims to identify trends in the population incidence of pedestrian traffic injury (PTI) in Victoria, Australia.Method: A retrospective review of data from the Victorian Emergency Minimum Dataset, the Victorian Admitted Episodes Dataset, the Victorian State Trauma Registry and the National Coronial Information System was conducted of patients with a PTI who present to a public hospital emergency department, were admitted to hospital, sustained major trauma or who died of their injuries from January 1st 2009 to December 31st 2013. The primary outcome measure was population incidence of pedestrian traffic-related emergency presentations, hospital admissions, major trauma and deaths.Results: Over the study period, 1838 cases presented to a public hospital emergency department and were discharged without admission to hospital and an additional 3241 cases were admitted to hospital. Of these, 628 cases were classified as major trauma including 90 in-hospital deaths. From January 1st 2008 to December 31st 2011, a total of 216 deaths occurred. A decrease in the population incidence of emergency presentations for PTI was observed over the study period. No significant change was observed in the population incidence of hospital admissions, major trauma cases or deaths from PTI. The demographics of PTI were observed more commonly to be young, intoxicated males and pedestrians aged over 65 years.Conclusions: Although the population-adjusted incidence of emergency presentations for PTI in Victoria has decreased from 2009 to 2013, no change was observed in the incidence of hospital admissions, major trauma or pedestrian fatalities. Novel programs designed to address high-risk groups should be considered to achieve further reductions in PTI and severity of injuries. [ABSTRACT FROM AUTHOR]

Background: Encouraging progress has been seen with reductions in Plasmodium falciparum malaria transmission in some parts of Africa. Reduced transmission might lead to increasing susceptibility to malaria among older children due to lower acquired immunity, and this has implications for ongoing control strategies.Methods and Findings: We conducted a longitudinal observational study of children admitted to Kilifi County Hospital in Kenya and linked it to data on residence and insecticide-treated net (ITN) use. This included data from 69,104 children aged from 3 mo to 13 y admitted to Kilifi County Hospital between 1 January 1990 and 31 December 2014. The variation in malaria slide positivity among admissions was examined in logistic regression models using the following predictors: location of the residence, calendar time, the child's age, ITN use, and the enhanced vegetation index (a proxy for soil moisture). The proportion of malaria slide-positive admissions declined from 0.56 (95% confidence interval [CI] 0.54-0.58) in 1998 to 0.07 (95% CI 0.06-0.08) in 2009 but then increased again through to 0.24 (95% CI 0.22-0.25) in 2014. Older children accounted for most of the increase after 2009 (0.035 [95% CI 0.030-0.040] among young children compared to 0.22 [95% CI 0.21-0.23] in older children). There was a nonlinear relationship between malaria risk and prevalence of ITN use within a 2 km radius of an admitted child's residence such that the predicted malaria positive fraction varied from ~0.4 to <0.1 as the prevalence of ITN use varied from 20% to 80%. In this observational analysis, we were unable to determine the cause of the decline in malaria between 1998 and 2009, which pre-dated the dramatic scale-up in ITN distribution and use.Conclusion: Following a period of reduced transmission, a cohort of older children emerged who have increased susceptibility to malaria. Further reductions in malaria transmission are needed to mitigate the increasing burden among older children, and universal ITN coverage is a promising strategy to achieve this goal. [ABSTRACT FROM AUTHOR]

Background: Large health care databases provide a cost-effective data source for observational research in the intensive care unit (ICU) if the coding is valid. The aim of this study was to investigate the accuracy of the recorded coding of ICU admission, mechanical ventilation, and acute dialysis in the population-based Danish National Patient Registry (DNPR). Methods: We conducted the study in the North Denmark Region, including seven ICUs. From the DNPR we selected a total of 150 patients with an ICU admission by the following criteria: (1) 50 patients randomly selected among all patients registered with an ICU admission code, (2) 50 patients with an ICU admission code and a concomitant code for mechanical ventilation, and (3) 50 patients with an ICU admission code and a concomitant code for acute dialysis. Using the medical records as gold standard we estimated the positive predictive value (PPV) for each of the three procedure codes. Results: We located 147 (98%) of the 150 medical records. Of these 147 patients, 141 (95.9%; 95% confidence interval [CI]: 91.8-98.3) had a confirmed ICU admission according to their medical records. Among patients, who were selected only on the coding for ICU admission, the PPV for ICU admission was 87.2% (95% CI: 75.6-94.5). For the mechanical ventilation code, the PPV was 100% (95% CI: 95.1-100). Forty-nine of 50 patients with the coding for acute dialysis received this treatment, corresponding to a PPV of 98.0% (95% CI: 91.0-99.8). Conclusion: We found a high PPV for the coding of ICU admission and even higher PPVs for mechanical ventilation, and acute dialysis in the DNPR. The DNPR is a valuable data source for observational studies of ICU patients. [ABSTRACT FROM AUTHOR]

Rationale: As the impact of home telemonitoring on patients with chronic obstructive pulmonary disease (COPD) is not fully understood and reduction in healthcare utilization is not proven, we attempt to evaluate the effects of home telemonitoring on healthcare utilization in patients with COPD. Subjects and Methods: We conducted a retrospective cohort study using the Veterans Health Administration database of COPD patients enrolled in the Care Coordination Home Telehealth (CCHT) program. We evaluated the effects of monitoring through this program in patients with moderate to severe COPD and frequent exacerbations. Numbers of emergency department (ED) visits, urgent care (UC) visits, and hospitalizations were all evaluated before and after enrollment. The differences in average pre-enrollment and during-enrollment numbers of hospital admissions, ED/UC visits, and exacerbations were tested for significance among all patients enrolled in the program who had one or more exacerbations at pre-enrollment; results were expressed on a per-year basis. Results: Data were available on a total of 1,133 patients with COPD enrolled in the CCHT program between 2005 and 2009. Given the objectives of our study, we only included 369 patients who had at least one exacerbation per year in the year prior to enrollment. Of these, 71.5% had a reduction in numbers of ED visits and exacerbations requiring hospitalizations after enrollment in the program. The average number of hospital admissions, ED visits, and total exacerbations were all reduced (0.41±1.68, 0.15±1.65, and 0.56±2.3, respectively; all with p <0.01). The pre-enrollment number of exacerbations was the only factor observed to be significantly associated with the reduction in number of exacerbations. Conclusions: In patients with COPD and frequent exacerbations, enrollment in a home telemonitoring program may decrease healthcare utilization. [ABSTRACT FROM AUTHOR]

Abstract: Background: Explorations of interactions between air pollution and seasonal changes have represented one approach in examining the consequences of global warming. However, only a few studies have focused on evaluating the effects of seasonal air pollution using data on both morbidity and mortality in Asia. Method: We examined the associations between PM10 concentrations and mortality and hospital admissions in Seoul, Korea for the periods 2000–2006 and 2001–2006. We employed a temperature-matched case-crossover design, where reference periods matched case days in regard to temperature (same rounded to degrees celsius (°C)), month, and year. Results: A total of 238,826 deaths were identified, along with 98,570 and 93,553 inpatient admissions for cardiovascular and respiratory diseases, respectively. We found that the association with PM10 and mortality/morbidity increased during the summer. During the study period, 10μg/m3 increase in PM10 was associated with the increase in mortality by 0.28% (95% confidence interval: 0.12, 0.44), 0.51% (0.19, 0.83), and 0.59% (–0.08, 1.26) for non-accidental, cardiovascular, and respiratory causes. 10μg/m3 increase in PM10 was also associated with increase in hospitalization from cardiovascular and respiratory causes by 0.77% (0.53, 1.01) and 1.19% (0.94, 1.44). In the summer, the increase in mortality and hospitalization was 0.57% (0.20, 0.93), 0.64% (–0.10, 1.38), 0.50% (–1.02, 2.05), 1.52% (0.89, 2.16), and 1.55% (0.87, 2.22). Conclusions: This study provides evidence that the effect of PM10 on mortality and morbidity varies with season and increases during the summer season. [Copyright &y& Elsevier]

Introduction: Media announcements about hospital admissions of seriously injured children resulting from violence demand special attention of medical staff. Physicians, nurses and life rescuers should be especially open-eyed during examination of a child. Hospital Emergency Ward team is particularly responsible for diagnosis and organizing medical and legal aid. The aim of study was the analysis of the occurrence of maltreatment among children treated due to non-accidental injuries within the last 5 years at the Department of Paediatric Surgery and Oncology, University Teaching Hospital No. 4 in Lodz, and at the Department of Paediatric Surgery and Urology, Polish Mother's Memorial Hospital in Lodz. Material and methods: Children aged between 0 to 18 years treated in the above mentioned clinics within 2000-2005 due to injuries caused by home violence, were taken into consideration. The following data were analyzed from medical records (hospital charts): age and sex of maltreated children, perpetrator of abuse, occurrence of pathology at home, time that elapsed from time of injury to hospital admission, type of injuries, radiological imaging results, course of treatment and further dealing with a child after leaving the hospital. The above mentioned investigations were approved by the Local Bioethical Committee and Management of both hospitals Results: Medical records of 42 children treated in both departments within 2000-2005 (M - 25; F - 17) due to different injuries caused by violence and maltreatment were received. The age of children ranged from 2 months to 17 years, the average - 8.2 years, median - 9 years. Almost all children came from Lodz (97.6%). The majority of them came to hospital on the same day when they were injured (66.6%), the average time of hospital stay - 5.5 days, median - 7 days. In most cases head injury was recorded. The most frequent appearance of maltreatment was subcutaneous haematoma located in different parts of the body. Five cases (12%) of bone fractures were noticed including 2 children with skull fractures. After completing the hospital treatment 74% of children were discharged back home. A suspicion of non-accidental injury was stated by physician in half of cases and the mother revealed the cause in 25% of cases. Some parents (28.5%) tried to tamper or manipulate the medical history. The most frequent causes of child abuse were fathers or mother's friends (32 of 42). Six of them were drunk during accidents. One fourth of the analysed children came from incomplete families. Conclusions: Every child with the diagnosis of maltreatment child unit (MCU) and his family should be supported and/or supervised by children aid organizations. Obligatory registration of injuries in children could facilitate the recognition of such events. Standardized card of MCU notification would help to estimate real range of these injuries. [ABSTRACT FROM AUTHOR]

Purpose: Individual expectations among community-dwelling older adults and their subsequent effect on placement status have recently been considered. Previous studies, however, have been limited by eligibility and exclusion criteria, treating expectations as a continuous measure, omitting potential confounders, and ignoring Race x Gender interactions. Design and Methods: We used data on 6,242 Black or White self-respondents who were 70 years old or older when they were enrolled in the survey of Assets and Health Dynamics Among the Oldest Old. We modeled expectations for nursing home placement over the next 5 years, as well as actual placement status, by using multivariable multinomial and binomial logistic regression models. Result: Expectations are not normally distributed: 14% of the participants refused to answer, 51 % estimated no chance, 10% indicated a 1% to 50% chance, 21% indicated an 11% to 50% chance and 4% indicated a 51% to 100% chance. Age, gender, education, social supports, and health status were associated with expectations, as well as an interaction effect for Black men. Age, social supports, health status, prior hospital or nursing home use, and expectations were associated with subsequent placement. Implications: Black and White older adults' expectations for nursing home placement rationally reflect their individual risk profiles and are associated with subsequent placement status. The expectations question may facilitate the early identification of high-risk individuals for further evaluation. [ABSTRACT FROM AUTHOR]

The article focuses on strategies used by hospital specialist in outpatient treatment in foot and ankle clinic. Topics discussed include the use of magnetic resonance imaging (MRI) technique, assessment of hospital cost-benefit of a patient, and the period of assessment in the clinic with both MRI and orthopaedic consultant.

A survey of the clinical experience of junior medical clerks and surgical dressers on their first clinical attachment in the Birmingham University Teaching Hospitals was organized by students over a three year period. A typical clinical student had performed basic clinical procedures such as putting up a drip, doing an ECG, bladder catheterization and seen a wide range of other procedures. Most students felt involved in the work of the firm, had clerked routine admissions, and regularly attended the firm's emergency admission night. Consultants on most firms were felt to be concerned about student progress. Students attached to district general hospitals gained a wider range of clinical experience than those at established teaching hospitals. Student-run audit is a useful way of monitoring the clinical experience gained by medical students. [ABSTRACT FROM AUTHOR]

The article analyzes the admissions and discharges of in-patient case-load at a comprehensive psychiatric department in a general hospital in Great Britain. The crude annual admission rate in 1964 risen, but the rate during each year remained below the national average. During the 4-year period, there was a progressive decline in the small percentage of patients dealt with other psychiatric beds. Gathering all age groups, findings showed that there was no evidence in an excessive number of beds being blocked by long-stay cases. The author did not confirm the unhopeful long-term forecasts that have been made concerning a general hospital-centered psychiatric service.

The article presents two management cases in health care for readers to analyze and develop a reasonable response. The first case is about a good employee who recently have problems with her attendance. Another is the case of a new admitting supervisor who received various complaints from employees which involve problems with administration, business office and the loose admitting practices of physicians.

Background: Outdoor pollen grain and fungal spore concentrations have been associated with severe asthma exacerbations at the population level. The specific impact of each taxon and the concomitant effect of air pollution on these symptoms have, however, still to be better characterized. This study aimed to investigate the short-term associations between ambient concentrations of various aeroallergens and hospitalizations related to asthma in the Brussels-Capital Region (Belgium), an area recording especially high rates of admissions.Methods: Based on administrative records of asthma hospitalizations and regular monitoring of 11 tree/herbaceous pollen taxa and 2 fungal spore taxa, daily time series analyses covering the 2008-2013 period were performed. Effects up to 6 days after exposure were captured by combining quasi-Poisson regression with distributed lag models, adjusting for seasonal and long-term trends, day of the week, public holidays, mean temperature and relative humidity. Effect modification by age and air pollution (PM, NO2, O3) was tested.Results: A significant increase in asthma hospitalizations was observed for an interquartile range increase in grass (5.9%, 95% CI: 0.0, 12.0), birch (3.2%, 95% CI: 1.1, 5.3) and hornbeam (0.7%, 95% CI: 0.2, 1.3) pollen concentrations. For several taxa including grasses, an age modification effect was notable, the hospitalization risk tending to be higher in individuals younger than 60 years. Air pollutants impacted the relationships too: the risk appeared to be stronger for grass and birch pollen concentrations in case of high PM10 and O3 concentrations respectively.Conclusions: These findings suggest that airborne grass, birch and hornbeam pollen are associated with severe asthma exacerbations in the Brussels region. These compounds appear to act in synergy with air pollution and to more specifically affect young and intermediate age groups. Most of these life-threatening events could theoretically be prevented with improved disease diagnosis/management and targeted communication actions. [ABSTRACT FROM AUTHOR]

Background The aim of this study was to examine the relationship between mortality and hospital admission data for the leading causes of unintentional injury in Ireland. [ABSTRACT FROM PUBLISHER]

Background: Heart failure (HF) remains a serious global health problem associated with poor quality of life, diminished functional class and frequent hospital admissions which leads to heavy personal, social, and economic burdens. Nurse-based telephone interventions have been associated with clear clinical benefits for patients with HF, in the West; however, their effectiveness is unknown in this region. Objectives: Assess the effectiveness of telephone intervention in patients with HF attending the Cardiovascular Disease Management Program (CVDMP), King Abdulaziz Cardiac Center (KACC). Methods: This prospective, quality improvement project assigned 40 consecutive patients with HF to standard care in the CVDMP and another 40 consecutive patients with HF to standard care with the addition of a telephone intervention. The telephone interview was carried out weekly for 12weeks inquiring about patient’s current symptoms and educational reinforcing regarding diet, exercise and medication adherence. Patient’s symptoms, quality of life, ER visits and hospitalization were followed over 3months. Analysis will be performed using SPSS Advanced Statistics for Windows, version 18. Results and conclusion: Pending. [ABSTRACT FROM AUTHOR]