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Introduction: The emergence of Coronavirus Disease-2019 (COVID-19) caught the world by surprise, leading to a widespread global pandemic that has had profound and distressing effects on various levels. Its impact has been far-reaching, causing severe consequences that continue to unfold. COVID-19 is a multisystem inflammatory disease involving all organs, including the female reproductive system. Aim: To determine the prevalence of COVID-19 among students and compare post-COVID-19 menstrual abnormalities in the home and hospital groups. Materials and Methods: A cross-sectional study was conducted to assess post-COVID-19 menstrual abnormalities among medical students at Department of Obstetrics and Gynaecology, NRI Institute of Medical Sciences, Visakhapatnam, Andhra Pradesh, in southern India from April to December 2022. A total of 600 medical students were approached, and 549 responded, among whom 258 students were reported as COVID-19 positive and 291 reported as COVID-19 negative. After excluding risk factors, 204 COVID-19 positive students were selected as the study population. Data were collected using a prevalidated questionnaire. The COVID-19 study population of 204 (100%) was further stratified into two groups based on the treatment taken at home 162 (79.4%) or in the hospital 42 (20.5%). Chi-square test and Fisher’s-exact tests were used to compare post-COVID-19 menstrual abnormalities, including cycle length abnormalities, Heavy Menstrual Bleeding (HMB), dysmenorrhoea, Premenstrual Syndrome (PMS), and hypomenorrhoea. Results: The prevalence of COVID-19 in the study population was 204, accounting for 37.15% of the total population 204/549. Out of the 204 students, 162 (79.4%) received home treatment, and 42 (20.5%) received hospital treatment. PostCOVID-19 menstrual cycle abnormalities were more prevalent in the hospital group 26/42 (61.9%) than in the home treatment group 76/162 (46.9%). The most common abnormality in both groups was PMS, with a prevalence of 21 (50%) in the hospital group and 38 (23.4%) in the home group. In the home group, 37 (22.8%) experienced longer cycles, 33 (20.3%) had dysmenorrhoea, and 19 (11.7%) had shorter cycles. In the hospital group, 14 (33.3%) had longer cycles, 13 (30.9%) experienced dysmenorrhoea, and 9 (21.4%) had shorter cycles. HMB was reported by 6 (14.2%) in the hospital group and 13 (8%) in the home group, while hypomenorrhoea occurred in 11 (6.7%) in the home group and 5 (11.9%) in the hospital group. A significant association (p=0.001) was found between the COVID-19 treatment groups and PMS. However, for other post-COVID-19 menstrual abnormalities, such as cycle length, dysmenorrhoea, HMB, and hypomenorrhoea, there was no significant association between these abnormalities and COVID-19 treatment groups. Conclusion: Post-COVID-19 menstrual abnormalities were more frequently observed in the hospital group compared to the home group. All post-COVID-19 menstrual irregularities resolved within six months, except for PMS.

Abstract Background The management of oral health during severe symptoms of Covid-19 is still a challenge, especially in intensive care units under invasive/noninvasive ventilation in hospital. Understanding the cause-and-effect relationships may allow for individual adjustment of oral care recommendations during Covid-19 disease. The study’s objective was to assess Covid-19 patients’ oral health status under hospital treatment due to pulmonary adverse Covid-19 outcomes. Material and methods Covid-19 patients (mean age 74.4 ± 15.4; n = 120, male n = 50/female n = 70) were admitted to hospital in the acute phase of Covid-19 between January and March 2022 who required oxygen therapy due to pneumonia, rapid respiratory failure, low saturation. Blood and radiological tests were taken according to National Health Fund guidelines. The condition of teeth (Decayed, Missing, Filled teeth as DMFT index), dental hygiene (Plaque Control Record as PCR index), periodontal status (probing depth PD, clinical attachment CAL, bleeding on probing BOP) and oral mucosa (BRUSHED and Beck scores) were examined. Results Charateristics of the teeth (dental caries 35.2%, DMFT Median 22), plaque retention (83.4%), advanced periodontitis (48.3%), xerostomia (74.2%), oral mucosa inflammation (80.8%), angular cheilitis (53.3%), hemorrhagic (21.7%) showed a high incidence of harmful oral conditions. BRUSHED model and Beck score indicated moderate oral dysfunction and need for oral care every 8 h. Spearman’s analysis revealed a significant positive correlation between pneumonia and neutrophile, interleukin-6 IL-6, C-reactive protein CRP (p = 0.01, p

Background: The management of oral health during severe symptoms of Covid-19 is still a challenge, especially in intensive care units under invasive/noninvasive ventilation in hospital. Understanding the cause-and-effect relationships may allow for individual adjustment of oral care recommendations during Covid-19 disease. The study's objective was to assess Covid-19 patients' oral health status under hospital treatment due to pulmonary adverse Covid-19 outcomes. Material and methods: Covid-19 patients (mean age 74.4 ± 15.4; n = 120, male n = 50/female n = 70) were admitted to hospital in the acute phase of Covid-19 between January and March 2022 who required oxygen therapy due to pneumonia, rapid respiratory failure, low saturation. Blood and radiological tests were taken according to National Health Fund guidelines. The condition of teeth (Decayed, Missing, Filled teeth as DMFT index), dental hygiene (Plaque Control Record as PCR index), periodontal status (probing depth PD, clinical attachment CAL, bleeding on probing BOP) and oral mucosa (BRUSHED and Beck scores) were examined. Results: Charateristics of the teeth (dental caries 35.2%, DMFT Median 22), plaque retention (83.4%), advanced periodontitis (48.3%), xerostomia (74.2%), oral mucosa inflammation (80.8%), angular cheilitis (53.3%), hemorrhagic (21.7%) showed a high incidence of harmful oral conditions. BRUSHED model and Beck score indicated moderate oral dysfunction and need for oral care every 8 h. Spearman's analysis revealed a significant positive correlation between pneumonia and neutrophile, interleukin-6 IL-6, C-reactive protein CRP (p = 0.01, p < 0.001, p < 0.001), negative to lymphocyte count (p < 0.001). Multiple and logistic regressions selected the following risk predictors for pneumonia as IL-6, CRP, obesity and for severe COVID-19 symptoms D-dimer level and a lack of targeted vaccination (p < 0.001). Among oral predictors, the PCR index and Beck score were significant for both outcomes (respectively p < 0.001, p < 0.012). Patients who received oxygen therapy with face masks had more often angular heilitis and debris (p = 0.025, p = 0.035). Conclusions: COVID-19 hospitalised patients with severe symptoms crossing with poor oral health-related conditions. This may exacerbate a response for COVID infection, and play a role in cytokine storm. For Covid-19 management, to inhibit extraoral/intraoral complications, it is recommended to adjust oral hygiene procedures, including antibacterial, protective, moisturising agents after individual oral health assessment. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB), caused by Mycobacterium tuberculosis is one of the treacherous infectious diseases of global concern. In this paper, we consider a deterministic model of TB infection with the public health education and hospital treatment impact. The effective reproductive number, R p h , that measures the potential spread of TB is presented by employing the next generation matrix approach. We investigate local and global stability of the TB-free equilibrium point, endemic equilibrium point, and sensitivity analysis. The analyses of the proposed model show that the model undergoes the phenomenon of backward bifurcation when the effective reproduction number (R p h) is less than one, where two stable equilibria, namely, the DFE and an EEP coexist. Further, we compute the sensitivity of the impact of each parameter on the effective reproductive number of the model by employing a normalized sensitivity index formula. Numerical simulation of the proposed model was conducted using Maple 2016 and MatLab R2020b software and compared with the theoretical results for illustration purposes. The investigation results can be useful in providing information to policy makers and public health authorities in mitigating the spread of TB infection by public health education and hospital treatment. [ABSTRACT FROM AUTHOR]

Socio-economic and racial/ethnic disparities in healthcare quality have been the point of huge discussion and debate. There is currently a public debate over healthcare legislation in the United States to eliminate the disparities in healthcare. We reviewed the literature and critically examined standard socio-economic and racial/ethnic measurement approaches. As a result of the literature review, we identified and discussed the limitations in existing quality assessment for identifying and addressing these disparities. The aim of this research was to investigate the difference between health outcomes based on patients' ability to pay and ethnic status during a single emergency admission. We conducted a multifactorial analysis using the 11-year admissions data from a single hospital to test the bias in short-term health outcomes for length of stay and death rate, based on 'payment type' and 'race', for emergency hospital admissions. Inconclusive findings for racial bias in outcomes may be influenced by different insurance and demographic profiles by race. As a result, we found that the Self-Pay (no insurance) category has the shortest statistically significant length of stay. While the differences between Medicare, Private and Government are not significant, Self-Pay was significantly shorter. That 'Whites' have more Medicare (older) patients than 'Blacks' might possibly lead to a longer length of stay and higher death rate for the group. [ABSTRACT FROM AUTHOR]

The goal is to study the features of the cognitive reserve (CR) in HIV-infected patients admitted to the hospital, the relationship of CR with cognitive disorders, stress and coping strategies, taking into account the drug history.Materials and methods. The study was conducted in the hospital of the Saint Petersburg Center for the prevention and control of AIDS and infectious diseases in 2019. Methods were used: 1) The Cognitive Reserve Index questionnaire (CRIq); 2) Montreal Cognitive Assessment (MoCA); 3) «Methods of coping behavior» by R. Lazarus. 4) Modified Impact of Event Scale (IES-R); 5) The Somatic Symptom Disorder — B Criteria Scale (SSD-12).Results. The study involved 57 HIV-infected patients (43.9% — women). The median age was 39.6 years. The correlation analysis revealed a positive relationship between the KR index and the «non-professional activity» subscale (r = 0.847, p = 0.000), age (r = 0.299, p = 0.024) and MoCA indicators (r = 0.290, p = 0.029). Indicators of the KR subscale «professional activity» have a negative relationship with the indicators of coping strategies «distancing» (r = -0.379, p = 0.004), «self-control» (r = -0.355, p = 0.008), «positive revaluation» (r = -0.293, p = 0.030), «problem solving planning» (r = -0.283, p = 0.035). MoCA indicators in patients with HIV infection are associated with the CR «Education» subscale (r = 0.306, p = 0.021) and the General CR index (r = 0.290, p = 0.029). Obsessive feelings and thoughts related to the impact of HIV infection are more often experienced by patients who have never abused drugs and are involved in professional activities than by patients with experience of drug use.Conclusion. Cognitive impairment and cognitive reserve in HIV-infected patients admitted to the hospital of the AIDS Center are related to coping behavior.

Background: GPs are well placed to enhance shared decision making (SDM) about treatment for patients with advanced cancer. However, to date, little is known about GPs' views about their contribution to SDM.Aim: To explore GPs' perspectives on their role in SDM about palliative cancer treatment and the requirements they report to fulfil this role.Design and Setting: Qualitative interview study among Dutch GPs.Method: GPs were sampled purposefully and conveniently. In-depth, semi-structured interviews were conducted, recorded, and transcribed verbatim. Transcripts were analysed by thematic analysis.Results: Fifteen GPs took part in this study. Most of them reported practices that potentially support SDM: checking the quality of a decision, complementing SDM, and enabling SDM. Even though most of the GPs believed that decision making about systemic cancer treatment is primarily the oncologist's responsibility, they did recognise their added value in the SDM process because of their gatekeeper position, the additional opportunity they offer patients to discuss treatment decisions, and their knowledge and experience as primary healthcare providers at the end of life. Requirements for them to support the SDM process were described as: good collaboration with oncologists; sufficient information about the disease and its treatment; time to engage in conversations about treatment; a trusting relationship with patients; and patient-centred communication.Conclusion: GPs may support SDM by checking the quality of a decision and by complementing and enabling the SDM process to reach high-quality decisions. This conceptualisation of the GP's supporting role in SDM may help us to understand how SDM is carried out through interprofessional collaboration and provide tools for how to adopt a role in the interprofessional SDM process. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB), caused by Mycobacterium tuberculosis is one of the treacherous infectious diseases of global concern. In this paper, we consider a deterministic model of TB infection with the public health education and hospital treatment impact. The effective reproductive number, Rph, that measures the potential spread of TB is presented by employing the next generation matrix approach. We investigate local and global stability of the TB-free equilibrium point, endemic equilibrium point, and sensitivity analysis. The analyses of the proposed model show that the model undergoes the phenomenon of backward bifurcation when the effective reproduction number (Rph) is less than one, where two stable equilibria, namely, the DFE and an EEP coexist. Further, we compute the sensitivity of the impact of each parameter on the effective reproductive number of the model by employing a normalized sensitivity index formula. Numerical simulation of the proposed model was conducted using Maple 2016 and MatLab R2020b software and compared with the theoretical results for illustration purposes. The investigation results can be useful in providing information to policy makers and public health authorities in mitigating the spread of TB infection by public health education and hospital treatment.

Introduction: Nasal polyps are a multifactorial inflammatory condition of the upper airways. Nasal polyps typically affect middle-aged and elderly patients, average age at diagnosis is 40 to 60, and men are affected more commonly than women. Aim: To analyse the reported prevalence of nasal polyps in the Polish population, including demographics and co-morbidities, and to estimate the costs of outpatient and hospital (inpatient) services financed by the National Health Fund. Material and methods: Statistical analysis of data extracted from the National Health Fund (NHF) registers for 2008-2018. Results: In 2018, the recorded prevalence of nasal polyps in Poland was 52.0/10,000 population (0.52%), amounting to 64.6/10,000 (0.65%) in men and 40.2/10,000 (0.40) in women. Nasal polyps were much more frequent in patients aged 55-59 (98.1/10000) and 75-79 years (98.7/10,000). Among men, the highest prevalence was found in the 75-79 age group (164.3/10,000 population), and among women in the 55-59 age group (75.1/10,000). In 2018, the Polish NHF spent PLN 17.2 million (equivalent to EUR 4.0 million/USD 4.7 million) on health services related to the diagnosis of nasal polyps. Hospital services accounted for 77.4% of the total cost. Conclusions: Nasal polyps are more than one and a half times as prevalent in men than in women. The recorded prevalence of nasal polyps increases with age, with the rates peaking in those between 75 and 79 years old, and is more often in urban than rural areas. [ABSTRACT FROM AUTHOR]

Schizophrenia is a serious mental disorder which requires complex treatment and care. Although proof for effective, cost-effective and affordable treatment is available, health economic research is lacking in many low and middle-income countries. The aim of this study was to evaluate the costs and outcomes for individuals with acute exacerbations of schizophrenia before and after inpatient admission and to evaluate the cost-effectiveness of the current treatment in the clinical practice. We used an ambispective comparative observational health economic study design. The participants were individuals with schizophrenia and their primary caregivers. Costs at baseline and follow-up were evaluated from a healthcare perspective. The primary outcomes were psychopathology, social functioning and quality of life for the patients and burden of informal care for the caregivers. Cost-effectiveness planes and cost-effectiveness acceptability curves were generated to illustrate the cost-effectiveness of treating schizophrenia in the real clinical practice, compared to a do-nothing alternative. The main finding is that treatment of individuals with schizophrenia results in improved outcomes for both patients and caregivers, while it is associated with increased healthcare costs from 135.75 Euro (SD = 193.36) per patient before hospital treatment to 189.00 Euro (SD = 126.98) per patient in the follow-up (95% CI: −112.48; −2.31). After application of sensitivity analysis at a particular level of willingness to pay, the treatment remains cost-effective for all 4 outcomes. In conclusion, the treatment of patients with schizophrenia in Bulgaria is cost-effective at acceptable levels of willingness to pay for a unit of improvement on four different outcomes.

Aim of the study was to identify patient variables that predict specific patterns of symptom course during and after hospital treatment for major depressive disorder (MDD). In a sample of 518 patients, four pairs of clinically relevant patterns of symptom change were contrasted. The time points of measurement were admission, discharge, 3 and 12 month after discharge. CATREG was used to identify the best sets of predictors from 28 variables. A greater reduction in self-criticism during hospital treatment was the strongest predictor of rapid and sustained improvement. Traumatic childhood experiences and lower abilities for communication with others predicted a transient relapse after discharge, while a co-morbid personality disorder and higher level of anxiety differentiated between those with a persistent relapse and those with only a transient relapse in depressive symptoms following discharge. Overall, patients with less severe depression at admission, better abilities in self-perception, and less self-criticism (baseline and/or greater reduction during treatment) showed a better outcome after 1 year. There is limited generalizability to other countries and treatment settings. Data on personality functioning were not available for all patients and findings are correlational in nature. However, findings are in support of a psychotherapeutic focus on a reduction of self-criticism in MDD. Patient with traumatization, a co-morbid personality disorder and lower abilities to communicate their emotional needs should get specific attention and support after discharge from hospital treatment.

The implementation of the strategic model for hospital health technology assessment in Poland requires the involvement of many stakeholders. HB-HTA fundamentally concerns hospitals and how they rationalize decision making in implementing innovative medical technologies. However, the need to obtain public funding after verifying the effectiveness of a given medical technology or to keep up with the evolving HB-HTA methodology naturally requires the involvement of both the payer (NFZ) and the Agency for Health Technology Assessment and Tariff System in activities connected with the implementation and development of HB-HTA. An important aspect of the coordination of activities in relation to hospital HTA is also the support given to hospitals by regional authorities - competent health departments in voivodeship offices - by assessing HB-HTA reports prepared by the hospitals and indicating regional competitive potential of a given medical technology. This creates a hybrid/mixed system of institutional support for innovative medical technologies implemented in hospitals. This institutional plurality within HB-HTA is a clear asset, strengthening the hospital's planned undertaking substantively and financially, especially when the assistance mechanisms undertaken are flexible, soft in nature, and allow hospital units to shape effective HB-HTA activities. [ABSTRACT FROM AUTHOR]

The concept of Hospital-Based Health Technology Assessment (HB-HTA) is conducive to the rationalization of decisions made by the hospital management regarding the implementation of innovative medical technologies in hospital units. This type of HTA is a bottom-up hospital initiative, but usually it is also supported systemically and involves other entities, such as: the Agency for Health Technology Assessment and Tariff System, the payer, or regional authorities. Providing support to the hospital in making the final decision on the implementation of innovative medical technology may include such aspects as: obtaining necessary funding for the implementation of technology, identification of the competitive potential of the planned project, or following the HB-HTA methodology in reporting. The process of decentralization of hospital management in Poland induces scholars to carry out research and draw conclusions about the involvement of regional authorities, mainly voivodeship offices and their departments responsible for health issues, in the HB-HTA process. The primary objectives of this paper are to present the results of research and analysis of the development and popularization of HB-HTA in Poland. These will be discussed in relation to the implementation of a regional functional model for hospital evaluation of innovative medical technologies and the creation of rules of cooperation between important institutions of sectoral (health) policy to support and develop HB-HTA at the regional (voivodeship) level, as well as the dissemination of knowledge, popularization of HB-HTA, and promotion of good practices. [ABSTRACT FROM AUTHOR]

Hospital-Based Health Technology Assessment (HB-HTA) aims to support local decision-making on investing in new health technologies limited to the hospital level. The goal of this study was to prepare and present the strategic functional model of HB-HTA in Poland with coordinating role of an organization labelled as the independent external organization (NOZ). The stakeholders of the HB-HTA process were identified, together with their interests and relations among them, as well as the goals and consequences of health policy in area of implementation of HB-HTA in Poland. The conduct of HB-HTA process was presented, the tasks foreseen for NOZ, its possible organizational forms, barriers, and possibilities of development; as well as the overall capacity of this organization in area of HB-HTA. It is foreseen that the development of HB-HTA in Poland based on NOZ should take place within a positively inclined environment, having a generally positive impact on the health care system, positive prognoses, and opportunities for implementation of HB-HTAh. [ABSTRACT FROM AUTHOR]

Background: Defibrillation in out-of-hospital cardiac arrest (OHCA) is increasingly performed by using an Automated External Defibrillator (AED). Therefore presence of a shockable rhythm is recurrently only documented by the AED. However, AED-information is rarely available to the treating physician.Purpose: To determine (1) how often a shockable rhythm was recorded only in the AED; (2) if so, how often information that a shockable rhythm had been present reached the physician.Methods: Data on OHCA patients with (presumed) cardiac cause with an AED connected in the years 2012-2014 (Study period 1) and 2016 (Study period 2) in the Amsterdam Resuscitation Study (ARREST) database were collected. We determined how often only the AED had defibrillated. In these patients, we retrospectively analyzed EMS run sheets and hospital discharge letters to determine if a shockable rhythm and/or AED use was correctly noted. In Study period 2, we prospectively contacted the physicians to study whether AED defibrillation was known.Results: In Study period 1, of 2840 OHCA CPR attempts with (presumed) cardiac cause, 1521 (54%) patients had a shockable rhythm, with 356 patients (13%) receiving AED defibrillation only. Of these patients, 11 hospital discharge letters (4%) contained no information about a shockable rhythm. In Study period 2, 125/1128 patients (11%) received AED defibrillation only; of these, in two cases the shockable rhythm was unknown by the physician.Conclusion: In 11-13% of OHCAs, a shockable rhythm is only seen on the AED-ECG. Adequate transfer to the physician of vital AED-information is essential but not always accomplished. [ABSTRACT FROM AUTHOR]

Aim of the study was to identify patient variables that predict specific patterns of symptom course during and after hospital treatment for major depressive disorder (MDD). In a sample of 518 patients, four pairs of clinically relevant patterns of symptom change were contrasted. The time points of measurement were admission, discharge, 3 and 12 month after discharge. CATREG was used to identify the best sets of predictors from 28 variables. A greater reduction in self-criticism during hospital treatment was the strongest predictor of rapid and sustained improvement. Traumatic childhood experiences and lower abilities for communication with others predicted a transient relapse after discharge, while a co-morbid personality disorder and higher level of anxiety differentiated between those with a persistent relapse and those with only a transient relapse in depressive symptoms following discharge. Overall, patients with less severe depression at admission, better abilities in self-perception, and less self-criticism (baseline and/or greater reduction during treatment) showed a better outcome after 1 year. There is limited generalizability to other countries and treatment settings. Data on personality functioning were not available for all patients and findings are correlational in nature. However, findings are in support of a psychotherapeutic focus on a reduction of self-criticism in MDD. Patient with traumatization, a co-morbid personality disorder and lower abilities to communicate their emotional needs should get specific attention and support after discharge from hospital treatment. [ABSTRACT FROM AUTHOR]

Schizophrenia is a serious mental disorder which requires complex treatment and care. Although proof for effective, cost-effective and affordable treatment is available, health economic research is lacking in many low and middle-income countries. The aim of this study was to evaluate the costs and outcomes for individuals with acute exacerbations of schizophrenia before and after inpatient admission and to evaluate the cost-effectiveness of the current treatment in the clinical practice. We used an ambispective comparative observational health economic study design. The participants were individuals with schizophrenia and their primary caregivers. Costs at baseline and follow-up were evaluated from a healthcare perspective. The primary outcomes were psychopathology, social functioning and quality of life for the patients and burden of informal care for the caregivers. Cost-effectiveness planes and cost-effectiveness acceptability curves were generated to illustrate the cost-effectiveness of treating schizophrenia in the real clinical practice, compared to a do-nothing alternative. The main finding is that treatment of individuals with schizophrenia results in improved outcomes for both patients and caregivers, while it is associated with increased healthcare costs from 135.75 Euro (SD = 193.36) per patient before hospital treatment to 189.00 Euro (SD = 126.98) per patient in the follow-up (95% CI: −112.48; −2.31). After application of sensitivity analysis at a particular level of willingness to pay, the treatment remains cost-effective for all 4 outcomes. In conclusion, the treatment of patients with schizophrenia in Bulgaria is cost-effective at acceptable levels of willingness to pay for a unit of improvement on four different outcomes. [ABSTRACT FROM AUTHOR]

Objective/Background: This longitudinal study explored factors influencing the rehospitalisation of patients with schizophrenia in Japan. Methods: Participants comprised patients with schizophrenia who were discharged from a psychiatric hospital in Japan. The investigations were conducted at the time of discharge and one year later. Demographics and clinical characteristics included the following: the type of occupational therapy (OT) interventions (group and individualized or group only); the assessment scales’ scores on hospitalisation; the community living conditions after discharge; and the contents of outpatient treatment (outpatient OT, day-care treatment, home-visit nursing, and adherence to outpatient treatment and medication). All variables were examined in a binomial logistic regression analysis to identify the factors for rehospitalisation. Results: The rehospitalisation rate was 31.8%, as 14 of 44 participants were rehospitalised within one year after discharge. The type of OT interventions (OR = 7.05, 95% CI = 1.36–36.69, p = .020) and the adherence to outpatient treatment and medication (OR = 9.48, 95% CI = 1.82–49.33, p = .008) were significant contributing factors to rehospitalisation. Conclusion: This study provided preliminary support for the finding that individualized occupational therapy and proper adherence to outpatient treatment and medication are associated with reducing the rehospitalisation of patients with schizophrenia in Japan.

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Despite multiple recommendations, intramuscular epinephrine is poorly prescribed in emergency department receiving pediatric anaphylaxis. To evaluate the role of severity symptoms on this use, we included all admissions for a diagnosis linked to possible allergy in the two pediatric emergency departments of our institution between January 2010 and December 2015. Selection and analysis were restricted to children under 18 years fulfilling Sampson's criteria for anaphylaxis. We retrospectively ranked these admissions with the Ring and Messmer anaphylaxis severity score and compared the use of epinephrine according to this classification. Among 422,483 admissions, 204 (0.05%) fulfilled the anaphylaxis criteria (170 (83.3%) grade II anaphylaxis, and 34 (16.7%) grade III; mean age 7.9 years). Previous allergy, anaphylaxis, and asthma were found in respectively 60.8%, 36.8%, and 35.1%. Food allergy was the main suspected causal trigger. Epinephrine was used in 32.7% (n = 65/199), before admission (11.4% (n = 23/201)) or in the emergency department (22.2% (n = 45/202)). Epinephrine was more frequently prescribed in grade III than in grade II anaphylaxis (84.8% vs 22.3%, p < 0.001; OR = 19.05 [7.05-54.10]). Upon discharge, epinephrine auto-injectors prescription and allergy referral were rare (31.7% and 44.2%).Conclusion: Pediatricians intuitively adapt their epinephrine use to the severity of the anaphylaxis and contribute to epinephrine underuse in pediatric anaphylaxis. What is known: • Intramuscular epinephrine is the recommended treatment for pediatric anaphylaxis. However, most of the European and North-American studies show a low prescription rate of epinephrine in both prehospital and pediatric emergency department management. • Reasons for such a low prescription rate are unknown. What is new: • This study confirms that intramuscular epinephrine is poorly prescribed in pediatric anaphylaxis (about one case among 10 before admission and one among 5 in pediatric emergency departments). • Despite recommendations, pediatricians intuitively adapt their prescription to the clinical severity of anaphylaxis, with a fourfold increase prescription in grade III compared to grade II anaphylaxis. This medical behavior ascertainment may be in part explained by the delay between the ED admission/management and the anaphylactic episode onset. [ABSTRACT FROM AUTHOR]

Objectives: To investigate a hypothesized positive association between employment in occupations where heavy lifting is likely to occur, and the risk of ischaemic heart disease (IHD). Material and Methods: Male blue-collar workers from Denmark (N = 516 180) were monitored with respect to hospital treatment or death due to IHD, through national registers over the years 2001–2010. Poisson regression was used to estimate relative rates of IHD between “workers in occupations which, according to an expert opinion, are likely to involve heavy lifting” and “other blue-collar workers.” Prevalent cases were excluded from the analysis. Results: The rate ratio was estimated at 0.97 (95% confidence interval (CI): 0.94–1.00) for deaths or hospitalizations due to IHD and 1.07 (95% CI: 0.94–1.21) for deaths due to IHD. Conclusions: The results do not support the hypothesis that occupational heavy lifting is an important risk factor for IHD.

This study describes how many detainees have been referred to emergency departments for further evaluation or emergency care while in police custody in Amsterdam (years 2012/2013). It provides insights into the diagnoses assigned by forensic doctors and hospital specialists and the appropriateness of the referrals. We made use of the electronic registration system of the Forensic Medicine Department of the Public Health Service Amsterdam. This department is in charge of the medical care for detainees in the Amsterdam region. Hospital diagnoses were obtained through collaboration with several Amsterdam-based hospitals. According to our results, in 1.5% of all consultations performed, the detainee was referred to hospital. The most frequent reasons for referral were injuries (66%), intoxication/withdrawal (11%) and cardiac problems (7%). In 18% of all referrals, hospital admission (defined as at least one night in the hospital) was the consequence. After review of hospital files, the indication for referral as stated by the forensic physician was confirmed in 77% of all cases. A minority of referrals was considered unnecessary (7%). The identified cases allow for a discussion of cases of over-referral. Future research should focus on the problem of under-referral and associated health risks. [ABSTRACT FROM AUTHOR]

Aims: A systematic review and meta-analysis have found that long working hours were prospectively associated with an increased risk of overall stroke. The primary aim of the present study was to test if this finding could be reproduced in a sample that has been randomly selected from the general workforce of Denmark. A secondary aim was to estimate the association for haemorrhagic and ischaemic stroke separately. Methods: Individual participant data on 20- to 64-year-old employees were drawn from the Danish Labour Force survey, 1999-2013, and linked to data on socio-economic status (sEs), migrations, hospitalisations and deaths from national registers. The participants were followed from the time of the interview until the end of 2014. Poisson regression was used to estimate age-, sex- and sEs-adjusted rate ratios for stroke as a function of weekly working hours. Results: With 35-40 working hours per week as reference, the estimated rate ratios for overall stroke were 0.97 (95% confidence interval (CI) 0.83-1.13) for 41-48 working hours, 1.10 (95% CI 0.86-1.39) for 49-54 working hours and 0.89 (95% CI 0.69-1.16) for ≥55 working hours. The estimated rate ratios per one category increase in working hours were 0.99 (95% CI 0.93--1.06) for overall stroke, 0.96 (95% CI 0.88--1.05) for ischaemic stroke and 1.15 (95% CI 1.02--1.31) for haemorrhagic stroke. Conclusions: Our analysis does not support the hypothesis that long working hours are associated with increased rates of overall stroke. It suggests, however, that long working hours might be associated with increased rates of haemorrhagic stroke. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this article is to present a Value Stream Mapping (VSM) map of the treatment process of stroke patients at the Institute of Psychiatry and Neurology (IPiN) and to demonstrate the benefits to the patient through the application of Lean principles in the above-mentioned healthcare organization. Case description: Map of the treatment of stroke shows the sequence of the various diagnostic and therapeutic activities - having started from the call an ambulance until the patient's discharge from the hospital. Presented in the article map shows the current status of the treatment of stroke patients in IPiN along with the most important from the point of view of management indicators and parameters. The basic source of data during the making of the map were own observations (gemba walk, i.e. the passage of an individual patient's path) and interviews conducted with medical and administrative staff involved in the process of patient treatment. Comment: Described by the VSM process of stroke treatment in hospital and then implemented in practice provides an opportunity to significantly improve the patient's condition through the early, comprehensive and individually rehabilitation matched to the patient needs, including early mobilization after stroke. [ABSTRACT FROM AUTHOR]

Aim: To assess the epidemiological and clinical differences between men and women with acute myocardial infarction (AMI). Patients and methods: This retrospective study included 579 patients (352 men and 221 women) who were hospitalized at the Coronary and postcoronary unit at the General Hospital, Karlovac, Croatia, from 2013 to 2016. We determined the frequency, patient's age, type of symptoms, cardiovascular risk the factors, localization, the time from the onset of symptoms to arrival to the hospital, treatment and complications during the hospitalization. Results: AMI is more frequent in men than in women (P < 0.001) and in men it is significantly more likely to occur at an earlier age than in women (P < 0.001). Men often have typical symptoms while women have atypical symptoms (P = 0.045). More often women have arterial hypertension (P = 0.017) and diabetes (P = 0.025), while men are more often smokers (P = 0.001). There was no difference between the gender regarding hyperlipidemia (P = 0,674). Distribution of localization (P = 0.608), the time required for the arrival to the hospital (P = 0.399) and all the complications of AMI are equal (P = 0.365). Men are more likely to receive PCI treatment, while women get the conservative therapy (P = 0.007). Conclusion: Compared with other studies, our women with AMI have less hyperlipidemia and do not come later to hospital than men. Possible causes are dietary habits and genetics or education and good organization of outpatient emergency medical assistance. [ABSTRACT FROM AUTHOR]