Search

Author(s): Gabriela Leon-Perez[sup.1] , Kenneth A. Wallston[sup.2] , Kathryn M. Goggins[sup.3] , Heidi M. Poppendeck[sup.3] , Sunil Kripalani[sup.4] , For the Vanderbilt Inpatient Cohort Study (VICS) Author Affiliations: (1) Department [...], Little is known about the role of stress on the psychological well-being of patients after cardiac hospitalization or about factors that protect against or exacerbate the effects of stress. We use prospective data from 1542 patients to investigate the relationship between post-discharge stress and changes in depressive symptoms, and whether the level of prior depressive symptoms, health competence, and perceived social support moderate this relationship. Net of depressive symptoms in the 2 weeks prior to hospitalization, higher levels of post-discharge stress significantly increase depressive symptoms 30 days after discharge. The level of prior depressive symptoms moderates the effect of stress. On the other hand, perceived health competence and social support buffer the negative effects of post-discharge stress. Knowing which patients are particularly vulnerable to experiencing stress and a subsequent increase in depressive symptoms can help trigger interventions prior to discharge and possibly ameliorate the prevalence of depression.

A small percentage of persons with leptospirosis, a reemerging zoonosis, experience severe complications that require hospitalization. The number of leptospirosis cases in the United States is unknown. Thus, to estimate [...]

Introduction Species A rotavirus (RVA) is the leading cause of severe childhood gastroenteritis worldwide and accounts for about 2 million hospitalizations and 453 000 deaths among young children annually. (1,2) [...], Objective To assess, by socioeconomic setting, the effect of nationwide vaccination against species A rotavirus (RVA) on childhood diarrhoea-related hospitalizations in Mexico. Methods Data on children younger than 5 years who were hospitalized for diarrhoea in health ministry hospitals between 1 January 2003 and 31 December 2011 were collected from monthly discharge reports. Human development indexes were used to categorize the states where hospitals were located as having generally high, intermediate or low socioeconomic status. Annual rates of hospitalization for diarrhoea--per 10 000 hospitalizations for any cause--were calculated. Administrative data were used to estimate vaccine coverage. Findings In the states with high, intermediate and low socioeconomic status, coverage with a two-dose monovalent RVA vaccine--among children younger than 5 years--had reached 93%, 86% and 71%, respectively, by 2010. The corresponding median annual rates of hospitalization for diarrhoea--per 10 000 admissions--fell from 1001, 834 and 1033 in the 'prevaccine' period of 2003- 2006, to 597, 497 and 705 in the 'postvaccine' period from 2008 to 2011, respectively. These decreases correspond to rate reductions of 40% (95% confidence interval, CI: 38-43), 41% (95% CI: 38-43) and 32% (95% CI: 29-34), respectively. Nationwide, RVA vaccination appeared to have averted approximately 16 500 hospitalizations for childhood diarrhoea in each year of the postvaccine period. Conclusion Monovalent RVA vaccination has substantially reduced childhood diarrhoea-related hospitalizations for four continuous years in discretely different socioeconomic populations across Mexico. Objectif Evaluer, par contexte socio-economique, les effets de la vaccination nationale contre le rotavirus A (RVA) sur les hospitalisations liees a la diarrhee infantile au Mexique. Methodes Les donnees chez les enfants de moins de 5 ans qui ont ete hospitalises pour cause de diarrhee dans les hopitaux du ministere de la sante entre le 1er janvier 2003 et le 31 decernbre 2011 ont ete recueillies a partir des rapports mensuels de sortie des hopitaux. Des indices de developpement humain ont ete utilises pour classer les etats dans lesquels les hopitaux sont situes comme des etats ayant un statut socioeconomique generalement eleve, intermediaire ou bas. Les taux annuels d'hospitalisation pour cause de diarrhee--par 10 000 hospitalisations, quelle qu'en soit la cause--ont ete calcules. Les donnees administratives ont ete utilisees pour estimer la couverture vaccinale. Resultats Dans les etats presentant des statuts socio-economiques eleves, intermediaires et bas, la couverture avec un vaccin monovalent contre le RVA administre en 2 doses--parmi les enfants de moins de 5 ans--a atteint 93%, 86% et 71%, respectivement, en 2010. Les taux annuels medians d'hospitalisation correspondants pour cause de diarrhee--par 10 000 admissions--ont chute de 1001, 834 et 1033 dans la periode <> de 2003 a 2006, a 597, 497 et 705 dans la periode <> de 2008 a 2011, respectivement. Ces diminutions correspondent a des reductions de taux de 40% (Intervalle de Confiance (IC) a 95%: 38-43), 41% (IC a 95%: 38-43) et 32% (IC a 95%: 29-34), respectivement. Dans tout le pays, la vaccination contre le RVA semble avoir evite environ 16 500 hospitalisations pour cause de diarrhee infantile chaque annee au cours de la periode post-vaccinale. Conclusion La vaccination monovalente contre le RVA a substantiellement reduit les hospitalisations liees a la diarrhee infantile pendant quatre ans de suite dans des populations socio-economiques differentes et distinctes dans tout le Mexique. Objetivo Evaluar, por el contexto socioeconomico, el erecto de la vacunacion a escala nacional contra el rotavirus de tipo A (RVA) en las hospitalizaciones vinculadas a la diarrea infantil en Mexico. Metodos Se recopilaron datos sobre ninos menores de 5 anos hospitalizados por diarrea en hospitales dei Ministerio de Salud entre el 1 de enero de 2003 y el 31 de diciembre de 2011 a partir de los informes de altas hospitalarias mensuales. Se usaron indices de desarrollo humano para clasificar los estados donde los hospitales estaban situados segun un nivel socioeconomico generalmente alto, intermedio o baio. Se calcularon las tasas anuales de hospitalizacion por diarrea, por 10 000 hospitalizaciones por cualquier causa. Se emplearon datos administrativos para estimar la cobertura de la vacuna. Resultados En los estados con nivel socioeconomico alto, intermedio y baio, la cobertura de la vacuna monovalente contra el rotavirus de tipo A de dos dosis habia alcanzado entre los ninos menores de 5 anos el 93 %, 86 % y 71%, respectivamente, en el afio 2010. Las tasas anuales medias correspondientes de hospitalizacion por diarrea (por 10 000 ingresos) cayeron, respectivamente, de 1001, 834 y 1033 en el periodo <> entre 2003 y 2006, a 597, 497 y 705 en el periodo <> entre 2008 y 2011. Estas disminuciones se corresponden con reducciones de las rasas dei 40 %.(intervalo de confianza dei 95 %, IC: 38-43), 41% (IC dei 95 %: 38-43) y el 32 % (IC del 95 %: 29-34), respectivamente. A nivel nacional, la vacunacion contra el rotavirus de tipo A parece haber evitado unas 16 500 hospitalizaciones por diarrea infantil cada ano dei periodo <>.

Despite advances in food safety, foodborne illness remains common in the United States; >9 million persons each year have a foodborne illness caused by a major pathogen (1). One challenge [...]

Aim To investigate the experiences of patients and nursing staff in relation to the care delivered to, and received by, older people with dementia in an acute hospital setting. Method [...]

EMERGENCY DEPARTMENT (ED) STUDIES in the United States have found that substantial proportions of both injured and noninjured patients report frequent use of the ED. One study found more than [...], Objective: Although injured patients in the emergency department (ED) report more frequent use of the ED compared with the general population, and alcohol-related admissions and chronic alcohol misuse have been found to be predictive of future ED admissions, these data are based on only a few U.S. studies. The purpose of this article was to explore the association of alcohol use and ED services use among injured patients cross-nationally. Method: Binary and multinomial logistic regression were used to analyze the association of alcohol consumption with prior ED visits among 9,743 injured patients surveyed in 37 EDs in 14 countries and reported in 23 studies from the combined Emergency Room Collaborative Alcohol Analysis Project (ERCAAP) and World Health Organization Collaborative Study of Alcohol and Injuries. Results: Drinking within 6 hours before injury was associated with prior ED visits during the last 12 months (odds ratio = 1.25, p < .05), with a positive dose-response relationship. Heavy drinkers and those drinkers who were alcohol-dependent were also significantly more likely to report multiple prior ED visits, reflecting an elevated burden of services use. At the ED level, stigmatization of alcohol use was the only significant contextual variable that consistently predicted cross-ED variation in the relationship between drinking and ED use, in which the association was weaker in areas where alcohol use is less accepted. Conclusions: This study lends additional support to the potential effectiveness of screening for acute and chronic alcohol use among ED injured patients to reduce ED services use and associated costs.

It has been well established that the nociceptive pathways, (sub)cortical centers, and neurochemical systems necessary for pain perception and transmission are intact and functional from an early stage of fetal [...], Objectives. Pain exposure during early infancy affects the pain perception beyond infancy into childhood. The objective of this study was to examine whether major surgery within the first 3 months of life in combination with preemptive analgesia alters pain responses to immunization at 14 or 45 months and to assess whether these alterations are greater in toddlers with a larger number of negative hospital experiences. Methods. Two groups of 50 toddlers each were compared: index group and control group. All index toddlers had participated within the first 3 months of their life in a randomized, clinical trial that evaluated the efficacy of preemptive morphine administration for postoperative analgesia. The controls were matched by type of immunization and community health care pediatrician. Pain reactions were recorded at routine immunization at either 14 (measles-mumps-rubella immunization) or 45 months (diphtheria-tetanus-trivalent polio immunization) of age. Outcome measures were facial reaction, coded by the Maximum Discriminative Facial Movement Coding System; heart rate (HR); and cortisol saliva concentration. Negative hospital experiences included number of operations requiring postoperative morphine administration, cumulative Therapeutic Intervention Scoring System scores, and length of stay in the intensive care unit or total hospitalization days. Results. No differences were found between the index and control groups in the facial display of pain, anger, or sadness or in physiologic parameters such as HR and cortisol concentrations. Intragroup analyses of the index group showed that after measles-mumps-rubella vaccination, the number of negative hospital experiences correlated positively with the facial responsiveness and negatively with HR responses. No effect was seen after diphtheria-tetanus-trivalent polio immunization. Conclusions. Major surgery in combination with preemptive analgesia within the first months of life does not alter pain response to subsequent pain exposure in childhood. Greater exposure to early hospitalization influences the pain responses after prolonged time. These responses, however, diminish after a prolonged period of nonexposure. Pediatrics 2003;111:129-135; prospective study, newborn infant, repetitive pain, biobehavioral pain response, analgesia.

Dartmouth researcher John Wennberg, M.D., has been studying practice variations since the early 1970s. In an interview with Medical Economics, he reveals what he's learned. Practice patterns vary so much [...]

ABBREVIATIONS. OR, odds ratio; SIDS, sudden infant death syndrome. The definition of early hospital discharge for newborns has varied widely during the past several decades.[1-7] The most current Guidelines for [...]

To date, formal studies on rehospitalization have used clinical diagnoses to predict and avoid costly readmission (Gooding & Jette, 1985). However, other studies have found that rehospitalization could be avoided [...], The main determinants of rehospitalization of elderly people were studied with a longitudinal sample of 264 persons older than 60 years at a midwestern, urban, university-affiliated hospital. Path analysis was applied to survey data collected for this study. Seventeen percent of subjects were readmitted within 30 days of discharge. Controlling for health and socioeconomic factors, the main determinant of readmission was the discharge placement; those placed back into the community for care in the home were more likely to be rehospitalized than those discharged to institutions. Contrary to predictions in the literature and the authors' expectations, patient involvement in discharge planning had no discernible effect on placement decisions and subsequent hospitalization. The implications of these findings for discharge planning by social workers are discussed.

Introduction Erectile dysfunction is a common health problem that increases rapidly in prevalence with age. While erectile dysfunction can be a distressing symptom in itself, there is increasing recognition of [...], Background: Erectile dysfunction is an emerging risk marker for future cardiovascular disease (CVD) events; however, evidence on dose response and specific CVD outcomes is limited. This study investigates the relationship between severity of erectile dysfunction and specific CVD outcomes. Methods and Findings: We conducted a prospective population-based Australian study (the 45 and Up Study) linking questionnaire data from 2006-2009 with hospitalisation and death data to 30 June and 31 Dec 2010 respectively for 95,038 men aged ≥ 45 y. Cox proportional hazards models were used to examine the relationship of reported severity of erectile dysfunction to all-cause mortality and first CVD-related hospitalisation since baseline in men with and without previous CVD, adjusting for age, smoking, alcohol consumption, marital status, income, education, physical activity, body mass index, diabetes, and hypertension and/or hypercholesterolaemia treatment. There were 7,855 incident admissions for CVD and 2,304 deaths during follow-up (mean time from recruitment, 2.2 y for CVD admission and 2.8 y for mortality). Risks of CVD and death increased steadily with severity of erectile dysfunction. Among men without previous CVD, those with severe versus no erectile dysfunction had significantly increased risks of ischaemic heart disease (adjusted relative risk [RR] = 1.60, 95% CI 1.31-1.95), heart failure (8.00, 2.64-24.2), peripheral vascular disease (1.92, 1.12-3.29), 'other' CVD (1.26, 1.05-1.51), all CVD combined (1.35, 1.19-1.53), and all-cause mortality (1.93, 1.52-2.44). For men with previous CVD, corresponding RRs (95% CI) were 1.70 (1.46-1.98), 4.40 (2.64-7.33), 2.46 (1.63-3.70), 1.40 (1.21-1.63), 1.64 (1.48-1.81), and 2.37 (1.87-3.01), respectively. Among men without previous CVD, RRs of more specific CVDs increased significantly with severe versus no erectile dysfunction, including acute myocardial infarction (1.66, 1.22-2.26), atrioventricular and left bundle branch block (6.62, 1.86-23.56), and (peripheral) atherosclerosis (2.47, 1.18-5.15), with no significant difference in risk for conditions such as primary hypertension (0.61, 0.16-2.35) and intracerebral haemorrhage (0.78, 0.20-2.97). Conclusions: These findings give support for CVD risk assessment in men with erectile dysfunction who have not already undergone assessment. The utility of erectile dysfunction as a clinical risk prediction tool requires specific testing. Please see later in the article for the Editors' Summary.

To the Editor: Zilberberg et al. described a notable increase in rates of Clostridium difficile infection (CDI)-related hospitalizations of children during 1997-2006 on the basis of analysis of data from [...]

To the Editor: Early epidemiologic reports suggested that infection with pandemic (H1N1) 2009 virus most commonly occurred in teenagers and young adults (1). Although this infection appears to have a [...]

Hospitalized diabetics with hypoglycemia have an increased risk of longer stays, inpatient death, and one-year mortality, according to researchers at Brigham and Women's Hospital in Boston. The researchers found that [...]

Following hip fracture, most long-term care residents do not regain pre-fracture function, irrespective of known prognostic factors. Researchers in Canada compared recovery between long-term care and community-dwelling residents six months [...]