Improvements of complex post-traumatic stress disorder symptoms during a multimodal psychodynamic inpatient rehabilitation treatment - results of an observational single-centre pilot study

Background: Complex post-traumatic stress disorder (CPTSD) describes chronic disturbances in self-organization (i.e. affect dysregulation; negative self-concept; severe difficulties in relationships) which are frequently observed in survivors of prolonged, repeated or multiple traumatic stressors. So far, evidence of psychodynamic treatment approaches for CPTSD is scarce.Methods: In this single-centre observational pilot study, symptom change during a 6-week psychodynamic inpatient treatment in a multimodal psychosomatic rehabilitation centre was evaluated using repeated measures analyses of variance (ANOVAs). Patients completed questionnaires on PTSD and CPTSD symptoms (ITQ), anxiety, depression and somatization (BSI-18), functional impairment (WHODAS) and epistemic trust, mistrust and credulity (ETMCQ) before (T1) and at the end of treatment (T2). A hierarchical linear regression analysis was calculated to identify factors associated with improved CPTSD symptoms.Results: A total of n = 50 patients with CPTSD were included in the study, of whom n = 40 (80%) completed treatment. Patients reported a significant reduction of CPTSD symptoms during treatment with a large effect size (-3.9 points; p < .001; η2 = .36), as well as a significant reduction of psychological distress (p < .001; η2 = .55) and functional impairment (p < .001; η2 = .59). At the end of treatment, 41.0% of patients no longer fulfilled the diagnostic criteria for CPTSD. Changes in epistemic stance included improved epistemic trust (β = -.34, p = .026) and decreased epistemic credulity (β = .37, p = .017), which together with lower age (β = .43, p = .012) and lower depression levels at baseline (β = .35, p = .054) were significantly associated with baseline adjusted mean change of CPTSD symptoms during therapy and explained 48% of its variance.Discussion: In our study, patients reported a significant reduction of CPTSD symptoms and comorbid symptoms during a multimodal psychodynamic inpatient rehabilitation treatment. Improved epistemic trust may facilitate the establishment of a trusting therapeutic relationship, thus fostering an environment of openness for knowledge transfer (i.e. social learning) and the exploration of diverse viewpoints and perspectives in the therapeutic process.

Prevalence and factors associated with the death of older people hospitalized due to Covid-19 in the state of Paraná

OBJECTIVE

To estimate the prevalence and to analyze the factors associated with the death of older people hospitalized due to Covid-19 in the state of Paraná.

METHOD

Cross-sectional study conducted with secondary data from older people with a positive diagnosis of Covid-19 living in the State of Paraná, collected from March 1, 2020 to August 31, 2021. Prevalence ratios were obtained by adjusting the regression model.

RESULTS

A total of 16,153 deaths of older people hospitalized in the State of Paraná were analyzed. The adjusted model revealed an association between death and some factors such as: belonging to the age group of 75 to 84 years (PR = 1.28; CI95% = 1.24-1.32) and 85 years or over (PR = 1.52; CI95% = 1.45-1.59); male (PR = 1.17; CI95% = 1.13-1.21); obesity (PR = 1.23; CI95% = 1.16-1.29); other morbidities (PR = 1.25; CI95% = 1.20-1.30); and having used ventilatory support (PR = 2.60; CI95% = 2.33-2.86). Older people vaccinated against influenza had a probability of death reduced by 11% (PR = 0.89; CI95% = 0.86-0.93).

CONCLUSION

The association of age, sex, and diagnosis of previous comorbidities with unfavorable outcomes from Covid-19 was identified. Having received the flu vaccine provided protection to elderly people who contracted SARS-CoV-2.

Time trend and costs of hospitalizations with diabetes mellitus as main diagnosis in the Brazilian National Health System, 2011 to 2019

OBJECTIVE

To analyze the diabetes mellitus (DM) temporal trend and hospitalization costs in Brazil, by region, Federative Units (FUs) and population characteristics, from 2011 to 2019.

METHODS

This was an ecological study with data from the Hospital Information System, analyzing the annual trend in hospitalization rates for DM according to sex, age, race/skin color and region/FU by Prais-Winsten generalized linear regression.

RESULTS

A total of 1,239,574 DM hospitalizations were recorded in the country and the hospitalization rates was 6.77/10,000 inhabitants in the period. The DM hospitalization rates trend was falling for both sexes and in most regions, while it was rising in the younger population and for length of stay (average 6.17 days). Total expenditure was US$ 420,692.23 and it showed a rising trend.

CONCLUSION

The temporal trend of hospitalization rates due to DM was falling, with differences according to region/FU and age group. Average length of stay and expenditure showed a rising trend.

MAIN RESULTS

From 2011 to 2019, the diabetes mellitus hospitalization rate was 6.77 per 10,000 inhabitants, with a falling trend. Total expenditure was US$420,692.23 and it showed a rising trend.

IMPLICATIONS FOR SERVICES

The study warns of the increase in child and adolescent hospitalizations, which indicates the need to invest in preventive actions and early diagnosis.

PERSPECTIVES

The increase in length of hospital stay and related costs indicates a worrying scenario for the Brazilian National Health System and emphasizes the need to improve access to and quality of care, with a focus on diabetes education, so as to avoid complications and hospitalizations.

Hospital admission and the occurrence of delirium in older adults with physical frailty: cross-sectional study

OBJECTIVE

To analyze the relationship between hospitalization and the occurrence of delirium in older adults with physical frailty.

METHOD

Cross-sectional study carried out in a public hospital in southern Brazil. Hospitalized older adults aged ≥ 60 years participated. Sociodemographic and clinical data were collected, physical frailty phenotype tests were performed and the Confusion Assessment Method was used. Descriptive analyzes were carried out and odds ratio values were estimated for the frailty and delirium variables.

RESULTS

Of the 320 older adults evaluated, 21.14% presented delirium, 49% were identified as pre-frail and 36.2% as frail. Of those affected by delirium, 71.6% were classified as frail and 28.3% as pre-frail (p < 0.001). An association was observed between the occurrence of delirium and frailty (OR 1.22; 95% CI 1.07 to 1.38), age ≥ 80 years (OR 1.14; 95% CI 1.01 to 1.32), epilepsy (OR 1.38; 95% CI 1.09 to 1.76), dementia (OR 1.58; 95% CI 1.37 to 1.82), and history of stroke (OR 1.14; 95% CI 1.03 to 1.26).

CONCLUSION

There was a high frequency of pre-frail and frail older adults, and the occurrence of delirium in frail was significantly higher. Special attention should be paid to frail older adults to prevent the occurrence of delirium during hospitalization.

Validation of the hospital resources assessment scale for the preservation of urinary continence in the elderly

OBJECTIVES

to validate the internal structure of the Hospital Resources Assessment Scale for the Preservation of Urinary Continence in the Elderly.

METHODS

validation study of the internal structure of a scale constructed based on the Donabedian conceptual model and an integrative review, with prior content validation. The scale was applied to the target population, and 124 nurses responded to the questionnaire. Exploratory Factor Analysis was performed using the FACTOR software, employing multiple techniques.

RESULTS

a factorial model with 11 items organized into two dimensions (support for human resources and material resources) was obtained. The "physical structure" dimension was removed from the initial model and adopted as a complementary checklist to the instrument, as it was not possible to obtain a factorable model with this dimension.

CONCLUSIONS

we provide a valid scale that can measure indicators, identifying weaknesses and/or strengths related to hospital resources for the preservation of urinary continence in the elderly.

Factors associated with the evolution of COVID-19 in pregnant women: a Brazilian population-based study

OBJECTIVE

To assess the evolution of COVID-19 among Brazilian pregnant women, identifying sociodemographic and clinical predictors related to admission to ICU - Intensive Care Unit and death.

METHOD

Cross-sectional, population-based study, carried out with a secondary database, based on data from the Influenza Epidemiological Surveillance Information System. Descriptive analysis was performed, followed by multiple linear regression with Poisson response, adopting critical p < 0.05.

RESULTS

Intensive care admission rates of 28.2% and death rates of 9.5% were identified. Region of residence, gestational trimester, number of comorbidities and respiratory signs and symptoms were associated with the risk of admission to intensive care. Age over 34 years, comorbidities, oxygen saturation equal to or less than 95%, admission to intensive care and ventilatory support, invasive or not, increased the risk of death.

CONCLUSION

Sociodemographic and clinical predictors showed an association with hospitalization in intensive care and death of pregnant women with COVID-19.

Applying Lean Healthcare in the hospitalization and patient discharge process: an integrative review

OBJECTIVES

to identify scientific evidence regarding the use of Lean Healthcare approach in the hospitalization and patient discharge process.

METHODS

this is an Integrative Review conducted in the PubMed, LILACS, SCOPUS, CINAHL, Web of Science, and Embase databases.

RESULTS

out of 904 records identified, three were included in this review. The studies demonstrated that when applied to discharge planning, the Lean philosophy brings favorable results, promoting improvements in the communication process, as well as assisting in workflow organization, with a reduction in length of stay and improvement in the quality of care.

FINAL CONSIDERATIONS

although the Lean methodology presents positive results, it is considered that the application of the philosophy in healthcare institutions is still not sustainable, as it is often restricted to specific departments or services. Thus, to maximize the success of implementation, the Lean philosophy needs to be incorporated into the organizational culture, representing the greatest challenge.

Transition of care in post-hospitalization patients due to covid-19 in a hospital in northeastern Brazil

OBJECTIVE

To analyze the transition of care for post-hospitalization patients due to covid-19 in a hospital in northeastern Brazil.

METHODS

Quantitative, cross-sectional, descriptive, and analytical study carried out between 2020 and 2021. The sample had 78 patients. Data collection took place by telephone with the support of a sociodemographic questionnaire and the care transition assessment instrument (Care Transitions Measure).

RESULTS

The average length of stay was 24.04 days. The average score for care transition was 71.68 (±11.71). "Self-management training" and "Understanding of medications" had higher averages, 75.15 (±13.76) and 74.10 (±16.20).

CONCLUSIONS

The average length of stay was 24.04 days. The average score for care transition was 71.68 (±11.71). "Self-management training" and "Understanding of medications" had higher averages, 75.15 (±13.76) and 74.10 (±16.20).

Ensayo Clínico Aleatorizado En Pacientes Covid- 19 Sobre El Efecto De La Fisioterapia Precoz En Su Acondicionamiento Físico

Introducción. La OMS recomienda las intervenciones tempranas de rehabilitación y movilización en pacientes hospitalizados por COVID-19. Los beneficios de la fisioterapia precoz, durante la estancia hospitalaria, no han sido probados en ensayos clínicos.

Objetivo: Evaluar los efectos de la fisioterapia precoz y educación para la salud en pacientes COVID-19 hospitalizados, en relación a los síntomas descritos en estudios previos, analizando diferencias entre grupos respecto a su acondicionamiento físico, necesidad de oxigenoterapia y estancia hospitalaria.

Metodología: Ensayo clínico aleatorizado con dos brazos, desarrollado en unidades de hospitalización y cuidados respiratorios intermedios, con pacientes COVID- 19. Incluidos 64 pacientes en el grupo experimental (implementación de un programa de Fisioterapia precoz tras 48-72h de ingreso) y 62 pacientes en el grupo control (tratamiento habitual del centro).

Variables sociodemográficas y clínicas: mMRC, oxigenoterapia, MRC-ss, 30 s-STST, FPM, Tinetti, FRAIL Scale y PCFS. Se evaluaron al ingreso, al alta y a los dos meses del alta.

Resultados: Los experimentales tuvieron menos días de ingreso y de oxigenoterapia convencional. Al alta, presentan menor riesgo de caída (72,9% vs 95,8%) y menor debilidad en MRC-ss (2,1% vs 14,6%). A los dos meses tenían menor fragilidad (5,0% vs 14,5%), mayor fuerza de prensión manual, menos disnea, mejores resultados en 30s-STST y menos limitaciones post-COVID (86,5% vs 96,4%).

Conclusión: La intervención de fisioterapia precoz en pacientes COVID-19 y la educación para la salud recibida, previene la debilidad muscular durante el ingreso, mejora el acondicionamiento físico al alta y a los dos meses y disminuye los días de estancia hospitalaria.ClinicalTrials.gov (NCT 05032885).

Repercussions of COVID-19 on psychiatric inpatient care in Latin America and the Caribbean

Objetive

To characterise the impact of the COVID-19 pandemic on psychiatric hospitalisations in the Latin American and Caribbean (LAC) region.

Methods

Descriptive study. 85 semi-structured interviews were conducted with health workers involved with psychiatric hospitalisations in general hospitals (GHs) and specialised psychiatric hospitals (SHs) from 18 LAC countries. The interviews were done between 8 May and 30 June 2020. The data were analysed quantitatively and qualitatively.

Results

An initial decrease in the demand for hospitalisation is reported, attributed to the population’s fear of approaching health services as well as restrictions on mobility. Stricter criteria for hospitalisation were reported with a double focus on the acute within the acute. The length of hospitalisations were mixed, with both increases and decreases in GHs and SHs. The therapeutic offer was drastically reduced, and interaction between hospitalised people and their support networks was restricted.

Conclusions

In the COVID-19 context, hospitalisation seems to be not the last but the only alternative for psychiatric treatment. The decrease in the number of beds in SHs could be a positive aspect for the reform of psychiatric care, but it is questioned since this reduction also occurs in GHs.

Impact of systemic corticosteroids on hospital length of stay among patients with COVID-19

BACKGROUND AND OBJECTIVE

The COVID-19 pandemic has posed a threat to hospital capacity due to the high number of admissions, which has led to the development of various strategies to release and create new hospital beds. Due to the importance of systemic corticosteroids in this disease, we assessed their efficacy in reducing the length of stay (LOS) in hospitals and compared the effect of 3 different corticosteroids on this outcome.

METHODS

We conducted a real-world, controlled, retrospective cohort study that analysed data from a hospital database that included 3934 hospitalised patients diagnosed with COVID-19 in a tertiary hospital from April to May 2020. Hospitalised patients who received systemic corticosteroids (CG) were compared with a propensity score control group matched by age, sex and severity of disease who did not receive systemic corticosteroids (NCG). The decision to prescribe CG was at the discretion of the primary medical team.

RESULTS

A total of 199 hospitalized patients in the CG were compared with 199 in the NCG. The LOS was shorter for the CG than for the NCG (median = 3 [interquartile range = 0-10] vs. 5 [2-8.5]; p = 0.005, respectively), showing a 43% greater probability of being hospitalised ≤ 4 days than > 4 days when corticosteroids were used. Moreover, this difference was only noticed in those treated with dexamethasone (76.3% hospitalised ≤ 4 days vs. 23.7% hospitalised > 4 days [p < 0.001]). Serum ferritin levels, white blood cells and platelet counts were higher in the CG. No differences in mortality or intensive care unit admission were observed.

CONCLUSIONS

Treatment with systemic corticosteroids is associated with reduced LOS in hospitalised patients diagnosed with COVID-19. This association is significant in those treated with dexamethasone, but no for methylprednisolone and prednisone.

Frailty and delirium in hospitalized older adults: A systematic review with meta-analysis

OBJECTIVE

to estimate the prevalence and synthesize diverse evidence about the relationship between frailty and delirium in hospitalized older adults.

METHOD

a systematic review with meta-analysis in which observational studies conducted with older adults about frailty, delirium and hospitalization, were selected without time of language restrictions. The search was conducted in the MEDLINE, EMBASE, CINAHL, Scopus, Web of Science and CENTRAL databases during August 2021. The precepts set forth by the Joanna Briggs Institute (JBI) - Evidence Synthesis Groups were followed. The meta-analysis model estimated the relative risk corresponding to the prevalence of frailty and delirium. The inverse variance method for proportions was used to estimate the prevalence values and relative risks for binary outcomes.

RESULTS

initially, 1,244 articles were identified, of which 26 were included in the meta-analysis (n=13,502 participants), with 34% prevalence of frailty (95% CI:0.26-0.42; I 2=99%; t 2=0.7618, p=0) and 21% for delirium (95% CI:0.17-0,25; I 2=95%; t 2=0.3454, p<0.01). The risk for hospitalized older adults to develop delirium was 66% (RR: 1.66; 95% CI:1.23-2.22; I2=92%; t2=0.4154; p<0.01).

CONCLUSION

34% prevalence of frailty and 21% of delirium in hospitalized older adults, with frailty being an independent risk factor for developing delirium, with an increased chance of 66% when compared to non-frail individuals.

Gastrointestinal symptoms and complications in patients hospitalized due to COVID-19, an international multicentre prospective cohort study (TIVURON project)

Background

Retrospective studies suggest that coronavirus disease (COVID-19) commonly involves gastrointestinal (GI) symptoms and complications. Our aim was to prospectively evaluate GI manifestations in patients hospitalized for COVID-19.

Methods

This international multicentre prospective cohort study recruited COVID-19 patients hospitalized at 31 centres in Spain, Mexico, Chile, and Poland, between May and September 2020. Patients were followed-up until 15 days post-discharge and completed comprehensive questionnaires assessing GI symptoms and complications. A descriptive analysis as well as a bivariate and multivariate analysis were performer using binary logistic regression. p < 0.05 was considered significant.

Results

Eight hundred twenty-nine patients were enrolled; 129 (15.6%) had severe COVID-19, 113 (13.7%) required ICU admission, and 43 (5.2%) died. Upon admission, the most prevalent GI symptoms were anorexia (n = 413; 49.8%), diarrhoea (n = 327; 39.4%), nausea/vomiting (n = 227; 27.4%), and abdominal pain (n = 172; 20.7%), which were mild/moderate throughout the disease and resolved during follow-up. One-third of patients exhibited liver injury. Non-severe COVID-19 was associated with ≥2 GI symptoms upon admission (OR 0.679; 95% CI 0.464–0.995; p = 0.046) or diarrhoea during hospitalization (OR 0.531; 95% CI 0.328–0.860; p = 0.009). Multivariate analysis revealed that worse hospital outcomes were not independently associated with liver injury or GI symptoms.

Conclusion

GI symptoms were more common than previously documented, and were mild, rapidly resolved, and not independently associated with COVID-19 severity. Liver injury was a frequent complication in hospitalized patients not independently associated with COVID-19 severity.

Hospitalized older adult: predictors of functional decline

OBJECTIVE

to identify the predictors of functional decline in hospitalized individuals aged 70 or over, between: baseline and discharge; discharge and follow-up, and baseline and three-month follow-up.

METHOD

a prospective cohort study conducted in internal medicine services. A questionnaire was applied (clinical and demographic variables, and predictors of functional decline) at three moments. The predictors were determined using the binary logistic regression model.

RESULTS

the sample included 101 patients, 53.3% female, mean age of 82.47 ± 6.57 years old. The predictors that most contributed to decline in hospitalization were the following: previous hospitalization (OR=1.8), access to social support (OR=4.86), cognitive deficit (OR=6.35), mechanical restraint (OR=7.82), and not having a partner (OR=4.34). Age (OR=1.18) and medical diagnosis (OR=0.10) were the predictors between discharge and follow-up. Being older, delirium during hospitalization (OR=5.92), and presenting risk of functional decline (OR=5.53) were predictors of decline between the baseline and follow-up.

CONCLUSION

the most relevant predictors were age, previous hospitalization, cognitive deficit, restraint, social support, not having a partner, and delirium. Carrying out interventions aimed at minimizing the impact of these predictors can be an important contribution in the prevention of functional decline.

Construction and validation of an instrument for the structural assessment of wards for urinary continence in older adults

OBJECTIVE

to build and validate an instrument for structural assessment of wards for the preservation of urinary continence in hospitalized older adults.

METHOD

this is a methodological study divided into two stages. The first corresponded to an integrative literature review that guided the construction of the instrument. The second consisted of the content validation stage of the instrument, by means of expert consensus, using the Delphi technique. The selected experts were recognized in the field and authors of the articles included in the integrative review.

RESULTS

six experts participated in the content validation, which resulted in the "Instrument for Structural Assessment of Wards for the Preservation of Urinary Continence in Older Adults", composed of 27 items, distributed in three dimensions: "physical structure", "human resources", and "material resources". Two Delphi rounds were carried out for validation, resulting in a final version with 83% agreement among the experts.

CONCLUSION

the instrument reached content validity, requiring application for clinical validation. However, it can be used by researchers and health staff in hospital settings, in order to identify structural weaknesses and guide the priority of interventions for the quality and safety of this care.

RISK OF NEONATAL HOSPITALIZATION ASSOCIATED TO DELIVERY BY CESAREAN SECTION IN A HIGH COMPLEXITY CLINIC IN BOGOTÁ, COLOMBIA, 2018

OBJECTIVE

To evaluate the association between cesarean delivery and hospitalization of the newborn and describe the indications for cesarean according to Robson's groups in the obstetrics service of a highly complex general institution.

METHODS

Cross-sectional study. All births occurred between March and July 2018 in a high complexity general teaching hospital in Bogotá, Colombia were included, by consecutive sampling up to a sample size of 1040 pregnant women. The frequency of caesarean section, indications, neonatal outcomes for each Robson group, and the risk of neonatal hospitalization are described using the crude and adjusted odds ratio (OR) using multivariate analysis.

RESULTS

1,493 births were included, of which 539 (36.3 %) were by cesarean section. Women with a history of uterine scar scheduled for elective caesarean section and those hospitalized for induction provide the majority of caesarean sections. The main indications for cesarean section were suspicion of unsatisfactory fetal status and prolongued labor. Adjusted for birth weight, caesarean section increased the overall risk of neonatal hospitalization (adjusted OR [aOR] = 2,2; IC 99 %: 1,3-3,7).

CONCLUSIONS

There are groups of Robson susceptible of intervention to decrease the rate of caesarean sections due to the suspicion of unsatisfactory fetal status and prolongation of labor. An association was found between cesarean delivery and subsequent neonatal hospitalization. Randomized controlled studies are required to determine the benefit of the strategies to reduce cesarean section rates and evaluate the association found.

[Hospital admission and mortality causes of HIV patients in a third level hospital]

OBJECTIVE

The aim of this study is to describe the HIV population admitted to a tertiary level hospital and analyze hospital admission and mortality causes during hospitalization.

METHODS

Observational, retrospective study carried out in a third level Hospital. Inclusion criteria: Patients ≥18 years with a prescription of ART and diagnosis of HIV known or discovered during admission. It was accepted hospital ward discharge diagnose as hospitalization causes. Clinical, analytical outcomes as well as causes of mortality were collected.

RESULTS

Among 162 hospitalized HIV infected, 128 met the inclusion criteria, 8 of those were diagnosed as naive HIV patients. 79.7% were male; Age 50.29 ± 9.81 years. The main reasons for hospital admissions (38.3%) were certain infectious and parasitic diseases (ICD-10 Classification) and more specifically human immunodeficiency virus [HIV] disease represented 24,1% of whole hospitalizations. Mortality rates of ≥18 years HIV patients that were admitted to hospital during 2016-2017 were the 13.52%. The main causes of death were certain infectious and parasitic diseases followed by malignancies.

CONCLUSIONS

Our results emphasize the need of intensifying the HIV early diagnosis as well as Pneumocystis jirovecii primary prophylaxis. Insist on ART adherence from infectology follow-up appointment and pharmacy care consultations, educate clinics on ART treatment prescription during hospital admission as well as requesting viral and CD4 lymphocytes loads to every HIV admitted patients.

Effect of a standardized approach on infants hospitalized for apparent life threatening events

Introduction: An apparent life-threatening event (ALTE) is a frequent cause of hospitalization in infants. However, there is little evidence about the existence of a standardized approach to discover the main etiology, although a correct causal diagnosis can affect clinical evolution, hospital stay, and health resources. Objective: To determine the effects of a standardized diagnostic approach in infants admitted with ALTE. Materials and methods: We conducted a retrospective cohort study with the data collected from clinical records of infants hospitalized for ALTE in the pediatric unit between 2002 and 2009. Two cohorts of patients were analyzed according to the procedures defined for these cases: Cohort 1 with clinical guidelines and cohort 2 with clinical guidelines, study protocol, and outpatient follow-up. Etiological causes, hospitalization periods and readmission rates were compared between both cohorts. Results: Of the 255 infants hospitalized for ALTE, 57.6% corresponded to cohort 1 and 42.3% to cohort 2. No differences were observed in age and gender between groups. The highest percentage of attributed causes (63.9 vs 87.0%; p<0.0001) and a shorter period of hospitalization (8.0 vs 5.0 days; p=0, 0001) were observed in cohort 2. No differences in hospital readmission were observed (10.5 vs 8.3 days; p=0.7435). Conclusions: The protocol-based approach for infants with EAL was associated with a higher percentage of recognition of attributed causes and a shorter hospitalization period. Therefore, our results allow recommending this type of standardization for the management of these patients.

Hospitalizations for cancer in international migrants versus local population in Chile

OBJECTIVE

To compare cancer hospital morbidity among the local population and the immigrant population in Chile.

METHODS

This is a prevalence study based on the analysis of hospital discharges of all the health centers of Chile. Cancer hospital discharges were characterized in 2012 according to the migratory status. The crude and specific rates of hospital morbidity for this cause were estimated for the analysis of their association with migratory status using zero-inflated negative binomial regression, adjusted for sociodemographic variables.

RESULTS

The neoplasms were the third cause of hospital discharges for immigrants and the seventh one for Chileans. The adjusted rate of cancer hospital discharges was higher for Chileans than immigrants, and the latter had fewer days of hospitalization and greater proportion of surgical interventions. In the group of immigrants, cancer hospital discharges mainly corresponded to patients belonging to the private system (46%), and in the group of Chileans they mainly corresponded to patients in the public system (71.1%). We observed a large difference in the proportion of cancer hospital discharges for patients with no health insurance between the two populations (22.6%: immigrants, 1.0%: Chileans). In both populations, the three most frequent types of cancer were: (i) lymphoid tissue, hematopoietic organs, and related tissues, (ii) digestive organs, and (iii) breast cancer.

CONCLUSIONS

Models of differentiated care should be considered for immigrants, with the creation of specific programs of information, coverage, and protection against cancer. More information on this problem must be generated at the local and international level.

[Psychiatric hospitalizations of child-youth population: An epidemiological study of Bahía Blanca City, Argentina]

INTRODUCTION

In recent years, there has been an increase in child and adolescent psychiatric consultations. The infant-youth population is a vulnerable group due to the evolutionary moment in which they are. They are the substrate of the impact of family and social crises. It is necessary to know the prevalent disorders, and the epidemiological profle of the population in question, to collaborate with a better understanding of the phenomenon and to make appropriate family and individual approaches in the subject.

MATERIALS AND METHODS

The number of children and adolescents who used the hospitalization device in the private sector of the city of Bahía Blanca, Argentina, from 2014 to 2016 is described. The medical records of hospitalized patients in the 12 to 19 year age range were analyzed.

RESULTS

The target population has an average age of 16 years; Almost 90% of the population is in school; More than 60% have their own home and live with their nuclear family. The reason for admission that demanded more days of hospitalization was Destructive, Impulse Control and Behavior Disorder. The reinternation rate of this study was 31.6%.

CONCLUSION

The intimate relationship of the increasing incidence of mental disorders in the child and adolescent population with the availability of families and society to contain and care for this vulnerable population is more evident.

Hospital morbidity due to paracoccidioidomycosis in Brazil (1998-2006)

OBJECTIVE

To analyse hospital morbidity records due to paracoccidioidomycosis in Brazil, including its nationwide distribution in time and space, as well as key epidemiological and sociodemographic characteristics.

METHODS

Descriptive analysis of hospital morbidity records due to paracoccidioidomycosis covering the period January 1998 to December 2006. Hospital records were obtained from the Hospital Information System of the Brazilian Unified Health System (SIH/SUS).

RESULTS

There were 6732 hospitalisations (82% male) due to paracoccidioidomycosis in the period, representing 4.3 per 1.0 million inhabitants. Admissions due to this mycosis were recorded in 27% of the 5560 Brazilian municipalities, covering 35% of the country. Ten municipalities concentrated 52% of all admissions. The temporal distribution of admissions for paracoccidioidomycosis showed a slight increase. The geographical analysis showed two distinct patterns of the disease: (i) traditional areas of southern and south-eastern regions, covering 60% of admissions, and (ii) a second pattern in northern Brazil revealed a transverse band of higher concentration with about 27% of admissions, particularly along the southern border of the Amazon region.

CONCLUSION

This first nationwide analysis of hospitalisation due to paracoccidioidomycosis in Brazil shows that it is the most prevalent systemic mycosis in Brazil. Despite its importance, there are major deficits in its proper registry, diagnostics and treatment. The particular epidemiological and medical challenges of paracoccidioidomycosis will not be met while the disease continues to be perceived as an isolated infectious entity restricted to a few faraway regions of the globe.

Infant twin mortality and hospitalisations after the perinatal period - a prospective cohort study from Guinea-Bissau

OBJECTIVE

To examine mortality and hospitalisations among infant twins and singletons after the perinatal period in Guinea-Bissau.

METHODS

The study was conducted from September 2009 to November 2012 by the Bandim Health Project (BHP). Newborn twins and unmatched singleton controls were included at the National Hospital Simão Mendes in the capital Bissau. Children were examined clinically at enrolment. Maternal, pregnancy and obstetric information was collected and HIV testing offered at birth. Follow-up occurred at home at 2, 6 and 12 months and through linkage with the paediatric admission register at the National Hospital.

RESULTS

About 495 twins and 333 singletons were alive on day 7 after birth. In total, 36 twins and 12 singletons died during follow-up, the post-perinatal infant mortality rate being 91/1000 person-years for twins and 42/1000 for singletons (HR = 2.11, 95% CI: 1.09-4.07). In a multivariable analysis among twins only, birth weight <2000 g [3.32, (1.36-8.07)], death of the cotwin perinatally [2.54, (1.16-5.57)] and severe maternal illness during pregnancy [2.35, (1.00-5.51)] were significant risk factors for twin death. In the subgroup with available HIV status, maternal HIV infection was strongly associated with twin mortality [3.16, (1.24-8.05)]. Death occurred at home for 60% of twins and 67% of singletons. During follow-up, 90 first-time hospital admissions were registered, with similar rates observed for twins (139/1000) and singletons (143/1000) [0.97, (0.61-1.52)].

CONCLUSION

The post-perinatal infant mortality rate of twins was double that of singletons. No excess in twin hospitalisations was observed, possibly implying obstacles to hospital admission for twins in case of severe illness.

Severe events in the first 6 months of life in a cohort of HIV-unexposed infants from South Africa: effects of low birthweight and breastfeeding status

OBJECTIVE

To report on risk factors for severe events (hospitalisation or infant death) within the first half of infancy amongst HIV-unexposed infants in South Africa.

METHODS

South African data from the multisite community-based cluster-randomised trial PROMISE EBF promoting exclusive breastfeeding in three sub-Saharan countries from 2006 to 2008 were used. The South African sites were Paarl in the Western Cape Province, and Umlazi and Rietvlei in KwaZulu-Natal. This analysis included 964 HIV-negative mother-infant pairs. Data on severe events and infant feeding practices were collected at 3, 6, 12 and 24 weeks post-partum. We used a stratified extended Cox model to examine the association between the time to the severe event and covariates including birthweight, with breastfeeding status as a time-dependent covariate.

RESULTS

Seventy infants (7%) experienced a severe event. The median age at first hospitalisation was 8 weeks, and the two main reasons for hospitalisation were cough and difficult breathing followed by diarrhoea. Stopping breastfeeding before 6 months (HR 2.4; 95% CI 1.2-5.1) and low birthweight (HR 2.4; 95% CI 1.3-4.3) were found to increase the risk of a severe event, whilst maternal completion of high school education was protective (HR 0.3; 95% CI 0.1-0.7).

CONCLUSIONS

A strengthened primary healthcare system incorporating promotion of breastfeeding and appropriate caring practices for low birthweight infants (such as kangaroo mother care) are critical. Given the leading reasons for hospitalisation, early administration of oral rehydration therapy and treatment of suspected pneumonia are key interventions needed to prevent hospitalisation in young infants.

[Monitoring a home care cohort]

OBJECTIVES

To evaluate home care by primary care teams for people over 65 years old with chronic conditions, in order to identify improvement opportunities. To identify patient and care variables associated with cognitive and functional impairment, nursing home admission, attendance at casualty units, hospital admission and death.

DESIGN

Analytic study of the follow-up of a cohort for 3 years.

SETTING

Primary health care teams in Catalonia, Spain.

PATIENTS

One thousand three hundred patients over 65 with chronic pathologies and cared for by home care programmes in Catalonia.

MAIN MEASUREMENTS

The following will be recorded annually: health status (Charlson, Barthel, Pfeiffer, Braden, and Gijón), data on the carer (Zarit), care received (social and health), self-perception of health (SF-12), Casualty attendance, short-term admissions and the final results, i.e. death or definitive admission to a nursing home or hospital. The statistical analyses will be based on logistic regression and a survival analysis.

CONCLUSIONS

The study should reveal patient characteristics with prognostic value, as well as identify the social and health factors related to better survival and lower consumption of health and social resources.

[Organizational characteristics of primary care and hospitalization for to the main ambulatory care sensitive conditions]

OBJECTIVES

To describe the variability in hospitalisation rates because of the most common ambulatory care sensitive conditions (ACSC), by town and gender; b) to describe the influence on these rates of the characteristics of primary care (reformed or non-reformed model and kind of centre), the health level of the population, geographical accessibility and other factors of a social and economic nature.

DESIGN

Observational, cross-sectional study of hospital discharges and ecological study for the analysis of rates between towns.

MAIN MEASUREMENTS

The rates of hospitalisation by gender for each ACSC (1997-1999), standardised for age through the indirect method by calculating the standardised rate ratios (SRR). The multivariate analysis used Poisson regression.

RESULTS

In the diagnoses studied, 41% of the towns had the same number of cases observed and expected for hospitalisation of men; and 65%, for women. Chronic obstructive pulmonary disease in men and heart failure in women were the illnesses that most varied. Hospitalisation rates for most illnesses were higher in towns without a health centre or with a non-reformed model, with over 3000 inhabitants and closer to hospital, although distance from the hospital was an influential factor only in bigger towns.

CONCLUSIONS

There is variability between towns in hospitalisation rates for the most common ACSC; b) the differences in hospitalisation rates for the ACSC studied are linked to organisational features of primary care, the size of the town and the distance from the hospital.

[Hospitalizations preventable by timely and effective primary health care]

OBJECTIVE

To know the specific health problems referred as ambulatory care sensitive conditions (ACSC) and to identify the primordial interventions of primary health care (PHC) in reducing hospitalisations due to ACSC.

DESIGN

Descriptive study of hospital discharges generated in Catalonia during 1998-1999, and a Delphi study to reach information about PHC primordial interventions.

MEASURES

Diagnostic codes of ACSC selected as markers of PHC effectiveness were used. We analysed hospital discharge distribution by age groups and overall, and hospitalisation rates with its 95% confidence intervals. Descriptive analysis of consensus reached by experts using self-administrated questionnaires was done.

RESULTS

The 8.42% of total discharges were due to ACSC. The majority of these (86.9%) fell in 4 of the 13 diagnostic categories included in the ACSC list. A great variety of pathologies with different frequencies were identified. Primary prevention and early diagnoses and treatment were considered as primordial interventions. Chronic health problems needed multimodal interventions.

CONCLUSIONS

Diagnostic codes included in each diagnostic category were congruent with the diseases identified. Interventions that could prevent hospitalisations due to ACSC are contemplated as role of PHC. Indicator validity to assess PHC effectiveness is maintained by both results.

[Role of primary care teams in hospitalization of children under 2 years of age?]

OBJECTIVE

To determine whether the structure of primary care teams on carrying out the healthy child health programme leads to a drop in the risk of admission to hospital of children under two, in comparison with the traditional clinic or out-clinic health system.

DESIGN

Case-reference epidemiological study.

CASES

40% of the children under 24 months admitted to paediatric or neonate floors of the Marqués de Valdecilla University Hospital. Reference: 15% of the recently born children alive in this hospital. Information was gathered through face-to-face interview and by examining health cards. The study ran from April 1995 to May 1996.

RESULTS

Children under two monitored habitually by a doctor belonging to a primary care team showed a drop in risk of hospital admission for all clinical diagnoses of 0.57 (95% CI, 0.35-0.93), after adjustment due to various confusion factors such as maternal education, social class, ethnic background, mother's age, mother's tobacco consumption, natural breast-feeding at birth, admission at birth. There was a drop of risk of hospital admission for high temperature without apparent cause in those children monitored habitually by a team doctor (adjusted RR = 0.41; 95% CI, 0.19-0.90).

CONCLUSIONS

The advantages of the paediatric health care reform with the structuring of the primary care teams and the accompanying activities performed lead to a drop in the risk of hospital admission of those children under two years old who are habitually monitored by a doctor belonging to a primary care team.