Use and misuse of the emergency room by patients with eating disorders in a matched-cohort analysis: What can we learn from it?

We examined the pattern of access to hospital emergency room (hER) in 2018-2021 among patients with eating disorders (ED) from Florence, Italy, diagnosed during 1994-2018, using a matched cohort design. We included 902 ED patients and an equal number of sex-, age-, and residence-matched individuals. We fitted conditional Poisson regression models with robust variance estimator to estimate incidence rate ratios (IRR) and 95% confidence intervals. ED patients accessed hER more than twice as often as matched individuals: the IRR was 2.11 (1.21-3.70), 2.02 (1.36-3.00), and 2.49 (1.71-3.61) among AN, BN, and BED patients. Factors associated with increased hER use were older age (≥40 years; for AN patients, also younger age, <20 years), BMI ≤ 16 kg/m2 (for AN), and psychopathological severity. The rise in access to hER was particularly marked during the early phases of the COVID-19 pandemic and declined only partially thereafter. Acute psychiatric symptoms and non-specific medical conditions represented the main causes of increased access to hER. Use of hER was more often inappropriate among ED patients than matched individuals. Integration of primary and mental health care may be necessary to counteract the high and often inappropriate use of hER by patients with ED.

Seasonal Effect on Association between Atmospheric Pollutants and Hospital Emergency Room Visit for Stroke.

BACKGROUND: The relationship between air pollution and stroke is conflicting. This study was conducted to document the relationship between daily changes in atmospheric pollutants and hospital emergency room visits (ERVs) for stroke. METHODS: Data of daily hospital ERVs for stroke and atmospheric pollutants in Changsha city between 2008 and 2009 were collected. Using a time-stratified bidirectional case-crossover design, we analyzed the association between atmospheric pollutants and stroke incidence in 4 seasons. RESULTS: In the single-pollutant model, we found changes in sulfur dioxide (SO2), nitrogen dioxide (NO2), and particulate matters (PM10) were significantly associated with cerebral hemorrhage and cerebral infarction (P < .05) in lags of 0-2 days in autumn. A 10-µg/m3 increase in SO2 in autumn was significantly associated with ERVs for both cerebral hemorrhage (odds ratio [OR], 1.166; 95% confidence interval [CI], 1.012-1.343) and cerebral infarction (OR, 1.214; 95% CI, 1.018-1.448). NO2 in autumn was significantly associated with ERVs for cerebral hemorrhage and infarction with OR = 1.162 (95% CI, 1.005-1.344) and OR = 1.137 (95% CI, 1.011-1.279), respectively. PM10 in autumn was significantly associated with ERVs for cerebral hemorrhage and infarction with OR = 1.147 (95% CI, 1.045-1.259) and OR = 1.091 (95% CI, 1.019-1.168), respectively. Results of the multipollutant model showed that in autumn after PM10 and NO2 adjustment, only a 10-µg/m3 increase in SO2 was significantly associated with ERVs for cerebral infarction (OR, 1.158; 95% CI, 1.006-1.333; P < .05). SO2, NO2, and PM10 were not associated with ERVs for cerebral hemorrhage (P > .05). CONCLUSIONS: This study demonstrates that the change in atmospheric SO2 levels in Changsha is significantly associated with the stroke incidence in autumn.

Acute exposure to fine particulate matter and cardiovascular hospital emergency room visits in Beijing, China.

Fine particulate matter (PM2.5) air pollution outbreaks have recently occurred frequently in China. However, evidence of the associations between short-term exposure to PM2.5 and cardiovascular morbidity is still limited in China. This study aimed to evaluate the associations between PM2.5 and hospital emergency room visits (ERVs) for cardiovascular diseases in urban areas in Beijing. Daily counts of cardiovascular ERVs were collected from ten large general hospitals from Jan 1 to Dec 31, 2013. Air pollution data were obtained from the Beijing Environmental Protection Bureau including 17 monitoring stations. A generalized additive Poisson model was used to examine the associations between PM2.5 and cardiovascular ERVs after controlling for seasonality, day of the week, public holidays, influenza outbreaks, and weather conditions. In total, there were 56,221 cardiovascular ERVs during the study period. The daily mean PM2.5 concentration was 102.1 µg/m3, ranging from 6.7 µg/m3 to 508.5 µg/m3. Per 10 µg/m3 increase in PM2.5 was associated with a 0.14% (95% confidence interval [CI]: 0.01%-0.27%) increase in cardiovascular ERVs at lag3. Cumulative delayed estimates were greatest at lag0-5 (0.30%, 95% CI: 0.09%-0.52%). The estimates of percentage change in daily ERVs per 10 µg/m3 increase in PM2.5 were 0.56% (95%CI: 0.16%-0.95%) for ischemic heart disease (IHD) at lag0-1, 0.81% (95%CI: 0.05%-1.57%) for heart rhythm disturbances (HRD) at lag0-1 and 1.21% (95%CI: 0.27%-2.15%) for heart failure (HF) at lag0, respectively. The effects of PM2.5 on IHD ERVs during high temperature days (>11.01 °C) were significantly higher than that on low temperature days (≤11.01 °C) at lag0, lag0-1, lag0-3 and lag0-5 (P < 0.05). The study suggests that PM2.5 has acute impacts on cardiovascular ERVs in Beijing, especially on IHD, HRD and HF. The effects of PM2.5 on IHD ERVs vary by temperature.

Uma psicologia precavida pela psicanálise: A clínica da urgência na unidade de pronto-socorro / A pscychology based on psychoanalysis: the urgence clinic in the emergency department

Apresentamos relatos, análises, e discussão, de uma experiência vivenciada por estagiários de Psicologia numa Unidade de Pronto-Socorro de um município do interior paulista, desenvolvida em uma pesquisa de iniciação científica. Trabalhando a partir da clínica orientada pelos referenciais da Psicanálise de Freud e Lacan, a inserção e práxis específica basearam-se na oferta de escuta em um Estabelecimento de Saúde situado no contexto hospitalar, com todas as particularidades do trabalho num serviço de Urgência-Emergência. Os resultados obtidos nos permitem postular a relevância da atuação de uma Psicologia precavida e avisada pela Psicanálise na área da Saúde. Tendo em vista a carência de referenciais bibliográficos nesta temática, também queremos contribuir com os profissionais que atuam na Urgência-Emergência do Pronto-Socorro, sem a pretensão de esgotar as questões deste campo ainda novo e pouco explorado. (AU)

This article comes from a scientific initiation researche experience. It reports, analyses and discusses a psychology trainees' experience in a Hospital Emergency Room in a town at São Paulo's State. Freud and Lacan's psychoanalysis theories are the clinic reference to this particular insertion and practice. The offer made for the psychology trainees was a psychological listening support to patients at a health establishment situated in the hospital, which was made considering all peculiarities of work organizing in an Emergency Room. The results allow us to postulate the importance of acting with a mode of psychology advised by psychoanalysis in the healthcare field. There ́s a lack of bibliographical references on this theme, so, we also want to contribute to the professionals that work in the Emergency Department, however, without the claim to exhaust the questions of this new and unexplored field. (AU)