Income and campus application disparities among European and non-European heritage Hispanic undergraduate applicants.

Leveraging every undergraduate application submitted by self-identified Hispanic applicants to the University of California system in the 2016 and 2017 application cycles, we show that a significant number of applicants claim Hispanic identity by virtue of European heritage. We subsequently demonstrate that Hispanic-identifying students of European descent are significantly more affluent and more likely to apply to selective University of California campuses than their non-European Hispanic peers. We comment on the practical implications of these disparities, as well as their relevance for studies of inequality in the social sciences and education.

A follow up report validating long term predictions of the COVID-19 epidemic in the UK using a dynamic causal model.

Background: This paper asks whether Dynamic Causal modelling (DCM) can predict the long-term clinical impact of the COVID-19 epidemic. DCMs are designed to continually assimilate data and modify model parameters, such as transmissibility of the virus, changes in social distancing and vaccine coverage-to accommodate changes in population dynamics and virus behavior. But as a novel way to model epidemics do they produce valid predictions? We presented DCM predictions 12 months ago, which suggested an increase in viral transmission was accompanied by a reduction in pathogenicity. These changes provided plausible reasons why the model underestimated deaths, hospital admissions and acute-post COVID-19 syndrome by 20%. A further 12-month validation exercise could help to assess how useful such predictions are. Methods: we compared DCM predictions-made in October 2022-with actual outcomes over the 12-months to October 2023. The model was then used to identify changes in COVID-19 transmissibility and the sociobehavioral responses that may explain discrepancies between predictions and outcomes over this period. The model was then used to predict future trends in infections, long-COVID, hospital admissions and deaths over 12-months to October 2024, as a prelude to future tests of predictive validity. Findings: Unlike the previous predictions-which were an underestimate-the predictions made in October 2022 overestimated incidence, death and admission rates. This overestimation appears to have been caused by reduced infectivity of new variants, less movement of people and a higher persistence of immunity following natural infection and vaccination. Interpretation: despite an expressive (generative) model, with time-dependent epidemiological and sociobehavioral parameters, the model overestimated morbidity and mortality. Effectively, the model failed to accommodate the "law of declining virulence" over a timescale of years. This speaks to a fundamental issue in long-term forecasting: how to model decreases in virulence over a timescale of years? A potential answer may be available in a year when the predictions for 2024-under a model with slowly accumulating T-cell like immunity-can be assessed against actual outcomes.

Exposure to acute ambient temperature extremes and neonatal intensive care unit admissions: A case-crossover study.

BACKGROUND: Extreme in utero temperatures have been associated with adverse birth outcomes, including preterm birth and low birthweight. However, there is limited evidence on associations with neonatal intensive care unit (NICU) admissions, which reflect a range of poor neonatal health outcomes. METHODS: This case-crossover study assesses the associations between ambient temperature changes during the week of delivery and risk of NICU admission. Data from the Consortium on Safe Labor (2002-2008) were linked to ambient temperature at hospital referral regions. Adjusted hazard ratios (HR) and 95 % confidence intervals (CI) estimated NICU admission risk with a 1 °C increase on each day of the week of delivery and of the average weekly temperature, adjusted for particulate matter ≤2.5 µm (PM2.5) and relative humidity. We also estimated associations with 1 °C increases and 1 °C decreases in temperatures during weeks of site-specific extreme heat (>90th and 95th percentiles) and cold (<5th and 10th percentiles), respectively. RESULTS: There were 27,188 NICU admissions with median (25th, 75th) temperature of 16.4 °C (5.8, 23.0) during the week before delivery. A 1 °C increase in temperature during the week of delivery was not associated with risk of NICU admission. However, analyses of extreme temperatures found that a 1 °C decrease in weekly average temperatures below the 10th and 5th percentiles was associated with 30 % (aHR = 1.30, 95 % CI 1.28, 1.31) and 47 % (aHR = 1.47, 95 % CI 1.45, 1.50) increased risk of NICU admissions, while a 1 °C increase in weekly average temperatures above the 90th and 95th percentiles was associated with more than two- (aHR = 2.29, 95 % CI 2.17, 2.42) and four-fold (aHR = 4.30, 95 % CI 3.68, 5.03) higher risk of NICU admission, respectively. CONCLUSIONS: Our study found temperature extremes in the week before delivery increased NICU admission risk, particularly during extreme heat, which may translate to more adverse neonatal outcomes as extreme temperatures persist.

Test preparation breeds success: Two quasi-experimental interventions in the context of the Swiss aptitude test for medical-school admissions.

BACKGROUND: In Switzerland, the scholastic aptitude test for medical-school selection takes place in three languages. This study examined the effects of two quasi-experimental interventions that aimed to reduce existing differences in test results between the French- and German-speaking language candidates. METHODS: Between 2018 and 2023, the population of applicants to Swiss medical schools consisted of N = 18'824 German- and French-speaking individuals. Based on a quasi-experimental design, we examined the effects of two interventions regarding preparatory material, in these cohorts. The first intervention (2022) consisting of practice trials in baccalaureate schools in the canton of Fribourg enabled French-speaking candidates primarily from the canton of Fribourg to prepare more intensively with official tasks. Practice trials enable future candidates to complete a published test version under original conditions and thus prepare how to approach the real test. The second intervention (2023) released new preparatory material in all languages for one group of tasks for which differences between the language groups were more pronounced than in the other tasks. The test provider offered this material for free download together with existing preparation materials and thereby enabled more intensive preparation. RESULTS: After the first intervention, the initially small to medium-sized mean differences in z-transformed test scores between French-speaking candidates from Fribourg and German-speaking candidates were nearly eliminated (from 0.39 to 0.05). Also for French-speaking candidates from outside of the canton of Fribourg, the mean differences were smaller than before the intervention (0.48 before, 0.39 after first intervention). After the second intervention, particularly the mean differences in test scores between German-speaking and French-speaking candidates from outside of Fribourg were further reduced (to 0.24). CONCLUSIONS: The two interventions regarding material for preparing to participate in the aptitude test affected candidates' test scores. They reduced the gap between German- and French-speaking candidates showing that the additional benefits of commercial offers for test preparation are limited. Hence, offering comparable official preparation material to all language groups enhances test fairness.

Association between P M 10 and respiratory diseases admission in peninsula Malaysia during haze.

Numerous studies have been conducted in other countries on the health effects of exposure to particulate matter with a diameter of 10 microns or less P M 10 , but little research has been conducted in Malaysia, particularly during the haze season. This study intends to investigate how exposure of P M 10 influenced hospital admissions for respiratory diseases during the haze period in peninsula Malaysia and it was further stratified by age group, gender and respiratory diseases categories. The study includes data from all patients with respiratory diseases in 92 government hospitals, as well as P M 10 concentration and meteorological data from 92 monitoring stations in Peninsula Malaysia starting from 1st January 2000 to 31st December 2019. A quasi-poison time series regression with distributed lag nonlinear model (DLNM) was employed in this study to examine the relationship between exposure of P M 10 and hospital admissions for respiratory diseases during the haze period. Haze period for this study has been defined from June to September each year. According to the findings of this study, P M 10 was positively associated with hospitalisation of respiratory disease within 30 lag days under various lag patterns, with lag 25 showing the strongest association (RR = 1.001742, CI 1.001029,1.002456). Using median as a reference, it was discovered that females were more likely than males to be hospitalized for P M 10 exposure. Working age group will be the most affected by the increase in P M 10 exposure with a significant cumulative RR from lag 010 to lag 030. The study found that P M 10 had a significant influence on respiratory hospitalisation in peninsula Malaysia, particularly for lung diseases caused by external agents(CD5). Therefore, it is important to implement effective intervention measures to control P M 10 and reduce the burden of respiratory disease admissions.

Association between long-term exposure to low ambient PM2.5 and cardiovascular hospital admissions: A UK Biobank study.

INTRODUCTION: A causal link between air pollution exposure and cardiovascular events has been suggested. However fewer studies have investigated the shape of the associations at low levels of air pollution and identified the most important temporal window of exposure. Here we assessed long-term associations between particulate matter < 2.5 µm (PM2.5) at low concentrations and multiple cardiovascular endpoints using the UK Biobank cohort. METHODS: Using data on adults (aged > 40) from the UK Biobank cohort, we investigated the associations between 1-year, 3-year and 5-year time-varying averages of PM2.5 and incidence of major adverse cardiovascular events (MACE), myocardial infarction (MI), heart failure, atrial fibrillation and flutter and cardiac arrest. We also investigated outcome subtypes for MI and stroke. Events were defined as hospital inpatient admissions. We fitted Cox proportional hazard regression models applying extensive control for confounding at both individual and area level. Finally, we assessed the shape of the exposure-response functions to assess effects at low levels of exposure. RESULTS: We analysed data from 377,736 study participants after exclusion of prevalent subjects. The average follow-up (2006-2021) was 12.9 years. We detected 19,353 cases of MACE, 6,562 of acute MI, 6,278 of heart failure, 1,258 for atrial fibrillation and flutter, and 16,327 for cardiac arrest. Using a 5-year exposure window, we detected positive associations (for 5 µg/m3 increase in PM2.5) for 5-point MACE of [1.12 (95 %CI: 1.00-1.26)], heart failure [1.22 (1.00-1.50)] and cardiac arrest [1.16 (1.03-1.31)]. We did not find any association with acute MI, while non-ST-elevation MI was associated with the 1-year exposure window [1.52 (1.12-2.07)]. The assessment of the shape of the exposure-response relationships suggested that risk is approximately linear for most of the outcomes. CONCLUSIONS: We found positive associations between long-term exposure to PM2.5 and multiple cardiovascular outcomes for different exposure windows. The cardiovascular risk tends to rise even at exposure concentrations below 12-15 µg/m3, indicating high risk below UK national and international thresholds.

Risk of suicide after hospitalizations due to acute physical health conditions-a cohort study of the Norwegian population.

BACKGROUND: It is well known that individuals recently discharged from psychiatric inpatient care face a high risk of suicide. Severe physical health conditions have also been linked to suicide risk. The risk of suicide following discharge from somatic hospitals is not known for individuals admitted due to acute physical health conditions. METHODS: A Cohort study using data from the entire Norwegian population aged 12 years and older from 2008 to 2022 linked with information on health service use and cause of death. We used Cox regression with age as time axis to estimate sex-adjusted hazard ratios of suicide following discharge for ages 12 to 64 years and 65 years and older. We also performed analyses after excluding hospitalizations with indications of concurrent mental disorders, self-harm, or suicide attempts. To assess individual risk, we performed an adapted case-crossover analysis among discharged patients who died from suicide. RESULTS: A total of 4 632,980 individuals aged 12 to 64 years and 1,469,265 individuals aged 65 years and older were included. Compared to unexposed individuals at similar ages, we found an increased risk of suicide in the first 4 weeks after discharge, with a hazard ratio (HR) of 7.0 (95% confidence interval (CI) 5.9 to 8.3) among those aged 12 to 64 years and 6.8 (95% CI 5.4 to 8.6) among those 65 years and older. In the younger age group, the risk was attenuated, with a HR of 2.4 (95% CI 1.7 to 3.2) after excluding hospitalizations with indications of concurrent mental disorders, self-harm, or suicide attempts. The corresponding HR was 4.8 (95% CI 3.5 to 6.4) among those 65 years and older, declining to 1.9, (1.2 to 3.1) in weeks 5 to 8 and 1.2 (0.7 to 2.2) in weeks 21 to 24. The case-crossover analysis confirmed that individuals 65 years and older were particularly vulnerable. CONCLUSIONS: The heightened risk of suicide following discharge from acute somatic hospitalization, even in the absence of concurrent mental disorders, self-harm, or prior suicide attempts, underscores the critical need for comprehensive mental health and existential support for patients post-discharge.

Comprehensive analysis of multiple sclerosis hospitalization trends in Spain (1998-2022).

OBJECTIVE: To analyse the trends in MS hospitalization rates in Spain (1998-2022) considering age, period, and birth cohort (A-P-C) effects. METHODS: This retrospective study used data on MS hospitalizations from the Spanish National Health System Minimum Basic Data Set (CMBD). Age-Standardized Hospitalization Rates (ASHRs) and Joinpoint analysis were used to assess trends. A-P-C analysis was performed to estimate age-specific rates, period and cohort effects. RESULTS: From 1998 to 2022, MS hospital admissions in Spain declined annually by -2.1 %, with women showing a slightly greater decrease (-2.3 %) than men (-1.7 %). Joinpoint analysis revealed non-parallel trends, with three inflection points indicating distinct periods of stabilization and decline. ASHR showed an overall decrease, with -2.0 % for men and -2.2 % for women annually. Risk of hospitalization peaked in the 25-29-year age group for men and 30-34-year age group for women, declining with age. Women consistently had higher risk ratios across age groups. Cohort analysis showed periods of stabilization and decline in MS hospitalization risk, aligning with joinpoint analysis findings. Risk increased for cohorts born in the early 20th century, peaking around 1938, followed by a progressive decline in later cohorts. CONCLUSIONS: Despite an aging population, MS hospitalization rates in Spain decreased. The risk of hospitalization for MS is affected by a person's age, the time period they were born in, the historical context of healthcare received, and potentially their sex.

Associations Between Anthropogenic Factors, Meteorological Factors, and Cause-Specific Emergency Department Admissions.

Unpredictable emergency department (ED) admissions challenge healthcare systems, causing resource allocation inefficiencies. This study analyses associations between air pollutants, meteorological factors, and 2,655,861 cause-specific ED admissions from 2014 to 2018 across 12 categories. Generalized additive models were used to assess non-linear associations for each exposure, yielding Incidence Rate Ratios (IRR), while the population attributable fraction (PAF) calculated each exposure's contribution to cause-specific ED admissions. IRRs revealed increased risks of ED admissions for respiratory infections (IRR: 1.06, 95% CI: 1.01-1.11) and infectious and parasitic diseases (IRR: 1.09, 95% CI: 1.03-1.15) during increased rainfall (13.21-16.97 mm). Wind speeds >12.73 km/hr corresponded to increased risks of ED admissions for respiratory infections (IRR: 1.12, 95% CI: 1.03-1.21) and oral diseases (IRR: 1.58, 95% CI: 1.31-1.91). Higher concentrations of air pollutants were associated with elevated risks of cardiovascular disease (IRR: 1.16, 95% CI: 1.05-1.27 for PM10) and respiratory infection-related ED admissions (IRR: 2.78, 95% CI: 1.69-4.56 for CO). Wind speeds >12.5 km/hr were predicted to contribute toward 10% of respiratory infection ED admissions, while mean temperatures >28°C corresponded to increases in the PAF up to 5% for genitourinary disorders and digestive diseases. PM10 concentrations >60 µg/m3 were highly attributable toward cardiovascular disease (PAF: 10%), digestive disease (PAF: 15%) and musculoskeletal disease (PAF: 10%) ED admissions. CO concentrations >0.6 ppm were highly attributable to respiratory infections (PAF: 20%) and diabetes mellitus (PAF: 20%) ED admissions. This study underscores protective effects of meteorological variables and deleterious impacts of air pollutant exposures across the ED admission categories considered.

Addressing Bias in the Occupational Therapy Admissions Process.

This study investigated the impact of a workshop in reducing unconscious bias in admissions committee members of an occupational therapy program to determine if workshop participation increased the number of underrepresented students in the program. A convenience sample of 50 committee members was used. A Wilcoxon matched pairs signed rank test indicated a significant increase in the post-test survey question scores. A chi-square test of independence revealed a significant increase in the number of students in the program from underrepresented groups. These results suggest that an online workshop can reduce perceived bias and increase diversity in an occupational therapy program.

Recent trends in hospital admission due to bipolar disorder in 10-19-year-olds in Spain: A nationwide population-based study.

INTRODUCTION: Bipolar disorder (BD) hospitalization rates in children and adolescents vary greatly across place and over time. There are no population-based studies on youth BD hospitalizations in Spain. METHODS: We identified all patients aged 10-19 hospitalized due to BD in Spain between 2000 and 2021, examined their demographic and clinical characteristics, and assessed temporal trends in hospitalizations - overall and stratified by age and presence of additional psychiatric comorbidity. We used Joinpoint regressions to identify inflection points and quantify whole-period and annual percentage changes (APCs) in trends. RESULTS: Of 4770 BD hospitalizations in 10-19-year-olds between 2000 and 2021 (average annual rate: 4.8 per 100,000), over half indicated an additional psychiatric comorbidity, most frequently substance abuse (62.2%), mostly due to cannabis (72.4%). During the study period, admissions increased twofold with an inflection point: Rates increased annually only between 2000 and 2008, for APCs 34.0% (95% confidence interval: 20.0%, 71.1%) among 10-14-year-olds, 10.3% (6.4%, 14.3%) among 15-19-year-olds, and 15.5% (11.5%, 22.7%) among patients with additional psychiatric comorbidity. Between 2009 and 2021, rates decreased moderately among 10-14-year-olds - APC: -8.3% (-14.1%, -4.4%) and slightly among 15-19-year-olds without additional psychiatric comorbidity - APC: -2.6(-5.7, -1.0), remaining largely stable among 15-19-year-olds overall. CONCLUSIONS: Recent trends in hospitalization due to BD in 10-19-year-olds in Spain indicate salient increases in the early 2000s - especially among (i) patients aged 10-14 (decreasing moderately after 2009 among 10-14-year-olds and plateauing among 15-19-year-olds) and (ii) patients with additional psychiatric comorbidity (i.e., cannabis use disorder). These findings suggest links with recent changes in clinical practices for children and recent trends in substance use among Spanish youth.

Geriatric Trauma Intensive Care Unit Admission Guideline is Associated With Reduction in Unplanned Intensive Care Unit Admissions.

INTRODUCTION: Geriatric trauma patients experience disproportionate adverse outcomes compared to younger patients with similar injuries and represent an important target for quality improvement. Our institution created a Geriatric Trauma Intensive Care Unit (ICU) Admission Guideline to identify high-risk patients and elevate their initial level of care. The goal of implementation was reducing unplanned ICU admissions (UIAs), a recognized surrogate marker for adverse outcomes. METHODS: The Geriatric Trauma ICU Admission Guideline was implemented on July 1, 2020, at a large academic level-1 trauma center. Using trauma registry data, we retrospectively analyzed geriatric patients who met the criteria for ICU admission 2 y preimplementation and postimplementation. The main outcome was UIAs in the target geriatric population. Secondary outcomes included hospital length of stay, ICU length of stay, ventilator days, mortality, and 30-d readmissions. Characteristics between groups were compared with t-test, Mann-Whitney U test, or chi-square test. Risk-adjusted logistic and negative binomial regressions were used for the categorical and continuous outcomes, respectively. RESULTS: A total of 1075 patients were identified with 476 in the preimplementation and 599 in the postimplementation group. The groups were similar across most demographic and physiologic characteristics, with the exception of a higher incidence of hypertension in the preimplementation group (77.7% versus 71.6%, P = 0.02) and COVID in the postimplementation group (3.8% versus 0.4%, P < 0.001). While mechanism of injury was similar, there was a higher incidence of traumatic brain injury in the preimplementation group (35.1% versus 26.2%, P = 0.002). In the postimplementation group, there was a higher incidence ≥3 rib fractures (68% versus 61.3%, P = 0.02) and an expected increase in initial ICU level of care (69.5% versus 37.1%, P < 0.001). The odds of a UIA after guideline implementation were reduced by half (adjusted odds ratio 0.52, 95% confidence interval 0.3-0.92). There was not a significant difference in the secondary outcomes of mortality, 30-d readmission, hospital-free days, ICU-free days, or ventilator-free days. CONCLUSIONS: Implementation of the Geriatric Trauma ICU Admission Guideline was associated with a reduction in UIAs by half in the target population. There was not a significant change in hospital-free days, ICU-free days, ventilator-free days, mortality, 30-d readmission, or venous thromboembolism. Further research is needed to better refine admission guidelines, examine the association of preventative admission on delirium, and determination of criteria that would allow safe, earlier downgrade.

Exploring the Impact of Generation Status on Pharmacy Admissions: A Comparative Study of First-Generation and Continuing-Generation College Students.

OBJECTIVE: First-generation college students (FGCSs) comprise a large demographic of health professions programs. Although FGCSs in pharmacy education have been studied, robust data describing FGCSs who pursue a Doctor of Pharmacy degree are sparse. The objective of this study was to describe the FGCS applicant population within pharmacy education from 2017 to 2023 and compare them with continuing-generation college student (CGCS) applicants. METHODS: We conducted a descriptive cross-sectional study using national Doctor of Pharmacy application data from the Pharmacy College Application Service between 2017 and 2023. RESULTS: Of the 83,446 applicants, 26% identified as an FGCS, with analysis demonstrating the breadth of differences between FGCS and CGCS. FGCSs were found to be older, more likely of minority status, and more likely to come from disadvantaged backgrounds. FGCSs also submitted a greater number of applications per student, were less likely to matriculate, and were more likely to be denied by at least 1 program. CONCLUSION: Important differences between FGCSs and CGCSs in the pharmacy school applicant pool were identified. These differences highlight the importance of studying recruitment strategies and support programs for FGCS pharmacy applicants, strategies to increase completed applications, and decrease melt in FGCSs once they are accepted into programs.

End-of-Life Healthcare Utilization in Lewy Body Dementia.

Background: Lewy body dementia (LBD) is the second most common neurodegenerative dementia in the US, presenting unique end-of-life challenges. Objective: This study examined healthcare utilization and care continuity in the last year of life in LBD. Methods: Medicare claims for enrollees with LBD, continuously enrolled in the year preceding death, were examined from 2011-2018. We assessed hospital stays, emergency department (ED) visits, intensive care unit (ICU) admissions, life-extending procedures, medications, and care continuity. Results: We identified 45,762 LBD decedents, predominantly female (51.8%), White (85.9%), with average age of 84.1 years (SD 7.5). There was a median of 2 ED visits (IQR 1-5) and 1 inpatient stay (IQR 0-2). Higher age was inversely associated with ICU stays (Odds Ratio [OR] 0.96; 95% Confidence Interval [CI] 0.96-0.97) and life-extending procedures (OR 0.96; 95% CI 0.95-0.96). Black and Hispanic patients experienced higher rates of ED visits, inpatient hospitalizations, ICU admissions, life-extending procedures, and in-hospital deaths relative to White patients. On average, 15 (7.5) medications were prescribed in the last year. Enhanced care continuity correlated with reduced hospital (OR 0.72; 95% CI 0.70-0.74) and ED visits (OR 0.71; 95% CI 0.69-0.87) and fewer life-extending procedures (OR 0.71; 95% CI 0.64-0.79). Conclusions: This study underscored the complex healthcare needs of people with LBD during their final year, which was influenced by age and race. Care continuity may reduce hospital and ED visits and life-extending procedures.

Unplanned hospital admissions within 24 h after 53,185 surgical procedures at a U.S. ambulatory surgery center.

BACKGROUND: Unplanned admission after surgery at an ambulatory surgery center (ASC) is an established measure of the quality of care and can affect the patient's experience. Previous studies on this topic are generally dated, focused on a single specialty, or studied 30-day admissions after ambulatory surgery. Few studies have reported admission within 24 h after surgery at an ASC which is a different but important measure of the quality of anesthetic and surgical care. Understanding admissions within 24 h of surgery can identify opportunities for improvement immediately after surgery. Therefore, our study was designed to assess the incidence and risk factors for unplanned hospital admissions within 24 h after surgery performed at a hospital ASC. METHODS: After Institutional Review Board approval, a retrospective analysis was performed on all adult patients who underwent surgery at a US ASC between January 1, 2016, and December 31, 2022. Data were obtained from the hospital's electronic medical record. The study sample was divided into two groups: those with an unplanned hospital admission within 24 h after surgery and those without an unplanned hospital admission. To evaluate risk factors for unplanned hospital admissions, univariate analyses with p value < 0.05 were utilized to identify significant patient variables related to hospital admissions. These variables were further adjusted using a multivariable Firth logistic regression. Descriptive statistics were used to explore the number of patients in different variable categories. RESULTS: Overall, 53,185 cases were identified for the 7-year period. The incidence of unplanned hospital admission over this period was 0.09% (95% CI 0.07-0.1122%; ranging from 0.05 to 0.12% per year. In the multivariable model, surgery duration (OR 1.010, 95% CI 1.007-1.012, p value < 0.0001), peripheral vascular disease (OR 14.489, 95% CI 4.862-43.174, p value < 0.0001), and deep venous thrombosis (OR 5.527, 95% CI 1.909-16.001, p value = 0.0016) were significantly associated with unplanned hospital admission. CONCLUSION: The overall incidence of unplanned hospital admission after surgery at a large tertiary care ambulatory surgery center is very low. This admission rate can also serve as a reference point for future studies and quality improvement initiatives.

Planned and unplanned hospital admissions and health-related school absence rates in children with neurodisability: Protocol for a population-based study using linked education and hospital data from England.

Background: Neurodisability describes a broad set of conditions affecting the brain and nervous system which result in functional limitations. Children with neurodisability have more hospital admissions than their peers without neurodisability and higher rates of school absence. However, longitudinal evidence comparing rates of hospital admission and school absence in children with neurodisability to peers without neurodisability throughout school is limited, as is understanding about whether differences are greatest for planned care (e.g., scheduled appointments) or unplanned care. This study will describe rates of planned and unplanned hospital admissions and school absence due to illness and medical reasons throughout primary school (Reception to Year 6, ages 4 to 11 in England) for children with neurodisability and all other children, using linked individual-level health and education data. Methods: We will use the ECHILD (Education and Child Insights from Linked Data) database, which links educational and health records across England. We will define a primary school cohort of children who were born in National Health Service-funded hospitals in England between 1 st September 2003 and 31 st August 2008, and who were enrolled in Reception (age 4/5) at state-funded schools. We will use hospital admissions records to identify children who have recorded indicators of neurodisability from birth up to the end of primary school (Year 6, age 10/11). Results: We will describe rates of planned and unplanned hospital admissions and health-related school absence for three groups of children: those with a neurodisability indicator first recorded before beginning primary school, those with neurodisability first recorded during primary school, and those without a record of neurodisability before end of primary school. Conclusions: We will further explore whether differences between these group vary across primary school years and by socioeconomic and demographic characteristics.

Neurodisability encompasses a range of health conditions which affect the brain and nervous system and result in difficulties with everyday activities, including learning. Children with neurodisability are more likely to be admitted to hospital and spend longer periods of time in hospital than children without neurodisability. They are also more likely to be absent from school. Yet, in England, these is a lack of evidence comparing admissions and absence rates in children with and without neurodisability throughout their school years. Evidence is also lacking on whether differences are greatest for planned care (e.g., scheduled appointments) or unplanned care. We will use hospital and education records from state-funded hospitals and schools in England to describe rates of hospital admission and school absences for children with and without neurodisability during their primary school years.

Investigation of non-communicable diseases prevalence, patterns, and patient outcomes in hospitalized populations: a prospective observational study in three tertiary hospitals.

BACKGROUND: Non-communicable diseases (NCDs) pose a significant global health challenge, constituting over 80% of mortality and morbidity. This burden is particularly pronounced in low- and middle-income countries (LMICs), including Ethiopia. Despite this, there's limited research on this issue in Africa. This study aims to investigate the prevalence, patterns, and outcomes of NCDs in hospitalized populations across three tertiary hospitals in Ethiopia. METHODS: A hospital-based cohort study (August 2022 - January 2023) included patients aged 14 and older diagnosed with cardiovascular diseases (CVDs), diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), asthma, or cancer at three Ethiopian hospitals. Data on demographics, socio-economic factors, clinical characteristics, and outcomes were collected through medical records and interviews. Logistic regression identified factors independently associated with in-hospital mortality, with p ≤ 0.05 considered statistically significant. RESULTS: In the study across three tertiary hospitals involving 2,237 patients, we uncovered the impact of NCDs. About 23.4% of patients struggled with NCDs, with cardiovascular diseases (53.3%), cancer (29.6%), diabetes (6.1%), and respiratory diseases (6.5%) being the most prevalent. Notably, among those affected, women comprised a slight majority (55.1%), with the average patient age being 47.2 years. Unfortunately, 15.3% of patients with NCDs faced in-hospital mortality. Our analysis revealed predictors of mortality, including cancer diagnosis (adjusted odds ratio [AOR]:1.6, 95% CI: 1.2-1.8, p = 0.01), medication adherence ( AOR: 0.36, 95% CI: 0.21-0.64, p < 0.001), concurrent infections (AOR: 0.36, 95% CI: 0.16-0.86, p < 0.001), chronic kidney diseases (CKD) (AOR: 0.35, 95% CI: 0.14-0.85, p = 0.02), and complications during hospitalization (AOR: 6.36, 95% CI: 3.45-11.71, p < 0.001). CONCLUSION: Our study reveals a substantial prevalence of NCDs among hospitalized patients, affecting approximately one in four individuals, primarily with CVDs and cancer. Alarmingly, a significant proportion of these patients did not survive their hospitalization, emphasizing the urgent need for targeted interventions to enhance outcomes in this population.

All-cause mortality and hospital admissions for nursing home residents during the COVID-19 pandemic: a Norwegian register-based cohort study.

BACKGROUND: This paper investigates the consequences of the COVID-19 pandemic on mortality and hospitalization among nursing home residents in Norway. While existing evidence shows that nursing home residents were overrepresented among COVID-19-related deaths, suggesting inadequate protection measures, this study argues that the observed overrepresentation in mortality and hospitalization may partly stem from the inherent frailty of this demographic. Using nationwide administrative data, we assessed excess deaths and hospitalization by comparing pandemic-era rates to those of a pre-pandemic cohort. METHODS: We compared mortality and hospitalization rates between a pandemic cohort of nursing home residents as of September 2019 (N = 30,052), and a pre-pandemic cohort as of September 2017 (N = 30,429). Both cohorts were followed monthly for two years, beginning in September 2019 and 2017, respectively. This analysis was conducted at the national level and separately for nursing home residents in areas with low, medium, and high SARS-CoV-2 community transmission. Event studies and difference-in-difference models allowed us to separate the impact of the pandemic on mortality and hospitalization from secular and seasonal changes. RESULTS: The pandemic cohort experienced a non-significant 0.07 percentage points (95% confidence interval (CI): - 0.081 to 0.221) increase in all-cause mortality during the 18 months following pandemic onset, compared to the pre-pandemic cohort. Moreover, our findings indicate a substantial reduction in hospitalizations of 0.27 percentage points (95% CI: - 0.464 to - 0.135) and a non-significant decrease of 0.80 percentage points (95% CI: - 2.529 to 0.929) in the proportion of nursing home residents hospitalized before death. The effect on mortality remained consistent across regions with both high and low levels of SARS-CoV-2 community transmission. CONCLUSIONS: Our findings indicate no clear evidence of excess all-cause mortality in Norway during the pandemic, neither nationally nor in areas with high infection rates. This suggests that early implementation of nationwide and nursing home-specific infection control measures during the pandemic effectively protected nursing home residents. Furthermore, our results revealed a decrease in hospitalizations, both overall and prior to death, suggesting that nursing homes adhered to national guidelines promoting on-site treatment for residents.

Interhospital variability in hospital admissions for patients with low-risk syncope presenting to the emergency department.

Background: Guidelines and risk scores have sought to standardize the management of syncope in the emergency department (ED), but variation in practice remains. Objective: The purpose of this study was to explore factors associated with admission for patients presenting to the ED with low-risk syncope. Methods: Our study population included adult patients in the Nationwide Emergency Department Sample between 2006 and 2019 who presented to an ED with a primary diagnosis of syncope. Multivariable hierarchical logistic regression analyses determined the association of patient or hospital factors with admission. Reference effect measures methodology assessed the relative contributions of patient, hospital, and unmeasured hospital factors. Results: Of the 3,206,739 qualifying encounters during the study period, 804,398 (25.1%) met low-risk criteria. Of these patients, 20,260 were admitted to the hospital (2.5%). Factors associated with increased odds of admission included increasing age and weekend presentation to the hospital, while female sex, lack of medical insurance, hospital region, teaching status, and higher ED volume decile were associated with lower odds of admission. Reference effect measures methodology demonstrated that unmeasured site variability contributed the widest range of odds for admission (odds ratio [OR] 5th percentile vs 95th percentile 0.23-4.38) compared with the composite patient (OR 0.33-3.68) or hospital (OR 0.65-1.30) factors. Conclusion: Admission patterns for low-risk syncope varies widely across institutions. Unmeasured site variation contributes significantly to the variability in admission rates, suggesting which hospital a patient presents to plays a disproportionate role in admission decisions. Further guidance to reduce practice variation in syncope care in the ED is needed.

Pattern of admissions and needs assessment for palliative care services among in-patients in a tertiary health facility in South-Western Nigeria.

BACKGROUND: Palliative care evolution focuses on education and medication accessibility. As little as 12% of palliative care needs are met. Assessment of the domains of Palliative care and patients' and families' experience are essential in life-limiting conditions. The Lagos University Teaching Hospital (LUTH), have the National Cancer Centre without offering palliative care services. AIM: The aim was to examine pattern of admissions and needs assessment for palliative services among patients admitted into LUTH wards. MATERIALS AND METHOD: Responses were entered into a data sheet inputted into Epi info version 7.2. Descriptive characteristics of the participants were presented as frequencies and percentages for age, sex, pattern of disease, domains of Palliative care, Advance care Plan, Preparation for home care, death and Education about the illness and category of medical conditions (palliative and non-palliative conditions). Together for Short Lives (TfSL) tool was used to categorize respondents' conditions into Palliative and Non-palliative conditions. Chi-square test was used to determine association between independent variables (pattern of diagnoses, stage of disease, advanced care plan, preparation for home care/ death and education on illness) and dependent variables (category of medical condition). Chi-square test was also used to explore the association between specialty of the managing doctor (independent variable) and Advance care plan (dependent variable). The level of statistical significance was P-value < 0.05. RESULTS: 80.6% of the respondents had palliative care conditions, 83.7% had family members as their caregiver while 13.2% of the participants had no caregiver and 65.9% had no advance care plan. There was no preparation for home care or death in 72.1%, 70.5% had education about their illness, and 68.2% were in the advanced stage of their disease. Participants attending the surgery non-trauma unit (51.6%) were more likely to have advance care plans. Adults were more likely to have palliative care conditions (79.8%) compared to children (20.2%), and was statistically significant. CONCLUSION: Majority of the participants need palliative care services but are unavailable and unmet and the most predominant condition was cancer. Majority had no advance care plan or preparation for home care or death despite having advanced stage of the disease. This survey emphasized the need for symptom management, communication and provision of support.