Association between socioeconomic status and hospitalisation requirement in older patients attended at the emergency department: A retrospective cohort study.

INTRODUCTION AND OBJECTIVE: A low socioeconomic status (SES) has been associated with poor health results. The present study aimed to investigate if SES of older patients attending the emergency department is associated with the use of healthcare resources and outcomes. PATIENTS AND METHODS: Observational, retrospective study including consecutive patients 65 years or older admitted to the emergency department. Variables at baseline, index episode, and follow-up were recorded. SES was measured using an indirect theoretical index and patients were categorised into two groups according to whether they lived in a neighbourhood with a low or high SES. Primary outcomes included hospitalisation after the emergency department visit and prolonged hospitalisation (>7 days) at index episode. Secondary outcomes included emergency department re-consultant and hospital admission in the following 3 months after the index episode, and all-cause mortality after long-term follow-up. Logistic regression and cumulative hazards regression models were used to investigate associations between SES and outcomes. RESULTS: The cohort included 553 patients (80 years [73-85], 50.5% female, 55.9% with low SES). After the emergency department visit, 234 patients (42.3%) required hospital admission. A low SES was inversely associated with hospitalisation with an adjusted odds ratio=0.654 (95% CI 0.441-0.970). Among hospitalised patients, a low SES was associated with prolonged hospitalisation (adjusted odds ratio=2.739; 95% CI 1.470-5.104). Follow-up outcomes, including all-cause mortality, were not associated with SES. CONCLUSIONS: Older patients living in more deprived urban areas were hospitalised less often after emergency department care, but hospital stays were longer. Understanding the effect of social determinants in healthcare use is mandatory to tailor resources to patient needs.

Feeding strategies for rearing replacement heifers in small-scale dairy production systems in the highlands of Central Mexico.

The growth of Holstein heifers in the campesino dairy systems in the highlands of Mexico was evaluated in three feeding strategies. Thirty-three heifers from 11 farmers, grouped according to strategy, were weighed every 14 days for 28 weeks. The live weight change over each 14-day period was estimated by individually regressing live weight over period, taking the regression coefficient as an unbiased estimate of live weight change. Regression coefficients were analysed as a randomized design with feeding strategies as treatments. Strategies were as follows: S1: grazed or cut pasture all year, maize silage and maize straw in the dry season, and 1.0-1.5 kg concentrate/heifer per day. S2: maize straw in the dry season, cut pasture forage, grazing of native grass, weeds from maize fields, and 1.0-1.5 kg concentrate/heifer per day. S3: maize straw in the dry season, grazed native grasses and weeds in the rainy season. Live weight gains were: S1, 0.511 kg/heifer per day; S2, 0.271 kg/heifer per day; and S3, 0.252 kg/heifer per day. Despite the better gains in S1, they are 24% below recommendations, arriving to service at 20 months of age. Not rearing their replacements may be a better alternative for campesino farmers under current economic conditions.