Chronic obstructive pulmonary disease (COPD) exacerbation: impact of comorbidities on length and costs during hospitalization.

OBJECTIVE: A retrospective cohort study was performed, using administrative database of the Local Health Unit Roma-A (LHU RM-A). The included subjects were residing in one of the four districts and were hospitalized for COPD exacerbation in healthcare facilities of the LHU during years 2010-2012. PATIENTS AND METHODS: The aim of the present study is to evaluate the impact of comorbidities, length and costs of hospital stay in patients with COPD exacerbations. Chronic obstructive pulmonary disease (COPD) is often associated with other diseases (cardiovascular diseases, diabetes, metabolic syndrome, chronic renal failure, depression) that can increase risk of mortality and hospitalization. RESULTS: A total of 1890 COPD patients are included in the study. The mean length of hospitalization is 12.25 days (SD ± 10.91), 11.63 days (SD ± 9.76) and 11.91 days (SD ± 9.69) with a mean cost of hospitalization amounting to euro 3683.48 (SD ± 2037.12), 3356.82 (SD ± 1674.86) and 3706.81 (SD ± 2087.72) in 2010, 2011 and 2012 respectively. The presence and number of comorbidities are positively and significantly associated to the length and cost of hospitalization. In particular, patients with cardiovascular diseases or diabetes mellitus associated with other comorbidities present the highest values of hospital stay and cost. The cost and the length of hospitalization were significantly linked to the number of comorbidities. CONCLUSIONS: Comorbidities play an important role in the hospital management of COPD exacerbation, increasing health care costs related to this disease.

[Anemias in preschool children: diagnosis, treatment and evaluation, Recife-PE, Brazil]. / Anemias em pre-escolares: diagnostico, tratamento e avaliação Recife-PE, Brasil.

The diagnosis and the effects of treatment of anemia were assessed in children aged 6-71 months. A total of 1,161 preschool children from a health center of INAMPS (Instituto Nacional de Assistência Médica e Previdência Social) in Recife, Pernambuco, was studied. Hemoglobin was determined by the method described by Hainline. WHO criteria were used to identify anemia. According to their age, nutritional status and family income, the children were divided into groups, and those with anemia were treated with ferrous sulphate and an anti-helminthic (mebendazole). Anemia prevalence was substantially higher in children aged 2 years, and a statistically significant association (0.01 level) was found between anemia and nutritional status and family income. After treatment, hemoglobin values were normal in 40% of the anemic children; simultaneously, mean hemoglobin values increased from 9.11 to 10.3 g/dl which was statistically significant (p less than 0.001). This investigation is part of a collaborative study performed in four Brazilian states to offer "know-how" to a national program for combating iron deficiency anemia.

[Nutritional status of children under 6, according to land tenure, in rural areas of the State of Pernambuco, Northeast of Brazil]. / Estado nutricional de crianças menores de seis anos, segundo posse da terra, em áreas rurais do Estado de Pernambuco, Nordeste do Brasil.

The purpose of this investigation was to analyze the distribution of protein-energy malnutrition, anemia and hypovitaminosis A in relation to accessibility and size of rural lands. About 689 families from the Agreste rural area (Pernambuco, North-East Brazil) were studied. A total of 1,257 children under 6 years of age were distributed in four groups according to the size of the land. The nutritional status was assessed according to the criteria of Gómez, Ariza-Macías and Seoane-Latham, modified by Batista Filho. In accordance with the Gómez' method, 55.1% of the children suffered from some degree of malnutrition. About 67.0% of the landless families suffered from malnutrition, in contrast to 25% of the landowners who had 50 or more than 50 hectares of land (p less than 0.01). Hemoglobin was determined in 976 children; 38.9% of them suffered from anemia. No significant differences were detected among the several groups of land tenants. Serum retinol levels were measured in 412 children and a high incidence of hypovitaminosis A was detected: 24% had serum retinol levels below 20 mcg/100 ml. No significant association was found in relation to the different land tenure groups. These data demonstrate a high prevalence of protein-energy malnutrition, anemia and hypovitaminosis A. A significant correlation between protein-energy malnutrition and the size of the land was also found, demonstrating that this region is one of the most affected by food and nutritional problems.