Hospital Outcomes in Antepartum Mental Disorders: A Study on 897,397 Pregnant Inpatients.

OBJECTIVE: To evaluate the impact of antepartum mental disorders (AMD) in medical and psychiatric comorbidities, and inpatient outcomes during hospitalizations for pregnancy/birth-related complications. METHODS: We used the national inpatient sample (NIS) data and included 19,170,562 female patients (age, 12-40 years) with a principal diagnosis of pregnancy/birth-related complications and grouped by co-diagnoses of AMD (N = 897,397). We used a binomial logistic regression model to evaluate the odds ratio (OR) for major severity of illness and adjusted for demographic confounders. RESULTS: The hospitalizations with AMD increased by 22.1% (p < 0.001) from 2010 to 2014. White females (66.1%) and those from low-income families (<25th percentile, 31.8%) majorly had comorbid AMD. Depression (43.8%) and drug abuse (27%) were prevalent psychiatric disorders in AMD inpatients. Comorbid AMD inpatients had a higher likelihood for major severity of illness (OR 2.475, 95% CI 2.459-2.491, p < 0.001). They also had a longer hospitalization stay with a mean difference of 0.486 days (95% CI 0.480-0.491) and higher total charges by $1889.420 per admission (95% CI 1852.670-1926.170) than non-AMD inpatients. CONCLUSIONS: AMD is associated with worsening of severity of illness in pregnancy/birth-related complications and require acute inpatient care. Mental health assessment and treatment of AMD, and education about efficacy and safety of psychiatric medications may help to improve outcomes in these patients.

Burden of Persistent Vomiting With Cannabis Use Disorder: Report From 55,549 Hospitalizations in the United States.

BACKGROUND: With increase in incidence rate of persistent vomiting (PV) in the post-legalization period it is important to understand adverse effects of cannabis use and its relationship with PV. OBJECTIVE: We investigated the relationship between cannabis use disorder (CUD) and PV-related hospitalization. METHODS: A Nationwide Inpatient Sample was analyzed from 2010 to 2014 for patients (aged 15-54 y) with a primary diagnosis of PV (N = 55,549), and a comparison was made between patients with the International Classification of Diseases, Ninth Edition classification of CUD versus non-CUD cohorts. We used logistic regression to study the odds ratio between CUD and PV. RESULTS: The number of PV-related hospitalizations with CUD had a significantly increased trend (P < 0.001), with a 286% increase over 5 years. A higher proportion of these patients with CUD were younger (15-24 y), female, and African American/Hispanic. In regression analysis, cannabis was associated with a seven-fold higher odds (95% confidence interval: 6.931-7.260) of PV-related hospitalization. CONCLUSIONS: This study found that CUD was independently associated with a 609% increased likelihood of PV-related hospitalization, and this association persisted even after adjusting for known risk factors and other substances.

Heroin Overdose-Related Child and Adolescent Hospitalizations: Insight on Comorbid Psychiatric and Substance Use Disorders.

OBJECTIVE: To evaluate the association between psychiatric comorbidities, substance use disorders and heroin overdose-related hospitalizations (HOD). Next, to understand the demographic trend of HOD hospitalizations and comorbidities. METHODS: Using the Nationwide Inpatient Sample (NIS), we included 27,442,808 child and adolescent hospitalizations, and 1432 inpatients (0.005%) were managed primarily for HOD. The odds ratio (OR) of the association of variables in HOD inpatients were measured using a logistic regression model. RESULTS: Adolescents had 56 times higher odds (95% CI 43.36-73.30) for HOD-related hospitalizations compared to 4.6% children under 11 years. About three-fifth of the HOD inpatients were male, and they had 1.5-fold higher odds (95% CI 1.30-1.64) compared to 43% females in the study population. Whites were considerably higher in proportion (81%) than other race/ethnicities. A greater portion of HOD inpatients (40%) were from high-income families. Most common comorbid psychiatric disorders were mood (43.8%) and anxiety (20.4%). The prevalent comorbid substance use disorders were opioid (62.4%), tobacco (36.8%) and cannabis (28.5%) use disorders. CONCLUSION: HOD-related hospitalizations were predominant in males, White and older adolescents (12-18 years). Prescription opioids are the bridge to heroin abuse, thereby increasing the vulnerability to other substance abuse. This requires more surveillance and should be explored to help reduce the heroin epidemic in children.

Conduct Disorder-Related Hospitalization and Substance Use Disorders in American Teens.

OBJECTIVE: Our study aimed to compare the demographic characteristics of conduct disorder (CD) inpatients versus other psychiatric inpatients in children and adolescents, and assess the association between conduct disorder patients and the spectrum of substance use disorders (SUD). METHODS: We included 800,614 psychiatric adolescent (12-18 years) inpatients, and this included 8885 inpatients (1.1%) primarily for conduct disorder in the Nationwide Inpatient Sample (2010-2014). ICD-9 codes were used to detect SUD, and a logistic regression model was used to evaluate the odds ratio (OR) for SUD in conduct disorder inpatients. RESULTS: A higher proportion of conduct disorder inpatients were of 12-15 years of age (62.6%), male (64.4%), and White (45.7%). The lower median household income was correlated with a higher prevalence of conduct disorder (36.4%). Among SUD, cannabis use (23.7%) was most prevalent in conduct disorder inpatients followed by tobacco and alcohol use (10.1% each). Conduct disorder inpatients have 1.7-fold higher odds (95% confidence interval (CI) 1.52-1.82) for alcohol use and 1.4-fold higher odds (95% CI 1.31-1.49) for cannabis use compared to the non-conduct disorder inpatients. Cannabis use was seen significantly in adolescents (49.1%, 12-15 years), male (75.6%), and African Americans (45.6%). CONCLUSION: Conduct disorder inpatients have a higher risk of comorbid SUD compared to other psychiatric illnesses. The most common substance to be abused is cannabis followed by tobacco and alcohol. Varying pattern of substance use was seen by demographics and these predictors may help the clinicians for early diagnosis and treatment to improve overall health-related quality of life.

Enterotoxigenicity screening of viable environmental Vibrio cholerae strains from rainwater pools in a university campus in Chennai, South India.

BACKGROUND: Vibrio spp., being primarily inhabitants of the aquatic environment, pose a severe health threat to humans. This problem is escalated in developing countries where water-logging after rainfall is very common. Therefore, screening of environmental water samples for the presence of clinically important species of Vibrio becomes essential. METHODS: This study was conducted for a period of 1 y. Water samples were collected every month from 4 locations where water pools formed after rains, on the campus of a university in Chennai, South India. The water samples were monitored for Vibrio species, and characterized isolates were screened for enterotoxigenicity. RESULTS: Thirty isolates of Vibrio cholerae belonging to a variety of serogroups and 11 strains of Vibrio species other than cholerae were isolated from the rainwater pools. On polymerase chain reaction (PCR) screening, while all the strains were positive for the ompW gene, none tested positive for the ctxA gene. CONCLUSIONS: Though all the environmental isolates of V. cholerae were non-epidemic, 4 isolates demonstrated enterotoxigenicity by rabbit ileal loop method and antibiotic resistance to drugs. This is of concern and underscores the importance of screening environmental specimens and improving civic infrastructure to prevent prolonged water-logging in developing countries.