Hospitalizations in older adults from the Zona da Mata of Minas Gerais, Brazil: data from the Unified Health System, 2016­2018

Introduction: The growing older population increases proportionately the demand for hospital care due to the increase in health problems. Objective: To estimate the prevalence and incidence of hospitalizations, and to investigate associated factors in older adults from the Zona da Mata of Minas Gerais, Brazil, between 2016-2018. Secondly, to provide a more comprehensive epidemiological overview of hospitalizations, the following were estimated: monthly hospitalization rate; hospital mortality rate; frequency of hospitalizations according to diagnosis, hospitalizations for conditions sensitive to primary care and in-hospital death; and hospital costs. Methods: This is an ecological and descriptive-analytic study. Data were obtained from the Brazilian Hospital Information System (SIH/SUS). Results: The prevalence of hospitalizations was 35.1% (31.2% in women and 39.7% in men). The monthly rate of hospitalizations was higher in older men when compared with older women (Rate-Ratio=1.35 [95% CI=1.27-1.43]) and adult men between 40­59 years (Rate Ratio=2.42 [95% CI=2.26-2.58]). The cumulative incidence of hospitalization was 144/1,000 older persons (125/1,000 women and 169/1,000 men). Factors significantly associated with hospitalizations were: male sex (PR=1.52 [95% CI=1.11-2.08]); hospitalization in surgical bed (PR=1.93 [95% CI=1.05-3.56]); absence of death (PR=1.94 [95% CI=1.03-3.65]); and hospital stay ≥15 days (PR=0.71 [95% CI=0.54 0.95]). The cost of hospitalizations was R$ 220,8 million (mean of R$ 201,700/day). Conclusion: The findings strengthen the need for preventive healthcare for the older population living in the Zona da Mata of Minas Gerais and alert managers to the substantial socioeconomic impact of hospitalizations.

Long-term disability after cerebral ischemic stroke following a Bothrops atrox snakebite in the Brazilian Amazon.

Bothrops atrox envenomations in the Brazilian Amazon are responsible for a number of local and systemic effects. Among these, stroke presents the worst prognosis for the patient since it may evolve into disabilities and/or premature death. This complication is caused by coagulation disorders and generates hemorrhagic and thrombotic conditions. This study presents a case report of a 54-year-old female patient who presented extensive cerebral ischemia after a B. atrox envenomation that occurred in the state of Amazonas, Brazil. The patient was hospitalized for 102 days, which included a stay in the intensive care unit. Clinical and laboratory findings indicated a thrombogenic coagulopathy. On discharge, the patient had no verbal response, partial motor response, and right hemiplegia. The assessment carried out four years after discharge evidenced incapacitation (bedridden)global aphasia and bilateral lower and upper limbs showed hypotrophy with a global decrease in strength. Ischemic stroke is a possible complication of B. atrox snakebites even after antivenom treatment, with the potential to cause debilitating long-term consequences.

Identification of Patterns of Hospitalizations in Child and Adolescent Mental Health Service.

Adolescence is a time of increased vulnerability to mental health conditions, which may necessitate hospitalization. This study sought to identify and characterize patterns of adolescent (re-)hospitalizations. The one-year (re-)hospitalization patterns of 233 adolescents were analyzed. The sequences of hospitalization and discharge was examined using cluster analyses. Results revealed five distinct (re-)hospitalization patterns or clusters: Cluster A represented brief hospitalizations with 56 cases (24.03%) averaging 7.71 days; cluster B consisted of repetitive short hospitalizations involving 97 cases (41.63%) with an average of 19.90 days; cluster C encompassed repetitive medium hospitalizations included 66 cases (28.33%) averaging 41.33 days; cluster D included long hospitalizations with 11 cases (4.72%) and an average of 99.36 days; cluster E depicted chronic hospitalizations, accounting for 3 cases (1.29%) with an average stay of 138.67 days. Despite no age-based differences across clusters, distinctions were noted in terms of sex, diagnoses, and severity of clinical and psychosocial difficulties. The study identified characteristics of both regular and atypical adolescent hospitalization users, emphasizing the distribution of hospitalization days and their associated clinical attributes. Such insights are pivotal for enhancing the organization of child and adolescent mental health services to cater to the growing care requirements of this age group.

Characteristics and treatment outcomes of malnutrition among infants aged less than 6 months in North-East Nigeria (2019-2022).

Recommendations for the management of malnutrition among infants aged less than 6 months (<6 m) are based on limited evidence. This study aimed to describe the characteristics, treatment outcomes and outcome-associated factors among malnourished infants <6 m admitted at Médecins Sans Frontières (MSF) inpatient and ambulatory therapeutic feeding centres (ITFC and ATFC) in North-East Nigeria, 2019-2022. We conducted a descriptive analysis of the cohorts and logistic regression to measure the association between two selected outcomes-inpatient mortality and defaulting from the ambulatory programme-and possible factors associated. In total, 940 infants <6 m were admitted at ITFC. Most of them presented severe acute malnutrition and comorbidities, with diarrhoea being the most frequent. On discharge, 13.3% (n = 125) of infants were cured, 72.9% (n = 684) stabilized (referred to ATFC), 6.5% (n = 61) left against medical advice and 4.2% (n = 39) died. The median length of hospital stay was 10 days [IQR 7-14]. A hospital stay shorter than 10 days was significantly associated with inpatient mortality (aOR = 12.51, 95% confidence interval [CI] = 3.72-42.11, p ≤ 0.01). Among 561 infants followed up at the ATFC, only 2.8% reported comorbidities. On discharge, 80.9% (n = 429) were cured, 16.2% (n = 86) defaulted and 1.1% (n = 6) died. Male sex (aOR = 1.94, 95% CI = 1.15-3.27, p = 0.01), internally displaced status (aOR = 1.70, 95% CI = 1.05-2.79, p = 0.03) and <-3 WLZ (aOR = 1.95, 95% CI = 1.05-3.63, p = 0.03) were significantly associated with programme defaulting. Stabilization and recovery rates among malnourished infants <6 m in the studied project align with acceptable standards in this humanitarian setting. Notable defaulting rates from outpatient care should be further explored.

Cardiovascular Outcomes of Sodium-Glucose Cotransporter-2 Inhibitors Therapy in Patients with Type 2 Diabetes Mellitus and Chronic Kidney Disease: A Systematic Review and Updated Meta-Analysis.

BACKGROUND AND OBJECTIVES: The efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) may depend on renal function, and this raises theoretical concern over its effects on cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). METHODS: This systematic review and updated meta-analysis of randomized controlled trials (RCTs) compared cardiovascular outcomes of patients with T2DM and CKD treated with SGLT2i to placebo. PubMed, Embase, and Cochrane were systematically searched. Prespecified subgroup analyses were performed in strata of estimated glomerular filtration rate (eGFR) of <45 mL/min/1.73 m² and 45 to 59 mL/min/1.73 m². RESULTS: Nine RCTs comprising 29,146 patients were selected. Average follow-up ranged from 0.75 to 4.2 years. SGLT2i were shown to reduce the risk of all-cause mortality (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.79-0.97; p=0.01), the composite of cardiovascular mortality or hospitalizations for heart failure (HHF: HR, 0.71; 95% CI, 0.65-0.78; p<0.001), cardiovascular mortality (HR, 0.86; 95% CI, 0.76-0.98; p=0.02), HHF (HR, 0.62; 95% CI, 0.55-0.71; p<0.001), major adverse cardiovascular events (HR, 0.85; 95% CI, 0.77-0.94; p=0.002), stroke (HR, 0.76; 95% CI, 0.59-0.97; p=0.03), and myocardial infarction (HR, 0.78; 95% CI, 0.67-0.91; p=0.001). These findings were consistent over strata of eGFR, albeit with a lower incidence of stroke in patients treated with SGLT2i with eGFR <45 mL/min/1.73 m² (p-value for interaction=0.04). CONCLUSIONS: Compared with a placebo, patients with T2DM and CKD treated with SGLT2i experience a reduction in all-cause mortality, cardiovascular mortality, and HHF. TRIAL REGISTRATION: PROSPERO Identifier: CRD42023401081.

Factors affecting 12-month unplanned readmissions for chronic obstructive pulmonary disease patients: the effect of mental disorders in an Australian cohort.

BACKGROUND: Many individuals with chronic obstructive pulmonary disease (COPD) experience frequent hospitalization and readmissions, which is burdensome on the health system. This study aims to investigate factors associated with unplanned readmissions and mortality following a COPD-related hospitalization over a 12-month period in Australia, focusing on mental disorders and accounting for the acute phase of the COVID-19 pandemic. METHODS: A retrospective cohort study using linked hospitalization and mortality records identified individuals aged ≥40 years who had at least one hospital admission with a principal diagnosis of COPD between 2014 and 2020 in New South Wales, Australia. A semi-competing risk analysis was conducted to examine factors associated with unplanned readmission and mortality. RESULTS: Adults with a mental disorder diagnosis, specifically anxiety, had a higher risk of 12-month unplanned readmission. Individuals with anxiety and dementia also had a higher risk of mortality pre- and post-unplanned readmission. Individuals who were admitted during the acute phase of the COVID-19 pandemic period had lower risk of unplanned readmission, but higher risk of mortality without unplanned readmission. CONCLUSION: Interventions aimed at reducing admissions should consider adults living with mental disorders such as anxiety or dementia to improve healthcare delivery and health outcomes for individuals living with COPD.

Health Care System Overstretch and In-Hospital Mortality of Intubated Patients With COVID-19 in Greece From September 2020 to April 2022: Updated Retrospective Cohort Study.

Background: Our previous analysis showed how in-hospital mortality of intubated patients with COVID-19 in Greece is adversely affected by patient load and regional disparities. Objective: We aimed to update this analysis to include the large Delta and Omicron waves that affected Greece during 2021-2022, while also considering the effect of vaccination on in-hospital mortality. Methods: Anonymized surveillance data were analyzed from all patients with COVID-19 in Greece intubated between September 1, 2020, and April 4, 2022, and followed up until May 17, 2022. Time-split Poisson regression was used to estimate the hazard of dying as a function of fixed and time-varying covariates: the daily total count of intubated patients with COVID-19 in Greece, age, sex, COVID-19 vaccination status, region of the hospital (Attica, Thessaloniki, or rest of Greece), being in an intensive care unit, and an indicator for the period from September 1, 2021. Results: A total of 14,011 intubated patients with COVID-19 were analyzed, of whom 10,466 (74.7%) died. Mortality was significantly higher with a load of 400-499 intubated patients, with an adjusted hazard ratio (HR) of 1.22 (95% CI 1.09-1.38), rising progressively up to 1.48 (95% CI 1.31-1.69) for a load of ≥800 patients. Hospitalization away from the Attica region was also independently associated with increased mortality (Thessaloniki: HR 1.22, 95% CI 1.13-1.32; rest of Greece: HR 1.64, 95% CI 1.54-1.75), as was hospitalization after September 1, 2021 (HR 1.21, 95% CI 1.09-1.36). COVID-19 vaccination did not affect the mortality of these already severely ill patients, the majority of whom (11,944/14,011, 85.2%) were unvaccinated. Conclusions: Our results confirm that in-hospital mortality of severely ill patients with COVID-19 is adversely affected by high patient load and regional disparities, and point to a further significant deterioration after September 1, 2021, especially away from Attica and Thessaloniki. This highlights the need for urgent strengthening of health care services in Greece, ensuring equitable and high-quality care for all.

Morbidity and trends in length of hospitalisation of very and extremely preterm infants born between 2008 and 2021 in the Netherlands: a cohort study.

OBJECTIVES: This study investigated changes in the length of stay (LoS) at a level III/IV neonatal intensive care unit (NICU) and level II neonatology departments until discharge home for very preterm infants and identified factors influencing these trends. DESIGN: Retrospective cohort study based on data recorded in the Netherlands Perinatal Registry between 2008 and 2021. SETTING: A single level III/IV NICU and multiple level II neonatology departments in the Netherlands. PARTICIPANTS: NICU-admitted infants (n=2646) with a gestational age (GA) <32 weeks. MAIN OUTCOME MEASURES: LoS at the NICU and overall LoS until discharge home. RESULTS: The results showed an increase of 5.1 days (95% CI 2.2 to 8, p<0.001) in overall LoS in period 3 after accounting for confounding variables. This increase was primarily driven by extended LoS at level II hospitals, while LoS at the NICU remained stable. The study also indicated a strong association between severe complications of preterm birth and LoS. Treatment of infants with a lower GA and more (severe) complications (such as severe retinopathy of prematurity) during the more recent periods may have increased LoS. CONCLUSION: The findings of this study highlight the increasing overall LoS for very preterm infants. LoS of very preterm infants is presumably influenced by the occurrence of complications of preterm birth, which are more frequent in infants at a lower gestational age.

Examining the impact of substance use on hospital length of stay in schizophrenia spectrum disorder: a retrospective analysis.

BACKGROUND: Among patients diagnosed with schizophrenia, the presence of substance use poses an aggravating comorbidity, exerting a negative impact on the course of the disease, adherence to therapeutic regimens, treatment outcomes, duration of hospital stays, and the frequency of hospitalizations. The primary objective of the present study is to investigate the relationship between comorbid substance use disorders, antipsychotic treatment, and the length of stay in individuals hospitalized for treatment of schizophrenia. METHODS: We conducted a retrospective analysis of electronic health records spanning a 12-month period, specifically focusing on adult patients diagnosed with schizophrenia who were discharged from the University Hospital of Psychiatry Zurich between January and December 2019. We documented the number and types of diagnosed substance use disorder, the antipsychotic treatment, the length of stay, and the number of previous hospitalizations for each patient. RESULTS: Over a third (n = 328; 37.1%) of patients with schizophrenia had comorbid substance use with cannabis being the most frequent consumed substance. Patients with substance use (either single or multiple) were more frequently hospitalized; those with multiple substance use more frequently than those with a single substance use (F(2, 882) = 69.06; p < 0.001). There were no differences regarding the rate of compulsory admission. Patients with no substance use had a lower HoNOS score at discharge (F(2, 882) = 4.06). Patients with multiple substance use had a shorter length of stay (F(2, 882) = 9.22; p < 0.001), even after adjusting for duration of illness, previous hospitalizations, diagnosis, and antipsychotic treatment. CONCLUSIONS: In patients with schizophrenia, comorbid single or multiple substance use has a relevant negative impact on treatment and thus on the course of disease. Substance use in patients with schizophrenia should therefore receive special attention in order to reduce re-hospitalization rates and improve the clinical outcome.

High-risk subgroups were not identified to benefit from thromboprophylaxis after hospitalization for COVID-19.

Background: The Accelerating COVID-19 Therapeutic Interventions and Vaccines-4c (ACTIV-4c) trial investigated prophylactic apixaban for 30 days following hospitalization for COVID-19. The overall incidence of early postdischarge death or thromboembolism was low, and the trial was closed early. Objectives: To identify a high-risk patient population who might benefit from postdischarge thromboprophylaxis through subgroup analyses stratified by age, race/ethnicity, obesity, D-dimer elevation, World Health Organization score, and modified International Medical Prevention Registry on Venous Thromboembolism score on 30-day composite outcome of all-cause death, arterial thromboembolism (ATE), and venous thromboembolism (VTE). Methods: Cumulative incidences of all-cause death, ATE, and VTE within 30 days were described for each subgroup. Time to death, ATE, or VTE by 30 days was analyzed using Cox proportional hazard models with interaction testing for each subgroup. Results: Among 1217 patients randomized to apixaban or placebo group, 32% were >60 years old. Modified International Medical Prevention Registry on Venous Thromboembolism score was ≥4 in 2% and 2 or 3 with an elevated D-dimer in an additional 9% of participants. The overall incidence of the primary endpoint was 2.13% in the apixaban group and 2.31% in the placebo group. At day 30, similar rates of the primary endpoint occurred within subgroups, except for participants aged >60 years. No benefit of thromboprophylaxis was seen in any subgroup. Conclusion: The combined incidence of 30-day death, ATE, and VTE was low in patients who survived COVID-19 hospitalization, except in patients over age 60 years. Due to the limited number of events, the findings remain inconclusive; nonetheless, the study did not identify a high-risk subgroup that would derive benefits from extended thromboprophylaxis.

Association of Glomerular Filtration Rate Decline With Clinical Outcomes in a Population With Type 2 Diabetes.

Background: While historical rate of decline in kidney function is informally used by clinicians to estimate risk of future adverse clinical outcomes especially kidney failure, in people with type 2 diabetes the epidemiology and independent association of historical eGFR slope on risk is not well described. Objective: Determine the association of eGFR slope and risk of clinically important outcomes. Design Setting and Patients: Observational population-based cohort with type 2 diabetes in Alberta. Measurement and Methods: An Alberta population-based cohort with type 2 diabetes was assembled, characterized, and observed over 1 year (2018) for clinical outcomes of ESKD, first myocardial infarction, first stroke, heart failure, and disease-specific and all-cause hospitalization and mortality. Kidney function was defined using KDIGO criteria using the most recent eGFR and albuminuria measured in the preceding 18 months; annual eGFR slope utilized measurements in the 3 years prior and was parameterized using three methods (percentiles, and linear term with and without missingness indicator). Demographics, laboratory results, medications, and comorbid conditions using validated definitions were described. In addition to descriptive analysis, odds ratios from fully adjusted logistic models regressing outcomes on eGFR slope are reported; the marginal risk of clinical outcomes was also determined. Results: Among 336 376 participants with type 2 diabetes, the median annual eGFR slope was -0.41 mL/min/1.73 m2 (IQR -1.67, 0.62). In fully adjusted models, eGFR slope was independently associated with many adverse clinical outcomes; among those with ≤10th percentile of slope (median -4.71 mL/min/1.73 m2) the OR of kidney failure was 2.22 (95% CI 1.75, 2.82), new stroke 1.23 (1.08, 1.40), heart failure 1.42 (1.27, 1.59), MI 0.98 (0.77, 1.23) all-cause hospitalization 1.31 (1.26, 1.36) and all-cause mortality 1.56 (1.44, 1.68). For every -1 mL/min/1.73 m2 in eGFR slope, the OR of outcomes ranged from 1.01 (0.98, 1.05 for new MI) to 1.09 (1.08, 1.10 for all-cause mortality); findings were significant for 10 of the 13 outcomes considered. Limitations: Causality cannot be established with this study design. Conclusions: These findings support consideration of the rate of eGFR decline in risk stratification and may inform clinicians and policymakers to optimize treatment and inform health care system planning.

Contexte: Bien que les antécédents de déclin de la fonction rénale soient utilisés de manière informelle par les cliniciens pour estimer le risque d'issues cliniques défavorables ­ particulièrement l'insuffisance rénale terminale (IRT) ­ chez les diabétiques de type 2, l'épidémiologie de la pente du DFGe et son association indépendante sur ce risque demeurent mal décrites. Objectif: Examiner l'association entre la pente du DFGe et le risque de résultats d'importance clinique. Sujets et conception de l'étude: Étude de cohorte observationnelle basée sur une population d'Albertains atteints de diabète de type 2. Méthodologie et mesures: Nous avons constitué, caractérisé et observé une cohorte d'Albertains atteints de diabète de type 2 sur une période d'un an (2018) pour les résultats cliniques suivants: IRT, premier infarctus du myocarde (IM), premier AVC, insuffisance cardiaque, ainsi que les hospitalisations et la mortalité liées à la maladie et à toutes causes confondues. La fonction rénale a été définie selon les critères KDIGO à partir des plus récentes valeurs de DFGe et d'albuminurie mesurées dans les 18 mois précédents. La pente annuelle du DFGe a été calculée à partir des mesures effectuées au cours des trois années précédentes et paramétrée selon trois méthodes (percentiles, termes linéaires avec et sans indications de données manquantes). Les données démographiques, les résultats de laboratoire, les médicaments et les comorbidités ont été décrits selon les définitions validées. En plus de l'analyze descriptive, des rapports de cotes (RC) pour les résultats liés au déclin du DFGe ont été établis à l'aide de modèles de régression logistique entièrement ajustés; le risque marginal des résultats cliniques d'intérêt a également été déterminé. Résultats: Parmi les 336 376 diabétiques de type 2 participants, la pente annuelle médiane du DFGe s'établissait à −0,41 ml/min/1,73 m2 (ÉIQ: −1,67 à 0,62). Dans les modèles ajustés, la pente du DFGe a été associée de façon indépendante à plusieurs issues cliniques défavorables. Parmi ceux qui présentaient une pente du DFGe ≤10e percentile (médiane: −4,71 ml/min/1,73 m2), le RC était de 2,22 (IC 95 %: 1,75 à 2,82) pour l'insuffisance rénale; de 1,23 (1,08 à 1,40) pour les nouveaux AVC; de 1,42 (1,27 à 1,59) pour l'insuffisance cardiaque; de 0,98 (0,77 à 1,23) pour les nouveaux IM; de 1,31 (1,26 à 1,36) pour les hospitalisations toutes causes confondues et de 1,56 (1,44 à 1,68) pour la mortalité toutes causes confondues. Pour chaque tranche de - 1 ml/min/1,73 m2 de la pente du DFGe, le RC des résultats cliniques variait de 1,01 (0,98 à 1,05) pour les nouveaux IM à 1,09 (1,08 à 1,10) pour la mortalité toutes causes confondues; les résultats étaient significatifs pour 10 des 13 résultats examinés. Limites: La causalité ne peut pas être établie avec ce plan d'étude. Conclusion: Ces résultats plaident en faveur de la prise en compte du taux de déclin du DFGe dans la stratification du risque. Ils peuvent également aider les cliniciens et les décideurs à optimiser le traitement et à planifier les systèmes de soins de santé.

Measuring the impact of maternal critical care admission on short- and longer-term maternal and birth outcomes.

PURPOSE: Factors increasing the risk of maternal critical illness are rising in prevalence in maternity populations. Studies of general critical care populations highlight that severe illness is associated with longer-term physical and psychological morbidity. We aimed to compare short- and longer-term outcomes between women who required critical care admission during pregnancy/puerperium and those who did not. METHODS: This is a cohort study including all women delivering in Scottish hospitals between 01/01/2005 and 31/12/2018, using national healthcare databases. The primary exposure was intensive care unit (ICU) admission, while secondary exposures included high dependency unit admission. Outcomes included hospital readmission (1-year post-hospital discharge, 1-year mortality, psychiatric hospital admission, stillbirth, and neonatal critical care admission). Multivariable Cox and logistic regression were used to report hazard ratios (HR) and odds ratios (OR) of association between ICU admission and outcomes. RESULTS: Of 762,918 deliveries, 1449 (0.18%) women were admitted to ICU, most commonly due to post-partum hemorrhage (225, 15.5%) followed by eclampsia/pre-eclampsia (133, 9.2%). Over-half (53.8%) required mechanical ventilation. One-year hospital readmission was more frequent in women admitted to ICU compared with non-ICU populations [24.5% (n = 299) vs 8.9% (n = 68,029)]. This association persisted after confounder adjustment (HR 1.93, 95% confidence interval [CI] 1.33, 2.81, p < 0.001). Furthermore, maternal ICU admission was associated with increased 1-year mortality (HR 40.06, 95% CI 24.04, 66.76, p < 0.001), stillbirth (OR 12.31, 95% CI 7.95,19.08, p < 0.001) and neonatal critical care admission (OR 6.99, 95% CI 5.64,8.67, p < 0.001) after confounder adjustment. CONCLUSION: Critical care admission increases the risk of adverse short-term and long-term maternal, pregnancy and neonatal outcomes. Optimizing long-term post-partum care may benefit maternal critical illness survivors.

The Hospital Burden of Flu in Italy: a retrospective study on administrative data from season 2014-2015 to 2018-2019.

BACKGROUND: Every year in Italy, influenza affects about 4 million people. Almost 5% of them are hospitalised. During peak illness, enormous pressure is placed on healthcare and economic systems. This study aims to quantify the clinical and economic burden of severe influenza during 5 epidemic seasons (2014-2019) from administrative claims data. METHODS: Patients hospitalized with a diagnosis of influenza between October 2014, and April 2019, were analyzed. Clinical characteristics and administrative information were retrieved from health-related Administrative Databases (ADs) of 4 Italian Local Health Units (LHUs). The date of first admission was set as the Index Date (ID). A follow-up period of six months after ID was considered to account for complications and re-hospitalizations, while a lookback period (2 years before ID) was set to assess the prevalence of underlying comorbidities. RESULTS: Out of 2,333 patients with severe influenza, 44.1% were adults ≥ 65, and 25.6% young individuals aged 0-17. 46.8% had comorbidities (i.e., were at risk), mainly cardiovascular and metabolic diseases (45.3%), and chronic conditions (24.7%). The highest hospitalization rates were among the elderly (≥ 75) and the young individuals (0-17), and were 37.6 and 19.5/100,000 inhabitants/year, respectively. The average hospital stay was 8 days (IQR: 14 - 4). It was higher for older individuals (≥ 65 years, 11 days, [17 - 6]) and for those with comorbidities (9 days, [16 - 6]), p-value < 0.001. Similarly, mortality was higher in elderly and those at risk (p-value < 0.001). Respiratory complications occurred in 12.7% of patients, and cardiovascular disorders in 5.9%. Total influenza-related costs were €9.7 million with hospitalization accounting for 95% of them. 47.3% of hospitalization costs were associated with individuals ≥ 65 and 52.9% with patients at risk. The average hospitalisation cost per patient was € 4,007. CONCLUSIONS: This retrospective study showed that during the 2014-2019 influenza seasons in Italy, individuals of extreme ages and those with pre-existing medical conditions, were more likely to be hospitalized with severe influenza. Together with complications and ageing, they worsen patient's outcome and may lead to a prolonged hospitalization, thus increasing healthcare utilization and costs. Our data generate real-world evidence on the burden of influenza, useful to inform public health decision-making.

Home Based Exercise Rehabilitation Programs to Prevent Physical Frailty and Hospitalization-Associated Disability.

Daily health management and exercise are important for staying healthy and avoiding the need for long-term care. However, it is not easy to maintain regular exercise. Therefore, exercise needs to be done efficiently. In recent years, due to the aging population and increasing severity of illness, older patients often experience a significant decline in physical function, even with minimal rest, which often interferes with their daily life after discharge from the hospital. Frailty not only affects ADLs, but also strongly influences prognosis, including the development of atherosclerotic disease and rehospitalization. This perspective is a summary of the 51st Metropolitan Public Lecture held on June 17, 2023, and discusses exercise-based rehabilitation programs that can be delivered at home to prevent physical frailty and avoid hospitalization-related disability.

Inpatient Psychiatric Care in the United States: Former Patients' Perspectives on Opportunities for Quality Improvement.

Patient-centered care is a salient value expressed by stakeholders, but a commitment to implementing patient-centered care environments lags in the context of inpatient psychiatry. The current study aimed to describe patients' suggestions for improving the quality of inpatient psychiatry. We fielded a national survey online in 2021, in which we asked participants to report their recommendations for care improvement through a free-response box. We used an inductive qualitative approach to synthesize responses into themes. Most responses described negative experiences, with suggested improvements implied as the inverse or absence of the respondent's negative experience. Among 510 participants, we identified 10 themes: personalized care, empathetic connection, communication, whole health approach, humane care, physical safety, respecting patients' rights and autonomy, structural environment, equitable treatment, and continuity of care and systems. To implement the value of patient-centered care, we suggest that those in positions of power prioritize improvement initiatives around these aspects of care that patients find most in need of improvement.

Effectiveness of early pharmaceutical interventions in symptomatic COVID-19 patients: A randomized clinical trial.

Objective: We assessed the effectiveness of oral Hydroxychloroquine (HC), Azithromycin (AZ) and Oseltamivir (OS), alone or combined, among patients hospitalized with mildly symptomatic coronavirus infectious disease (COVID-19). Methods: Following the approval of the National Bioethics Committee and prospective registration (clinicaltrials.gov NCT04338698), a multicenter randomized clinical trial of adaptive design was conducted at 10 multispecialty hospitals in Pakistan. Patients were randomized into seven treatment groups. Starting April 15, 2020, consenting, eligible, otherwise healthy adult patients or those with co-morbidities under control, were recruited if they presented with mildly symptomatic COVID-19 (scored 3 on a 7-point ordinal scale anchored between 1 = not hospitalized, able to undertake normal activities, to 7 = death) confirmed by quantitative Real-Time Polymerase Chain Reaction (qRT-PCR). Two primary outcomes were assessed by day seven: Turning qRT-PCR negative; and clinical improvement of two points from the baseline. Outcome rates were compared using a chi-square test. Multiple imputations were applied to handle missing data. An interim data analysis was carried out on July 19, 2020, following which the study continued without treatment group changes. Data Safety and Monitoring Board advised to stop recruitment due to its futility on January 18, 2021. Results: Of 471 patients randomized, a total of 426 (90.4%) completed the follow-up for primary outcomes. Based on imputed data analyses at day seven: Total qRT-PCR negative cases were 137/471 (29%, 95% CI 25.0 - 33.4). By day seven, a total of 111/471 (23.5%, 95% CI 19.8 - 27.6) showed clinical improvement. No serious or non-serious adverse event was reported. Conclusions: Among patients with mild COVID-19, there was no statistically significant difference in the effectiveness of oral antimalarial, antiviral, or antibiotic treatments.Clinicaltrials.gov ID: NCT04338698.

Impact of a Pilot Project for Integrated Care on Hospitalization Rate among Older Adults in South Korea.

Introduction: Since 2019, the Korean government has implemented a pilot project for integrated care to encourage healthy aging of older adults. This study investigated the changes in hospitalization rates among older adults who participated in the integrated care pilot project. Methods: Administrative survey data collected from 13 local governments and the National Health Insurance Database were used in present study. The participants comprised 17,801 older adults who participated in the pilot project between August 01, 2019 and April 30, 2022 and 68,145 matched controls. A propensity score matching method was employed to select the control group, and this study employed difference-in-differences (DID) approach to examine variations in the hospitalization rate. Results: The DID analysis revealed that the odds ratio for rates of hospitalization among older adults who participated in the pilot project was 0.88 (95% confidence interval [CI] 0.84, 0.91) in comparison to control group. In specifically, as compared to the control group, the odds ratio for hospitalization rates among the pilot project's discharged patients was 0.17 (95% CI 0.15, 0.20). Although not statistically significant, the odds ratio of older adults who utilized LTCI services was 0.93 (95% CI 0.83, 1.05), and the odds ratio of older adults who applied for LTCI but were rejected or were intensive social care was 1.09 (95% CI 0.95, 1.26) compared to the comparison group. Discussion: The findings imply that the discharged patient group had greater medical demands than the other types, and it can be claimed that this is the group that may anticipate greater efficacy while using health services. In addition, the integrated care services provided by the pilot project have the effect of reducing unnecessary hospitalization such as social hospitalization. Conclusion: Participants in the integrated care pilot project showed a lower hospitalization rate than the older adults who did not participate in the project but had similar characteristics. In particular, the admission rate of discharged patients showed a sharp decline.

Incidence of incontinence-associated dermatitis in hospitalised neonates. Adaptation and validation of a severity scale.

INTRODUCTION: Up to 60% of hospitalised neonates may develop incontinence-associated dermatitis (IAD). Our aim was to adapt the Clinical Evaluation Scale for Characterization of the Severity of Diaper Dermatitis to the Spanish population and to find out the nationwide frequency of IAD in hospitalized neonates. METHODS: Cross-cultural adaptation and assessment of content validity of the scale. We carried out a prospective, multicentre observational study of the incidence of nappy rash in postnatal wards and neonatal intensive care units in 6 Spanish hospitals. RESULTS: We obtained a content validity index of 0.869 for the total scale (95% CI, 0.742-0.939). The sample included 196 neonates. The cumulative incidence of IAD was 32.1% (9.1% mild-moderate, 8% moderate and 1.6% severe). The incidence rate was 2.2 IAD cases per 100 patient days. A stool pH of less than 5.5, a greater number of bowel movements a day, a greater daily urine output and the use of oral drugs were among the factors associated with the development of IAD. CONCLUSION: The Spanish version of the Clinical Evaluation Scale for Characterization of the Severity of Diaper Dermatitis had an adequate content validity for the assessment of DAI in the hospitalised neonatal population. Mixed feeding, treatment with oral drugs and the use of medical devices in the perianal area were associated with an increased risk of nappy dermatitis in infants.

Peer-Run Respite Approaches to Supporting People Experiencing an Emotional Crisis.

Research shows that guests experience peer-run respites as empowering and safe places where they feel more seen, heard, and respected than they do in conventional settings. This column describes the successful and unique processes of peer-run respites that support guests in emotional crisis and facilitate healing. In a discussion informed by their experiences and the literature, the authors examine how peer-run respites differ from conventional psychiatric crisis response services in their basic philosophy: how emotional crisis is understood, the goal of crisis response, how trauma is viewed, the importance of self-determination, power dynamics, and relationality.

Effects of Affordable Care Act on uninsured hospitalization: Evidence from Texas.

OBJECTIVE: To examine the impact of the Affordable Care Act (ACA) health insurance exchanges (Marketplace) on the rate of uninsured discharges in Texas. DATA SOURCE AND STUDY SETTING: Secondary discharge data from 2011 to 2019 from Texas. STUDY DESIGN: We conducted a retrospective study estimating the effects of the ACA Marketplace using difference-in-difference regressions, with the main outcome being the uninsured discharge rate. We stratified our sample by patient's race, age, gender, urbanicity, major diagnostic categories (MDC), and emergent type of admissions. DATA COLLECTION/EXTRACTION METHODS: We used Texas hospital discharge records for non-elderly adults collected by the state of Texas and included acute care hospitals who reported data from 2011 to 2019. PRINCIPAL FINDINGS: The expansion of insurance through ACA Marketplaces led to reductions in the uninsured discharge rate by 9.9% (95% CI, -17.5%, -2.3%) relative to the baseline mean. The effects of the ACA were felt strongest in counties with any share of Hispanic, in counties with a larger population of Black, and other racial groups, in counties with a significant share of female and older age individuals, in counties considered to be urban, in high-volume diagnoses, and emergent type of admissions. CONCLUSIONS: These findings indicate that the ACA facilitated a shift in hospital payor mix from uninsured to insured.