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PubMed2006

Pediatric emergency department recidivism: demographic characteristics and diagnostic predictors.

INTRODUCTION: Overcrowding in emergency departments remains a national problem. Increases in patient volume and illness severity are among the factors contributing to this crisis. Of particular interest is a small group of patients who account for a disproportionate number of ED visits and are known as recidivists. Demographic and diagnostic characteristics were examined in an attempt to describe this national issue with more clarity. METHODS: The hospital decision support system was used to identify 2 readmission indicators (3-month return visits and 48-hour returns). Descriptive statistics and multiple regression techniques were used to analyze the characteristics of recidivists. Chart reviews and telephone interviews were conducted to further explore ED utilization. RESULTS: Twenty-five percent of the sample (N = 932) had at least one visit during the previous 3 months (N = 237). Four percent of the sample had a 48-hour return visit (N = 38). The findings revealed that the traditional determinants of ED utilization such as insurance and chronicity of symptoms are not reliable predictors of return visits. The risk factors of age, race, and diagnosis were significantly associated with return visit at a significance level less than .05. The findings confirm that some demographic and diagnostic predictability of return visits is indeed evident for pediatric patients. DISCUSSION: Although the sample is not representative, the data are helpful in identifying some of the issues of pediatric recidivism. Findings provide some understanding of parents' utilization of the emergency department and identified high-risk pediatric recidivists. Data also revealed specific disease entities warranting focused attention, such as nervous system diseases, sense organ diseases, digestive system diseases, infectious diseases, and parasitic diseases for children younger than 1 year. Patients with these problems may be at greater risk for return visits. ED nurses might consider nurse-initiated treatment protocols.

After-Hours Care↗
PubMed2004

Involuntary unemployment and mortality in Taiwan.

BACKGROUND AND PURPOSE: Unemployment is known to be associated with increased mortality, but little data is available from Taiwan, where dramatic structural changes in the economy have increased unemployment in recent years. The aim of this study was to investigate the effect of unemployment on mortality in Taiwan. METHODS: The study design was a cohort study with a control group. The unemployed group included 92,563 involuntarily unemployed individuals in 2001. Those in the control group (n = 92,599) were randomly selected from 1,230,000 employees, and matched with those in the unemployed group, by age, gender, income, firm size and urbanization, using a frequency matching mechanism. All subjects were followed during the period from January 2001 to December 2002. The adjusted hazard ratio was estimated using the Cox proportional hazards model. RESULTS: After adjusting for other factors, unemployment was associated with a higher risk of mortality (hazard ratio, 1.99; 95% confidence interval [CI], 1.60-2.48). The gender-specific adjusted hazard ratios for unemployment were 2.07 (95% CI, 1.59-2.70) for men and 1.82 (95% CI, 1.22-2.69) for women. Unemployed men had a significantly higher mortality risk for cardiovascular disease, digestive system diseases, all other diseases (except for cancer, digestive system and cardiovascular diseases), and other external causes (not including suicide) than men who were employed. In contrast, unemployed women had a significantly higher mortality risk only for other diseases, compared women who were employed. CONCLUSION: Unemployment is an important risk factor for mortality in Taiwan. The long-term impact of unemployment on mortality in Taiwan remains to be explored.

Adolescent↗
PubMed1988

Mortality among workers at a nuclear fuels production facility.

A retrospective cohort mortality study was conducted in a population of workers employed at a facility with the primary task of production of nuclear fuels and other materials. Data for hourly and salaried employees were analyzed separately by time period of first employment and length of employment. The hourly (N = 6,687 with 728 deaths) and salaried (N = 2,745 with 294 deaths) employees had a mortality experience comparable to that of the United States and, in fact, exhibited significant fewer deaths in many categories of diseases that are traditionally associated with the healthy worker effect. Specifically, fewer deaths were noted in the categories of all causes, all cancers, cancer of the digestive organs, lung cancer, brain cancer (hourly workers only), diabetes, all diseases of the circulatory system, all respiratory diseases, all digestive system diseases, all diseases of the genitourinary system (hourly only), and all external causes of death. A statistically significant, and as yet unexplained increase in leukemia mortality (6 observed vs. 2.18 expected) appeared among a subset of the hourly employees, first hired before 1955, and employed between 5-15 years.

Cohort Studies↗
PubMed2001

[Epidemiology of liver and bile duct diseases in Moscow population].

There is analysis of liver and biliary tract diseases epidemiology in Moscow during 1993-1998 years. The data of Moscow Health Department's Medical Statistical Bureau were used. The diseases of digestive system (diseases are in percents) are 9.3% of common diseases among the adults persons (18 years old and more) in Moscow, and are 8.1% in teenagers. (15-17 years old). Increase of the diseases of digestive system prevalence was demonstrated in Moscow during this time from 10,692 to 13,929 for 100,000 persons among adults and from 9251 to 12,496 among teenagers. Morbidity of the diseases of digestive system was increased among adults from 1550 to 1953 and from 2512 to 3312 among teenagers at the same time. Prevalence of cholangitis among adults was increased on 40.8% at the same time. This index in teenagers is high as well, but it isn't even. The most high increase was demonstrated in 1997 year (821 cases for 100,000 teenagers). Increase of cholelithiasis, cholecystitis and cholangitis morbidity among the adults and teenagers was 66.2% and 73.1% accordingly in 1997 year. Prevalence of chronic liver diseases and liver cirrhosis was increased on 104.9% (in two times) during 6 years (1993-1998). Morbidity of these diseases was increased in 2 times as well at the same time.

Adolescent↗
PubMed2004

The socioeconomic gradient and chronic illness and associated risk factors in Australia.

OBJECTIVE: To examine the prevalence of major chronic diseases and their risk factors in different socioeconomic groups in the Australian population, in order to highlight the need for public policy initiatives to reduce socioeconomic inequalities in health. METHODS: Data were provided by the Australian Bureau of Statistics (ABS) from the 2001 National Health Survey (NHS) for selected chronic diseases and associated risk factors. Conditions selected were those, which form the National Health Priority Area (NHPA) conditions (other than injury, which has not been included in this paper, with its focus on chronic disease); plus other 'serious' chronic conditions, in line with the classification developed by Mathers; and for which sufficient cases were available for analysis by socioeconomic status. Indirectly age-standardised prevalence rates were calculated by broad age group for Australia and for five groups of socioeconomic status; rate ratios were calculated to show variations in prevalence between these groups. RESULTS: Significant socioeconomic inequalities were evident for many of the major chronic diseases; the largest was for diabetes mellitus (at ages 25 to 64 years); and for many diseases, there was also a strong, continuous socioeconomic gradient in the rates.Circulatory system diseases (in particular, hypertensive disease) and digestive system diseases also exhibited a strong differential in the 25 to 64 year age group.In the 65 years and over age group, the strongest inequalities were evident for mental and behavioural problems, diabetes (with a continuous socioeconomic gradient in rates) and respiratory system diseases.A number of risk factors for chronic diseases, namely self-reported smoking, alcohol misuse, physical inactivity and excess weight showed a striking association with socioeconomic status, in particular for people who were smokers and those who did not exercise. CONCLUSION: This analysis shows that the prevalence of chronic disease varies across the socioeconomic gradient for a number of specific diseases, as well as for important disease risk factors. Therefore, any policy interventions to address the impact of chronic disease, at a population level, need to take into account these socioeconomic inequalities.

Journal Article↗
PubMed1995

Serum beta 2-microglobulin in chronic diseases of the pancreas.

Elevated serum concentrations of beta 2-Microglobulin (beta 2-MG) has been reported in a variety of chronic diseases and solid tumors. We determined serum beta 2-MG concentrations in 140 subjects divided into five groups: group 1, 34 patients with proven chronic pancreatitis, 8 of whom were studied during a painful relapse; group 2, 40 patients with pancreatic cancer staged according to the Cubilla-Fitzgerald classification; group 3, 40 healthy subjects; group 4, 10 patients with digestive nonpancreatic carcinomas; group 5, 16 patients with benign digestive nonpancreatic diseases. Serum soluble interleukin-2 receptor (sIL-2R) was also determined in all patients with pancreatic diseases as an index of immune system activation. In addition, serum CA 19-9 was assayed in patients of groups 2 and 4, and C-reactive protein (CRP) of groups 1 and 5. Renal function, evaluated by serum creatinine determination, was normal in all subjects studied. Patients with pancreatic cancer and those with chronic pancreatitis had serum concentrations of beta 2-MG significantly higher than those of healthy subjects (p < 0.001 and p < 0.005, respectively). Patients with stage I and stage III pancreatic cancer had similar serum levels of beta 2-MG, and these concentrations were significantly lower than those of patients with stage II tumors (p < 0.002 and p < 0.05, respectively). In chronic pancreatitis patients, those studied during painful relapse of the disease had serum concentrations of beta 2-MG similar to those studied during clinical remission.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Health risks among enlisted males in the U.S. Navy: race and ethnicity as correlates of disease incidence.

A cross-sectional study of all Black and Caucasian enlisted males in the U.S. Navy between 1974 and 1979 was conducted to determine if there were any significant racial group differences in disease incidence. First hospitalization rates for sixteen ICDA-8 diagnostic categories and selected diagnoses were examined and compared on the basis of race, age, year hospitalized, education and occupation. Results indicated that total disease incidence among Black males has declined in the past decade, with a reduction in total first hospitalizations from 1652 per 10,000 men in 1974 to 1088 per 10,000 men in 1979. Total incidence rates for Caucasian males in the same period declined from 1347 per 10,000 men to 1100 per 10,000 men. However, Blacks were found to be at significant risk for: mental disorders; diseases of the genitourinary system; diseases of the circulatory system; diseases of the digestive system; diseases of the blood and blood-forming organs; symptoms and ill-defined conditions; supplementary classifications; and diseases of the musculoskeletal system. Caucasians had significant higher incidence rates for diseases of the skin and subcutaneous tissue, and accidents, poisonings and violence. Nevertheless, the study results indicated that the populations of Blacks and Caucasians in the Navy are not uniform with respect to disease incidence. There exist numerous subgroups within either racial group, defined on the basis of certain demographic and social characteristics, which are at risk for particular diseases. In addition, the relationship between race and disease is mediated by several factors, including genetic predisposition, socioeconomic status and cultural patterns of belief and behavior. No single factor can account for the excess risk for all diseases among all members of either racial group.

Adult↗
PubMed1990

Surgery of the neonatal bovine digestive tract.

Many disorders of the calf's gastrointestinal tract require surgical intervention if a successful outcome is to be obtained. The most common abnormalities in this category are abomasal volvulus, abomasal ulcers, small intestinal accidents, and atresia of the spiral colon. These can be differentiated by the age of the animal at presentation and a careful physical examination. Special considerations in neonatal gastrointestinal surgery include: ensuring adequate serum immunoglobulin status, rapid treatment of dehydration and hypoglycemia, and consideration of the inheritability of any corrected defects. Prompt attention to metabolic disturbances and correction of the abnormalities are essential for a successful outcome.

Animals↗
PubMed2003

The clinical role of the bile acids in selected paediatric and surgical diseases.

This article contains basic information on the chemical structure, formation of the micelle, biosynthesis of the bile acids and its control, as well as entero-hepatic circulation of bile acids. Physiological function and the most serious disorders of bile acids in the course of diarrhoea in children are described. Some possibilities of clinical use of the bile acids are also evaluated, such as the conservative treatment of cholecystolithiasis or the monitoring of liver function in hepato-pancreato-biliary surgery.

Bile Acids and Salts↗
PubMed2003

Multivariate analysis suggests improved perioperative outcome in Crohn's disease patients receiving immunomodulator therapy after segmental resection and/or strictureplasty.

BACKGROUND: Medical management of moderate to severe Crohn's disease (CD) using immunomodulator agents has not eliminated surgical treatment of disease complications. The effect of improved medical treatment on perioperative CD surgical outcome is not known. We analyzed the impact of immunomodulator therapy on the rate of intraabdominal septic complications (IASC) in CD patients undergoing bowel reanastomosis or strictureplasty. METHODS: Surgical outcome was reviewed in 100 consecutive CD patients who underwent segmental resection with primary anastomosis or strictureplasty between 1998 and 2002. Multivariate analysis was performed to determine the effect of immunomodulator therapy on rate of IASC (intraabdominal abscess, anastomotic leak, or enterocutaneous fistulae). Immunomodulator agents included azathioprine, 6-MP, methotrexate, and infliximab. RESULTS: IASC developed in 11 of 100 (11%) operations. Immunomodulator use was associated with fewer IASC (4/72 procedures; 5.6%), compared with 7/28 (25%) cases with patients not on therapy (P<.01). IASC were not influenced by steroid use, smoking status, preoperative abscess, or fistula or albumin levels. Immunomodulator use did not affect the length of resection or the rate and number of strictureplasties. CONCLUSION: Medical management with immunomodulator therapy is safe and significantly decreases postoperative IASC in CD patients undergoing surgical procedures requiring bowel anastomosis or strictureplasty.

Abdominal Abscess↗
PubMed2005

Low-molecular-weight heparin for the prevention of postoperative venous thromboembolism after abdominal surgery: a review.

PURPOSE OF REVIEW: To analyze the effect of low-molecular-weight heparin in abdominal surgery, which carries a significant risk of thrombosis, a risk further increased by cancer. RECENT FINDINGS: Searches in EMBASE and PubMed between 1980 and 2004 were conducted to identify studies of thromboprophylaxis in abdominal surgery patients. Sixteen comparative studies were identified. They showed that low-molecular-weight heparin is as effective as unfractionated heparin in reducing venous thromboembolism and, at appropriate doses, can reduce bleeding complications. In very-high-risk cancer patients, a higher dose of low-molecular-weight heparin may offer increased efficacy without increasing the risk of bleeding. Extending the standard 7-10-day low-molecular-weight heparin prophylaxis period may benefit certain high-risk patient groups. SUMMARY: Patients undergoing abdominal surgery should be stratified according to thromboembolism risk and given prophylaxis accordingly. Low-molecular-weight heparin is a recommended alternative to unfractionated heparin in moderate- or high-risk patients. In patients with cancer, high doses of low-molecular-weight heparin may offer increased efficacy without increased bleeding, and an extended 4-week period of prophylaxis could be beneficial.

Anticoagulants↗