(1/2057) Asthma visits to emergency rooms and soybean unloading in the harbors of Valencia and A Coruna, Spain.
Soybean unloading in the harbor of Barcelona, Spain, has been associated with large increases in the numbers of asthma patients treated in emergency departments between 1981 and 1987. In this study, the association between asthma and soybean unloading in two other Spanish cities, Valencia and A Coruna, was assessed. Asthma admissions were retrospectively identified for the period 1993-1995, and harbor activities were investigated in each location. Two approaches were used to assess the association between asthma and soybean unloading: One used unusual asthma days (days with an unusually high number of emergency room asthma visits) as an effect measure, and the other estimated the relative increase in the daily number of emergency room visits by autoregressive Poisson regression, adjusted for meteorologic variables, seasonality, and influenza incidence. No association between unusual asthma days and soya unloading was observed in either Valencia or A Coruna, except for one particular dock in Valencia. When the association between unloaded products and the daily number of emergency asthma visits was studied, a statistically significant association was observed for unloading of soya husk (relative risk = 1.50, 95% confidence interval 1.16-1.94) and soybeans (relative risk = 1.31, 95% confidence interval 1.08-1.59) in A Coruna. In Valencia, a statistical association was found only for the unloading of soybeans at two particular docks. Although these findings support the notion that asthma outbreaks are not a common hidden condition in most harbors where soybeans are unloaded, the weak associations reported are likely to be causal. Therefore, appropriate control measures should be implemented to avoid soybean dust emissions, particularly in harbors with populations living in the vicinity. (+info)
(2/2057) Record linkage as a research tool for office-based medical care.
OBJECTIVE: To explore the feasibility of linking records to study health services and health outcomes for primary care patients. DESIGN: A cohort of patients from the Family Medicine Centre at Mount Sinai Hospital was assembled from the clinic's billing records. Their health numbers were linked to the Ontario Hospital Discharge Database. The pattern of hospital admission rates was investigated using International Classification of Diseases (ICD) codes for primary discharge diagnosis. A pilot case-control study of risk factor management for stroke was nested in the cohort. SETTING: Family medicine clinic based in a teaching hospital. PARTICIPANTS: A cohort of 19,654 Family Medicine Centre patients seen at least once since 1991. MAIN OUTCOME MEASURES: Admission rates by age, sex, and diagnosis. Numbers of admissions for individual patients, time to readmission, and length of stay. Odds ratios for admission for cerebrovascular disease. RESULTS: The 19,654 patients in the cohort had 14,299 discharges from Ontario hospitals in the 4 years from 1992 to 1995, including 3832 discharges following childbirth. Some patients had many discharges: 4816 people accounted for the 10,467 admissions excluding childbirth. Excluding transfers between institutions, there were 4975 readmissions to hospital during the 4 years, 1392 (28%) of them within 28 days of previous discharge. Admissions for mental disorders accounted for the greatest number of days in hospital. The pilot study of risk factor management suggested that acetylsalicylic acid therapy might not be effective for elderly primary care patients with atrial fibrillation and that calcium channel blocker therapy might be less effective than other therapies for preventing cerebrovascular disease in hypertensive primary care patients. CONCLUSIONS: Record linkage combined with data collection by chart review or interview is a useful method for studying the effectiveness of medical care in Canada and might suggest interesting hypotheses for further investigation. (+info)
(3/2057) Evaluation of the quality of an injury surveillance system.
The sensitivity, positive predictive value, and representativeness of the Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) were assessed. Sensitivity was estimated at four centers in June through August 1992, by matching independently identified injuries with those in the CHIRPP database. The positive predictive value was determined by reviewing all "injuries" in the database (at Montreal Children's Hospital) that could not be matched. Representativeness was assessed by comparing missed with captured injuries (at Montreal Children's Hospital) on demographic, social, and clinical factors. Sensitivity ranged from 30% to 91%, and the positive predictive value was 99.9% (i.e., the frequency of false-positive capture was negligible). The representativeness study compared 277 missed injuries with 2,746 captured injuries. The groups were similar on age, sex, socioeconomic status, delay before presentation, month, and day of presentation. Injuries resulting in admissions, poisonings, and those presenting overnight were, however, more likely to be missed. The adjusted odds ratio of being missed by CHIRPP for admitted injuries (compared with those treated and released) was 13.07 (95% confidence interval 7.82-21.82); for poisonings (compared with all other injuries), it was 9.91 (95% confidence interval 5.39-18.20); and for injuries presenting overnight (compared with those presenting during the day or evening), it was 4.11 (95% confidence interval 3.11-5.44). These injuries were probably missed because of inadequate education of participants in the system. The authors conclude that CHIRPP data are of relatively high quality and may be used, with caution, for research and public health policy. (+info)
(4/2057) The effects of pravastatin on hospital admission in hypercholesterolemic middle-aged men: West of Scotland Coronary Prevention Study.
OBJECTIVES: The purpose of the study was to assess the effect of lipid reduction with pravastatin on hospital admissions in middle-aged men with hypercholesterolemia in the West of Scotland Coronary Prevention Study. BACKGROUND: A prospective, randomized controlled trial was undertaken in primary care centers in the West of Scotland. METHODS: A total of 6,595 participants randomized to receive pravastatin 40 mg or placebo daily were followed up for a mean of 4.9 years (range 3.5 to 6.1 years). Analysis of hospital admissions was undertaken according to the "intention to treat" principle both for cardiovascular diseases and noncardiovascular diseases (including malignant neoplasms, psychiatric diagnoses, trauma and other causes). A secondary analysis of hospitalization in patients who were > or = 75% compliant was performed. RESULTS: During the trial, 2,198 (33%) of the 6,595 men were admitted to hospital on 4,333 occasions, of which 1,234 (28%) were for cardiovascular causes. Pravastatin reduced the number of subjects requiring hospital admission for cardiovascular causes by 21% (95% CI [confidence interval] 9 to 31, p = 0.0008) overall, and by 27% (95% CI 15 to 38) in compliant participants. The number of admissions per 1,000 subject-years for cardiovascular disease was reduced by 10.8 (95% CI 4 to 17.4, p = 0.0013) in all subjects, and by 15.6 (95% CI 8.3 to 23, p < 0.0001) in compliant participants. Pravastatin had no significant influence on hospital admission for any noncardiovascular diagnostic category. There were 13.4 fewer admissions per 1,000 subject-years for all causes in the pravastatin-treated group (95% CI -0.4 to 27.3, p = 0.076). No significant difference in duration of hospital stay was found between the pravastatin and placebo patients in any diagnostic group. CONCLUSIONS: Pravastatin therapy reduced the burden of hospital admissions for cardiovascular disease, without any adverse effect on noncardiovascular hospitalization. (+info)
(5/2057) Patient readmission and support utilization following anterior temporal lobectomy.
The aim of this study was to examine factors precipitating patient readmission, following anterior temporal lobectomy (ATL) for refractory epilepsy. A second aim was to explore the use of hospital outpatient and community support services ('outpatient services') by this patient population. These aims served the more general goal of identifying patients most likely in need of services additional to those routinely provided by our Seizure Surgery Follow-up and Rehabilitation Programme. The medical records of 100 consecutive ATL patients were retrospectively examined for the incidence and diagnoses precipitating acute readmission, and the utilization of additional outpatient services. Twenty-one patients (21%) required readmission post-ATL, totalling 47 readmissions between them. Psychiatric diagnoses were the most prevalent (53%), including anxiety, depression and/or post-ictal psychosis. Epileptological diagnoses were the other main precipitant (28%). Additional outpatient services were predominantly utilized for ongoing psychological support. Of the 21 patients requiring readmission, 10(10%) also needed additional outpatient services. These patients were predominantly female or unemployed, in contrast to male or employed patients who tended to require readmission only. Seventeen patients (17%) were maintained within the community using additional outpatient services only. Characteristics of these patients included disrupted family dynamics, limited social networks, and/or a psychiatric history. These patients were also more frequently beyond the 24-month follow-up period of the programme. A profile of patients most in need of additional support services can be constructed to assist team planning of proactive management strategies for the rehabilitation phase of ATL. (+info)
(6/2057) Effect of guidelines on management of head injury on record keeping and decision making in accident and emergency departments.
OBJECTIVE: To compare record keeping and decision making in accident and emergency departments before and after distribution of guidelines on head injury management as indices of implementation. DESIGN: Before (1987) and after (1990) study of accident and emergency medical records. SETTING: Two accident and emergency departments in England. PATIENTS: 1144 adult patients with head injury in department 1 (533 in 1987, 613 in 1990) and 734 in department 2 (370, 364 respectively). MAIN MEASURES: Recording of relevant symptoms and signs as determined in the guidelines; presence of, indications for, and rates and appropriateness of skull x ray examination and admission. RESULTS: The median number of guidelines variables recorded for all study periods ranged from 7 to 9 out of a possible maximum of 27. For key decision making variables the presence or absence of penetrating injury was least likely to be recorded (< or = 1%) and that of loss of consciousness most likely (> or = 75%). Altogether, the proportion of patients receiving skull x ray examination or admitted varied from 25%-60% and 7%-23% respectively; overall, 69% (1280/1856) and 64% (1177/1851) of patients were managed appropriately. However, no consistent change occurred in the departments between the study periods. For instance, in department 1 the proportion of appropriate x ray examinations rose significantly after distribution of the guidelines (from 61% (202/330) to 73% (305/417)) and appropriate decisions on whether to x ray or not also rose (from 65% (340/522) to 72% (435/608)). There was no significant change in department 2, although the proportion of appropriate admissions fell (from 33% (55/166) to 15% (19/130)). CONCLUSIONS: Recording practice and decision making were variable and had not consistently improved after dissemination of the guidelines. Strategies are required to ensure effective implementation of guidelines. (+info)
(7/2057) Can admission notes be improved by using preprinted assessment sheets?
Inpatient medical notes often fail to record important details of patient history and findings on clinical examination. To overcome problems with content and legibility of notes we introduced preprinted notes for the admission of children to this hospital. The quality of the information recorded for 100 children whose admissions were clerked with the preprinted notes was compared with that recorded for 100 whose admissions were recorded with the traditional notes. All case notes were selected randomly and retrospectively from traditional notes written from April to October 1993 and from preprinted notes written from October 1993 to April 1994. The quality of information was assessed according to the presence or absence of 25 agreed core clinical details and the number of words per clerking. In admissions recorded with the preprinted notes the mean number of core clinical details present was significantly higher than those recorded with traditional notes (24.0 v 17.6, p < 0.00001). Admissions recorded with the preprinted notes were also significantly shorter (mean 144 words v 184 words, p < 0.0001). The authors conclude that information about children admitted to hospital is both more complete and more succinct when recorded using preprinted admission sheets. (+info)
(8/2057) Falling diarrhoea mortality in Northeastern Brazil: did ORT play a role?
The impact of oral rehydration therapy (ORT) on the recent decline in diarrhoea mortality in the northeast of Brazil was studied. Proportionate infant mortality fell from 32% in 1980 to 17% in 1989 and infant deaths attributed to diarrhoea dropped from 41% to 25%, resulting in an overall reduction of 57%. Similar decreases were observed for children aged 1-4 years. Diarrhoea admissions also fell from 57% of infant hospitalizations in 1980 to 30% in 1990. None of the other major causes of death or admissions showed such decline. ORT was introduced in the early 1980s, being used in 35% of all episodes in 1991 and in 62% of those regarded as severe by the mother. Other changes included a worsening of socioeconomic conditions and increases in water supply, vaccine coverage, breastfeeding duration and nutritional status. A simulation model estimated that changes in factors other than ORT would lead to a 21% reduction in infant diarrhoea mortality, or about one-third of the actual decline. Finally, an ecological analysis showed that ORT use rates were inversely correlated to infant diarrhoea mortality (r=-0.61; p=0.04). Despite the shortcomings of the available data, these findings suggest an important impact of ORT on diarrhoea mortality. (+info)