Trends in the hospital care of acute childhood asthma 1970-8: a regional study.

In the South-west Thames Region over the period 1970-8 the number of admissions for asthma in children aged 5-14 years increased from 256 to 684, an increase of 167%. Factors associated with this trend were investigated by an analysis of routine hospital statistics and examination of case notes for 1970 and 1978 from every hospital in the region. The trend was caused partly by an increase in readmission rates. There was a more than fivefold increase in self-referrals; these patients had less severe asthma on admission and a higher readmission rate than patients referred by general practitioners. Drug management before and after admission changed considerably over the nine years, as did hospital investigations. Overall, there was little change in the level of severity on admission. The increase in admissions was not associated with a reduction in deaths from asthma in the region and occurred in spite of major advances in the drug control of asthma; this indicates an inadequacy of ambulatory care. The shift in the balance of care towards the hospital and the increasing adoption of a primary care function by the hospital indicate a need for hospitals and general practice to agree jointly on management policies for acute asthma.     

Causes,temporal trends,and the effects of urbanization on admissions of wild raptors to rehabilitation centers in England and Wales

Data from wildlife rehabilitation centers (WRCs) can provide on‐the‐ground records of causes of raptor morbidity and mortality, allowing threat patterns to be explored throughout time and space. We provide an overview of native raptor admissions to four WRCs in England and Wales, quantifying the main causes of morbidity and mortality, trends over time, and associations between threats and urbanization between 2001 and 2019. Throughout the study period, 14 raptor species were admitted totalling 3305 admission records. The Common Buzzard (Buteo buteo; 31%) and Tawny Owl (Strix aluco; 29%) were most numerous. Relative to the proportion of breeding individuals in Britain and Ireland, Peregrine Falcons (Falco peregrinus), Little Owls (Athene noctua), and Western Barn Owls (Tyto alba) were over‐represented in the admissions data by 103%, 73%, and 69%, respectively. Contrastingly Northern Long‐eared Owls (Asio otus), Western Marsh Harriers (Circus aeruginosus), and Merlin (Falco columbarius) were under‐represented by 187%, 163%, and 126%, respectively. Across all species, vehicle collisions were the most frequent anthropogenic admission cause (22%), and orphaned young birds (10%) were most frequent natural cause. Mortality rate was highest for infection/parasite admissions (90%), whereas orphaned birds experienced lowest mortality rates (16%). For one WRC, there was a decline in admissions over the study period. Red Kite (Milvus milvus) admissions increased over time, whereas Common Buzzard and Common Kestrel admissions declined. There were significant declines in the relative proportion of persecution and metabolic admissions and an increase in orphaned birds. Urban areas were positively associated with persecution, building collisions, and unknown trauma admissions, whereas vehicle collisions were associated with more rural areas. Many threats persist for raptors in England and Wales, however, have not changed substantially over the past two decades. Threats associated with urban areas, such as building collisions, may increase over time in line with human population growth and subsequent urban expansion.     

Psychiatric hospitalization in Ontario: the revolving door in perspective.

Ontario government statistics have indicated that during the 1960s the proportion of readmissions to psychiatric hospitals doubled to form two thirds of all admissions. Since this pertained to events rather than to individuals, a cohort of patients first admitted in 1969 was followed for 4 years to trace the pattern of readmission and the characteristics of patients at risk of readmission. Routinely returned data were linked and a sample from the greater metropolitan Toronto area was randomly selected. Of the cohort, 31% were readmitted, 8% three or more times. Age and diagnosis distinguished those readmitted. Most with multiple readmissions were under 25 years of age. Although diagnoses were equally distributed on first admission among psychotic, neurotic and other nonpsychotic disorders, with no significant change on readmission or multiple readmission, there was a predictably greater proportion of functional psychoses among the high-risk group and also an equal representation of personality, addictive and the remaining nonpsychotic conditions. The vulnerable few are identifiable early in their intermittent hospital career. It can be concluded that statistics suggesting that two thirds of admissions are readmissions are misleading.     

The effects of the 2009 dust storm on emergency admissions to a hospital in Brisbane, Australia

In September 2009 an enormous dust storm swept across eastern Australia. Dust is potentially hazardous to health as it interferes with breathing, and previous dust storms have been linked to increased risks of asthma and even death. We examined whether the 2009 Australian dust storm changed the volume or characteristics of emergency admissions to hospital. We used an observational study design, using time series analyses to examine changes in the number of admissions, and case-only analyses to examine changes in the characteristics of admissions. The admission data were from the Prince Charles Hospital, Brisbane, between 1 January 2009 and 31 October 2009. There was a 39% increase in emergency admissions associated with the storm (95% confidence interval: 5, 81%), which lasted for just 1 day. The health effects of the storm could not be detected using particulate matter levels. We found no significant change in the characteristics of admissions during the storm; specifically, there was no increase in respiratory admissions. The dust storm had a short-lived impact on emergency hospital admissions. This may be because the public took effective avoidance measures, or because the dust was simply not toxic, being composed mainly of soil. Emergency departments should be prepared for a short-term increase in admissions during dust storms.     

Ectopic Pregnancy: A Statistical Review of 360 Cases

In a statistical analysis of 360 cases of ectopic pregnancy admitted to the Montreal General Hospital over a 20-year period ending December 1964, ectopic gestation occurred once in every 83 admissions to the gynecological service. This incidence has remained constant over the years. Only one out of four patients had had more than one child and 30% of the patients had absolute or relative infertility. Diagnosis was delayed or not made in 58 patients. There was evidence that neurogenic factors play a role in the etiology of ectopic gestation. Ten per cent of the patients had had a previous operation for the same condition. Symptomatology is variable and the possibility of ectopic pregnancy must never be overlooked in a woman of child-bearing age. Once the diagnosis is made the treatment is early operation. The morbidity rate in this series was 28% and there was one death.     

Injuries and deaths associated with off-road recreational vehicles among children in Manitoba.

Injuries and deaths associated with off-road recreational vehicles are of increasing concern in North America. We reviewed all hospital admissions and deaths attributed to these vehicles in Manitoba from April 1979 to April 1985 among children 16 years of age or younger. Of the 693 hospital admissions and deaths 480 were associated with motorbikes, snowmobiles or all-terrain vehicles (ATVs). The incidence of injuries resulting from snowmobile and dirtbike accidents remained stable over the study period; however, there was an almost exponential increase in the number of admissions because of ATV-related injuries. There were 21 deaths during the study period. Preventive measures through legislation are necessary to reduce the numbers of injuries and deaths; these include mandatory registration, licensing and enhanced safety regulations.     

An analysis of paternal age and 47,+21 in 35,000 new prenatal cytogenetic diagnosis data from the New York State Chromosome Registry: no significant effect

Summary In 35,680 fetuses of women who had prenatal cytogenetic diagnosis done upon amniotic fluid specimens obtained during 2nd trimester amniocentesis and in whom there was no increased cytogenetic risk except for age, there was no statistically significant evidence for an increase of 47,+21 at any paternal age after adjustment for maternal age. The ratio of observed-to-expected numbers in fathers less than 30 years old was 1.0 and in fathers 40 years or older was 0.9 when compared with numbers derived from maternal-age-specific rates in men 30–39 years old. The ratio was 1.1 for those younger than 34 years when compared with rates in fathers aged 34–39 years old. Only for men 55 years or older was there any, even suggestive, increase. The ratio was roughly 1.5 (9 observed to about 6 expected). This was not statistically significant, and moreover, the increase such as it was, was in men married to women 37–42 years old. Regression analyses using several additive parental age models introducing a parabolic function for paternal age, failed to reveal any paternal age contribution.     

Histopathological changes of the hypophysis in malnutrition in elderly subjects

Major objectives in forensic gerontology are physical and mental disorders during aging, which can be caused by various factors involving nutrition and stress, often accompanied by dysfunction in the neuroendocrine systems including the hypophysis. The objective of the present study was to investigate the histopathological changes in the adenohypophysis in elderly subjects using autopsy materials. Hypophyses with a scaphoid shape (group S: 16 males and 4 females; mean age, 78.6 years) and a normal one (group C: 30 males and 20 females; mean age, 65.2 years) were compared. Incidence of the scaphoid-shaped hypophysis mildly increased with age, being 17% in the elderly over 65 years of age. The weight of the pituitary gland in group S (0.42 +/- 0.1 g) was lower than that of group C (0.65 +/- 0.2 g). The degree of fibrosis was higher in group S (31.6% +/- 5.4%) than in group C (18.3% +/- 6.3%). Immunohistochemical staining showed no significant differences in the proportion of the ACTH cells and the TSH cells between the two groups (p > 0.05). However, there was an increase in the proportion of gonadotrophs, prolactin cells, and S-100-containing cells in group S and a decrease in that of GH cells (p < 0.05). These findings may be associated with reduced anabolic, gonadal and hepatic functions due to malnutrition.     

Ambient temperature and emergency room admissions for acute coronary syndrome in Taiwan

Acute coronary syndrome (ACS) is an important public health problem around the world. Since there is a considerable seasonal fluctuation in the incidence of ACS, climatic temperature may have an impact on the onset of this disease. The objective of this study was to assess the relationship between the average daily temperature, diurnal temperature range and emergency room (ER) admissions for ACS in an ER in Taichung City, Taiwan. A longitudinal study was conducted which assessed the correlation of the average daily temperature and the diurnal temperature range to ACS admissions to the ER of the city’s largest hospital. Daily ER admissions for ACS and ambient temperature were collected from 1 January 2000 to 31 March 2003. The Poisson regression model was used in the analysis after adjusting for the effects of holiday, season, and air pollutant concentrations. The results showed that there was a negative significant association between the average daily temperature and ER admissions for ACS. ACS admissions to the ER increased 30% to 70% when the average daily temperature was lower than 26.2°C. A positive association between the diurnal temperature range and ACS admissions was also noted. ACS admissions increased 15% when the diurnal temperature range was over 8.3°C. The data indicate that patients suffering from cardiovascular disease must be made aware of the increased risk posed by lower temperatures and larger changes in temperature. Hospitals and ERs should take into account the increased demand of specific facilities during colder weather and wider temperature variations.     

Trends in Severity of Illness on ICU Admission and Mortality among the Elderly

Background

There is an increase in admission rate for elderly patients to the ICU. Mortality rates are lower when more liberal ICU admission threshold are compared to more restrictive threshold. We sought to describe the temporal trends in elderly admissions and outcomes in a tertiary hospital before and after the addition of an 8-bed medical ICU.

Methods

We conducted a retrospective analysis of a comprehensive longitudinal ICU database, from a large tertiary medical center, examining trends in patients’ characteristics, severity of illness, intensity of care and mortality rates over the years 2001–2008. The study population consisted of elderly patients and the primary endpoints were 28 day and one year mortality from ICU admission.

Results

Between the years 2001 and 2008, 7,265 elderly patients had 8,916 admissions to ICU. The rate of admission to the ICU increased by 5.6% per year. After an eight bed MICU was added, the severity of disease on ICU admission dropped significantly and crude mortality rates decreased thereafter. Adjusting for severity of disease on presentation, there was a decreased mortality at 28- days but no improvement in one- year survival rates for elderly patient admitted to the ICU over the years of observation. Hospital mortality rates have been unchanged from 2001 through 2008.

Conclusion

In a high capacity ICU bed hospital, there was a temporal decrease in severity of disease on ICU admission, more so after the addition of additional medical ICU beds. While crude mortality rates decreased over the study period, adjusted one-year survival in ICU survivors did not change with the addition of ICU beds. These findings suggest that outcome in critically ill elderly patients may not be influenced by ICU admission. Adding additional ICU beds to deal with the increasing age of the population may therefore not be effective.     

支气管激发试验对咳嗽变异性哮喘诊断和治疗的新思考

目的：通过分析我院经行支气管激发试验明确诊断的咳嗽变异性哮喘（CVA）的临床和肺功能特点,为诊断和治疗CVA提供一些有益的参考。方法：临床资料采用回顾性分析,共收集142例支气管激发试验阳性而经临床诊断明确为咳嗽变异型哮喘的病例,将其按年龄分为5组,分别对不同年龄组在分布例数、症状特点、肺通气功能、激发剂量进行对比分析。结果：在142例CVA患者中,〈30岁组病例42例（29.6%）,30~40岁组30例（21.1%）,40~50岁组28例（19.7%）,50~60岁组26例（18.3%）,〉60岁组16例（11.3%）。在症状方面,除均有慢性咳嗽（〉3周）外,随着年龄的增大,各组中出现胸闷、气促等症状的病例比例逐渐增多。在肺通气功能方面,〈30岁组的肺通气功能测定明显好于〉60岁组。而另外3组之间组与组之间无明显差异,但各组与〈30岁组及〉60岁组之间均有明显差异。结论：咳嗽变异型哮喘患者以中青年患者居多,老年患者较少,随着年龄的增长,其临床表现及肺通气功能越来越接近典型支气管哮喘,由此推想,若有条件的医院能广泛开展支气管激发试验,对咳嗽变异型哮喘患者进行早期诊断。     

Short-term effects of pollen species on hospital admissions in the city of Madrid in terms of specific causes and age

Background In recent years there has been a notable increase in respiratory diseases in industrialised countries, which is attributed to a combination of chemical atmospheric pollution and the allergens existing in the atmosphere of big cities. Few studies, however, have analysed the effect of different pollen species on the different causes of hospital admissions other than those exclusively owing to asthma. Objective The aim of this investigation was to analyse the influence of the most abundant pollen species with the highest allergenic potential in Madrid’s atmosphere on daily emergency hospital admissions – from all causes and specific causes – according to different age groups. Methods An ecological time-series design was adopted in which the effects were quantified using Poisson regression models, taking into account different confusion factors, such as chemical and acoustic atmospheric pollution. Results Statistically significant associations were found between pollen species and hospital admissions due to respiratory causes, and between pollen species and all causes of hospital admissions and, to a lesser degree, circulatory causes. The impact was greater in the younger age groups. Concentrations of Poaceae and Platanus pollen species were the factors showing the highest correlation to the different causes of admission. Conclusion The relative risks analysis revealed a significant effect between the pollen species analysed and health for admitted patients of all age groups; this effect was greater than that detected for the environmental variables traditionally analysed in urban atmospheres.     

Decline in mortality,AIDS, and hospital admissions in perinatally HIV-1 infected children in the United Kingdom and Ireland

Objective To describe changes in demographic factors, disease progression, hospital admissions, and use of antiretroviral therapy in children with HIV.Design Active surveillance through the national study of HIV in pregnancy and childhood (NSHPC) and additional data from a subset of children in the collaborative HIV paediatric study (CHIPS).Setting United Kingdom and Ireland.Participants 944 children with perinatally acquired HIV-1 under clinical care.Main outcome measures Changes over time in progression to AIDS and death, hospital admission rates, and use of antiretroviral therapy.Results 944 children with perinatally acquired HIV were reported in the United Kingdom and Ireland by October 2002; 628 (67%) were black African, 205 (22%) were aged ≥ 10 years at last follow up, 193 (20%) are known to have died. The proportion of children presenting who were born abroad increased from 20% in 1994-5 to 60% during 2000-2. Mortality was stable before 1997 at 9.3 per 100 child years at risk but fell to 2.0 in 2001-2 (trend P < 0.001). Progression to AIDS also declined (P < 0.001). From 1997 onwards the proportion of children on three or four drug antiretroviral therapy increased. Hospital admission rates declined by 80%, but with more children in follow up the absolute number of admissions fell by only 26%.Conclusion In children with HIV infection, mortality, AIDS, and hospital admission rates have declined substantially since the introduction of three or four drug antiretroviral therapy in 1997. As infected children in the United Kingdom and Ireland are living longer, there is an increasing need to address their medical, social, and psychological needs as they enter adolescence and adult life.     

Childhood Malaria Admission Rates to Four Hospitals in Malawi between 2000 and 2010

Introduction

The last few years have witnessed rapid scaling-up of key malaria interventions in several African countries following increases in development assistance. However, there is only limited country-specific information on the health impact of expanded coverage of these interventions.

Methods

Paediatric admission data were assembled from 4 hospitals in Malawi reflecting different malaria ecologies. Trends in monthly clinical malaria admissions between January 2000 and December 2010 were analysed using time-series models controlling for covariates related to climate and service use to establish whether changes in admissions can be related to expanded coverage of interventions aimed at reducing malaria infection.

Results

In 3 of 4 sites there was an increase in clinical malaria admission rates. Results from time series models indicate a significant month-to-month increase in the mean clinical malaria admission rates at two hospitals (trend P<0.05). At these hospitals clinical malaria admissions had increased from 2000 by 41% to 100%. Comparison of changes in malaria risk and ITN coverage appear to correspond to a lack of disease declines over the period. Changes in intervention coverage within hospital catchments showed minimal increases in ITN coverage from <6% across all sites in 2000 to maximum of 33% at one hospital site by 2010. Additionally, malaria transmission intensity remained unchanged between 2000–2010 across all sites.

Discussion

Despite modest increases in coverage of measures to reduce infection there has been minimal changes in paediatric clinical malaria cases in four hospitals in Malawi. Studies across Africa are increasingly showing a mixed set of impact results and it is important to assemble more data from more sites to understand the wider implications of malaria funding investment. We also caution that impact surveillance should continue in areas where intervention coverage is increasing with time, for example Malawi, as decline may become evident within a period when coverage reaches optimal levels.     

Hospitalization for mental illness: evaluation of admission trends from 1941 to 1971.

A study of the diagnostic composition of the inpatient population of Ontario and Canadian psychiatric facilities has shown an important change in hospital-treated illness over the period 1941-71. Patients with nonpsychotic disorders accounted for 54% of all admissions to Ontario public mental hospitals in 1971, compared with only 8% in 1941. The trend was similar for both first admissions and proportion of readmissions, and was similar for psychiatric units of general hospitals. In contrast, the overall rate of first admission for psychotic disorders to inpatient facilities remained remarkably constant over time, as did the proportion of readmissions among all admissions. The findings dispel the notion that the increasing proportion of readmissions is due largely to a rapid turnover of former long-stay psychotic patients (the "revolving-door phenomenon"). The findings could not be attributed to a changing prevalence of types of psychiatric illness, increased availability of psychiatric inpatient facilities or comprehensive medical insurance.     

A Simple Insightful Approach to Investigating a Hospital Standardised Mortality Ratio: An Illustrative Case-Study

Background

Despite methodological concerns Hospital Standardised Mortality Ratios (HSMRs) are promoted as measures of performance. Hospitals that experience an increase in their HSMR are presented with a serious challenge but with little guidance on how to investigate this complex phenomenon. We illustrate a simple penetrating approach.

Methods

Retrospective analysis of routinely collected hospital admissions data comparing observed and expected deaths predicted by the Dr Foster Unit case mix adjustment method over three years (n = 74,860 admissions) in Shropshire and Telford NHS Trust Hospital (SaTH) constituting PRH (Princess Royal Hospital) and RSH (Royal Shrewsbury Hospital); whose HSMR increased from 99 in the year 2008/09 to 118 in the year 2009/10.

Results

The step up in HSMR was primarily located in PRH (109 to 130 vs. 105 to 118 RSH). Disentangling the HSMR by plotting run charts of observed and expected deaths showed that observed deaths were stable in RSH and PRH but expected deaths, especially at PRH, had fallen. The fall in expected deaths has two possible explanations–genuinely lower risk admissions or that the case-mix adjustment model is underestimating the risk of admissions perhaps because of inadequate clinical coding. There was no evidence that the case-mix profile of admissions had changed but there was considerable evidence that clinical coding process at PRH was producing a lower depth of coding resulting in lower expected mortality.

Conclusion

Knowing whether the change (increase/decrease) in HSMR is driven by the numerator or the denominator is a crucial pivotal first step in understanding a given HSMR and so such information should be an integral part of the HSMR reporting methodology.     

火灾恢复年限对大兴安岭森林乔灌草多样性及优势种影响

林火是大兴安岭地区森林生态系统的重要影响因子,研究火灾对植物多样性和优势种多度长期影响,有助于火灾区域森林生态系统重建与管理。本研究以大兴安岭不同火烧年限（1~5、5~10、10~20、20~30、30~40和40~50年）48对配对样地（火烧样地与邻近未火烧对照样地）为研究对象,利用二者差值变化来探讨森林恢复年限对植物多样性指数影响,通过对乔灌草相对多度变化确认火灾恢复对优势种的影响。研究结果表明：（1）火烧与对照间乔木多样性和丰富度差值先降后升趋势,在10年左右最低,而恢复30~40年后与对照样地相当或更高。灌木与乔木变化趋势相似,但是变化趋势多达到统计学显著（P<0.05）,灌木Shannon-wiener多样性指数和丰富度差值随年限增加而线性上升。草本Simpson多样性指数随火烧年限增加而直线下降,但是均匀度与丰富度没有出现线性变化。（2）乔灌草优势种变化趋势为：乔木层白桦（Betula platyphylla）在火烧5~30年占比均超过30%,在30年后占比不超过15%,同时兴安落叶松（Larix gmelinii）在30~40年占比超过50%;灌木层在0~30年均是越桔（Vaccinium vitis-idaea）占比最大,30年之后变为榛子（Corylus heterophylla）,草本层5~30年均是小叶章（Deyeuxia angustifolia）占比最大,30年之后变为其他物种。对照样地乔木层主要是兴安落叶松,占比超过50%,灌木层主要是越桔（Vaccinium vitis-idaea）,草本层主要是小叶章（Deyeuxia angustifolia）。整体来看,乔木火后恢复需要更长的时间,而灌木和草本火后恢复更快。植物多样性及优势种变化是研究其对生态服务功能（如碳汇）影响的基础,我们研究结果为天保工程后续实施及科学管理大兴安岭森林生态系统提供数据支撑。     

Increasing trend in the number of Southern Rockhopper Penguins (Eudyptes c. chrysocome) breeding at the Falkland Islands

The Falkland Islands currently supports one of the largest Southern Rockhopper Penguin (Eudyptes c. chrysocome) populations. Archipelago-wide censuses conducted in 2000 and 2005 revealed that the number of breeding pairs had declined by 30 % during this period. To establish whether the breeding population continued to decline, an archipelago-wide census was conducted in 2010. We report a conservative estimate of 319,163 ±SD 24,820 pairs breeding at the Falkland Islands in 2010. This represents a 51 % increase when compared with the number counted in 2005. A simple stochastic population model was developed to investigate the extent to which changes in demographic parameters between 2005 and 2010 could account for the increase in breeding pairs. The population model predicted a 38 % increase in the number of breeding pairs over a 5-year period (289,431 ±SD 24,615). The increase in the number of breeding pairs was therefore probably attributed to improved vital rates in the period between the 2005 and 2010 archipelago-wide censuses in combination with other factors such as a reduction in the proportion of adult birds that abstained from breeding. Based on the 2010 Falkland Islands estimate, the global population of the subspecies E. c. chrysocome is now closer to 870,000 breeding pairs of which the Falkland Islands accounts for approximately 36 %, the second largest proportion after Chile. We conclude that despite fluctuations, the number of Southern Rockhopper Penguins breeding at the Falkland Islands has increased over the last 15 years and suggest that the ‘Vulnerable’ conservation status of the species be re-assessed.     

Seasonal distribution and changes in the nutritive quality of living,dead and detrital fractions of Zostera marina L.

Samples of eelgrass, Zostera marina L., were collected monthly from December 1974 through December 1975 in a shallow embayment near Beaufort, N.C., and separated into green leaves, dead leaves, and leaf detrital material. Each component was analysed for dry weight, organic matter, inorganic and organic carbon, nitrogen and amino compounds.The standing crop of green and dead blades reached a maximum in April through June, while detrital matter had peaks in December, April and July–September. Inorganic carbon in the three grass fractions showed seasonal variations similar to those observed for epiphytic biomass in previous years, and represented 14, 24, and 30% of the total carbon associated with the green and dead leaves and detrital fragments, respectively. Organic carbon represented a decreasing proportion of the dry weight of these three fractions on a dry weight basis while there was a significant increase in organic carbon on an ash-free dry weight basis in the detrital fragments relative to the head dead blades. During senescence there was a loss of nitrogen from the leaves and an increase in the nitrogen content of the organic matter of the detritus relative to the dead leaves. The latter suggests that there was microbial growth on the detritus and subsequent nitrogen immobilization from the surrounding medium. There were significant decreases of lysine, histidine, arginine, glycine, tyrosine, and glucosamine in the dead leaves relative to the detritus. The glucosamine, derived from N-acetyl-glucosamine, a product of murein which is a component of microbial cell walls, had a seasonal distribution similar to that of the epiphytic community and available inorganic nitrogen in the surrounding water. The relative proportions of N-acetyl-glucosamine, nitrogen and organic carbon were all higher in the fall and winter.