Hospital at home: What is its place in the health system?

Given the expansion of hospital at home in Western countries, policymakers, providers and financial managers are exploring the causes for this and examining whether hospital at home is an alternative to hospitalization for reasons of cost containment and quality of care. The purpose of this paper is to describe hospital at home, discuss its development and examine its role in the health system. A variety of models of hospital at home exist, serving a varied patient case-mix. This article claims that the reasons for the expansion of medical home care are not solely economic. Although a number of studies have examined the cost effectiveness of this service, no consensus has been reached. In fact, the growth of this service seems to be related to a number of other factors: the increase in the number of elderly and chronically ill people, the lack of availability and accessibility of acute and sub-acute inpatient services, technological innovation, improvements in the standard of living and the preference of some patients to be treated at home. Therefore, hospital at home must be examined, not as an independent service, but as part of a continuum of services, with the hospital system at one end and community services at the other end. Further research will help determine its optimal place along this continuum.     

Development and Validation of a Technology-Based System for Tracking and Reporting Dietary Intake at School Meals

Objective

This report describes the development and validation of a technology-based system that integrates data on food choice, nutrition, and plate waste to generate feedback reports summarizing students' dietary intake at school meals.

Progressive, ascending neurological impairment: a spinal epidural abscess that presents as Guillain-Barré syndrome

Over the course of 4 days, a 65-year-old man developed fever and thoracic back pain, followed by weakness and sensory changes in both legs. Physical examination revealed dyspnoea, subfebrile temperature, neck pain withoutnuchal rigidity, sensory impairment, areflexia and weakness in both legs (and arms to a lesser extent). Guillain-Barré syndrome was considered, and treatment with intravenous immunoglobulins was started. The patient nevertheless developed respiratory insufficiency, progressive leg paresis and nuchal rigidity. Spinal MRI revealed an extensive cervicothoracic epidural abscess. Surgical decompression and drainage were performed, followed by antibiotic treatment; the patient recovered and was able to walk with assistance. A spinal epidural abscess can be difficult to recognise and is potentially lethal. The diagnosis should be considered in patients with fever and back pain, especially when these coincide with symptoms of neurological impairment. The efficacy of therapy depends on timely recognition; to this end, neuroimaging with MRI is essential.     

Who is at Risk of Inadequate Weight Gain During Pregnancy? Analysis by Occupational Status Among 15,020 Deliveries in a Regional Hospital in Japan

A lower bodyweight may be associated with adverse birth outcomes, such as low birth weight and being small for a given gestational age. In Japan, the rate of low birth weight has been increasing over the last two decades, such that both low pre-pregnancy weight and inadequate weight gain during pregnancy are viewed as critical issues in terms of the reproductive health of Japanese women. The aim of our study was to evaluate the relationship between socioeconomic status (SES) and inadequate weight gain during pregnancy. A cross-sectional, hospital-based study using data from a large hospital in Hamamatsu city, Japan, from 1997 to 2010 was conducted. Among a total of 21,855 deliveries, 15,020 participants were analyzed. Odds ratios and confidence intervals were estimated using a logistic regression model. We defined maternal occupational status as follows: home-maker married to a salaried-spouse, home-maker married to a self-employed spouse, home-maker married to a professional, all other home-makers, office worker, professional, and all other occupations. In the high SES groups (home-makers married to self-employed spouse and professional spouse, as well as office workers and professional workers), we found an association with inadequate weight gain during pregnancy, especially among underweight women. There was no association between SES and inadequate weight gain among normal-weight and overweight women. Japanese women from higher socioeconomic backgrounds appear to be at greater risk for inadequate weight gain. This result may contribute to enhancing prenatal education on pregnancy-related weight gain in Japan.     

A Matched-Cohort Evaluation of a Bedside Asthma Intervention for Patients Hospitalized at a Large Urban Children’s Hospital

Emergency care and hospitalizations account for 36% of asthma-related medical expenses for children. National asthma guidelines emphasize the need for asthma self-management education at multiple points of care, including the hospital, to help prevent acute exacerbations. The integration of a bedside asthma education program into discharge planning at a busy urban children’s hospital aimed to reduce repeat emergency department (ED) visits and hospitalizations by educating the community’s highest-risk children and their families about asthma. A trained respiratory professional provided 45 minutes of individualized bedside education to families at the hospital and one follow-up support phone call within 3 weeks after discharge. Children receiving the intervention were matched to a control group of children not receiving the intervention by age and 2 markers of past utilization using data obtained from hospital records. Repeat ED utilization was analyzed using a Cox proportional hazards model controlling for sex, residence, race or ethnicity, and year. Compared to 698 matched controls, no significant improvement was observed in the 698 intervention participants or any subgroups followed for 12 months after the intervention.     

Hospital ownership and cost and quality of care: is there a dime's worth of difference?

Nonprofit organizations may predominate when output quality is difficult to monitor. Hospital care has this characteristic. This study compared program cost and quality of care for Medicare patients hospitalized following onset of four common conditions by hospital ownership. Payments on behalf of Medicare patients admitted to for-profit hospitals during the first 6 months following a health shock were higher than for those admitted to other hospitals. With quality measured in terms of survival, changes in functional and cognitive status, and living arrangements, we found no differences in outcomes by hospital ownership.     

Who is at risk of irregular meal intake? Results from a population-based study

Aim  

Irregular meal intakes have several harmful effects on health and yet it is largely unknown which factors are related to irregular meal intakes. In order to understand variations in regularity of meal intakes, associations between sociodemographics, health conditions, health behaviours, work characteristics and meal intakes were studied.     

“Life is at a standstill” Quality of life after lower extremity trauma in Malawi

Quality of Life Research - Low- and middle-income countries face a disproportionate burden of death and disability from injuries, many of which are due to road traffic accidents or falls. Lower...     

Why is later age at retirement beneficial for cognition? Results from a French population-based study

Objective

To determine whether and how age at retirement influences the risk of dementia. The association between the age at retirement, the number of working years and the risk of dementia was evaluated over 12 years of follow-up.

Design

A prospective population-based study.

Setting

Three-City cohort, a French population-based study of community-dwelling individuals aged 65 to 95.

Participants

The sample consisted of 1,658 non-demented participants at baseline.

Measurements

All participants were evaluated at home at the initial visit and at two years interval for a period of 12 years. An active research of dementia was conducted at each follow-up; all suspected cases were analysed by an independent committee of neurologists. Information regarding retirement age and number of working years was collected at baseline using a structured questionnaire.

Results

The multivariate Cox model, including both the age at retirement and the number of working years and adjusted for potential confounders, revealed that the risk of dementia was independently associated with the age at retirement (p=0.022) but not with the number of working years (p=0.296).

Conclusion

Although our results are in accordance with previous studies (i.e., older age at retirement is associated with decreased risk of dementia), it provides additional information regarding the possible explanation for such results. Given that a longer working life did not reduce the risk of dementia, the age at retirement cannot be considered as a new factor of cognitive reserve but rather seems to be a psycho-social vulnerability factor. Further evidence is necessary to identify work and retirement related factors that influence the association between the age at retirement and the risk of dementia.