Depressive symptoms in users and non-users of depot medroxyprogesterone acetate

To evaluate the possible effects of depot medroxyprogesterone acetate (DMPA) injectable contraception on depressive symptoms, we conducted a population-based prospective study with women aged 18–39 years old enrolled at a health maintenance organization. At baseline, 183 women used DMPA and 274 were non-users. Data on depressive symptoms and on factors potentially related to DMPA use and depression were collected by questionnaire at 6-month intervals for up to 3 years. In multivariate longitudinal analysis, we found an increased likelihood of reporting depressive symptoms among continuous DMPA users (OR = 1.44; 95% CI = 1.00–2.07) and discontinuers (OR = 1.60; 95% CI = 1.03–2.48) when compared to non-users. Women who discontinued DMPA use had elevated depressive symptoms prior to discontinuation (OR = 2.30; 95% CI = 1.42–3.70) and immediately following discontinuation (OR = 2.46; 95% CI = 1.46–4.14), and depressive symptoms subsided at subsequent visits relative to non-users. Our prospective analyses found an association between DMPA use and depressive symptoms but further research is needed to determine whether the relationship is causal.     

Occurrence of hospital infection among interned elderly in a university hospital

OBJECTIVE: Hospital infection is an important cause of morbidity and mortality in the elderly population. The objective of this study was to evaluate the occurrence of hospital infection and risk factors associated with it. METHODS: This is a prospective study of a sample of 332 elderly people, 60 years and older, interned in a university hospital, between September 1999 and February 2000. Sample size was calculated according to the Fisher and Belle formula, with a confidence interval of 0.95%, from a total of 760 elderly patients interned, in proportion to the number of patients present in each in-patient unit, in the 1997. Criteria for defining hospital infection were those established by the Center for Diseases and Prevention Control. Odds ratio and logistic regression were utilized for statistical analysis of the data. RESULTS: The rate of hospital infection was 23.6%. The prevalent topographies of infection were respiratory infections (27.6%), urinary tract infections (26.4%) and surgical wound infections (23.6%). The period of hospitalization of patients who did have hospital infections was 6.9 days, while those who had hospital infections were hospitalized for 15.9 days (p<0.05). Mortality rate among hospitalized patients was 9.6% and the rate of lethality among patients with hospital infection was 22.9% (p<0.05). Risk factors found for hospital infection were cholangiography (odds ratio (OR) =46.4, confidence interval 95% (CI95%) =4.4-485); diabetes mellitus (OR=9.9, CI 95% =4.4-22.3); chronic obstructive pulmonary disease (OR=8.3, CI 95% =2.9-23.7); urinary catheters (OR=5, CI 95% =2.7-11.8); hospitalization with community infection (OR=3.9, CI 95% =1.7-8.9) and mechanic ventilation (OR=3.8, CI 95% =1.9-6.3). CONCLUSIONS: Hospital infection presented elevated incidence and lethality and it increased the period of hospitalization among the elderly studied.     

Mumps Complications and Effects of Mumps Vaccination, England and Wales, 2002�C2006

We analyzed data from hospital admissions and enhanced mumps surveillance to assess mumps complications during the largest mumps outbreak in England and Wales, 2004–2005, and their association with mumps vaccination. When compared with nonoutbreak periods, the outbreak was associated with a clear increase in hospitalized patients with orchitis, meningitis, and pancreatitis. Routine mumps surveillance and hospital data showed that 6.1% of estimated mumps patients were hospitalized, 4.4% had orchitis, 0.35% meningitis, and 0.33% pancreatitis. Enhanced surveillance data showed 2.9% of mumps patients were hospitalized, 6.1% had orchitis, 0.3% had meningitis, and 0.25% had pancreatitis. Risk was reduced for hospitalization (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.43–0.68), mumps orchitis (OR 0.72, 95% CI 0.56–0.93) and mumps meningitis (OR 0.28, 95% CI 0.14–0.56) when patient had received 1 dose of measles, mumps, and rubella vaccine. The protective effect of vaccination on disease severity is critical in assessing the total effects of current and future mumps control strategies.     

Admission of nursing home residents to a hospital internal medicine department

ObjectiveHospitalization of nursing home residents is costly and potentially exposes residents to iatrogenic disease and psychological harm.Design and SettingIn this study, we analyzed the data from the Basic Minimum Data Set of patients hospitalized from the nursing home who were discharged from all the internal medicine departments at the National Health Service hospitals in Spain between 2005 and 2008, according to the data provided by the Ministry of Health and Consumer Affairs.ResultsBetween January 2005 and December 2008, 2,134,363 patients were admitted to internal medicine departments in Spain, of whom 45,757 (2.1%) were nursing home residents. Overall, 7898 (17.3%) patients died during hospitalization, 2442 (30.91%) of them in the first 48 hours. The following variables were the significant predictors of in-hospital mortality in multivariate analysis: age (odds ratio [OR] 1.02, 95% confidence intervals [CI] 1.02–1.03), female gender (OR 1.13, 95% CI 1.13–1.17), dementia (OR 1.09, 95% CI 1.03–1.16), previous feeding tube (OR 1.34, 95% CI 1.09–1.79), malignant disease (OR 2.03, 95% CI 1.86–2.23), acute infectious disease (OR 1.18, 95% CI 1.12–1.25), pressure sores (OR 1.88, 95% CI 1.62–1.95), acute respiratory failure (OR 2.00, 95% CI 1.90–2.10), and nosocomial pneumonia (OR 2.5, 95% CI 2.23–2.72).ConclusionsTwo of every 100 patients admitted to internal medicine departments came from nursing homes. The rate of mortality is very high in these patients, with almost one third of patients dying in the first 48 hours, which suggests that many of these transfers were unnecessary. The cost of these admissions for 1 year was equivalent to the annual budget of a 300- to 400-bed public hospital in Spain. The mechanism of coordination between nursing homes and public hospitals must be reviewed with the aim of containing costs and facilitating the care of patients in the last days of life.     

Does nutritional risk, as assessed by Nutritional Risk Index, increase during hospital stay? A multinational population-based study

BACKGROUND: Progressive nutritional depletion has been reported during hospital stay. This prospective study compared the proportion of nutritional risk at hospital admission in three European countries and further evaluated nutritional risk at late versus early phase of hospitalization in one hospital. METHODS: Nutritional risk was determined in Geneva, Switzerland (n = 652), Berlin, Germany (n = 621) and Nice, France (n = 107) at hospital admission, and during hospital stay (0-100 d) in Nice (n = 527) by the Nutritional Risk Index (NRI) = (1.519 x serum albumin, g/l)+41.7 x (present weight/usual weight). NRI score of >100: no risk (NR); 97.5-100: mild risk; 83.5-97.5: moderate risk (MR); 83.5: severe risk (SR). Logistic regressions were used to determine the odds ratios (OR) between MR or SR and length of hospital stay (LOS) 16d compared to 1-15 d or nutritional assessment at 16-100 d compared to 1-15 d of hospitalization. RESULTS: Patients, assessed at hospital admission, who were hospitalized >16d were more likely (P < 0.001) to be at MR (OR 2.0, CI 1.4-3.0) or SR (OR 3.3, CI 1.7-6.2) than patients hospitalized 1-15 d. Nice patients assessed at 16-100 d were more likely (P < 0.001) to be at MR (OR 5.4, CI 2.1-14.3) and SR (OR 14.7, CI 5.4-40.0) than patients assessed at 1-15 d of hospitalization. CONCLUSIONS: The risk of MR or SR by NRI was greater in patients assessed during hospitalization than in patients assessed at hospital admission, which suggests that patients evaluated later during hospitalization are at greater risk than patients evaluated in the early phase of hospitalization. Ongoing assessment during hospitalization seems important to identify patients who are at increased risk for complications.     

Socioeconomic factors in Helicobacter pylori infection among Danish adults.

OBJECTIVES: This study examined the relationship between housing conditions, educational level, occupational factors, and serologically diagnosed acute and chronic Helicobacter pylori infection. METHODS: Immunoglobulin G and immunoglobulin M serum antibodies against H. pylori were measured in 3589 Danish adults who participated in a population study. RESULTS: Low socioeconomic status (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 1.7, 3.0), short duration of schooling (OR = 2.0, 95% CI = 1.3, 2.5), lack of training/education (OR = 1.4, 95% CI = 1.2, 1.7]), unskilled work (OR = 1.7, 95% CI = 1.2, 2.5), and high work-related energy expenditure (OR = 1.4, 95% CI = 1.1, 1.9) increased the likelihood of chronic H. pylori infection. Infection was frequent in people who had lived abroad. Increased levels solely of immunoglobulin M antibodies were found more often in people who were divorced (OR = 2.3, 95% CI = 1.2, 4.4) or unmarried (OR = 2.0, 95% CI = 1.1, 3.8) or who worked long hours (OR = 2.0, 95% CI = 1.1, 4.0). CONCLUSIONS: Educational and occupational factors relate to the likelihood of chronic H. pylori infection in adults. The rate of acute infection is high in single individuals.     

Combined estimates of effectiveness of mifepristone 10 mg in emergency contraception

The present paper combines the estimates of efficacy and side effects of 10 mg mifepristone for emergency contraception obtained from randomized trials. A total of 6083 women participating in 12 randomized trials and receiving 10 mg mifepristone for emergency contraception up to 120 h after intercourse, were analyzed for efficacy. Between 4188 and 5833 women were analyzed for side effects and 3601 for delay of menses of more than 7 days. Prevented fractions, the effect of delay and of further acts of intercourse after treatment administration were analyzed in 3440 women, using individual data. The combined pregnancy rate from all the 12 trials was 1.7% [101/6083, 95% confidence interval (CI): 1.3–2.2]. From the three trials providing individual data, the combined pregnancy rate was 1.3% (45/3440, 95% CI: 0.9–1.7) and the estimate of pregnancies prevented was 83.4% (95% CI: 77.4–87.8). There was a sharp decline in efficacy when treatment was administered during the 5th day after intercourse compared to administration during the 1st day, the odds of pregnancy increasing by a factor of 5.3 (95% CI: 1.9–14.9). The relative risk of pregnancy was about 28 times higher among women with unprotected acts of coitus between treatment administration and the onset of next menses, compared with women reporting none [odds ratio (OR) = 27.6, 95% CI: 12.7–60.2]. The increase in risk for women reporting protected acts of intercourse during this interval was not statistically significant (OR = 1.8, 95% CI: 0.9–3.8). There was a large heterogeneity among trials in all side effects and delay of menses of more than 7 days (all had p < 0.0001 for the test of homogeneity). The percentage of women with nausea ranged from 0.0–19.4% (highest upper 95% confidence limit: 23.0%), that of vomiting from 0.0–4.3% (highest upper 95% confidence limit: 6.1%), that of lower abdominal pain from 4.3–19.1% (highest upper 95% confidence limit: 22.7%). The percentage of women with delay of menses of more than 7 days ranged from 4.3–25.8% (highest upper 95% confidence limit: 34.1%). We conclude that 10 mg mifepristone is an effective emergency contraception regimen, with an acceptable side-effects profile. Postponing treatment until the 5th day seriously decreases efficacy. The risk of pregnancy is dramatically increased among women having unprotected acts of intercourse between treatment administration and the onset of next menses. This risk may be enhanced for women whose ovulation is postponed by treatment.     

Review of the utilisation of a university hospital in Barcelona (Spain): evolution 1992-1996

Background: To test the applicability of the appropriateness evaluation protocol (AEP) as a tool for reviewing hospital utilisation. To quantify and to compare the rate of inappropriate admissions and amount of in-hospital days, emphasising the main causes and factors in the hospital associated with inappropriateness during the studied periods of time. Patients and methods: Two retrospective studies were carried out, the first one in 1992, when 2048 clinical histories were analysed, and the second in 1996, with 1099 reviewed histories. The tool used for the evaluation of the level of hospital utilisation is the AEP. Results: The proportion of admissions considered to be inappropriate was 25% (95% CI: 20.8–24.5) in 1992, and 16% (95% CI: 13.8–18.2) in 1996. Premature admission was the most frequent cause of inappropriateness in both periods. The logistic regression model built for the dependent variable admission showed the following variables to be associated to inappropriateness: scheduled admission (OR: 15; 95% CI: 10.8–20.7) and (OR: 10; 95% CI: 6–16.5), weekend admission (OR: 2; 95% CI: 1.3–1.2) and (OR: 2; 95% CI: 1.2–2.3), for 1992 and 1996, respectively. The rate of inappropriate in-hospital stays in 1992 was 29% (95% CI: 28.3–29.6), and 13.5% (95% CI: 12.7–14.3) in 1996. Hospital organisational problems were the main cause of inappropriate in-hospital days in 1992, and diagnostic/therapeutical tests that could be performed ambulatorily ranked first in 1996. The logistic regression model built for the dependent variable in-hospital days had the following independent variables associated to its inappropriateness: discharge on week-days (OR: 1.4; 95% CI: 1.2–1.8) and (OR: 0.6; 95% CI: 0.5–0.8) and length of stay (OR: 2; 95% CI: 1.8–2.4) and (OR: 2.4; 95% CI: 2.3–2.5), for 1992 and 1996 respectively, among other variables. Conclusion: Periodic checking of the utilisation levels with the application of methods such as the AEP will contribute towards adapting hospital management in the more competitive current setting.     

农村高返贫风险脑卒中患者就诊行为与自评治疗效果关联分析

  目的  了解中国农村≥40岁高返贫风险脑卒中患者就诊行为、自评治疗效果情况及二者关联。  方法  利用“健康扶贫动态管理系统”数据,筛选14 614名农村≥40岁高返贫风险脑卒中患者,采用描述性分析和多因素Logistic回归分析模型对其就诊情况与自评治疗效果进行关联性分析。  结果  14 614名脑卒中患者中,自评病情好转率为62.5%;到基层医疗机构、县域内医疗机构进行就诊、住院治疗和5年间因脑卒中就诊次数为1~2次的患者比例较高,患者年医疗花费中位数为4 646.53元。多因素Logistic回归分析模型结果显示,在基层就诊(OR=1.10,95% CI:1.02~1.19)、住院治疗(OR=2.01,95% CI:1.83~2.21)和年医疗花费越高的患者自评治疗效果更好,2016-2020年间就诊3~5次(OR=0.77,95% CI:0.70~0.84)、6次及以上(OR=0.59,95% CI:0.51~0.67)的患者与就诊1~2次的患者相比,自评治疗效果较差。  结论  农村≥40岁高返贫风险脑卒中患者的就诊情况与自评治疗效果紧密相关。     

Hepatitis C virus infection in injection drug users in Bavaria: risk factors for seropositivity

Background: Hepatitis C Virus (HCV) infection is the most common disease among intravenous drug users (IDUs). Patients and method: All patients admitted to the detoxification unit 1991–1997 and meeting ICD-10 diagnosis of opioid dependency were tested for anti-HCV serology. Results: Thousand and forty nine patients were included in the study. About 61.3% of the IDUs were anti-HCV positive. Increasing age (PR: 1.46; 95% CI: 1.34–1.60), living with a significant other drug user (PR: 1.17; 95% CI: 1.05–1.31), history of therapy (PR: 1.62; 95% CI: 1.50–1.74), history of imprisonment (PR: 1.48; 95% CI: 1.36–1.61), history of emergency treatment (PR: 1.23; 95% CI: 1.12–1.35), additional daily consumption of benzodiazepines (PR: 1.10; 95% CI: 1.00–2.21) or alcohol (PR: 1.26; 95% CI: 1.14–1.38), frequency of injecting heroin (daily: PR: 0.86; 95% CI: 0.78–0.96; previously: PR: 1.14; 95% CI: 1.03–1.26) and type of opioid dependency (methadone: PR: 1.26; 95% CI: 1.13–1.41) were significant factors, considered as individual factors, for positive anti-HCV serology. Using multiple logistic regression we found that older age (OR: 3.54, 95% CI: 1.30–9.67), longer duration of opioid use (OR: 5.74; 95% CI: 1.82–18.13), living with a significant other drug user (OR: 1.47; 95% CI: 1.01–2.16), history of therapy (OR: 4.87; 95% CI: 1.67–14.20), history of imprisonment (OR: 1.92; 95% CI: 1.12–3.28), history of emergency treatment (OR: 1.45; 95% CI: 1.06–1.99) and additional daily consumption of alcohol (OR: 1.49; 95% CI: 1.04–2.13) remained independently associated with positive anti-HCV serology. Conclusions: These data support the need for early prevention strategies, namely, education of teachers in schools and further training of counsellors informing IDUs of what they can do to minimise the risk of becoming infected or of transmitting infectious agents to others.     

The use of nicotine-replacement therapy by hospitalized smokers

BACKGROUND: No-smoking policies are mandatory in U.S. hospitals. Consequently, smokers who are hospitalized must temporarily stop smoking. Nicotine-replacement therapy (NRT) could help hospitalized smokers relieve nicotine withdrawal symptoms, comply with no-smoking policies, and sustain tobacco abstinence after discharge. The extent of NRT use in the hospital setting is unknown. We describe the prevalence and patterns of NRT use in hospitalized smokers. DESIGN: Prospective observational study within a randomized smoking-intervention trial. SETTING/PARTICIPANTS: Six hundred fifty adult smokers admitted to the medical and surgical services of a large urban teaching hospital that prohibits smoking in all indoor areas. Follow-up was at 6 months. MAIN OUTCOME MEASURE: Inpatient pharmacy records of nicotine patch or gum use. RESULTS: Only 34 of 650 smokers (5.2%) received NRT during their hospital stay, including only 9.6% of smokers who reported difficulty refraining from smoking while hospitalized and 9.0% of hospitalized smokers with nicotine withdrawal. NRT was more likely to be prescribed to patients with nicotine withdrawal (OR 2.23; 95% CI: 1.01, 4.90), a higher daily cigarette consumption (OR 1.04; 95% CI: 1.01, 1.06), and a longer hospitalization (OR 1.05; 95% CI: 1.00, 1.10). NRT use was independent of a patient's intention to quit smoking after discharge and was not associated with smoking cessation 1 and 6 months after discharge. CONCLUSIONS: NRT was rarely used in this hospital, even among those who could have benefited from it to treat nicotine-withdrawal symptoms. When NRT was used, relief of nicotine withdrawal, rather than assistance with smoking cessation, appeared to be the primary goal. Greater use of NRT could benefit the estimated 6.5 million smokers who are hospitalized annually by reducing nicotine withdrawal, encouraging smoking cessation, and ensuring compliance with hospital no-smoking policies.     

Hospital admissions for pertussis in Spain, 1995-1998

This epidemiological survey was undertaken to estimate the annual burden of hospitalizations for pertussis in Spain during a four-year period 1995–1998. Data were obtained from the national surveillance system for hospital data. All hospital discharges for pertussis (ICD-9- CM 033) were analyzed. The annual incidence of hospitalization for pertussis was 1.7 per 100,000 population. Eighty-nine percent of the cases were <1 year of age (incidence of 78 per 100,000) and 95% were ≤5 years of age (incidence of 28 per 100,000). During the study period, 14 deaths were reported among patients hospitalized by pertussis. Despite of the high inmunization rates, many pertussis cases occur each year, mostly of them among very young children.     

Which clinical indicators and resident characteristics are associated with health care practitioner nursing home visits or hospital transfer for urinary tract infections?

OBJECTIVES: (1) To determine factors associated with practitioner visitation and/or hospital transfer for skilled nursing facility (SNF) patients who develop a urinary tract infection (UTI) and (2) to determine if SNF patients with a Do Not Resuscitate (DNR) directive are less likely to be personally assessed and/or transferred to the hospital in the event of a UTI when compared to patients without a DNR directive. DESIGN: Retrospective cohort study using nursing home medical record review. PARTICIPANTS: Participants were 564 residents from 35 nursing homes in 3 states who became acutely ill with UTI during the first 90 days of their nursing home admission. They were identified from 2832 random nursing home Medicare admissions and divided into 2 groups, those with DNR directives (n = 334) and those without (n = 230). MEASUREMENTS: Logistic regression was used to determine factors associated with practitioner in-person assessment and/or hospitalization, and to determine differences in the likelihood of practitioner in-person assessment and/or hospitalization among those with DNR directives versus those without DNR directives. RESULTS: Only one third (29%) of patients with unstable vital signs were seen by a practitioner or transferred to a hospital. Factors associated with practitioner assessment or hospital transfer were elevated temperature (OR 1.7, CI 1.04-2.64), pulse more than 100 beats per minute (OR 1.7, CI 1.01-2.99), and delirium (OR 2.1, CI 1.267-3.44). White residents were less likely to be assessed by a practitioner or transferred to a hospital (OR 0.45, CI 0.22-0.95). DNR directives were not significantly associated with fewer in-person assessments (P = .067). CONCLUSION: Only one third of SNF patients who developed a UTI with unstable vital signs were personally assessed by a practitioner and/or hospitalized. Patients with delirium were twice as likely to be assessed or transferred to a hospital, suggesting that practitioners use delirium as an indicator of illness severity. However, practitioner visit or transfer was also associated with ethnic background. In the absence of good evidence regarding which nursing home residents are likely to benefit from hospitalization or an urgent practitioner visit, these care decisions will continue to be associated with factors that are unknown.     

Self-reported and performance-based functional status and associated factors among elderly men: the Finnish cohorts of the Seven Countries Study

Health and functional status were studied in 470 men aged 70–89, the survivors of the Finnish cohorts of the Seven Countries Study. We aimed to compare subjective (self-reported activity of daily living [ADL]) and objective methods (four physical performance tests) in the assessment of physical function and to identify which factors are related to physical function. Poor ADL and decreased physical performance were mainly explained by the same health-related factors. The strongest determinants of ADL were depressive symptomatology odds ratio [OR] 4.8, 95% confidence interval [CI] 2.7–8.8), osteoarthritis (OR 3.3, 95% CI 1.8–5.9), vertigo (OR 2.5, 95% CI 1.2–5.5) and diabetes (OR 2.3, 95% CI 1.2–4.6). Self-reported ADL and performance-based measures were in general strongly correlated with each other, although there was some discordance owing to the fact that these performance tests examine functional limitations, whereas the self-reported ADL reflects disability. The choice of which measurement to use in assessing functional status should be based on research objectives and the type of population under study.     

Provision of health counseling in office-based practices and hospital outpatient clinics

OBJECTIVE: To compare the rates of health counseling provided during primary care visits in two different types of ambulatory care settings. METHODS: Secondary analysis of the 2000 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS). RESULTS: Of the estimated 722 million adult ambulatory care visits during 2000, 90.8% were made to office-based physician practice settings and 9.2% to hospital-based outpatient departments. Consistent with previous reports, the demographic profile of patients who seek primary care in hospital outpatient departments differs from those seen in office-based practices. Provision of health counseling for exercise [OR = 1.4; 95% confidence intervals (CI): 1-1.8], diet (OR = 1.6; 95% CI: 1.2-2.3), breast self-exam (OR = 2; 95% CI: 1.1-3.6) and stress management (OR = 1.7; 95% CI: 1-2.7) during patient visits was more likely to be reported in the office-based practices than in hospital outpatient clinics. The visit-based rates of health counseling for HIV/STD prevention, tobacco use, mental health or injury prevention were low in both settings. CONCLUSIONS: There is opportunity to improve rates of preventive counseling in primary care settings and to reduce disparities that exist. Identifying the reasons for these disparities and effective interventions will be important steps in providing equitable care in the area of preventive health counseling.     

Long COVID symptoms in a population-based sample of persons discharged home from hospital

ObjectivesThe impact of long COVID among persons hospitalized and discharged home is unknown. We aimed to (1) report the prevalence of long COVID in persons hospitalized for COVID-19 and discharged home; (2) estimate the prevalence of physical, sensory, and psychological/mental health impairments; and (3) explore associated factors.MethodsWe conducted a telephone survey of adult residents in Laval, Quebec, who were discharged home ≥ 2 months post-hospitalization for COVID-19. Participants responded to a standard questionnaire regarding persistent symptoms. We calculated the prevalence of long COVID and of persistent types of symptoms and evaluated associated factors using bivariate analysis and multivariable logistic regression.ResultsIn our sample (n = 398), 70% reported physical symptoms, 58% psychological problems, and 16% sensory impairments. 31.5% reported being troubled by persistent symptoms (long COVID). Factors associated with long COVID were a greater number of symptoms (odds ratio (OR) = 1.97, 95% confidence interval (CI) = 1.69–2.28) and increased hospital stay (OR = 1.03, 95% CI = 1.01–1.06). Other factors associated with physical and psychological symptoms were female sex (OR = 2.17, 95% CI = 1.27–3.71 and OR = 2.06, 95% CI = 1.25–3.39; respectively), higher education level (OR = 2.10, 95% CI = 1.20–3.68 and OR = 2.43, 95% CI = 1.44–4.14; respectively), and obesity (OR = 1.95, 95% CI = 1.15–3.34 and OR = 1.70, 95% CI = 1.05–2.77; respectively).ConclusionIn this population-based study of persons hospitalized for COVID-19 and discharged home, nearly one third were troubled by symptoms for 2 months or more post-discharge. There was a high proportion with persistent physical and psychological/mental health symptoms. Further research will assess the specific needs of these patients to inform health policy makers on service requirements for these persons.     

Referral and delivery outcomes in Kivu,Democratic Republic of Congo

BACKGROUND: The process of referral between the first and the second level of the health system in the Democratic Republic of Congo is poorly understood. This report intends to study the association between the referral and the hospital perinatal outcomes. METHODS: Delivery outcomes in a retrospective cohort of 1162 women admitted between June 95 and May 96, in two referral hospitals in Kivu were analyzed according to the referral status and the women's characteristics. RESULTS: Forty-three percent (n=492)of women admitted, corresponding to 2.3% of expected pregnant women, were referred. Referred women had higher risks of obstetrical complications (OR=2.0; CI95%: 1.3-3.1) and intervention (OR=1.5; CI95%: 1.0-2.3) and similar risks of low birth weight and perinatal mortality. Women with complications during the antenatal period had a double risk of intervention and perinatal mortality. The risk of obstetrical intervention was lower when women had attended 2 visits (OR=0.5; CI95%: 0.3-0.8); the risk of low birth weight was lowest only for mothers who had attended one visit (OR=0.5; CI95%: 0.3-0.9). Distance > or =90 minutes walking from home to hospital raised the risk of obstetrical complication (OR=1.7; CI95%: 1.1-2.5), the risk of obstetrical intervention (OR=1.5; CI95%: 1.0-2.1), and the risk of perinatal mortality (OR=1.6; CI95%: 1.0-2.7). Late admission raised the risk of perinatal mortality (OR=1.8; CI95%: 1.2-2.9) and lowered the risk of obstetrical complication (OR=0.7; CI95%: 0.5-1.0). Part payment of care was associated with higher risks of low birth weight (OR=1.9; CI95%: 1.3-2.9), perinatal mortality (OR=2.2; CI95%: 1.4-3.5) and obstetrical intervention (OR=2.4; CI95%: 1.7-3.4). CONCLUSION: These results suggest a deficit of referred cases considering that 15% of pregnant women in the area covered by the referral hospitals should have been referred. They confirm the negative influence of economic and geographic constraints on the delivery outcomes. They point out the relevance of making reorganization of the referral system a priority.