Increasing hospital admissions for pneumonia, England

Pneumonia is an important cause of illness and death in England. To describe trends in pneumonia hospitalizations, we extracted information on all episodes of pneumonia that occurred from April 1997 through March 2005 recorded in the Hospital Episode Statistics (HES) database by searching for International Classification of Diseases 10th revision codes J12-J18 in any diagnostic field. The age-standardized incidence of hospitalization with a primary diagnosis of pneumonia increased by 34% from 1.48 to 1.98 per 1,000 population between 1997-98 and 2004-05. The increase was more marked in older adults, in whom the mortality rate was also highest. The proportion of patients with recorded coexisting conditions (defined by using the Charlson Comorbidity Index score) increased over the study period. The rise in pneumonia hospital admissions was not fully explained by demographic change or increasing coexisting conditions. It may be attributable to other population factors, changes in HES coding, changes to health service organization, other biologic phenomenon, or a combination of these effects.     

Impact of influenza infection on children's hospital admissions during two seasons in Athens, Greece

A prospective epidemiologic surveillance of hospitalizations associated with influenza was conducted in order to calculate population-based hospitalization rates. Eligible children were 6 months to 13 years of age and were admitted to one of the two large children's hospitals in the Athens area during two influenza seasons. Nasopharyngeal aspirates were tested for influenza by a polymerase reaction assay. Influenza accounted for 9.9-11.8% of all admissions during the influenza season and the overall annual rate of hospitalizations was 13.6-16.8 cases per 10,000 children being highest for children under 5 years of age (26-31.2/10,000 children). Febrile seizures and acute otitis media were the two most common complications associated with influenza and antibiotics were administered to 61% of flu positive patients. Influenza is associated with high hospitalization rates among young children and these may be substantially reduced with the introduction of routine immunization.     

上海地区某医院门诊儿童流感社会经济负担调查

目的 监测和评估2011年至2012年流感季节上海地区儿童流行性感冒(流感)的流行特征及其相应社会经济负担.方法 在2011年6月至2012年5月连续1年间,前瞻性监测因流感样疾病就诊于复旦大学附属儿科医院的门诊患儿,收集呼吸道标本和临床资料,进行流感病毒的检测.在流感暴发流行期间,采用问卷调查法评估确诊病例的疾病负担.结果 共入选1 119例患儿,流感病毒阳性病例370例(33.1％),甲型H3N2流感病毒阳性109例(9.7％),乙型流感病毒阳性279例(24.9％),未发现新型甲型H1N1流感病毒感染病例.不同月份流感检出率为1.1％ ～ 91.2％,不同月份优势流行株有所差异,2011年12月至2012年2月以乙型流感流行为主,2012年3月至2012年4月以甲型H3N2流感流行为主.共232例确诊流感的患儿接受问卷调查,其中甲型H3N2流感儿童病例69例,乙型流感儿童病例163例.每例流感患儿在医院就诊的平均费用为706.10元,每例流感患儿因家人误工造成的间接经济损失为293.80元,每例流感患儿总的平均费用为999.90元.每例平均就诊次数2.7次;抗生素使用率67.2％;家庭成员继发发病率21.1％;肺炎并发症发生率5.6％.甲型H3N2流感与乙型流感对于患儿及其家庭所造成的疾病负担无明显差异.结论 2011年6月至2012年5月期间上海地区儿童流感主要系甲型H3N2流感病毒和乙型流感病毒感染所致.在流感流行期间,流感对儿童及其家庭有明显的社会经济学影响,提倡接种流感疫苗预防儿童流感,降低疾病负担.     

The risk of lower respiratory tract infection following influenza virus infection: A systematic and narrative review

BackgroundLower respiratory tract infections (LRTI) are a major cause of morbidity and mortality worldwide, particularly in young children and older adults. Influenza is known to cause severe disease but the risk of developing LRTI following influenza virus infection in various populations has not been systematically reviewed. Such data are important for estimating the impact specific influenza vaccine programs would have on LRTI outcomes in a community. We sought to review the published literature to determine the risk of developing LRTI following an influenza virus infection in individuals of any age.Methods and findingsWe conducted a systematic review to identify prospective studies that estimated the incidence of LRTI following laboratory-confirmed influenza virus infection. We searched PubMed, Medline, and Embase databases for relevant literature. We supplemented this search with a narrative review of influenza and LRTI. The systematic review identified two prospective studies that both followed children less than 5 years. We also identified one additional pediatric study from our narrative review meeting the study inclusion criteria. Finally, we summarized recent case-control studies on the etiology of pneumonia in both adults and children.ConclusionsThere is a dearth of prospective studies evaluating the risk of developing LRTI following influenza virus infection. Determining the burden of severe LRTI that is attributable to influenza is necessary to estimate the benefits of influenza vaccine on this important public health outcome. Vaccine probe studies are an efficient way to evaluate these questions and should be encouraged going forward.     

我院15年人才培养的回顾性研究

目的 通过分析医院近15年的人才培养情况,阐述医院人才培养的创新性制度.方法 整理15年人才培养的基本情况,运用配对T检验和Wilcoxon秩和检验等统计方法分析培养前后人才医、教、研、管理能力的变化状况.结果 通过培养,人才的医、教、研、管理能力有显著性的提升.结论 只有建立创新性的人才培养制度,才能提升医院的综合竞争力,更好地服务于患者.     

Stochastic demand, production responses and hospital costs

This paper considers the production responses to demand uncertainty within the hospital sector. It is noted that such responses have an impact on hospital cost structures. An empirical model is specified. Estimation is undertaken on a sample of UK hospitals over the period 1993-1995, differentiating between hospital output which arises from uncertain demand (emergency treatment) and output considered to be predictable (elective treatment). The model estimates that the cost of an elective admission is approximately 45% of the cost of an emergency admission. Demand uncertainty imposes a direct cost equivalent to around 5% of the total cost of emergency admission.     

Incidence,direct costs and duration of hospitalization of patients hospitalized with community acquired pneumonia: A nationwide retrospective claims database analysis

BackgroundCommunity-acquired pneumonia (CAP) is one of the most common acute infections associated with a substantial clinical and economic burden. There have been few studies assessing incidence rate, duration of hospitalization, and costs of hospitalized CAP by age and care-setting.MethodsA retrospective study was conducted using a nationwide Dutch database containing healthcare claims data of 16.7 million inhabitants. Patients with at least one claim with a discharge diagnosis of CAP between January 2008 and December 2011 were selected. The main outcome measures considered were the incidence rate, duration of hospitalization, and the direct costs of hospitalized CAP stratified by age and care-setting.ResultsIn total, 195,372 CAP cases were included in the analysis resulting in an average incidence of 295 per 100,000 population per year. Sixty-three percent (123,357) of the included patients were hospitalized for 1 or more nights, of which 5.9% (n = 7241) spent at least one night in the Intensive Care Unit (ICU). Overall, these 123,357 patients spent 824,985 days in the hospital of which 48,324 were spent on the ICU. The mean duration of hospitalization of ICU patients and general ward patients was 15.2 days and 6.2 days, respectively. The total costs related to all 195,372 CAP episodes during these 4 years were €711 million, with the majority (76%) occurring among those aged 50 years and older. Median (and mean) costs were dependent on age and type of care with costs ranging from €344 (€482) per episode for 0–9 year olds treated in the outpatient hospital setting up to €10,284 (€16,374) per episode for 50–64 year olds admitted to the ICU.ConclusionThere is a large variation in terms of incidence, disease burden and costs across different age groups and the treatment setting. Effective interventions, targeted at older adults, to prevent pneumonia could reduce the (financial) burden due to pneumonia.     

大同市大气SO_2与5岁以下儿童呼吸系统疾病住院的浓度-反应关系研究

目的研究大气SO_2水平与5岁以下儿童呼吸系统疾病每日住院人数的浓度-反应关系。方法住院数据来自2005—2006年大同市主要的9所医院的电子病历首页,空气质量数据来自市内3个空气监测点,气象数据来自山西省气象局。用广义相加模型(GAM)建立浓度-反应关系;用多重结构断裂点检测法确定浓度-反应关系曲线上的拐点;用约束性分段线性函数估计相对危险度。结果大气SO_2与5岁以下儿童呼吸系统疾病日住院人数的浓度-反应关系主要呈非线性相关,曲线呈C、S和J三种形状。关于滞后效应,整个研究期和非采暖期均只有当天(lag0)分析结果有统计学意义,SO_2每升高10μg/m~3,5岁以下儿童呼吸系统疾病住院人数分别增加1.50%和2.93%;采暖期在滞后3 d(lag3)、5 d(lag5)、6 d(lag6)分析结果有统计学意义,在滞后3 d(lag3)效应最强,SO_2每升高10μg/m~3,5岁以下儿童呼吸系统疾病住院人数增加2.08%。关于平均效应,整个研究期和采暖期多数曲线分析结果有统计学意义,且表现为危险度随平均天数增大而增大的趋势,7 d移动平均(avg06)SO_2每升高10μg/m~3,5岁以下儿童呼吸系统疾病住院人数分别增加1.35%和1.60%;非采暖期分析结果均无统计学意义。结论大气SO_2浓度的升高可以导致儿童呼吸系统疾病住院人数增加,浓度-反应关系主要呈曲线相关。     

The contribution of influenza to combined acute respiratory infections, hospital admissions, and deaths in winter

The impact of influenza is assessed by comparing events during epidemics with those expected outside epidemic periods (defined from incidence data collected by the Weekly Returns Service of the Royal College of General Practitioners from 1989 to 1998 for influenza-like illness, acute otitis media, acute bronchitis, and all respiratory infections combined in the community and virus isolate data). Estimates of the consulting populations for each condition in England and Wales were derived by extrapolating the difference between observed and baseline incidence rates to the total population. Similar methods were applied to data on hospital admissions for cardiac and respiratory diseases and to deaths. Each year an average of 422,000 extra people consulted and were diagnosed with influenza-like illness during the epidemic period; among 1.1 million extra people who presented with acute respiratory infections. There were 3028 excess respiratory admissions (England only) in the age group 65 to 74 years and 6049 who were aged over 75 years, but no excess cardiac admissions. An average of 12,554 deaths occurred in England and Wales during influenza epidemic periods each year. Age specific national data are needed to interpret the economic impact of an illness in relation to the setting for health care delivery.     

Influenza vaccination of hospital staff in Germany: a five-year survey on vaccination coverage and policies: identified deficits in influenza immunisation campaigns for hospital employees

Summary. Objectives: Influenza vaccination of hospital staff is recommended by STIKO, the German committee for vaccination. A survey was conducted to assess compliance with this recommendation. The occupational health services of 25 hospitals participated in a survey and provided data by questionnaire on influenza vaccination and on hospital policies to promote coverage of employees.Methods: Vaccination activities were monitored by occupational health services (OHS) for five consecutive years from 1997 to 2002. The hospital sample covered a total of 17089 beds (3.23% of the hospital capacity in Germany) and a total number of 41969 employees (4.39% of hospital staff).Results: The proportion of hospitals actively offering influenza vaccination increased from 48% in 1997/98 to 92% in 2001/02. Vaccination coverage of all staff in 1997 was only 3.3% and reached 8.4% in 2001/02. Coverage of vaccinating hospitals increased from 5.0% to 10.4%. Poster campaigns and managing board commitment had significant impact.Conclusions: Considerable progress has been made to involve more hospitals and to increase coverage for vaccination of hospital employees. Nevertheless, coverage levels remain unacceptably low. Recommendations are ignored extensively.

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Zusammenfassung. Influenzaimpfung von Krankenhauspersonal in Deutschland: eine Fünfjahresuntersuchung zu Durchimpfungsraten, Impfpolitik und -defiziten in 25 deutschen KrankenhäusernFragestellung: Die Impfung von Krankenhauspersonal gegen Influenza wird von der Ständigen Impfkommission (STIKO) empfohlen. Die Umsetzung dieser Empfehlung in deutschen Krankenhäusern wurde untersucht. Die Betriebsärzte von 25 Krankenhäusern nahmen an einer Umfrage teil, für die sie Daten ihres jeweiligen Hauses zur Influenzaimpfung und Impfpolitik bereitstellten.Methode: Die Untersuchung fand in fünf aufeinander folgenden Jahren (1997–2002) statt. Die Stichprobe umfasste insgesamt 17089 Betten (3,23% der gesamten deutschen Bettenkapazität) und 41969 Angestellten (4,39% des deutschen Krankenhauspersonals).Ergebnisse: Der Anteil der impfenden Krankenhäuser stieg von 48% in der Saison 1997/98 auf 92% in 2001/02. Die Durchimpfungsrate lag 1997 bei nur 3,3% und 2001/02 erreichte sie 8,4%. Die Impfrate in impfenden Krankenhäusern stieg im gleichen Zeitraum von 5,0% auf 10,4%. Poster-Kampagnen und Einbeziehung der Krankenhausleitung haben signifikanten Einfluss.Schlussfolgerung: Es zeigt sich eine deutliche Steigerung sowohl der Krankenhäuser mit Impfangebot als auch der Durchimpfungsrate des Krankenhauspersonals. Nichtsdestotrotz bleibt diese aber auf einem nicht akzeptabel niedrigem Niveau.

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Résumé. Vaccination contre la grippe du personnel hospitalier en Allemagne: une recherche de cinq ans sur les taux de vaccination et la politique appliquée en matière de vaccination dans 25 hôpitaux allemandsObjectifs: La vaccination du personnel hospitalier contre la grippe est recommandée par la Commission permanente de la vaccination du Robert Koch Institut. Cette étude a porté sur lapplication de cette recommandation dans les hôpitaux allemands. Les médecins du travail de 25 hôpitaux ont participé à une enquête dans le cadre de laquelle ils ont fourni les données suivantes: prévalence de la vaccination contre la grippe et méthodes de promotion de la vaccination.Méthodes: Lenquête a eu lieu cinq années consécutives (1997–2002). Elle a porté sur 25 hôpitaux, soit sur 41969 employés (4,39% du personnel hospitalier allemand).Résultats: La proportion dhôpitaux pratiquant la vaccination est passée de 48% pour la période 1997/98 à 92% pour 2001/02. En 1997, le taux de vaccination ne sélevait quà 3,3% pour atteindre 8,4% en 2001/02. Le taux de vaccination dans les hôpitaux pratiquant déjà la vaccination en 1997 est passé durant la même période de 5,0% à 10,4%. Limplication de la direction hospitalière ainsi que le recours à des affiches ont eu un impact significatif.Conclusions: Le nombre dhôpitaux proposant la vaccination, ainsi que le taux de vaccination ont nettement augmenté. Néanmoins, ce taux reste à un niveau inacceptablement bas.

     

Effectiveness of influenza vaccination in elderly diabetic patients: A retrospective cohort study

Purpose

Studies regarding the clinical benefits of influenza vaccination in diabetic patients are limited. This study evaluated if the elderly diabetic patients who have had influenza vaccination would have benefits such as reduced medical care and mortality.

Methods

We used the universal insurance claims data from 2001 to 2009 in Taiwan to identify annual elderly patients with diabetes cohorts with (N = 4454) and without (N = 4571) influenza vaccination. The risk of developing pneumonia or influenza, respiratory failure, intensive care, hospitalization, and mortality were measured and compared between cohorts within one year of follow-up.

Results

The vaccine cohort had lower incidences of pneumonia or influenza and respiratory failure compared with the non-vaccine cohort. More importantly, the vaccine cohort had a hospitalization rate that was 11% less than the non-vaccine cohort (29.6 vs. 33.1 per 100 person-years) with an adjusted hazard ratio (HR) of 0.88 (95% CI 0.81–0.96). The vaccine cohort was also less likely to be admitted to the intensive care unit (ICU) [0.58 vs. 2.05 per 100 person-year; adjusted HR 0.30 (95% CI 0.19–0.47)] and less likely to expire [3.13 vs. 7.96 per 100 person-year; adjusted HR 0.44 (95% CI 0.36–0.54)]. Influenza vaccination reduced the hospitalization cost by 1282.6 USD, compared with patients without influenza vaccination (95% CI −2210.3, −354.8).

Conclusion

Influenza vaccination is associated with a reduced risk of morbidity, hospitalization, ICU admissions, and mortality. In addition, the hospitalization cost is reduced.     

Spatial implications of covariate adjustment on patterns of risk: respiratory hospital admissions in Christchurch, New Zealand

Epidemiological studies that examine the relationship between environmental exposures and health often address other determinants of health that may influence the relationship being studied by adjusting for these factors as covariates. While disease surveillance methods routinely control for covariates such as deprivation, there has been limited investigative work on the spatial movement of risk at the intraurban scale due to the adjustment. It is important that the nature of any spatial relocation be well understood as a relocation to areas of increased risk may also introduce additional localised factors that influence the exposure-response relationship. This paper examines the spatial patterns of relative risk and clusters of hospitalisations based on an illustrative small-area example from Christchurch, New Zealand. A four-stage test of the spatial relocation effects of covariate adjustment was performed. First, relative risks for respiratory hospitalisations from 1999 to 2004 at the census area unit level were adjusted for age and sex. In three subsequent tests, admissions were adjusted for annual exposure to particulate matter less than 10 microm in diameter (PM10), then for a deprivation index, and finally for both PM10 and deprivation. Spatial patterns of risk, disease clusters and cold and hot spots were generated using a spatial scan statistic and a Getis-Ord Gi* statistic. In all disease groups tested (except the control disease), adjustment for chronic PM10 exposure and deprivation modified the position of clusters substantially, as well as notably shifting patterns and hot/cold spots of relative risk. Adjusting for PM10 and/or for deprivation shifted clusters in a similar spatial fashion. In Christchurch, the resulting shift relocated the cluster from a purely residential area to a mixed residential/industrial area, possibly introducing new environmental exposures. Researchers should be aware of the potential spatial effects inherent in adjusting for covariates when considering study design and interpreting results.     

Achieving optimal influenza vaccination rates: a survey-based study of healthcare workers in an urban hospital

In the USA, more than 36 000 deaths and 114 000 hospitalisations result from the influenza virus annually. Healthcare workers have been identified as a key source of influenza outbreaks. Despite Centers for Disease Control and Prevention recommendations to vaccinate all healthcare workers, the rate remains low. A survey-based investigation of influenza vaccination rates and related factors was carried out in an urban community teaching medical centre. A total of 570 surveys revealed a 56.5% influenza vaccination rate among participants. Participants who received the vaccine had a significantly higher mean influenza knowledge score compared to those who did not receive the vaccine (P=0.003). Also, a relationship was identified between those who received the vaccine and the perception that the purpose of the vaccine is to prevent patients from being exposed to influenza (P=0.001). Lastly, hospital departments in which managers actively encouraged and facilitated vaccination had higher rates in general.     

Cost-effectiveness of dual influenza and pneumococcal vaccination among the elderly in Shenzhen,China

ObjectiveTo assess the cost-effectiveness of dual influenza and pneumococcal vaccination for the elderly in Shenzhen, China.MethodsA Markov state-transition model with a weekly cycle was developed to compare the outcomes of dual influenza and pneumococcal vaccination for the prevention of influenza and pneumococcal infections compared with no vaccination among 70–74 years old people in Shenzhen over 5 years. The model allowed seasonal variation of influenza activity. We calculated the incremental cost-effectiveness ratio (ICER) with costs and quality-adjusted life years (QALYs) discounted at 5% annually from the societal perspective. The impact of parameter uncertainty on the results was examined using one-way and probabilistic sensitivity analyses (PSA).ResultsIn the base case, dual vaccination prevented 5042 influenza infections, 26 IPD cases, 3 disabilities, 34 deaths, and cost US$7.1 per person while resulting in a net gain of 0.0026 QALYs compared with no vaccination. Using once the Chinese gross domestic product per capita in 2019 (US$10,289) as the willingness-to-pay threshold, dual vaccination was cost-effective with an ICER of US$2699 per QALY gained. One-way sensitivity analyses showed that the ICER was relatively sensitive to changes in influenza attack rates and influenza vaccine effectiveness. Based on the results of PSA with 1000 Monte Carlo simulations, receiving both vaccines was cost-effective in 100% of the repetitions.ConclusionThe current study provides evidence that dual influenza and pneumococcal vaccination is a cost-effective disease prevention strategy for the elderly in Shenzhen, China.     

北京市肺炎球菌疫苗免费接种政策对老年人肺炎住院的影响

目的  分析北京市肺炎球菌疫苗免费接种政策实施前后北京市老年人群肺炎住院情况的变化,评估该项政策对老年人肺炎防治的效果。方法  利用北京市城镇职工医疗保险数据库2014―2019年收集的老年人群住院数据,以2019年1月作为政策的干预分界点,应用中断时间序列模型(interrupted time series, ITS)分析政策实施前后北京市老年人群肺炎住院人次的变化。结果  免费接种政策实施前北京市≥65岁老年人因肺炎住院人次呈上升趋势(RR=1.019,P < 0.001),政策实施后上升趋势有所减缓(RR=0.971,P=0.013);敏感性分析中,≥65岁老年人因股骨骨折住院人次在政策实施前后则没有明显变化(RR=0.992,P=0.503)。结论  肺炎疫苗免费接种政策与老年人肺炎住院趋势减缓有一定关联,应进一步采取相关策略提高该疫苗的接种可及性。