Surgical-site infection due to Staphylococcus aureus among elderly patients: mortality, duration of hospitalization, and cost.

OBJECTIVES: To examine the impact of surgical-site infection (SSI) due to Staphylococcus aureus on mortality, duration of hospitalization, and hospital charges among elderly surgical patients and the impact of older age on these outcomes by comparing older and younger patients with S. aureus SSI. DESIGN: A nested cohort study. SETTING: A 750-bed, tertiary-care hospital and a 350-bed community hospital. PATIENTS: Ninety-six elderly patients (70 years and older) with S. aureus SSI were compared with 2 reference groups: 59 uninfected elderly patients and 131 younger patients with S. aureus SSI. RESULTS: Compared with uninfected elderly patients, elderly patients with S. aureus SSI were at risk for increased mortality (odds ratio [OR], 5.4; 95% confidence interval [CI95], 1.5-20.1), postoperative hospital-days (2.5-fold increase; CI95, 2.0-3.1), and hospital charges (2.0-fold increase; CI95, 1.7-2.4; dollar 41,117 mean attributable charges per SSI). Compared with younger patients with S. aureus SSI, elderly patients had increased mortality (adjusted OR, 2.9; CI95, 1.1-7.6), hospital-days (9 vs 13 days; P = .001), and median hospital charges (dollar 45,767 vs dollar 85,648; P < .001). CONCLUSIONS: Among elderly surgical patients, S. aureus SSI was independently associated with increased mortality, hospital-days, and cost. In addition, being at least 70 years old was a predictor of death in patients with S. aureus SSI.     

The burden of hospitalization due to overweight and obesity in Brazil

This article estimates the burden of hospitalization associated with overweight and obesity in Brazil. The analysis of all hospitalizations for men and women from 20 to 60 years of age was based on the National Healthcare Expenditure Database (SIH-SUS), covering more than 70% of all hospital admissions. Data were for the year 2001. Attributable fraction of hospitalizations associated with diseases related to obesity and overweight was based on the combined risks of United States and European cohorts. The population-attributable fraction for each disease studied was multiplied by values reimbursed to the hospitals and summed to obtain total direct costs. Overall costs of overweight and obesity represent 3.02% of total hospitalization costs for men and 5.83% for women, corresponding to 6.8 and 9.3% of all hospitalization (excluding pregnancy). Diseases associated with overweight and obesity had a significant impact on hospitalizations and economic costs in Brazil, and overall percentages were similar to those from developed countries. Since the nutritional transition is still under way in Brazil, overweight had a higher impact than obesity on disease prevalence and costs.     

Long-term exposure to cement dust and later hospitalization due to respiratory disease

Summary The relationship between exposure to cement dust in a Portland cement factory and later hospitalization due to respiratory disease and in particular chronic obstructive lung disease (COLD) was examined in a cohort initially examined in 1974. A total of 546 men with different lengths of employment in the cement factory were compared with 857 randomly sampled men of the same age from the same geographical area. Information on hospitalization was obtained from a nationwide register administered by the Danish National Board of Health. During a 9-year, 8-month period, 7.8% of the total population studied had been admitted to hospital at least once because of respiratory disease and 4.3% had been admitted because of COLD. Cement workers had no increased rates of hospitalization when compared with other blue collar workers from the random sample or the whole random sample. A vague tendency towards increasing rates of hospitalization due to COLD with increasing duration of exposure to cement dust up to 30 years was found. Given at least one hospitalization, exposure to cement dust was not related to the accumulated number of days in hospital in the observation period. We conclude that long-term exposure to cement dust does not lead to higher morbidity of severe respiratory disease than other types of blue collar work.This study was supported by grants from The Danish Medical Research Council (12-5877) and the Knud Højgaard Foundation (7818)     

One-year mortality among elderly people after hospitalization due to fall-related fractures: comparison with a control group of matched elderly

Fall-related fractures among the elderly represent an important public health problem. Severe fractures have been related to increased risk of death. In order to investigate the mortality profile of elderly individuals with severe fractures, 250 patients aged 60 years and over, hospitalized due to fall-related fractures and 250 elderly without fractures living in the local community were followed-up for one year. They were matched according to sex, age, time of hospitalization and neighborhood. Deaths were identified using probabilistic linkage of the research dataset and the local mortality registry. The one-year cumulative mortality was 25.2% in the case of individuals with severe fractures and 4% for those individuals without. The mortality distribution was not homogeneous across the follow-up period. Two-thirds of deaths among the elderly individuals hospitalized due to fracture occurred within the first 3 months, whereas mortality among those individuals without fractures took place later. Heart disease, pneumonia, GI bleeding, sepsis, and pulmonary embolism, diabetes and stroke were important causes of one-year mortality.     

The effect of job loss on overweight and drinking

This paper examines the impact of job loss due to business closings on body mass index (BMI) and alcohol consumption. We suggest that the ambiguous findings in the extant literature may be due in part to unobserved heterogeneity in response and in part due to an overly broad measure of job loss that is partially endogenous (e.g., layoffs). We improve upon this literature using: exogenously determined business closings, a sophisticated estimation approach (finite mixture models) to deal with complex heterogeneity, and national, longitudinal data from the Health and Retirement Study. For both alcohol consumption and BMI, we find evidence that individuals who are more likely to respond to job loss by increasing unhealthy behaviors are already in the problematic range for these behaviors before losing their jobs. These results suggest the health effects of job loss could be concentrated among “at risk” individuals and could lead to negative outcomes for the individuals, their families, and society at large.     

Parental job loss and infant health

This paper is the first to explore the extent to which the health effects of job displacement extend to the children of displaced workers. Using detailed work and fertility histories from the Panel Study of Income Dynamics, estimates are identified by comparing the outcomes of children born after a displacement to the outcomes of those born before. This analysis reveals that husbands’ job losses have significant negative effects on infant health. They reduce birth weights by approximately four and a half percent with suggestive evidence that the effect is concentrated on the lower half of the birth weight distribution.     

Sex difference in hospitalization due to asthma in relation to age

To describe the sex and age differences in asthma hospitalization among the Canadian population, we conducted an analysis based on a total of 9,486,173 hospital records in Canada for a 3-year period (1994/1995, 1995/1996, and 1996/1997), including 204,304 asthma patients and 288,977 asthma-related records. Asthma as one of the first five diagnoses, accounted for 3.0% of total hospitalizations, which was almost constant across the 3-year study period. The 3-year cumulative incidence of asthma hospitalization was substantially higher for young boys than girls, and it was reversed for adults. The incidence ratio for females vs. males for asthma hospitalization reached 2.8 for individuals 25 to 34 years of age, decreased gradually with increasing age, and then approached unity for those aged 80 years or more. The data suggest that sex is an important determinant for asthma, and the sex effect varies considerably over a life span.     

Quantile treatment effects of job loss on health

Studies on health effects of job loss mostly estimate mean effects. We argue that the effects might differ over the distribution of the health status and use quantile regression methods to provide a more complete picture. To take the potential endogeneity of job loss into account, we estimate quantile treatment effects where we rely on job loss due to plant closures. We find that the effect of job loss indeed varies across the mental and physical health distribution. Job loss due to plant closures affects physical health adversely for individuals in the middle and lower part of the health distribution while those in best physical condition do not seem to be affected. The results for mental health, though less distinct, point in the same direction. We find no effects on BMI.     

Estimation of mortality due to AIDS--a review

HIV/AIDS has emerged as a major public health problem since its recognition as an emerging disease a couple of decades ago. While detection of HIV/AIDS cases remains a problem, ascertainment of AIDS deaths has emerged as a bigger challenge and concern. Despite a plethora of literature focusing on the methods to estimate AIDS deaths, none seems to be fulfilling the requirements for universal acceptance. In this paper, we give a systematic review of various methods used by experts to have a reliable estimate of the number of deaths due to AIDS. Initial assessments were derived from morgue based estimates in Africa which showed that AIDS was a leading cause of death. Its impact on demography was noticed in some of the studies conducted wherein age and sex specific mortality rates, standardized mortality ratios, potential years of life lost and decrease in life expectancy were calculated. "Excess mortality factor" as observed in 1980s and 1990s also indicated the approximate number of AIDS deaths. Besides, orphan hood method and verbal autopsy technique too, emerged as reliable means to identify mortality due to AIDS. Some indirect methods like estimation of deaths due to opportunistic infections like tuberculosis could also be a good indicator. The paper reviews the merits and possible biases encountered with each of the methods.     

Multidrug-resistant Acinetobacter infection mortality rate and length of hospitalization

Acinetobacter infections have increased and gained attention because of the organism's prolonged environmental survival and propensity to develop antimicrobial drug resistance. The effect of multidrug-resistant (MDR) Acinetobacter infection on clinical outcomes has not been reported. A retrospective, matched cohort investigation was performed at 2 Baltimore hospitals to examine outcomes of patients with MDR Acinetobacter infection compared with patients with susceptible Acinetobacter infections and patients without Acinetobacter infections. Multivariable analysis controlling for severity of illness and underlying disease identified an independent association between patients with MDR Acinetobacter infection (n = 96) and increased hospital and intensive care unit length of stay compared with 91 patients with susceptible Acinetobacter infection (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.2-5.2 and OR 2.1, 95% CI 1.0-4.3] respectively) and 89 uninfected patients (OR 2.5, 95% CI 1.2-5.4 and OR 4.2, 95% CI 1.5-11.6] respectively). Increased hospitalization associated with MDR Acinetobacter infection emphasizes the need for infection control strategies to prevent cross-transmission in healthcare settings.     

Depression as a predictor of hospitalization due to coronary heart disease

BACKGROUND: Studies have shown that patients with depression have higher rates of coronary heart disease (CHD) than people in the general population. However, large-scale population-based data on incidence rates of CHD in people with depression are needed. This study analyzed whether hospitalization for depression predicts CHD in men and women after accounting for socioeconomic status and geographic region. METHODS: Data from the family coronary heart disease database at the Karolinska Institute, Stockholm, were used to identify all people in Sweden aged 25 to 64 at onset of depression and aged 25 to 79 at onset of nonfatal CHD during the study period (1987 to 2001). Standardized incidence ratios (SIRs) of CHD among those with and without depression were compared. All analyses were conducted in 2005. RESULTS: There were 1767 cases of CHD among those with depression during the study period. The risk of developing CHD was strongest for those aged <40; the SIR was 2.17 (95% confidence interval [CI]=1.50-3.03). The risk was attenuated with increasing age in both men and women. People aged 70 to 79 at onset of depression did not have an increased risk of CHD. CONCLUSIONS: Even after accounting for socioeconomic status and geographic region, depression is a clinically significant risk factor for developing CHD, especially in men and women aged 25 to 50. Primary healthcare teams should make particular efforts to identify young to middle-aged women and men who have depression, especially in combination with other CHD risk factors.     

Changes in the job situation due to telemedicine.

Little is known either about how telemedicine changes the job situation or about how the working environment might be improved for those involved in telemedicine. To investigate these issues, qualitative interviews were carried out with 30 people in Norway working with telepsychiatry (12 respondents), teledermatology (six respondents), a telepathology frozen-section service (10 respondents) and tele-otolaryngology (two respondents). The median annual number of remote consultations in telepsychiatry was nine, in teledermatology 81 and in the telepathology frozen-section service nine. The positive aspects of working with telemedicine included less travelling, which gave more time for other work, less need to travel in poor weather, new contacts, an increased sense of professional security (because support was readily available) and the satisfaction of seeing partners in communication. At its present volume, telemedicine generally fits into daily work patterns quite well. Problems do occur, but they can be solved by appropriate organizational measures. Long-term scheduling of telemedical sessions may be important. Many telemedicine workers want to have the equipment in their own office. Working with telemedicine can be tiring and those interviewed wanted to limit the number of hours per week. A solution may be to use large clinics, such as university clinics, where the telemedical work could be distributed between several specialists. Large telemedicine clinics with a full-time dedicated staff would need careful consideration of working practices.     

Temporality and identity loss due to Alzheimer's disease

Proceeding from the assumption that the social construction of one's identity is a life long process, and that it is formed, maintained, and altered in daily social interaction, this paper examines the loss of identity attributes in a person with Alzheimer's disease as the changes are perceived by a family member. Specifically, the paper focuses on: (1) strategies caregivers used to 'hang on to' their respective loved ones as they were once known, and (2) the temporally subjective aspects of that experience.     

Increasing hospitalization and death possibly due to Clostridium difficile diarrheal disease.

This study calculated yearly estimated national hospital discharge (1985 to 1994) and age-adjusted death rates (1980 to 1992) due to bacterial, viral, protozoal, and ill-defined enteric pathogens. Infant and young child hospitalization (but not death) rates in each category increased more than 50% during 1990 to 1994. Age-adjusted death and hospitalization rates due to enteric bacterial infections and hospitalizations due to enteric viral infections have increased since 1988. The increases in hospitalization and death rates from enteric bacterial infections were due to a more than eightfold increase in rates for specified enteric bacterial infections that were uncoded during this period (ICD9 00849). To identify bacterial agents responsible for most of these infections, hospital discharges and outpatient claims (coded with more detail after 1992) were examined for New Mexico''s Lovelace Health Systems for 1993 to 1996. Of diseases due to uncoded enteric pathogens, 73% were due to Clostridium difficile infection. Also, 88% of Washington State death certificates (1985 to 1996) coded to unspecified enteric pathogen infections (ICD0084) listed C. difficile infection.     

Maternal mortality due to heart disease]

A retrospective study on maternal mortality in pregnant women with cardiac disease over a period of eleven years (January 1979 to December 1989) was undertaken. The objective was an analysis of the main aspects of this association. Cardiac disease was diagnosed in 694 patients (4.2%) of a total of 16,423 admitted to the Obstetrics Department of the Escola Paulista de Medicina. As for etiology, rheumatic disease (52.3%); Chagas's disease (19.3%) and congenital disease (8.1%) were the most frequent causes. There were 51 maternal deaths, according to FIGO's definition (1967), corresponding to a maternal mortality rate of 428.2/100,000 livebirths during the same period. Twelve of these maternal deaths were due to cardiac disease (maternal mortality rate of 100.8/100,000 livebirths). The statistical analysis identified the following aspects associated with maternal mortality among patients with cardiac disease: primigravida, lack of adequate prenatal care, and cardiac surgery performed previously to and/or during pregnancy. Congestive heart failure with pulmonary edema (41.7%) and thromboembolism (25.0%) were the most frequent causes of maternal death among patients with cardiac disease. The NYHA functional classification was not a good parameter for pregnancy prognosis: eleven patients (91.7%) were considered as belonging to the favorable group before they became pregnant. Most maternal deaths occurred during the first 72 hours after delivery. Therefore, this period was considered most critical for maternal mortality in patients with cardiac disease. No relation-ship was found among the factors: maternal age, race, marital status, delivery and maternal mortality among patients with cardiac disease.(ABSTRACT TRUNCATED AT 250 WORDS)     

Estimating out-of-hospital mortality due to myocardial infarction

We developed a model to estimate out-of-hospital deaths due to Myocardial Infarction (MI), which was based on a detailed database of MI admissions to Pennsylvania hospitals during 1998. Our estimation method addresses the problem of geographical selection bias in inpatient databases, which occurs when MI patients with poor geographic access are undersampled. A Geographic Information System (GIS) was used to determine travel times between hospitals and patients, based on patients' zip code of residence. Nearness to a hospital was positively associated with in-hospital mortality (P<0.01) and emergency admissions (P<0.01) and negatively associated with out-of-hospital mortality (P<0.01). Model predictions were made for a range of input values and validated using empirical data.