Emergency Visits for Opioid Overdoses Soared During the Pandemic

ObjectivesTo investigate whether there were any socioeconomic disparities in utilisation of hospital care services during end of life in Hong Kong.MethodsSecondary data analyses were conducted using frequency of the accident and emergency (A&E) department visits and hospital admissions during the last year of life in all public hospitals from 2004 to 2014 in Hong Kong. A total of 1 237 044 A&E records from 357 853 patients, and 1 878 982 admission records from 375 506 patients were identified for analyses. In total, 395 019 unique deceased patients were identified from both datasets.ResultsRegression analyses showed that comprehensive social security assistance (CSSA) recipients used A&E services 1.29 times more than the non-recipients. Being either a CSSA recipient or an elderly home resident was more likely to be admitted to hospitals and stayed longer. Elderly home residents tended to stay longer than those from the community in the earlier months during the last year of life regardless of CSSA status; however, non-elderly home residents surpassed the residents in the duration of stay at hospitals towards the later months of the last year of life. There were also significant differences in hospital utilisation across various districts of residence.ConclusionsPeople of lower socioeconomic position tend to have higher emergency visits and hospitalisation during their last year of life in Hong Kong, implying the presence of health inequality during end of life. However, due to Hong Kong’s largely pro-rich primary care system, the predominantly public A&E and inpatient services may inadvertently act as a mitigator of such health inequalities.

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EPIDEMIOLOGY OF ASTHMA IN CHILDREN, WITH PARTICULAR REFERENCE TO WIND SPEED AND WIND DIRECTION

PEDIATRICS ◽

10.1542/peds.31.1.134 ◽

1963 ◽

Vol 31 (1) ◽

pp. 134-143

Author(s):

Guy René Newell ◽

Lida Inge Swafford

Keyword(s):

Air Pollution ◽

Wind Speed ◽

Wind Direction ◽

Pediatric Emergency ◽

Sharp Peak ◽

Emergency Visits ◽

Asthma In Children

There are many reports relating air pollution to asthma. Specific agents have been implicated, although not always concretely demonstrated. This study of 2,400 pediatric emergency visits for asthma compares its epidemiology in children and adults, particularly as to effects associated with wind speed and wind direction. Outbreaks of asthma in children were not nearly as conspicuously related to wind speed and direction as were those in adults. The severity of attacks, as judged by emergency visits for relief, increased in the fall and fell off during the summer. More boys than girls were affected; the frequency of visits gradually built up with age, except for a drop at the immediate prepubertal ages, followed by a sharp peak at age 14 years. Thus "duration of exposure" could not be clearly related to the frequency of attacks. These observations have raised questions and speculations which we hope will lead to further studies.

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Impact of Office-based Opioid Treatment on Emergency Visits and Hospitalization in Adolescents with Opioid Use Disorder

The Journal of Pediatrics ◽

10.1016/j.jpeds.2019.12.058 ◽

2020 ◽

Vol 219 ◽

pp. 236-242

Author(s):

Kim S. Walker ◽

Andrea E. Bonny ◽

Erin R. McKnight ◽

Milap C. Nahata

Keyword(s):

Opioid Use Disorder ◽

Opioid Use ◽

Emergency Visits ◽

Opioid Treatment

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THE EFFECTS OF FRAILTY, POLYPHARMACY, AND COGNITION ON HEALTH OUTCOMES: A STUDY ON INTERRAI RESIDENTIAL CARE DATA

Innovation in Aging ◽

10.1093/geroni/igz038.330 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S86-S86

Author(s):

Macy Zou ◽

Ronald Kelly ◽

Betty Chinda ◽

Mckenzie Braley ◽

Tony Zhang ◽

...

Keyword(s):

Older Adults ◽

Health Outcomes ◽

Residential Care ◽

Frailty Index ◽

Interactive Effects ◽

Deficit Accumulation ◽

Emergency Visits ◽

Ongoing Research ◽

Risk Of Death ◽

Increased Risk

Abstract Frailty Index (FI), polypharmacy and cognition status are significant health concerns in older adults. We conducted this study to investigate the interplay of frailty, polypharmacy, and cognition, in determining health outcomes. InterRAI Residential Care (RAI-RC MDS2.0) data were retrieved from residential care homes in Surrey, BC, Canada. Older residents (65+ years) who had RAI-RC records between 2016 and 2018 were used in the analysis (n=976). A deficit accumulation-based FI was generated using 36 variables. Information on polypharmacy and cognition were obtained by accounting the total number of medications and the cognitive performance scale. Information on falls, emergency visits, and mortality were followed. Multivariate Cox proportional hazard models were used to examine the effects of these variables on different outcomes. The FI showed a near Gaussian distribution (median= 0.370 mean= 0.372 SD= 0.143), and increased linearly with age on a logarithm scale (R=0.75, p<0.001). Residents with cognitive impairment showed a higher level of the FI (KW= 863.3, p<0.001). A higher FI was associated with an increased risk of death (HR=15.2 p=0.006) and emergency visits (HR=2.72 p=0.048), adjusting for age, sex, medications, and education levels. Frailty, polypharmacy, and cognition levels are associated and have interactive effects on health outcomes. Ongoing research is to validate the findings with large samples in different health settings, and to understand the underlying processes of the effect. The close relationships between frailty, polypharmacy, and cognition with health outcomes call for effective integrated strategies for healthcare of older adults with multiple complex health problems.

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