scholarly journals INDICATORS OF MORBIDITY AND MORTALITY BY FEMUR FRACTURES IN OLDER PEOPLE: A DECADE-LONG STUDY IN BRAZILIAN HOSPITALS

2020 ◽  
Vol 28 (3) ◽  
pp. 142-148
Author(s):  
VIVIANE CRISTINA ULIANA PETERLE ◽  
JOÃO CARLOS GEBER JUNIOR ◽  
WILLIAN DARWIN JUNIOR ◽  
ALEXANDRE VASCONCELOS LIMA ◽  
PAULO EMILIANO BEZERRA JUNIOR ◽  
...  
Keyword(s):  
Older Adults ◽  
Mortality Rate ◽  
Average Length ◽  
Federal District ◽  
Population Based ◽  
Northern Region ◽  
Level Of Evidence ◽  
Average Length Of Stay ◽  
Femur Fractures ◽  
Unified Health System

ABSTRACT Objective: To evaluate the profile of femur fractures in older adults in Brazil between 2008 and 2018. Methods: Population-based time series study with data from the Department of Informatics of the Unified Health System (Datasus), including 480,652 hospitalizations, of adults from 60 years and over, with hip fracture (ICD10-S72). Results: There was an increase of 76.9% in the hospitalization register (mean 5.87%/year) and an average incidence rate of 19.46 fractures for every 10,000 older adults. In total, 68% of hospitalizations were female, 28% from São Paulo. The average length of stay was 8.9 days, being higher in the Northern Region (11.8) and in the Federal District (18.7). Average mortality rate was 5%, being higher in men (5.45%) and over 80 years old. Northeast Region had the lowest mortality rate (3.54%). Southeast Region had the highest rate (5.53%). Total cost of hospitalizations was R$ 1.1 billion, with an average of R$ 100 million/year. Average cost per hospitalization was higher in the Southern Region (R$ 2,491.00). Conclusion: Femoral fracture is an important cause of mortality among older adults, with a higher incidence in women but higher mortality in men, with high cost to the system and regional differences. Level of Evidence II, Economic and decision analyses - developing an economic or decision model.

scholarly journals Epidemiology of bacterial meningitis among children in Brazil, 1997-1998

2001 ◽  
Vol 35 (3) ◽  
pp. 249-255 ◽  
Author(s):  
Débora PL Weiss ◽  
Paul Coplan ◽  
Harry Guess
Keyword(s):  
Bacterial Meningitis ◽  
Western Europe ◽  
Average Length ◽  
Case Fatality ◽  
Antibiotic Use ◽  
Health Department ◽  
Population Based ◽  
Haemophilus Influenzae Type ◽  
Average Length Of Stay ◽  
Meningitis In Children

OBJECTIVE: To document the incidence and the descriptive epidemiology of bacterial meningitis among individuals under age 20 in a geographically defined region in Brazil during the two-year period immediately preceding the introduction of Haemophilus influenzae type b (Hib) vaccines into the national immunization program of Brazil. METHODS: Population-based epidemiological study of all cases of bacterial meningitis reported among residents of Campinas, Brazil, under age 20 (n=316,570) during the period of 1997-98, using comprehensive surveillance records compiled by the Campinas Health Department from cases reported among hospital inpatients, outpatients, emergency room visits, death certificates, and autopsy reports. RESULTS: The incidence of bacterial meningitis (n=274) was 334.9, 115 and 43.5 cases/10(5) person-years (pys) for residents of Campinas under age 1, 5 and 20, respectively. All cases were hospitalized, with an average length of stay of 12 days. Documented prior antibiotic use was 4.0%. The case-fatality rate of bacterial meningitis in individuals under age 20 was 9% (24/274) with 75% of deaths occurring in children under the age of five. The incidence of Hib meningitis (n=26) was 62.8 and 17 cases/10(5) pys in children age <1 and <5, respectively. CONCLUSIONS: The incidence of Hib meningitis in children under the age of 5 in Campinas during 1997-98 was similar to that reported in the US, Western Europe, and Israel prior to widespread Hib vaccine use in those regions. This study provides a baseline for later studies to evaluate changes in the etiology and incidence of bacterial meningitis in children after introduction of routine Hib vaccination in Brazil.

scholarly journals Association of socioeconomic and clinical variables with the state of frailty among older inpatients

2015 ◽  
Vol 23 (6) ◽  
pp. 1121-1129 ◽  
Author(s):  
Darlene Mara dos Santos Tavares ◽  
Isabella Danielle Nader ◽  
Mariana Mapelli de Paiva ◽  
Flavia Aparecida Dias ◽  
Maycon Sousa Pegorari
Keyword(s):  
Older Adults ◽  
Average Length ◽  
The State ◽  
Chi Square ◽  
Frailty Phenotype ◽  
Cross Sectional ◽  
Average Length Of Stay ◽  
Hospitalization Period ◽  
Older Inpatients ◽  
Materials Used

Objectives: to identify the prevalence of frailty among inpatient older adults in a clinical hospital and check the association of the socioeconomic and clinical characteristics with the state of frailty. Method: observational, cross-sectional and analytical study, conducted with 255 hospitalized patients. Materials used: structured instrument for the economical and clinical data and frailty phenotype of Fried. Descriptive and bivariate statistical analysis was carried out and, by means of chi-square tests and ANOVA One-way (p<0.05). Results: the prevalence of frailty corresponded to 26.3%, while pre-frailty represented 53.3%. The highest proportion of frail seniors was identified for 80 years or older (p = 0.004), widowed (p = 0.035) and with the highest average length of stay (p = 0.006). Conclusion: inpatient older adults presented high percentages of frail states associated with socioeconomic variables and hospitalization period. The identification of the health conditions related to pre-frailty and frailty can foster the planning and implementation of the assistance to older adults in this context.

scholarly journals SLEEP APNEA ASSOCIATED COMORBIDITIES AND MORTALITY IN AN OLDER VETERAN POPULATION

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S263-S264
Author(s):  
Denise M Kresevic ◽  
muralidahar pallaki ◽  
Christopher J Burant ◽  
Clare Gideon ◽  
Emily Schroeder ◽  
...  
Keyword(s):  
Heart Failure ◽  
Older Adults ◽  
Sleep Apnea ◽  
Mortality Rate ◽  
Population Based ◽  
Older Individuals ◽  
Male Veterans ◽  
The Relationship ◽  
Overall Mortality

Abstract Evidence continues to mount that sleep apnea (SA) occurs in 10-25% of Americans and is associated with significant morbidity and mortality (Schulman 2018). Among veterans, SA has been reported four times more often as compared to other non-veteran cohorts. (Wong 2015). The risk of developing dementia is increased in older individuals with OSA (Shastri, Bangar, & Holmes, 2015). The prevalence and characteristics of older adults with dementia and sleep apnea is not well known and long-term population-based studies on mortality have been lacking. Recent studies have reported overall mortality rates of 19%, in those individuals with SA, an increased rate of 1.5-3 times the mortality rate as compared to those individuals those without SA. Current recommendations support SA screening of high risk individuals including those with symptoms of snoring, fatigue, memory and concentration problems and mood changes. (Krist 2018). Despite a large number of older adults with suspected SA and comorbidities, the majority are not screened, referred, diagnosed and treated. In this VA pilot study of outpatient older male veterans with dementia and SA, N=195, mean age 75.83 years, SD=9.1, 51.3% were white, 37.5% were black. Frequently found comorbidities were: hypertension 88%, congestive heart failure 41%, Diabetes. 62% and, stroke 21%. Of note, among those who died, SA was significantly related to congested heart failure (r=.32, p&lt;.001) and COPD (r=.40, p&lt;.001). The overall mortality rate of 27% was higher than previous reports. Further investigation is needed to better understand the relationship between comorbidities, and SA, screening, treatment and mortality.

scholarly journals 283. Population-Based Co-infection of Carbapenem-Resistant Organisms and SARS-CoV-2 in Massachusetts

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S247-S248
Author(s):  
Ashley Geoghegan ◽  
Jessica Leaf ◽  
Monina Klevens ◽  
Scott Troppy
Keyword(s):  
Average Length ◽  
Klebsiella Oxytoca ◽  
Antibiotic Use ◽  
Hospital Staff ◽  
Time Frame ◽  
Population Based ◽  
Case Definition ◽  
Average Length Of Stay ◽  
Carbapenem Resistant ◽  
The Impact

Abstract Background Concerns about antibiotic resistance are exacerbated in COVID-19 patients due to frequent antibiotic use, increase in mechanical ventilation and reusable equipment, conservation of PPE, and strain on hospital staff. We described cases with co-infection of carbapenem-resistant organisms (CRO) and SARS-CoV-2 and compared rates in the Massachusetts population. Methods All providers and hospitals are required to report CROs and SARS-CoV-2 to the Massachusetts Virtual Epidemiologic Network (MAVEN). We selected cases with both a positive SARS-CoV-2 test and a laboratory confirmed CRO from January through July 2020. We classified by which result occurred first and described demographic and clinical characteristics. We standardized the CRO case definition by excluding CR-Pseudomonas aeruginosa and calculated rates per 100,000 to assess the impact of SARS-CoV-2 on the population-based frequency of CROs. Analyses were conducted in SAS 9.4. Results 28 confirmed cases of SARS-CoV-2 infection were also diagnosed with a CRO. They were an average age of 71.8, 60.7% male, 67.9% white, and 64.3% were in congregate care prior to their diagnoses. Mortality was 5/28 (17.9%). The 23 (82.1%) with a positive SARS-CoV-2 result first were all hospitalized at least once compared to 40% in the CRO first group (p=0.003). 11 (47.8%) of the SARS-CoV-2 first were already admitted when they tested CRO positive; 7 (30.4%) were admitted for the CRO separately from COVID-19 treatment. None of the CRO first group were admitted for CRO infection. Average length of stay for the SARS-CoV-2 first group was higher than the CRO first group (62.3 days vs 11.0 days; p=0.049). Cases positive for CRO first were all infected with CR-Escherichia coli whereas those positive for SARS-CoV-2 first were infected with CRAB, CRPA, or a CRE (Klebsiella oxytoca or Klebsiella pneumoniae) (p&lt; 0.0001). The rate of CRO/COVID coinfection was 0.203 per 100,000 population; the rates for January through July of CRO alone were 2.5 per 100,000 in 2020 and 2.4 per 100,000 in 2019. Conclusion Characteristics of individuals co-infected with CRO and SARS-CoV-2 differed by which diagnosis was made first; however, the SARS-CoV-2 pandemic did not impact the CRO population rate during the time frame studied. Disclosures All Authors: No reported disclosures

scholarly journals Prevalence and factors associated with underweight among Brazilian older adults

2019 ◽  
Vol 24 (7) ◽  
pp. 2443-2452
Author(s):  
Priscila Maria Stolses Bergamo Francisco ◽  
Daniela de Assumpção ◽  
Flávia Silva Arbex Borim ◽  
Deborah Carvalho Malta
Keyword(s):  
Older Adults ◽  
Population Based ◽  
Northern Region ◽  
The Body ◽  
Individual Factors ◽  
Prevalence Rates ◽  
Chi Square ◽  
Cross Sectional ◽  
Significance Level ◽  
Chi Square Test

Abstract The aim of this study was to estimate the prevalence of underweight among older adults according to socio-demographic characteristics in different regions of Brazil as well as determine associated contextual and individual factors. Cross-sectional population-based study with older adults (≥ 65 years) interviewed by telephone survey in 2014. The body mass index was calculated based on weight and height. Associations were determined using Pearson’s chi-square test, considering a 5% significance level. Adjusted prevalence ratios were estimated using multilevel Poisson regression. Mean age was 73.3 years and the prevalence of underweight was 15.6% (95%CI: 14.1-17.1%). Higher prevalence rates of underweight were found among women, individuals aged ≥ 80 years, smokers and those who reported the regular consumption of beans. The prevalence rate of underweight was lower among those who reported abusive alcohol intake and those with a medical diagnosis of hypertension. The northern region of the country had the highest prevalence of underweight after adjusting for associated individual factors. The findings demonstrate the subgroups with higher prevalence rates of underweight that demand greater attention from the health services in terms of recovering of an adequate nutritional status.

516 Mortality from Inhalation Injury in Oxygen Dependent Patients Exceeds Prediction from Prognostic Models

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S95-S96
Author(s):  
Kathleen Singer ◽  
Jalen Harvey ◽  
Elizabeth Dale
Keyword(s):  
Mortality Rate ◽  
Length Of Stay ◽  
Average Length ◽  
Small Sample Size ◽  
Small Sample ◽  
Chi Square ◽  
Average Length Of Stay ◽  
Risk Of Mortality ◽  
Secondary Outcomes ◽  
Chi Square Analysis

Abstract Introduction The Boston Criteria and the Abbreviated Burn Severity Index (ABSI) are two widely accepted models for predicting mortality in burn patients. We aimed to elucidate whether these models are able to accurately predict risk of mortality in patients who sustain burns while smoking on home oxygen given their overall clinical fragility. Methods We conducted a retrospective chart review of 48 patients admitted to our burn center from November 2013 to September 2017 who sustained a burn while smoking on home oxygen. Yearlong mortality was the primary outcome of the investigation; secondary outcomes included discharge to facility, length of stay, and need for tracheostomy. We then calculated the expected mortality rate for each patient based on Boston Criteria and ABSI, respectively, and compared the mortality rate observed in our cohort. Results Patients in our cohort suffered a 54% mortality rate within a year of injury, compared to a 23.5% mortality predicted by Boston Criteria, which was found to be statistically significant by chi-square analysis (p &lt; 0.05). ABSI predicted mortality was 19.7%. While the absolute value of difference in mortality was greater, this was not found to be significant on chi-square analysis due to the small sample size. Our secondary outcomes revealed 42% discharge to facility, average length of stay of 6.2 days, and 6.25% required tracheostomy. Patients in our cohort suffered a 54% mortality rate within a year of injury, compared to a 23.5% mortality predicted by Boston Criteria, which was found to be statistically significant by chi-square analysis (p &lt; 0.05). ABSI predicted mortality was 19.7%. While the absolute value of difference in mortality was greater, this was not found to be significant on chi-square analysis due to the small sample size. Our secondary outcomes revealed 42% discharge to facility, average length of stay of 6.2 days, and 6.25% required tracheostomy. Conclusions Patients whose burns are attributable to smoking on home oxygen may have an increased risk of mortality than prognostication models, such as the Boston Criteria and ABSI, may suggest. This bears significant clinical impact, particularly regarding family and provider decision-making in pursuing aggressive management. Applicability of Research to Practice This data indicates that these injuries are direr than expected, which may have significant impact on family and provider decision-making.

scholarly journals 936 Outcomes of A Single Site Receiving Model for General Surgery During the COVID-19 Pandemic in A Scottish NHS Board

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Kilpatrick ◽  
A MacDonald
Keyword(s):  
Mortality Rate ◽  
General Surgery ◽  
Conservative Management ◽  
Average Length ◽  
Operative Management ◽  
Single Site ◽  
University Hospital ◽  
Average Length Of Stay ◽  
Time Period ◽  
Surgical Conditions

Abstract Aim: To assess overall patient outcomes of converting to a single-site receiving unit for general surgery during the height of the covid-19 pandemic. Method Prospective study of all general surgery inpatients, who would normally be looked after at University Hospital Monklands, between 17/04/20-06/06/20, the beginning and end of a single-site receiving model within NHS Lanarkshire. Results There was a 32% reduction in admissions from 278 to 188, from the same time period in 2019. The 30-day mortality rate was 3.2% in comparison to 2.8% in 2019. Of 59 patients (31.4%) who had surgery, 13.5% had a complication of varying degree. The post-operative 30-day mortality rate was 0%. Only 4 patients (2%) were diagnosed with covid-19, none of which died. Laparoscopic appendicectomy was favoured over conservative management, with average length of stay (LoS) being 3.2 days and 5 days respectively. Acute cholecystitis was overall managed conservatively with average LoS being 8.8 days for operative management, compared to 4.1 days for conservative management. Conclusions Overall outcomes during this time were not found to be significantly worse when compared to the previous year. The rate of contracting covid-19 in the unit was low. Laparoscopic surgery can still be carried out safely for selected acute surgical conditions.

scholarly journals EPIDEMIOLOGY AND MORTALITY OF THORACOLUMBOSACRAL SPINAL ARTHRODESIS IN BRAZIL: THE LAST 10 YEARS

2020 ◽  
Vol 19 (2) ◽  
pp. 120-122
Author(s):  
DEIVID RAMOS DOS SANTOS ◽  
DANTE BERNARDES GIUBILEI ◽  
MARCIO OLIVEIRA PENNA DE CARVALHO ◽  
ERIC DE SOUZA TEIXEIRA ◽  
RODRIGO LIMA GOMES ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Statistical Tests ◽  
P Value ◽  
Chi Square ◽  
Level Of Evidence ◽  
Unified Health System ◽  
Spinal Arthrodesis ◽  
Posterior Arthrodesis ◽  
Using Data ◽  
Epidemiological Profile

ABSTRACT Objective To describe the epidemiology and mortality of thoracolumbosacral arthrodesis surgery in Brazil in the last 10 years. Methods Study conducted using data from the SIH of the Unified Health System (SUS) covering the time period from 2008 to 2018 for all regions of Brazil. The data obtained were analyzed using the BioStat 5.3 program, using Chi-square statistical tests, observing a p-value <0.05 and a 95% confidence interval. Results A total of 66,631 anterior or posterior approach TLS surgeries were registered. The overall mortality rate was 9.37 deaths per thousand procedures. There are regions with mortality much higher than the national average. The mortality rate increases proportionally with the number of levels involved in posterior arthrodesis. Conclusions The study of the epidemiological profile of thoracolumbosacral arthrodesis is important, especially in a country whose population is heterogeneous but has different mortality rates among regions. Therefore, it is necessary to create measures that identify and prevent the factors that lead to the death of patients undergoing such a procedure. Level of evidence II; Retrospective, analytical, quantitative and descriptive study.

scholarly journals Clinical Characteristics of Liver Cirrhosis Patients in Internal Medicine Inpatient Ward of Fatmawati General Hospital and Factors Affecting Mortality during Hospitalization

2021 ◽  
Vol 22 (1) ◽  
pp. 3-8
Author(s):  
Nikko Darnindro ◽  
Annela Manurung ◽  
Edi Mulyana ◽  
Arnold Manurung
Keyword(s):  
Liver Cirrhosis ◽  
Mortality Rate ◽  
Hepatitis B ◽  
Creatinine Level ◽  
Mortality Risk ◽  
Average Length ◽  
Bivariate Analysis ◽  
Factors Affecting ◽  
Inpatient Ward ◽  
Average Length Of Stay

Background: liver cirrhosis is a global health problem. The mortality rate due to cirrhosis was estimated to achieve 1 million per year worldwide. The aim of this study is to elaborate the characteristics of patients  with liver cirrhosis and factors affecting mortality during hospitalization in Fatmawati General Hospital.Method: The design of this study was retrospective cohort involving patients admitted to the hospital between January and March 2019.Results: Among 41 liver cirrhosis patients, it was found that the average age was 52.9 ±13.8 years old and the percentage of male patients among participants was 75.6%. Patients who died during hospitalization was 12.2%. The average length of stay in hospital was 10.8±6.4 days. Patients were admitted to the hospital with various complaints; the most common complaint was gastrointestinal bleeding in 46.3%, decreased consciousness in 22% and massive ascites in 17.1% patients. Physical examination findings of anaemic conjunctiva, icteric sclera, and shifting dullness were found in 73.2%; 29.3% and 61% patients, respectively. Icteric condition during hospital admission has higher mortality risk with RR 9.6 (95% CI: 1.2-77.8). Approximately 53.7% cirrhosis patients were diagnosed with hepatitis B, while 22% of them  were diagnosed with hepatitis C. Coinfection of hepatitis B and C were found in 4.8% patients, while 29% patients were neither infected with hepatitis B nor C. Based on the laboratory examination, creatinine level 1.3 mg/dL had higher mortality risk with RR 8.3 (95% CI: 1.04-66.7), while natrium level ≤ 125 mmol/L had higher mortality risk with RR 26.4 (95% CI: 3.6-191). Based on Child-Pugh classification, 24.4% patients had Child-Pugh A, while 14.6% had Child Pugh C, and 39% patients could not be classified. The mean Child-Pugh score in this study was 8 ± 2.2. Through the bivariate analysis, we found the association between Child-Pugh classification and mortality; higher classification has higher mortality risk (p = 0.028). Child-Pugh C had mortality risk with RR = 9.5 (95% CI: 1.2-75.1).Conclusion: Liver cirrhosis patients were hospitalized due to the ongoing decompensation. The mortality rate during hospitalization in liver cirrhosis patients was high. Mortality in these patients was associated with icteric condition upon admission, high initial creatinine level, low sodium level, and high Child-Pugh classification.

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