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2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Solveig Halldorsdottir ◽  
Ragnhildur Gudrun Finnbjornsdottir ◽  
Bjarki Thor Elvarsson ◽  
Gunnar Gudmundsson ◽  
Vilhjalmur Rafnsson

Abstract Background In Iceland air quality is generally good; however, previous studies indicate that there is an association between air pollution in Reykjavik and adverse health effects as measured by dispensing of medications, mortality, and increase in health care utilisation. The aim was to study the association between traffic-related ambient air pollution in the Reykjavik capital area and emergency hospital visits for heart diseases and particularly atrial fibrillation and flutter (AF). Methods A multivariate time-stratified case-crossover design was used to study the association. Cases were those patients aged 18 years or older living in the Reykjavik capital area during the study period, 2006–2017, who made emergency visits to Landspitali University Hospital for heart diseases. In this population-based study, the primary discharge diagnoses were registered according to International Classification of Diseases, 10th edition (ICD-10). The pollutants studied were NO2, PM10, PM2.5, and SO2, with adjustment for H2S, temperature, and relative humidity. The 24-h mean of pollutants was used with lag 0 to lag 4. Results During the study period 9536 cases of AF were identified. The 24-h mean NO2 was 20.7 μg/m3. Each 10 μg/m3 increase in NO2 was associated with increased risk of heart diseases (ICD-10: I20-I25, I44-I50), odds ratio (OR) 1.023 (95% CI 1.012–1.034) at lag 0. Each 10 μg/m3 increase in NO2 was associated with an increased risk of AF (ICD-10: I48) on the same day, OR 1.030 (95% CI: 1.011–1.049). Females were at higher risk for AF, OR 1.051 (95% CI 1.019–1.083) at lag 0, and OR 1.050 (95% CI 1.019–1.083) at lag 1. Females aged younger than 71 years had even higher risk for AF, OR 1.077 (95% CI: 1.025–1.131) at lag 0. Significant associations were found for other pollutants and emergency hospital visits, but they were weaker and did not show a discernable pattern. Conclusions Short-term increase in NO2 concentrations was associated with heart diseases, more precisely with AF. The associations were stronger among females, and among females at younger age. This is the first study in Iceland that finds an association between air pollution and cardiac arrhythmias, so the results should be interpreted with caution.


2021 ◽  
Vol 7 (12) ◽  
pp. 112925-112943
Author(s):  
Henrique Aprijo Benetti ◽  
Daiany Cristina Gil Glioli Custódio ◽  
Patrícia Ribeiro Da Silva ◽  
Loara de Assis Souza ◽  
Gesnaquele Souza Da Cruz ◽  
...  

2021 ◽  
Author(s):  
Eric Sy ◽  
Sandy Kassir ◽  
Jonathan F Mailman ◽  
Sarah Lauren Sy

Abstract Background:Older adults are increasingly being admitted to intensive care units, with frailty recognized as a risk factor for worse outcomes. The Hospital Frailty Risk Score (HFRS) was developed for use in administrative databases of older adults, but it has not yet been well-validated for critically ill patients. The objective of this study was to validate the HFRS to predict prolonged hospitalization, in-hospital mortality, and 30-day emergency hospital readmissions in critically ill patients.Methods:We selected index hospitalizations of older adults (≥75 years old) receiving mechanical ventilation, using the United States Nationwide Readmissions Database from January 1, 2016 to November 30, 2018. Frailty risk was determined by the HFRS using International Classification of Diseases, Tenth Revision Clinical Modification (ICD-10-CM) codes, and further subcategorized into low (score <5), intermediate (score 5-15), and high (score >15) risk for frailty. We evaluated the HFRS to predict prolonged hospitalization, in-hospital mortality, and 30-day emergency hospital readmissions, using multivariable logistic regression after adjustment for patient and hospital characteristics. Model performance was assessed using the c-statistic, Brier score, and calibration plots.Results:Among the 649,330 weighted index hospitalizations in the cohort, 50.0% were female, the median (interquartile range [IQR]) age was 81 (78-86) years old, and the median (IQR) HFRS was 10.8 (7.7-14.5). Among the cohort, 9.5%, 68.3%, and 22.2% were subcategorized as low, intermediate, and high risk for frailty, respectively. After adjustment, patient hospitalizations with high frailty risk were associated with increased risks of prolonged hospitalization (adjusted odds ratio [aOR] 5.59 [95% confidence interval [CI] 5.24-5.97], c-statistic 0.694, Brier score 0.216) and 30-day emergency hospital readmissions (aOR 1.20 [95% CI 1.13-1.27], c-statistic 0.595, Brier score 0.162), compared to low frailty risks. Conversely, high frailty risk using the HFRS was inversely associated with in-hospital mortality (aOR 0.46 [95% CI 0.45-0.48], c-statistic 0.712, Brier score 0.214). Calibration plots demonstrated good calibration for the adjusted analyses.Conclusions:The HFRS is associated with prolonged hospitalization and 30-day readmission in older adults receiving mechanical ventilation. Further research is necessary to develop frailty scores that accurately and intuitively predict mortality in critically ill patients.


PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260534
Author(s):  
Maria Memtsa ◽  
Venetia Goodhart ◽  
Gareth Ambler ◽  
Peter Brocklehurst ◽  
Edna Keeney ◽  
...  

Objective To determine whether the participation of consultant gynaecologists in delivering early pregnancy care results in a lower rate of acute hospital admissions. Design Prospective cohort study and emergency hospital care audit; data were collected as part of the national prospective mixed-methods VESPA study on the “Variations in the organization of EPAUs in the UK and their effects on clinical, Service and PAtient-centred outcomes”. Setting 44 Early Pregnancy Assessment Units (EPAUs) across the UK randomly selected in balanced numbers from eight pre-defined mutually exclusive strata. Participants 6606 pregnant women (≥16 years old) with suspected first trimester pregnancy complications attending the participating EPAUs or Emergency Departments (ED) from December 2016 to July 2017. Exposures Planned and actual senior clinician presence, unit size, and weekend opening. Main outcome measures Unplanned admissions to hospital following any visit for investigations or treatment for first trimester complications as a proportion of women attending EPAUs. Results 205/6397 (3.2%; 95% CI 2.8–3.7) women were admitted following their EPAU attendance. The admission rate among 44 units ranged from 0% to 13.7% (median 2.8). Neither planned senior clinician presence (p = 0.874) nor unit volume (p = 0.247) were associated with lower admission rates from EPAU, whilst EPAU opening over the weekend resulted in lower admission rates (p = 0.027). 1445/5464 (26.4%; 95%CI 25.3 to 27.6) women were admitted from ED. There was little evidence of an association with planned senior clinician time (p = 0.280) or unit volume (p = 0.647). Keeping an EPAU open over the weekend for an additional hour was associated with 2.4% (95% CI 0.1% to 4.7%) lower odds of an emergency admission from ED. Conclusions Involvement of senior clinicians in delivering early pregnancy care has no significant impact on emergency hospital admissions for early pregnancy complications. Weekend opening, however, may be an effective way of reducing emergency admissions from ED.


2021 ◽  
Vol 1 (2) ◽  
pp. 48-51
Author(s):  
Diva Miftachul Rahma ◽  
Firauz Ihsan F

In this era of the COVID-19 pandemic, there are many things that need to be watched out for and also need to be prepared. The role of the government as one of the leaders of a country needs to have a plan to overcome these problems. One of the efforts made by the government is to create a Covid-19 emergency hospital by converting the Kemayoran and Pademangan  Wisma Athletes. The selection of this athlete's home is considered to be able to accommodate patients affected by COVID-19. But not only that, every room in this emergency hospital is a shield for every patient. Each room in the athlete's house has its own role and function, not least as a means of defense for every patient, to support this, the use of descriptive and narrative analysis is to explain how the architectural layout in the athlete's house and also use narrative analysis techniques to focus on an idea that can be developed into a related part. From the results of this analysis, it is also expected to get results to provide new knowledge, about how patients in the athlete's house become a means of defense for themselves.  


2021 ◽  
Vol 10 (2) ◽  
pp. 270
Author(s):  
Lailia Ayu Rachmawati

ABSTRACTBackground: Coronavirus Disease Of 2019 (COVID-19) has been declared by the WHO as a pandemic and Indonesia have expressed COVID-19 as a disaster non-natural form of the outbreak of the disease. The increasing cases COVID-19 in Indonesia, The Provincial government of DKI Jakarta building of Emergency Hospital COVID-19. The emergency hospital to consider the health aspects of the environment to minimize the risk of disease transmission. The purpose of this study is to determine the aspects of environment health in Emergency Hospital COVID-19 of Provinsi DKI Jakarta.Objectives: Analyzing the environmental health aspects of the COVID-19 emergency hospital in DKI Jakarta ProvinceMethods: We used descriptive research with secondary data from online seminar by web, guidebook dan regulation about of Environmental Health of Emergency Hospitals COVID-19, issued by the Ministry of Health of the Republic of Indonesia.Results: Aspects of environmental health at the Emergency Hospital COVID-19 of Province DKI Jakarta such as : Availability of clean water and drinking water at the hospital with assuming a capacity of 3000 patients, the hospital requires 1,500 m3 of water/ day and 15 m3 of drinking water/ day. Available means the toilet and the sink in accordance with the number of units. Domestic solid waste management with temporary storage of Kemayoran with capacity of 280 m3 and the processing of organic waste and inorganic. Medical solid waste management in collaboration with third parties to be destroyed by incinerators. Liquid waste management with wastewater treatment plant (WWTP). Vector control and Rodent at the emergency hospital is done make of insect killer, trapping, spraying, and fogging. The provision of a kitchen emergency response chaired by nutritionist and food ingredients always be checked before it is processed.Conclusions: All aspects of environmental health at Emergency Hospital COVID-19 of Province DKI Jakarta have met the requirements according to the Regulation of Ministry of Health of The Republic Indonesia  Number 7 at 2019 about Environmental Health in Hospital.Keyword: environmental health, hospital, COVID-19 


Author(s):  
A.A. Kaminskyi

Objective ‒ to analyze data of patients with hypertensive supratentorial hemorrhages who were hospitalized in Kyiv Emergency Hospital in 2019‒2020.Materials and methods. We analyzed data of 232 patients who were treated for hypertensive intracerebral hemorrhage at the Kyiv Emergency Hospital in 2019‒2020. Patients were included regardless of admission status and chosen treatment tactics (surgical, medical). The study did not include patients with subtentorial hemorrhage, patients with tumor hemorrhage, arteriovenous malformations, aneurysms, angiomas, ischemic and mixed strokes.Results. Among patients males are predominated (149 (64 %)). The average age of patients was 60 years (group of men ‒ 56 years, group of women ‒ 69 years). 77 (33 %) patients were delivered in a comatose state (GCS ≤8 points), 36 (16 %) were in a coma (GCS 9‒12 points), 81 patients were in a state of stupor (GCS 13‒14 points), in a clear mind ‒ 31 (13 %). In 7 (3 %) cases it is impossible to determine the level of consciousness (in patients with seizures or after the introduction of sedative drugs before admission to hospital). 85 patients were operated (surgical activity ‒37 %), who underwent 97 surgical interventions. The overall mortality was 42 %, postoperative mortality ‒ 43 %. Patients who had a compression-dislocation syndrome were operated on. Mortality in the group of patients admitted in a coma mortality was 85 % regardless of the method of treatment.Conclusions. Hemorrhagic strokes predominate in men, due to lifestyle and uncontrolled hypertension in patients. The results of treatment of patients with hypertensive intracerebral hemorrhage indicate the need for early hospitalization, early CT, differentiated approache to surgical removal of hematomas (lobar, lateral with dislocation syndrome), intensive care in patients in a comatose state, even with massive hemorrhages. The results of hypertensive intracerebral hemorrhage depend on the location of the hemorrhage, the severity of the patient’s condition, the timing of hospitalization in specialized stroke departments, the dynamics of cerebrovascular disorders (completed stroke and stroke in development).


Author(s):  
Antonia Célia de Castro Alcântara ◽  
Hermano Alexandre Lima Rocha ◽  
Caroline Calisto da Silva ◽  
Sabrina Gabriele Maia Oliveira Rocha ◽  
Danielle Leite Cunha de Queiroz ◽  
...  

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