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Objective To investigate the incidence of multiple disease coexistence in emergency department patients over 65 years old and its impact on the risk of death in hospital, so as to provide theoretical basis for reducing the risk of death in emergency department patients over 65 years old. Methods From January 2019 to January 2020, elderly patients over 65 years old who received emergency treatment in our hospital were selected as subjects to analyze the coexistence of multiple diseases. The information of current disease, blood pressure, blood glucose level and other potential influencing factors, as well as the incidence of hospitalization after emergency treatment were collected, and the factors influencing the risk of death in hospital were analyzed and discussed. Results During the study period, there were 1 195 patients over 65 years old, including 469 patients with multi-disease coexistence (excluding malignant tumors), with an incidence rate of 39.25%. Among the elderly patients in the emergency department, the top four diseases with multiple coexisting diseases are as follows: ischemic stroke (43.92%), acute myocardial infarction (24.95%), hemorrhagic stroke (16.84%), and falls (11.30%). In addition, “ischemic stroke + hypertension + diabetes + coronary heart disease” accounted for the highest proportion (42.22%) in the combination of multi-disease coexisting diseases, followed by "myocardial infarction + ischemic stroke + hypertension + Diabetes + coronary heart disease” (21.11%), and the third in the composition ratio was “fall + ischemic stroke + hypertension + diabetes + coronary heart disease” (0.66%). Among the 469 patients with multi-disease coexistence, a total of 68 died during hospitalization after emergency department; 469 patients were divided into two groups: the dead and the survivors, and the potential factors affecting the risk of death were analyzed. The multivariate regression analysis showed that male (OR=1.485 , P<0.001), age over 80 years (OR=3.090, P<0.05), more than four types of comorbidities (OR=4.407, P<0.001), BMI level showed weight loss (OR=4.366, P<0.001) and Comorbidities included hypertension (OR=3.564, P<0.001) as a potential risk factor, which would increase the risk of death; while normal blood pressure (OR=0.581, P<0.001) might potentially reduce the risk of death. Conclusion Special attention should be paid to the elderly patients over 65 years old who are male, over 80 years old, thin and with many types of comorbidities (more than four types), especially those with hypertension at the same time, in order to reduce hospitalization after emergency department risk of death during the period.
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Objectives To describe the Epstein Barr virus (EBV) infection of children in Hefei, analyze its epidemiological characteristics, and explore the factors affecting EBV infection. Methods The children as the outpatient in the department of our hospital were recruited as the research subjects from June 2018 to June 2021. Epidemiological data of the research subjects were collected from medical records and the laboratory tests were performed to detect the related serological indicators of EBV. The distribution characteristics of different serological antibodies of EBV were described. According to the types of serological antibodies, all research subjects were divided into three states: primary infection, previous infection and non-infection. Logistics regression was used to analyze the factors affecting the infection status. Results There were 480 children in this study. The mean age and body mass index of all research subjects were 8.7±1.5 years and 20.78±3.2kg/m2, respectively. There were 276 boys(57.50%) and 204 girls(42.50%). 67 children(12.92%) were positive for VCA-IgM antibody. 326 children(67.92%) were positive for VCA-IgG antibody. 290 children(60.42%) were positive for NA-IgG antibody and 25 children(5.21%) were positive for EA-IgG antibody. There was no significant distribution difference of serological antibodies in gender, season of onset, disease duration, fever, angina and enlargement of lymph nodes. However, there were significant distribution differences of serological antibodies among different body mass index(χ2=50.207, P2=48.295, Pprimary infection vs. non-infectionprimary infection vs. non-infection=0.580; Pprevious infection vs. non-infection=0.038, ORprevious infection vs. non-infection=2.347). Conclusion The previous infection by EBV is the mainly infection type in children aged 6 to 12 year. The positive VCA-IgG antibody accounts for the most in previous infection. Age is the important influencing factor on EB infection. The younger the age, the higher the probability of primary infection. Besides, the positive VCA-IgM antibody is the main pattern of primary infection in children.
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Abstract Increased frequency of heat waves (HWs) is one of the prominent consequences of climate change. Its impact on human health has been mostly reported in the northern hemisphere but has been poorly studied in the southern hemisphere. The aim of this study was to analyze the effects of the HWs waves occurred in the warm season 2013-14 on mortality in the center-north region of Argentina, where 22 million people live. It was carried out an observational study of ecological-type contrasting the mortality occurred during the HWs of the summer 2013-14 with the mortality in the summers 2010-11 to 2012-13, free from HWs. The mortality was analyzed according to the following variables: place of residence, age, sex and cause of death. During the HWs of the summer 2013-14, 1877 (RR=1.23, 95%CI 1.20-1.28) deaths in excess were registered. Moreover, the death risk significantly increased in 13 of the 18 provinces analyzed. The mortality rates by sex revealed heterogeneous behaviour regarding both the time and spatial scale. The death risk increased with age; it was particularly significant in four provinces for the 60-79 years group and in six provinces in people of 80 years and over. The death causes that showed significantly increments were respiratory, cardiovascular, renal diseases and diabetes.
Resumo O aumento da frequência das ondas de calor (OsC) é uma das consequências proeminentes das alterações climáticas. O seu impacto na saúde humana tem sido relatado principalmente no hemisfério norte, mas tem sido mal estudado no hemisfério sul. O objetivo deste estudo foi analisar os efeitos das OsC ocorridas no verão de 2013-14 sobre a mortalidade na região centro-norte da Argentina, onde 22 milhões de pessoas vivem. Foi realizado um estudo observacional de tipo ecológico que contrasta a mortalidade ocorrida durante as OsC do verão 2013-14 com a mortalidade nos verões 2010-11 a 2012-13. A mortalidade foi analisada de acordo com local de residência, idade, sexo e causa de morte. Durante as OsC do verão de 2013-14, registaram-se 1.877 (RR=1.23, 95%IC 1.20-1.28) mortes em excesso. O risco de morte (RM) aumentou significativamente em 13 das 18 províncias analisadas. As taxas de mortalidade por sexo revelaram um comportamento heterogêneo tanto no tempo como na escala espacial. O RM foi aumentado com a idade; este aumento foi particularmente significativo em quatro províncias para o grupo de 60-79 anos e em seis províncias em pessoas com mais de 80 anos. As causas de morte que mostraram significativamente incrementos foram: doenças respiratórias, cardiovasculares, renais e diabetes.
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Objective:To analyze the laboratory parameters and clinical characteristics of TTP patients, so as to provide reference for the timely diagnosis and death risk assessment or TTP.Methods:83 patients with TTP from June 2016 to March 2022 in our hospital were analyzed retrospectively. They were divided into survival and death groups. The differences in general information, clinical symptoms and laboratory parameters were compared between the two groups. The prognostic prediction score was constructed by combining parameters which differ between the two groups to calculate the corresponding mortality risk.Results:83 patients were included in the study, of whom 81.1% (60/74), 91.1% (72/79) and 86.2% (50/58) had increased AST, IBIL and cTnI results, and all (78/78) had higher LDH at admission. Hb was decreased in 97.5% (79/81) patients, and PLT of 97.5% (79/81) patients was less than 30×10 9/L. There were no significant differences in gender, age, blood type, presence of fever, ADAMTS-13 activity and PLASMIC score between the survival group (58 cases) and the death group (25 cases), but the proportion of neurologic symptoms in the death group was significantly higher than that in the survival group. AST, IBIL, cTnI and APTT at admission were significantly higher in the death group than in the survival group ( P<0.05). The risk of death was 4.86, 9.74, 3.71, and 5.33 for those with high AST, IBIL, APTT, and cTnI levels, respectively, compared with those with low levels at admission. At last, AST, IBIL, APTT, cTnI and neurological symptoms were included to construct a score model. For each 1 point increase, the risk of short-term death in TTP patients was 3.24. Conclusions:Multiple laboratory markers have high negative exclusion value for TTP. For TTP patients with high AST, IBIL, cTnI and APTT and neurologic symptoms, more attention and active treatment should be paid to reduce mortality.
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Objectives To analyze the features on temperature and mortality of Changsha in 2009-2019, and to explore the association between temperatures variation between neighboring days (TVN) and mortality by using time-series analysis. Methods A Poisson generalized linear regression model combined with a distributed lag non-linear model was used to analyse the association between TVN and mortality. Results A total of 404 328 deaths were studied in Changsha during 2010-2019，the proportion of people aged over 65 years, males respiratory disease, and cardiovascular disease were 74.1761%, 58.9842%, 11.11% and 54.4671%, respectively. During the 3652-day study period, the daily mean maximum and minimum temperature were 35.8℃ -2.8℃. The TVN varied from -12.30℃ to 10.8℃,and a significant correlation was found between TVN and mortality risk, with 1.12% (RR=1.0112，95% CI：1.0061~1.0164) mortality risk increased for 1℃ rise in TVN, and the greatest effect of TVN on mortality was at 4 days lag. Based on age, gender and group study For cardiovascular disease and respiratory disease，a 1℃ increased in TVN were associated with 2.97% and 1.52% death risk increase respectively. The effect appeared on the first day after exposure and lasted for 7 days, the maximum affection came on the fourth day. According to the analysis on age, gender and death-cause, the elderly man over 65 years old, respiratory disease people were more vulnerable to the temperature change between day by day. Conclusion This study provides a comprehensive picture of the non-linear associations between temperature variation and mortality, and there is a certain lag effect. The findings on vulnerability characteristics can help improve clinical and public health practices to reduce disease burden associated with current and future abnormal weather.
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Objective:To construct the prediction model of death risk of Stanford type A aortic dissection (AAD) based on Cox proportional risk regression model.Methods:AAD patients who were diagnosed and received surgical treatment admitted to the department of cardiothoracic surgery of Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology from January 1st, 2019 to April 30th, 2020 were enrolled. The general situation, clinical manifestations, pre-hospital data, laboratory examination and imaging examination results of the patients were collected. The observation period was up to the death of the patients or ended on April 30th, 2021. They were divided into the model group and the verification group according to the ratio of 7∶3. Lasso method was used to screen prognostic variables from the data of the modeling group, and multivariate Cox regression analysis was included to construct the AAD death risk prediction model, which was displayed by nomogram. The receiver operator characteristic curve (ROC curve) was used to evaluate the discrimination of the model, the calibration curve to evaluate the accuracy of the model, and the clinical decision curve (DCA) to evaluate the effectiveness of the model.Results:A totel of 454 patients with AAD were finally included, and the mortality was 19.4% (88/454). Lasso regression analysis was used to screen out 10 variables from the data of 317 patients in the model group, and the prediction model of death risk was constructed: 0.511×abdominal pain+1.061×syncope+0.428×lower limb pain/numbness-0.365×emergency admission-1.933×direct admission-1.493×diagnosis before referral+0.662×preoperative systolic blood pressure (SBP) < 100 mmHg (1 mmHg = 0.133 kPa)+0.632×hypersensitivity cardiac troponin I (hs-cTnI) > 34.2 ng/L+1.402×De Bakey type+0.641× pulmonary infection+1.472×postoperative delirium. The area under the ROC curve (AUC) and 95% confidence interval (95% CI) of the AAD death risk prediction model were 0.873 (0.817-0.928), and that of the verification group was 0.828 (0.740-0.916). DCA showed that the net benefit value of the model was higher. The calibration curve showed that there was a good correlation between the actual observation results and the model prediction results. Conclusion:The AAD death risk prediction model based on abdominal pain, syncope, lower limb pain/numbness, mode of admission, diagnosis before referral, preoperative SBP < 100 mmHg, hs-cTnI > 34.2 ng/L, De Bakey type , pulmonary infection, and postoperative delirium can effectively help clinicians identify patients at high risk for AAD, evaluate their postoperative survival and timely adjust treatment strategies.
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RESUMEN Introducción: Un mortinato, es un evento del embarazo que supone un resultado negativo para padres, familias y personal de salud involucrado. La falta de recursos podría ser el principal obstáculo al acceso de atención prenatal, síntoma de inequidades en salud. El débil conocimiento de causas de mortinatalidad se asocia a la creencia de que son inevitables; sin embargo, muchos factores vinculantes son potencialmente modificables. Objetivo: Describir las causas de mortinatalidad en Chile. Material y métodos: Estudio transversal y analítico. El análisis se precisó desde las 22 semanas gestacionales, según criterio estándar de la Organización Mundial de la Salud. Las causas de mayor frecuencia se utilizaron para determinar asociación mediante test con nivel de significación estadística p<0,05. Resultados: El mayor porcentaje de muertes fetales se registró a las 35 o más semanas (35,63%). Principales macro-causas de mortinatalidad fueron tipo: fetal (47,0%), placentaria (31,4%) y desconocida (10,89%). Principales causas específicas fueron: hipoxia intrauterina (24,4%), causa no especificada (10,87%), y anomalías morfológicas-funcionales placentarias (10,83%). Causa específica hipoxia intrauterina se asocia a edad gestacional, edad materna y nivel educacional materno (p<0,05). Conclusiones: La salud prenatal es reflejo de atención obstétrica, calidad y progreso en atención sanitaria. Existen brechas en detección de causas y calidad de los registros, por lo que las causas desconocidas tiendan al alza en el tiempo. Es recomendable adicionar al registro de muertes fetales componentes temporal, biológico y social maternos.
ABSTRACT Introduction: A stillbirth is an event in pregnancy that supposes a negative result for parents, families and the health personnel involved. The lack of resources could be the main obstacle to accessing prenatal care, a symptom of health imbalance. The poor knowledge of the causes of stillbirth is associated with the belief that these events are inevitable; however, many binding factors are potentially modifiable. Objective: To describe the causes of stillbirths in Chile. Material and methods: A cross-sectional and analytical study was conducted. The analysis was determined from the 22 weeks´ gestation, according to the standard criterion of the World Health Organization. The most frequent causes were used to determine the association between test and the level of statistical significance p <0.05. Results: The highest percentage of fetal deaths was recorded at 35 or more weeks (35.63%). The main macro-causes of stillbirth were: fetal (47.0%), placental (31.4%), and unknown (10.89%). The main specific causes were intrauterine hypoxia (24.4%), unspecified cause (10.87%), and placental morphological-functional abnormalities (10.83%). The specific cause of intrauterine hypoxia is associated with gestational age, maternal age, and maternal educational level (p <0.05). Conclusions: Prenatal health demonstrates obstetric care, quality, and progress in health care. There are gaps in the detection of the causes and quality of records, so unknown causes tend to rise over time. It is advisable to add temporal, biological and social components to the registry of fetal deaths.
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Objective The aim is to investigate the association between body mass index (BMI) and risk of all-cause mortality among patients with type 2 diabetes. Methods A total of 17 638 patients with type 2 diabetes registered in the management of National Basic Public Health Services in two areas of southern and northern Jiangsu were recruited. Cox proportional risk regression model was used to calculate the hazard ratio(HR) value and 95% confidence interval (95% CI) of different BMI groups in the follow-up period. Results The subjects were followed up for a total of 77 451 person-years with an average duration of 4.39 years, and 1 274 patients died during the follow-up period. The number of death in low weight group (BMI<18.5 kg/m2), normal weight group (18.5 kg/m2≤BMI<24 kg/m2), overweight (24 kg/m2≤BMI<28 kg/m2) and obese group (BMI≥28 kg/m2) were 39, 575, 484 and 176 respectively.The corresponding mortalities were 15.6%, 9.5%, 6.2% and 5.1%, respectively. Compared to normal weight group, the adjusted HR of all-cause mortality in low weight, overweight and obese group were 1.66 (95% CI: 1.20-2.30), 0.68 (95% CI: 0.61-0.77), 0.58 (95% CI: 0.48-0.68), respectively. Conclusions Low-weight patients have the highest risk of all-cause mortality compared with normal counterparts, while both overweight and obese people have a lower risk of death. Overweight and obesity may reduce the risk of all-cause mortality in type 2 diabetic patients.
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Objective To investigate the effect of blood glucose levels on peripheral blood T lymphocyte programmed death-1 factor (PD-1) and the prognosis of 28-day in patients with severe sepsis and type 2 diabetes mellitus (T2DM).Methods A total of 106 severe sepsis patients with T2DM and 50 healthy subjects as controls were included in this prospective study.According to the blood glucose levels at admission,patients were divided into three groups:the blood glucose ＜ 6.1 mmol/L group,the blood glucose 6.1 to 11.1 mmol/L group,and the blood glucose ＞ 11.1mmol/L group.The patients were followed up for trace the 28-day outcomes,and the levels of peripheral blood PD-1 + CD4 + T lymphocytes and PD-1 + CD8 + T lymphocytes were detected.The Kaplan-Meier survival curves were used to compare the risk of 28-day death in patients with different blood glucose levels.Results The levels of peripheral blood PD-1 + CD4 + T lymphocytes and PD-1 + CD8 + T lymphocytes were higher in patients with severe sepsis and T2DM than those in healthy subjects.The mortality of blood glucose ＜ 6.1 mmol/L group (56.52％) was higher than that of blood glucose 6.1 to 11.1 mmol/L group (24.3％) and the blood glucose ＞ 11.1 mmol/L group (28.3％) (P ＜ 0.05),Kaplan-Meier survival curve showed that the 28-day mortality risk of patients with blood glucose ＜ 6.1 mmol/L was higher than that of patients with blood glucose 6.1 to 11.1 mmol/L group and blood glucose ＞ 11.1 mmol/L group (The Log-rank test values were 6.523 and 5.794,the P values were 0.011 and 0.016).The level of PD-1 + CD8 + T lymphocytes in the blood glucose ＜ 6.1 mmol/L group was higher than that in the blood glucose 6.1 to 11.1 mmol/L group and the blood glucose ＞ 11.1 mmol/L group (P =0.013).Conclusions The patients with severe sepsis and T2DM getting blood glucose level ＜ 6.1 mmol/L at admission may be suffered from severe immunosuppression,and more attention should be paid to the risk of 28-days mortality in these patients..
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Objective To investigate the prognostic value of National Early Warning Scores (NEWS) combined with arterial lactate level in elderly patients with critical illness in emergency department.Methods A total of 413 elderly patients with critical illness randomly (random number) selected from resuscitation room in emergency department from September 2013 to July 2015 were enrolled in this study.NEWS system was employed to determine the patients' condition.Arterial lactate level was detected.The patients were followed for the 30-day death by telephone calls and patients were divided into survival group and death group.Multivariate logistic regression analysis and receiver operating characteristic curve (ROC) were used to evaluate the prognostic values of NEWS score,arterial lactate level,and NEWS score combined with arterial lactate level in patients without survival.Results There were significant differences in NEWS score and arterial lactate level between the death group and the survival group.The results of multiple factor regression showed that NEWS score,arterial lactate level,and NEWS score combined with arterial lactate level were all independent predictors of 30-day death (P ＜ 0.05,OR ＞ 1).The AUCs of the three evaluation modalities were 0.721,0.746 and 0.762,respectively.There was a significant difference in the area under the ROC curve between NEWS score and NEWS score combined with arterial lactate level.The optimal cut-off point of NEWS score was 7,and arterial lactate level was 2.7 mmol/L.Conclusions NEWS score,arterial lactate level,and NEWS score combined with arterial lactate level were independent predictors of 30-day death in elderly patients with critical illness in emergency department.They all had some predictive value,and NEWS score combined with arterial lactate level had higher capability to predict 30-day death in elderly patients with critical illness in emergency department than NEWS score alone.
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Objective To verify the validity and feasibility of national early warning score (NEWS) in evaluation of death risk in elderly patients with critical illness,in order to find out which scoring method is more suitable for elderly critical illness patients.Methods A prospective case-control study was conducted.The critical illness patients aged over 60 years old with the length of hospital stay over 24 hours,and admitted to Department of Emergency of Qingdao Municipal Hospital from January to December 2015 were enrolled.The clinical data including in emergency and the actual outcome of patients were collected,and the patients were divided into death group and survival group according to 30-day outcome.Patients in the two groups were assessed by using NEWS and risk classification according to the first results of vital signs monitoring.Multivariate logistic regression model was used to analyze the relationship between the NEWS classification and the risk of death in elderly critical ill patients.Results 1 950 emergency elderly patients with critical illness were enrolled,with 78 cases (4.0％) dead within 30 days and 1 872 survived (96.0％).Compared with the survival group,patients in death group were older (years:79.8 ± 10.8 vs.75.3 ± 8.9,t =4.335,P ＜0.001),and had higher acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score (22.9± 4.6 vs.18.2 ± 4.8,t =8.487,P ＜ 0.001),lower Glasgow coma scale (GCS) score (12.2 ± 4.5 vs.13.4 ± 5.2,t =-2.007,P =0.045),higher incidence of respiratory system diseases (29.5％ vs.17.9％,x 2 =12.742,P =0.013),higher NEWS score (11.2 ± 5.5 vs.3.9 ± 2.7,t =22.063,P ＜ 0.001),as well as higher proportion of patients with NEWS classification of high risk and very high risk (65.4％ vs.15.8％,x 2 =263.125,P ＜ 0.001).With the increase of NEWS risk classification,mortality rate was also increased,and the mortality rate in the patients with low,medium,high and very high risk were 0.81％ (9/1 108),3.63％ (18/496),5.83％ (13/223),30.89％ (38/123),respectively,with statistically significant difference (x 2 =179.741,P ＜ 0.001).It was showed by logistic regression analysis that the NEWS score of elderly patients with critical illness were positively correlated with 30-day death.The 30-day death risk of patients with middle risk,high risk and very high risk was 4.600,9.052 and 54.598 folds of the patients with low risk respectively.Conclusion NEWS score can be used to assess the risk of death in emergency elderly patients with critical illness.NEWS risk classification can quantify and classify the risk of death in the elderly patients with critical illness.
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OBJETIVO: Identificar, na admissão dos lactentes com após eventos com aparente risco de morte (apparent life-threatening event, ALTE), fatores que possam indicar maior risco de evolução para o óbito. MÉTODOS: Estudo transversal retrospectivo, descritivo e analítico com lactentes menores de 12 meses, com evento súbito de cianose, palidez, hipotonia e/ou apneia, atendidos na unidade de emergência de hospital universitário de nível terciário. Para avaliação da associação, determinaram-se os valores de odds ratio bruto e ajustado por regressão logística (método stepwise forward Wald). RESULTADOS: Foram avaliados 145 pacientes com idade média de 105 dias (mediana = 65 dias). Onze (7,6 por cento) evoluíram para óbito, com idade média de 189 dias (mediana = 218 dias), enquanto que a idade média dos sobreviventes foi de 98 dias (mediana = 62 dias) (p = 0,003). Atividades que precederam o evento, antecedente de prematuridade e número de episódios não apresentaram associação com o óbito. Apresentou relação significativa o relato de palidez pelos observadores. Entre os 11 lactentes, 3 apresentaram melhora imediata e espontânea; já 8 pacientes [27,6 por cento; p < 0,001; OR = 14,3 (IC95 por cento 3,51-58,3)] não tiveram melhora espontânea. Os diagnósticos de doença do trato respiratório e do sistema cardiocirculatório também foram significantes. Na análise multivariada, mostraram significância estatística: não melhora imediata e espontânea [p = 0,015; OR = 6,06 (IC95 por cento 1,02-35,94)] e diagnóstico de doença do sistema cardiocirculatório [p = 0,047; OR = 164,27 (IC95 por cento 7,34-3.673,78)]. CONCLUSÃO: Os lactentes que apresentaram ALTE tiveram maior risco de óbito quando presentes na faixa etária acima dos 6 meses e quando os eventos tiveram duração prolongada, principalmente quando ocorreram como manifestação de doenças do sistema cardiocirculatório.
OBJECTIVE: To detect factors associated with greater risk of death in infants after an apparent life-threatening event (ALTE). METHODS: This cross-sectional, retrospective, descriptive and analytic study evaluated infants younger than 12 months who had a sudden event of cyanosis, pallor, hypotonia or apnea and were seen in the emergency department of a tertiary university hospital. Forward stepwise logistic regression (Wald) was used to calculate and adjust odds ratios to evaluate associations. RESULTS: Mean age of the 145 patients included in the study was 105 days (median = 65 days). Eleven (7.6 percent) died, and their mean age was 189 days (median = 218 days). Mean age of survivors was 98 days (median = 62 days) (p = 0.003). Activity before the event, prematurity and number of events were not associated with death. A significant association was found with pallor. Of the 11 infants, 3 had spontaneous resolution of ALTE, whereas 8 patients [27.6 percent; p < 0.001; OR = 14.3 (95 percentCI 3.51-58.3)] did not. The associations with respiratory or cardiovascular disease were also significant. In multivariate analysis, immediate spontaneous resolution [p = 0.015; OR = 6.06 (95 percentCI 1.02-35.94)] and diagnosis of cardiovascular disease [p = 0.047; OR = 164.27 (95 percentCI 7.34-3.673.78)] remained statistically significant. CONCLUSION: Infants who experienced an ALTE had a higher risk of subsequent death when their age was greater than 6 months and the event had a long duration, particularly when ALTE was associated with cardiovascular disease.
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Female , Humans , Infant , Male , Cardiovascular Diseases/complications , Brief, Resolved, Unexplained Event/mortality , Respiratory Tract Diseases/complications , Epidemiologic Methods , Brief, Resolved, Unexplained Event/complicationsABSTRACT
Objective To determine the effects of the early enteric nutrition (EEN) up to scratch on the outcomes of the critical care patients with different degrees of severity of illness. Method There were 192 critically ill patients eligible for enrollment for study during the past 18 months in our ICU. They were classified by using APACHE Ⅱ scores. The aim of this retrospective analysis of the early enteric nutrition was to see if the enteric nufore, the patients were divided into two groups: up to scratch group and not up to scratch group. According to APACHE Ⅱ scores, the patients of each group were further divided into three sub-groups in terms of scores below 15, between15 and 25, and above 25, respectively. Results There were 62 patients in the group of EEN up to scratch, and 130 patients' EEN did not up to scratch. When the scores of APACHE Ⅱ were below 15, the length of hospital stay (LOS) was significantly shorter in group of EEN up to scratch in comparison with that of EEN not up to scratch (t = 6.453, P = 0.000). When the scores of APACHE Ⅱ were between15 and 25, the LOS in ICU (t = 3.966, P = 0.000), in hospital (t = 8.165,P = 0.000), The cost of medical care (t = 4.812,P= 0.000) and the mortality (x2 = 5.421,P = 0.038) were all significantly less in patients with EEN up to scratch. However, when the scores of APACHE Ⅱ were above 25, only the cost of medical care ( t = 7.364, P = 0.000) was significantly lower in patients of EEN up to scratch than that of EEN not up to scratch. Conclusions The EEN up to scratch can significantly improve the outcomes of critical patients and the clinical value of EEN up to scratch depends on the severity of illness.
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OBJECTIVES: This 3-year longitudinal study was conducted to evaluate the influence of self-rating health perception on health care utilization and all cause-death risk. METHODS: The hypothesis was tested using a community-based samples, among which subjects 3,414 were interviewed in 1995. Self-rating health perception was assessed by single-item question. Three components of health care utilization amount(number of visits, number of medications, yearly health care expenses) per year were measured using medical insurance data during 3-year follow-up period among subjects in district health care insurance. There were 123 deaths from all causes among 3,085 subjects interviewed. RESULTS: The results showed that those who had poor health perception revealed more increases in the amount of health care utilization than good health perception group (p<0.05). After adjusting for age and sex, the poor health perception group had higher death risk over 3 years than good health perception group(hazard ratio=1.88). but, after adjusting health care utility, supplementary, was not significant. CONCLUSION: These results suggest that self-rating health percep-tion was associated with difference in health care utilization and all cause-death risk.