Smokeless tobacco use: A meta-analysis of risk and attributable mortality estimates for India.

BACKGROUND: Use of smokeless tobacco (SLT) is widely prevalent in India and Indian subcontinent. Cohort and case–control studies in India and elsewhere report excess mortality due to its use. OBJECTIVE: The aim was to estimate the SLT use‑attributable deaths in males and females, aged 35 years and older, in India. MATERIALS AND METHODS: Prevalence of SLT use in persons aged 35 years and older was obtained from the Global Adult Tobacco Survey in India and population size and deaths in the relevant age‑sex groups were obtained from UN estimates (2010 revision) for 2008. A meta‑relative risk (RR) based population attributable fraction was used to estimate attributable deaths in persons aged 35 years and older. A random effects model was used in the meta‑analysis on all‑cause mortality from SLT use in India including four cohort and one case–control study. The studies included in the meta‑analysis were adjusted for smoking, age and education. RESULTS: The prevalence of SLT use in India was 25.2% for men and 24.5% for women aged 35 years and older. RRs for females and males were 1.34 (1.27–1.42) and 1.17 (1.05–1.42), respectively. The number of deaths attributable to SLT use in India is estimated to be 368127 (217,076 women and 151,051 men), with nearly three‑fifth (60%) of these deaths occurring among women. CON CLUSION: SLT use caused over 350,000 deaths in India in 2010, and nearly three‑fifth of SLT use‑attributable deaths were among women in India. This calls for targeted public health intervention focusing on SLT products especially among women.

Active surveillance to determine the impact of methicillin resistance on mortality in patients with bacteremia and influences of the use of antibiotics on the development of MRSA infection

Introduction Methicillin-resistant Staphylococcus aureus (MRSA) is among the most important pathogens of nosocomial infections, mainly in intensive care units (ICUs), and accounts for 40-60% of all healthcare-associated S. aureus infections. We evaluated the incidence of nosocomial infection by S. aureus, identified the risk factors for MRSA infection, and evaluated the effect of resistance to methicillin on mortality in patients. Methods We conducted MRSA surveillance at a university hospital in Brazil from January 1, 2010, to December 31, 2010, and performed a retrospective case-control matched study to evaluate the frequency of subsequent MRSA bacteremia and death among patients. We evaluated and compared the risk factors between patients with MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) infection. Results Sepsis was the most common cause of infection (17.7/1,000 patient-days), followed by surgical site (11.4/1,000 patient-days), pneumonia (4.1/1,000 patient-days), and urinary tract infection (2.4/1,000 patient-days). The significant risk factors were time of hospitalization, use of central vascular catheter (CVC), urinary catheter, nasogastric tube, parenteral nutrition, tracheostomy, mechanical ventilation, and previous antibiotic administration, the latter of which was the only independent risk factor for MRSA infection. Mortality was significantly higher in patients with MRSA. The number of antibiotics tested was not related to increases in the frequency of MRSA/1,000 patient-days. The incidence of mortality attributable to MRSA (bloodstream infection) BSI was 50%. Conclusions Surveillance results showed that the use of high levels of antibiotics was directly related to the development of MRSA infection, and the mortality attributable to MRSA in patients with bacteremia was significant. .

Healthcare-associated Staphylococcus aureus bloodstream infection: length of stay, attributable mortality, and additional direct costs

This study aimed to determine the excess length of stay, extra expenditures, and attributable mortality to healthcare-associated S. aureus bloodstream infection (BSI) at a teaching hospital in central Brazil. The study design was a matched (1:1) case-control. Cases were defined as patients > 13 years old, with a healthcare-associated S. aureus BSI. Controls included patients without an S. aureus BSI, who were matched to cases by gender, age (± 7 years), morbidity, and underlying disease. Data were collected from medical records and from the Brazilian National Hospital Information System (Sistema de Informações Hospitalares do Sistema Único de Saúde - SIH/SUS). A Wilcoxon rank sum test was performed to compare length of stay and costs between cases and controls. Differences in mortality between cases and controls were compared using McNemar's tests. The Mantel-Haenzel stratified analysis was performed to compare invasive device utilization. Data analyses were conducted using Epi Info 6.0 and Statistical Package for Social Sciences (SPSS 13.0). 84 case-control pairs matched by gender, age, admission period, morbidity, and underlying disease were analyzed. The mean lengths of hospital stay were 48.3 and 16.2 days for cases and controls, respectively (p < 0.01), yielding an excess hospital stay among cases of 32.1 days. the excess mortality among cases compared to controls that was attributable to s. aureus bloodstream infection was 45.2%. Cases had a higher risk of dying compared to controls (OR 7.3, 95% CI 3.1-21.1). Overall costs of hospitalization (SIH/SUS) reached US$ 123,065 for cases versus US$ 40,247 for controls (p < 0.01). the cost of antimicrobial therapy was 6.7 fold higher for cases compared to controls. healthcare-associated s. aureus BSI was associated with statistically significant increases in length of hospitalization, attributable mortality, and economic burden. Implementation of measures to minimize the risk of healthcare-associated bacterial infections is essential.

Infecciones nosocomiales, mortalidad atribuible y sobre estancia hospitalaria / Nosocomial infections, attributable mortality and hospital outstay

Resumen

Introducción: un sistema activo de vigilancia de infecciones nosocomiales (IN), ahorran dinero a las instituciones, a los sistemas de salud y sobre todo impactan en la vida de los pacientes.

Objetivo: describir el comportamiento de las IN y sus repercusiones en los pacientes y un hospital de alta especialidad.

Metodología: se realizó un estudio transversal, descriptivo, donde se estudió la prevalencia de IN, sobre estancia y mortalidad atribuible por IN. Se incluyeron todos los pacientes hospitalizados de enero a junio de 2011, captados por el sistema de vigilancia de infecciones. Para el análisis se utilizaron: frecuencia, «T¼ de Student y «U¼ Mann Whitney e intervalos de confianza (IC95%).

Resultados: de 8,388 pacientes que egresaron, se identificaron 565 pacientes con un total de 81 5 IN. El promedio de edad fue 49.13±17.9 y en los pacientes con IN 49.28 ± 18.3 años. Las IN encontradas fueron neumonía 24.2%, seguida por bacteriemias 20.9%, infección de vías urinarias 15.2%, infecciones relacionadas a catéter 13%, infección de sitio quirúrgico 11.4%. La mortalidad general fue de 5.93% y la mortalidad de los pacientes con IN 25.15% con una probabilidad de muerte de 76.6% para quien desarrolla IN p<0.00, el servicio con mayor sobre estancia por IN fue hematología 1,552 días.

Conclusiones: la proporción de la mortalidad hospitalaria atribuible a NI fue 25.15%. Las IN son muy costosas para los sistemas de salud, siendo muchas de estas muertes prevenibles con un sistema de vigilancia epidemiológica de IN eficiente para establecer medidas preventivas y de control, así como, supervisión continua de las prácticas clínicas.

Abstract

Introduction: an active system of surveillance of nosocomial infections (NI) saves money for hospitals, healthcare systems, and above all, impacts the lives of patients.

Objective: Describe the behavior of nosocomial infections (NI) at the Speciality Hospital and its impact on patients and the hospital.

Methodology: transversal descriptive study was conducted from January to June 2011. Variables were prevalence, overstay and mortality attributable to NI.

All hospitalized patients in the infections surveillance system were included. Data analysis used included frequency, Student's t, Mann Whitney U test with confidence interval of 95%.

Results: of the 8,388 patients discharged from hospital, 565 patients were identified with a total of 815 NI. The average age of all patients was 49.13 ± 17.9, age of patients with IN was 49.28 + 18.3 years with a median of 50 years (p = 0.42). Pneumonia was the most common NI at 24.2%, followed by bacteremia, 20.9%, urinary tract infections, 1 5.2%, catheter-related infections, 13%, surgical site infections. 11.4%. Overall mortality was 5 .93%, and mortality of patients with NI was 25.15%. The probability of death was 76.6% for patients with NI (p <0.00). The Services with the most hospital overstays from NI were hematology with 1552 day.

Conclusions: NI are costly to hospitals and healthcare systems, many of these deaths are preventable with a system of epidemiological surveillance to establish efficient Ni prevention and control measures, and continuous clinical practice monitoring.

Tobacco use: A major risk factor for non communicable diseases in South-East Asia region.

Tobacco use is a serious public health problem in the South East Asia Region where use of both smoking and smokeless form of tobacco is widely prevalent. The region has almost one quarter of the global population and about one quarter of all smokers in the world. Smoking among men is high in the Region and women usually take to chewing tobacco. The prevalence across countries varies significantly with smoking among adult men ranges from 24.3% (India) to 63.1% (Indonesia) and among adult women from 0.4% (Sri Lanka) to 15% (Myanmar and Nepal). The prevalence of smokeless tobacco use among men varies from 1.3% (Thailand) to 31.8% (Myanmar), while for women it is from 4.6% (Nepal) to 27.9% (Bangladesh). About 55% of total deaths are due to Non communicable diseases (NCDs) with 53.4% among females with highest in Maldives (79.4%) and low in Timor-Leste (34.4%). Premature mortality due to NCDs in young age is high in the region with 60.7% deaths in Timor Leste and 60.6% deaths in Bangladesh occurring below the age of 70 years. Age standardized death rate per 100,000 populations due to NCDs ranges from 793 (Bhutan) and 612 (Maldives) among males and 654 (Bhutan) and 461 (Sri Lanka) among females respectively. Out of 5.1 millions tobacco attributable deaths in the world, more than 1 million are in South East Asia Region (SEAR) countries. Reducing tobacco use is one of the best buys along with harmful use of alcohol, salt reduction and promotion of physical activity for preventing NCDs. Integrating tobacco control with broader population services in the health system framework is crucial to achieve control of NCDs and sustain development in SEAR countries.