Burden of Outpatient Visits Attributable to Ambient Temperature in Qingdao, China / 生物医学与环境科学（英文）

Climate change has been referred to as one of the greatest threats to human health, with reports citing likely increases in extreme meteorological events. In this study, we estimated the relationships between temperature and outpatients at a major hospital in Qingdao, China, during 2015-2017, and assessed the morbidity burden. The results showed that both low and high temperatures were associated with an increased risk of outpatient visits. High temperatures were responsible for more morbidity than low temperatures, with an attributed fraction (AF) of 16.86%. Most temperature-related burdens were attributed to moderate cold and hot temperatures, with AFs of 5.99% and 14.44%, respectively, with the young (0-17) and male showing greater susceptibility. The results suggest that governments should implement intervention measures to reduce the adverse effects of non-optimal temperatures on public health-especially in vulnerable groups.

Effects of Temperature on Outpatient Visits for Urticaria among Lanzhou Residents Based on Distributed Lag Non-linear Model / 中国医学科学院学报

Objective To evaluate the influence of temperature on the outpatient visits for urticaria in Lanzhou City and its hysteresis and to find out the sensitive populations by sex and age stratification.Methods We collected the urticaria outpatient data in three grade A class three hospitals as well as the meteorological data and air pollutant data in Lanzhou from January 2011 to December 2017.The distributed lag non-linear model(DLNM)was employed to analyze the influence of daily mean temperature on the outpatient visits for urticaria.Stratification analysis was performed for different age groups(0-14,15-59,≥60 years)and different sex populations.Results Temperature had a non-linear relationship with the outpatient visits for urticaria,and there existed hysteresis.During the research period,the average daily outpatient visits for urticaria at the three hospitals in Lanzhou was 25,ranging from 1 to 76.With the rise in the daily mean temperature within 0-10 ℃,the risk of outpatient visits for urticaria first increased and then decreased.When the daily mean temperature was 2 ℃,hysteresis occurred on the 18th day,and the relative risk(

Impact of fine particulate matters on the daily number of emergency visits and outpatient visits of 5 hospitals in Beijing, Shanghai, and Guangzhou, 2013-2015 / 中华预防医学杂志

Objective@#To explore the effect of fine particulate matters (PM2.5) exposure on emergency visits and outpatient visits of 5 hospitals in Beijing, Shanghai and Guangzhou from 2013 to 2015.@*Methods@#Using convenient sampling method, 5 general hospitals in Beijing, Shanghai and Guangzhou were selected which included Beijing hospital, China-Japan friendship hospital, Xinhua hospital affiliated to Shanghai jiaotong University School of Medicine, the liwan hospital of the third affiliated hospital and the first affiliated hospital of Guangzhou Medical University. The emergency and outpatient data, air pollution monitoring data and meteorological data were collected from January 1, 2013 to December 31, 2015. A generalized additive model was used to analyze the effect of PM2.5 exposure on daily hospital emergency and outpatient visits, and Meta analysis was used to obtain the combined effect value.@*Results@#The number of emergency and outpatient visits of 5 hospitals was 1 378 501 and 18 139 779 in total, respectively. The mean±SD of PM2.5 exposures in Beijing hospital, China-Japan friendship hospital, Xinhua hospital affiliated to Shanghai jiaotong University School of Medicine, the liwan hospital of the third affiliated hospital and the first affiliated hospital of Guangzhou Medical University were (81.8±68.7), (83.2±69.7), (54.4±34.1), (43.5±24.8) μg/m3, respectively. Results of single pollutant model analysis showed that 0-1 day lag concentrations of PM2.5 had the largest effect on emergency visits and outpatient visits. For a 10 μg/m3 increase of PM2.5 concentration, excess risk (ER) (95%CI) of emergency and outpatient visits was 0.56% (0.14%, 0.99%) and0.63% (0.07%, 1.19%), respectively. After adjusting for O3, NO2, SO2, and CO, for a 10 μg/m3 increase of PM2.5 concentrations, the ER (95%CI) of emergency visits was 0.50% (0.10%, 0.90%), 0.34% (-0.02%, 0.69%), 0.36% (0.02%, 0.69%) and 0.56% (0.10%, 1.03%), respectively and the ER (95% CI) of outpatient visits was 0.65% (0.08%, 1.21%), 0.29% (-0.17%, 0.75%), 0.48% (-0.06%, 1.03%) and 0.48%(-0.02%, 0.99%), respectively.@*Conclusion@#Our results suggested that PM2.5 exposure can increase emergency and outpatient visits of 5 hospitals in Beijing, Shanghai and Guangzhou.

A Study on the Spatial Accessibility to the Psychiatry Department in General Hospital and Its Relationship with the Visit of Mental Patients / 보건행정학회지

BACKGROUND: This study was purposed to analyze the effect of spatial accessibility to the psychiatry department in general hospital on the outpatient visit of mental patients. METHODS: Data was provided from the Statistics Korea and Statistical Geographic Information Service, National Health Insurance Service, Health Insurance Review and Assessment Service, and Korea Transport Institute in 2015. The study regions were 103 administrative regions such as Si and Gu. The 103 regions had at least one general hospitals with a psychiatry department. The number of outpatient visit of mental patients in regions was used as the dependent variable. Spatial accessibility to mental general hospital was used as the independent variable. Control variables included such as demographic, economic, and health·medical factors. This study used network analysis and multi-variate regression analysis. Network analysis by ArcGIS ver. 10.0 (ESRI, Redlands, CA, USA) was used to evaluate the average travel time and travel distance in Korea. Multi-variate regression analysis was conducted by SAS ver. 9.4 (SAS Institute Inc., Cary, NC, USA). RESULTS: Travel distance and time had significant effects on the number of outpatient visits in mental patients in general hospital. Average travel time and travel distance had negative effects on the number of visits. Variables such as (number of total population, percentage of aged population over 65, and number of mental general hospital) had significant effects on the number of visit in mental patients. CONCLUSION: Health policy makers will need to consider the spatial accessibility to the mental healthcare organization in conducting regional health planning.

Rotavirus vaccine and health-care utilization for rotavirus gastroenteritis in Tsu City, Japan

Background: Rotavirus vaccines were introduced in Japan in November 2011. We evaluated the subsequent reduction of the health-care burden of rotavirus gastroenteritis. Methods: We conducted active surveillance for rotavirus gastroenteritis among children under 5 years old before and after the vaccine introduction. We surveyed hospitalization rates for rotavirus gastroenteritis in children in Tsu City, Mie Prefecture, Japan, from 2007 to 2015 and surveyed the number of outpatient visits at a Tsu City clinic from 2010 to 2015. Stool samples were obtained for rotavirus testing and genotype investigation. We assessed rotavirus vaccine coverage for infants living in Tsu City. Results: In the pre-vaccine years (2007-2011), hospitalization rates for rotavirus gastroenteritis in children under 5 years old were 5.5, 4.3, 3.1 and 3.9 cases per 1000 person-years, respectively. In the post-vaccine years (2011-2015), the rates were 3.0, 3.5, 0.8 and 0.6 cases per 1000 person-years, respectively. The hospitalization rate decreased significantly in the 2013-2014 and 2014-2015 seasons compared to the average of the seasons before vaccine introduction (p < 0.0001). In one pre-vaccine year (2010-2011), the number of outpatient visits due to the rotavirus infection was 66. In the post-vaccine years (2011-2015), the numbers for each season was 23, 23, 7 and 5, respectively. The most dominant rotavirus genotype shifted from G3P[8] to G1P[8] and to G2P[4]. The coverage of one dose of rotavirus vaccine in Tsu City was 56.5% in 2014. Conclusion: After the vaccine introduction, the hospitalization rates and outpatient visits for rotavirus gastroenteritis greatly decreased.

Outpatient Follow-Up Visit after Hospital Discharge Lowers Risk of Rehospitalization in Patients with Schizophrenia: A Nationwide Population-Based Study

OBJECTIVE: Non-adherence to medication is a recognized problem in psychiatric patients and may be one of the most challenging aspects of treatment for patients with schizophrenia. Failure of follow-up care after discharge greatly increases non-adherence to prescribed medications, relapse and rehospitalization. However, it is still unknown whether and how much outpatient follow-up visits can mitigate the risk of rehospitalization. Therefore we sought to investigate the continuity and effectiveness of outpatient care after inpatient discharge and its effect on rehospitalization of patients with schizophrenia. METHODS: Data were extracted from National Health Insurance Claim Database covering the period from 2007 through 2010. We identified 10,246 patients aged 18 years or older who were admitted in psychiatric facilities with the diagnosis of schizophrenia between January 1 and December 31 in 2007. The number of outpatient visits within 60 days after discharge from index admission was defined as the indicator for the continuous care and rehospitalization was inspected during the following 36-month period. Cox's proportional hazard model was used to examine the factors affecting the risk of rehospitalization including the number of outpatient visits, age, sex, comorbidities, antipsychotics, and characteristics of medical institution. RESULTS: We found that 12.7% (n=1,327) of the patients visited psychiatric outpatient department once within 60 days after hospital discharge, 34.8% (n=3,626) twice, and 27.8% (n=2,900) more than three times. Patients taking atypical antipsychotics showed higher proportion in 2 or more outpatient visits, whereas patients taking typical antipsychotics showed higher proportion in one or no outpatient visits. Cox hazard ratios of rehospitalization for the factor of 3 or more outpatient visits referenced to that of no follow-up visit were 0.567 (0.428-0.750, 95% confidence interval) within 90 days, 0.673 (0.574-0.789) within 180 days, 0.800 (0.713-0.898) within a year, 0.906 (0.824-0.997) within 2 years, and 0.993 (0.910-1.084) within 3 years. CONCLUSION: Although continuous outpatient treatment is important for relapse prevention, patients with schizophrenia showed a low rate of outpatient visit as 62.6% of total patients in 2 or more visits within 60 days after discharge. Lack of follow-up treatment might lead to increase psychotic symptoms and raised risk of relapse and rehospitalization. Our data suggest that the number of outpatient visits within 60 days after discharge in patients with schizophrenia is an important indicator of rehospitalization within a year. Therefore, further efforts to examine factors affecting failure of outpatient follow-up after discharge are warranted.

Association between Ambient Air Pollution and Outpatient Visits for Acute Bronchitis in a Chinese City / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate the short-term association between outdoor air pollution and outpatient visits for acute bronchitis, which is a rare subject of research in the mainland of China.</p><p><b>METHODS</b>A time-series analysis was conducted to examine the association of outdoor air pollutants with hospital outpatient visits in Shanghai by using two-year daily data (2010-2011).</p><p><b>RESULTS</b>Outdoor air pollution was found to be associated with an increased risk of outpatient visits for acute bronchitis in Shanghai. The effect estimates of air pollutants varied with the lag structures of the concentrations of the pollutants. For lag06, a 10 μg/m(3) increase in the concentrations of PM10, SO(2), and NO(2) corresponded to 0.94% (95% CI: 0.83%, 1.05%), 11.12% (95% CI: 10.76%, 11.48%), and 4.84% (95% CI: 4.49%, 5.18%) increases in hospital visits for acute bronchitis, respectively. These associations appeared to be stronger in females (P<0.05). Between-age differences were significant for SO(2) (P<0.05), and between-season differences were also significant for SO(2) (P<0.05).</p><p><b>CONCLUSION</b>Our analyses have provided the first evidence that the current air pollution level in China has an effect on acute bronchitis and that the rationale for further limiting air pollution levels in Shanghai should be strengthened.</p>

Relationship between Air Pollutant and Daily Hospital Visits for Respiratory Diseases in Guangzhou:a Time-Series Study / 环境与健康杂志

Objective To know the relationship between air pollutants and daily hospital visits for respiratory diseases in Guangzhou. Methods The data of daily hospital visits for respiratory diseases in a hospital in Guangzhou during 2006 to 2008, along with the daily meteorological factors, air pollutants concentration (NO2, PM10,PM2.5 and SO2) were collected. The time series analysis auto-regression model was used, considering the potential confounding factors such as seasonal and meteorological factors. Results Daily hospital visits for respiratory diseases presented a significant week effect, the time of higher daily hospital visits for respiratory diseases was the same of higher concentration of pollutants. When SO2 and NO2 increased by 10 ?g/m3, the daily hospital visits increased by 3%(P

An Application of Discrete Probability Models to the Number of Outpatient Visits

It is hypothesized that the number of outpatient visits can be represented by three different probability models: the truncated Poisson distribution, the Zeta distribution and the logarithmic series distribution. Maximum likelihood estimates of parameters of the above distributions were obtained by using grouped data according to the number of visits. A goodness-of-fit test was also made to compare the fit of the three distributions and the value of this statistic was classified and compared according to the types of medical care facilities. Based on the likelihood ratio statistic as a test criterion, both the truncated Poisson and Zeta distributions were not appropriate for the model of the number of outpatient visits. However, the logarithmic series distribution provides a good fit to data in the case of university hospitals, general hospitals and hospitals. When we apply this distribution in the 10 most common diseases, the estimates of the parameter vary from 0.39567 to 0.54176 for university hospitals, from 0.45329 to 0.65387 for general hospitals, and from 0.55104 to 0.77625 for hospitals. On the other hand in the case of clinics, even the logarithmic series distribution cannot be fitted to the data well. A characteristic of clinic utilization with almost homogeneous treatment patterns, in spite of the fact that there are a great many clinics, could be the reason for the above results.