ABSTRACT
BACKGROUND: Hospital readmission is common among patients with heart failure. Vulnerability to decline in physical function may increase the risk of noncardiovascular readmission for these patients, but the association between vulnerability and the cause of unplanned readmission is poorly understood, inhibiting the development of effective interventions. OBJECTIVES: We examined the association of vulnerability with the cause of readmission (cardiovascular vs. noncardiovascular) among hospitalized patients with acute decompensated heart failure. DESIGNS, SETTINGS, AND PARTICIPANTS: This prospective longitudinal study is part of the Vanderbilt Inpatient Cohort Study. MAIN OUTCOME AND MEASURES: The primary outcome was the cause of unplanned readmission (cardiovascular vs. noncardiovascular). The primary independent variable was vulnerability, measured using the Vulnerable Elders Survey (VES-13). RESULTS: Among 804 hospitalized patients with acute decompensated heart failure, 315 (39.2%) experienced an unplanned readmission within 90 days of discharge. In a multinomial logistic model with no readmission as the reference category, higher vulnerability was associated with readmission for noncardiovascular causes (relative risk ratio [RRR] = 1.36, 95% confidence interval [CI]: 1.06-1.75) in the first 90 days after discharge. The VES-13 score was not associated with readmission for cardiovascular causes (RRR = 0.94, 95% CI: 0.75-1.17). CONCLUSIONS: Vulnerability to functional decline predicted noncardiovascular readmission risk among hospitalized patients with heart failure. The VES-13 is a brief, validated, and freely available tool that should be considered in planning care transitions. Additional work is needed to examine the efficacy of interventions to monitor and mitigate noncardiovascular concerns among vulnerable patients with heart failure being discharged from the hospital.
Subject(s)
Heart Failure , Patient Readmission , Humans , Patient Readmission/statistics & numerical data , Male , Female , Aged , Prospective Studies , Longitudinal Studies , Aged, 80 and over , Risk Factors , Middle Aged , HospitalizationABSTRACT
Accurate data on young people's sexual behaviour and sexual health practice is essential to inform effective interventions and policy. However, little empirical evidence exists to support methodological design decisions in projects assessing young people's sexual health, especially in African contexts. This short report uses original empirical data collected in Ghana in 2012 to assess the effects of data collection mode and interviewer gender on young people's reporting of sexual health and access to supportive sexual health resources. The findings indicate that the effect of data collection mode may vary by gender, and there is no indication of an interviewer gender effect for males in this study. Preliminary results suggest that building strong rapport with research participants in this context may lead to reduced sexual health data quality. These findings merit further investigation and have direct implications for the design of projects measuring sexual health and related variables in Ghana.
Subject(s)
Data Collection/methods , Interviews as Topic , Reproductive Health , Self Report , Sexual Behavior , Adolescent , Effect Modifier, Epidemiologic , Female , Ghana , Humans , Interpersonal Relations , Male , Self Disclosure , Sex Factors , Young AdultABSTRACT
Drawing on insights from attachment theory, this study examined whether three types of attachment to God--secure, avoidant, and anxious--were associated with health-risk behaviors, over and above the effects of religious attendance, peer support, and demographic covariates, in a sample of 328 undergraduate college students. Contrary to prior theory, secure attachment to God is not inversely associated with recent alcohol or marijuana use, or substance use prior to last sexual intercourse. Instead, avoidant and anxious attachment to God are associated with higher levels of drinking; anxious attachment to God is associated with marijuana use; and avoidant attachment to God is associated with substance use prior to last sexual intercourse. These patterns are gender-specific; problematic attachment to God is linked with negative outcomes solely among men.
