Economic and survival burden of dysphagia among inpatients in the United States.

The inpatient burden of dysphagia has primarily been evaluated in patients with stroke. It is unclear whether dysphagia, irrespective of cause, is associated with worse clinical outcomes and higher costs compared to inpatients with similar demographic, hospital, and clinical characteristics without dysphagia. The aim of this study is to assess how a dysphagia diagnosis affects length of hospital stay (LOS), costs, discharge disposition, and in-hospital mortality among adult US inpatients. Annual and overall dysphagia prevalence, LOS, hospital charges, inpatient care costs, discharge disposition, and in-hospital mortality were measured using the AHRQ Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (2009-2013). Patients aged 45 years or older with ≤180 days of stay in hospital with and without dysphagia were included. Multivariable survey regression methods with propensity weighting were used to assess associations between dysphagia and different outcomes. Overall, 2.7 of 88 million (3.0%) adult US inpatients had a dysphagia diagnosis (50.2% male, 72.4% white, 74.6% age 65-90 years) and prevalence increased from 408,035 (2.5% of admissions) in 2009 to 656,655 (3.3%) in 2013. After inverse probability of treatment weighting adjustment, mean hospital LOS in patients with dysphagia was 8.8 days (95% CI 8.66-8.90) compared to 5.0 days (95% CI 4.97-5.05) in the non-dysphagia group (P < 0.001). Total inpatient costs were a mean $6,243 higher among those with dysphagia diagnoses ($19,244 vs. 13,001, P < 0.001). Patients with dysphagia were 33.2% more likely to be transferred to post-acute care facility (71.9% vs. 38.7%, P < 0.001) with an adjusted OR of 2.8 (95% CI 2.73-2.81, P < 0.001). Compared to non-cases, adult patients with dysphagia were 1.7 times more likely to die in the hospital (95% CI 1.67-1.74). Dysphagia affects 3.0% of all adult US inpatients (aged 45-90 years) and is associated with a significantly longer hospital length of stay, higher inpatient costs, a higher likelihood of discharge to post-acute care facility, and inpatient mortality when compared to those with similar patient, hospital size, and clinical characteristics without dysphagia. Dysphagia has a substantial health and cost burden on the US healthcare system.

Indication of reactor ν(e) disappearance in the Double Chooz experiment.

The Double Chooz experiment presents an indication of reactor electron antineutrino disappearance consistent with neutrino oscillations. An observed-to-predicted ratio of events of 0.944±0.016(stat)±0.040(syst) was obtained in 101 days of running at the Chooz nuclear power plant in France, with two 4.25 GW(th) reactors. The results were obtained from a single 10 m(3) fiducial volume detector located 1050 m from the two reactor cores. The reactor antineutrino flux prediction used the Bugey4 flux measurement after correction for differences in core composition. The deficit can be interpreted as an indication of a nonzero value of the still unmeasured neutrino mixing parameter sin(2)2θ(13). Analyzing both the rate of the prompt positrons and their energy spectrum, we find sin(2)2θ(13)=0.086±0.041(stat)±0.030(syst), or, at 90% C.L., 0.017

Prenatal drug education in public and private schools of Nebraska.

Substance abuse during pregnancy continues to be a serious health problem in the United States. Hazards associated with the use of alcohol, tobacco, and other drugs by pregnant women have been documented. The extent to which prenatal drug education is included in school health education has not been addressed. This survey determined the nature and extent of prenatal drug education being conducted by Nebraska school teachers in health-related fields. Educators in public and private schools who teach health-related courses were surveyed. Respondents indicated prenatal drug education is being addressed in a variety of courses. Amount of time devoted to the topic was 2.68 hours overall. Problems associated with providing prenatal drug education included inadequate teacher knowledge and training, lack of appropriate materials, and time limitations in the curriculum. Implications for comprehensive school health education are identified.

Hazardous exposures during pregnancy.

A teratogen is any environmental agent that permanently harms the developing fetus. Health-care providers who care for pregnant women are consulted regarding a variety of agents, including prescribed or over-the-counter medications, vaccinations, diseases or infections, chemical agents in the work place or at home, radiation, and alcohol, tobacco, and "street drugs." Patients also may have questions about the impact of paternal exposures on subsequent offspring and the safety of maternal use of medications while breastfeeding. Thus, it is important for the caregivers to be knowledgeable concerning basic principles of teratogenesis, such as the effects of timing, dosage, and fetal susceptibility, and the impact of specific agents on the fetus or pregnancy. Clinicians should be cognizant of the possibilities for prenatal diagnosis of fetal damage, strategies to decrease risk, and available resources.