Predictors of 30-Day Readmission After Inpatient Endoscopic Retrograde Cholangiopancreatography: A Single-Center Experience.

INTRODUCTION: The 30-day hospital readmission rate is a nationally recognized quality measure. Nearly one-fifth of medicare beneficiaries are hospitalized within 30 days of discharge, resulting in a cost of over $26 billion dollars annually. Endoscopic retrograde cholangiopancreatography (ERCP) remains the endoscopic procedure with the highest risk of morbidity and mortality. We set out to analyze the clinical characteristics predictive of 30-day readmission after an inpatient ERCP. METHODS: We performed a retrospective chart review of all inpatient ERCPs performed at our institution between 12/1/2014 and 9/30/2018. Clinical characteristics and outcomes of these patients were compared to determine predictors of 30-day readmission. RESULTS: A total of 497 inpatient ERCP procedures done for biliary or pancreatic indications, constituting 483 patients, were identified. There were 52 readmissions that occurred among 48 patients within 30 days of discharge. Basic demographic characteristics were similar between both groups. Comorbidities were significantly higher in those who were readmitted. Multivariate analysis revealed significantly greater odds of readmission with prior liver transplantation (OR = 4.15), cirrhosis (OR = 3.20), and pancreatic duct stent placement (OR = 2.56). Subgroup analysis for biliary indications revealed cholecystectomy before discharge and early ERCP to be protective against readmission. CONCLUSION: A history of liver transplantation and cirrhosis are predictive of increased 30-day readmission rates after an inpatient ERCP. Pancreatic duct stent placement is associated with readmission; however, this phenomenon is likely related to stenting for pancreatic endotherapy. Cholecystectomy before discharge and early ERCP are predictive of decreased need for readmission in procedures done for biliary indications.

Stressors among Hispanic adults from immigrant families in the United States: Familismo as a context for ambivalence.

OBJECTIVES: Ongoing exposure to social stressors is widely believed to undermine the health of Hispanic immigrant families. The current work aims to explore and interpret expressions of familismo as a framework through which postimmigration experiences are interpreted and potentially given meaning. METHOD: Qualitative data were obtained from 16 focus groups in California and Massachusetts (N = 93). Fifty-two percent of the participants identified as male and 59% primarily spoke Spanish. RESULTS: Analyses revealed 3 distinct forms of ambivalence specific to familismo among Hispanic adults from immigrant families. Give and take described experiences wherein immigrants turn their backs on family in the short term to realize a better long-term future for the family. Negative change explained family misfortunes that arise in the pursuit of a better future for the family and creates doubts about the vision that motivated migration. Forced shifts suggests the navigation of daily life necessitates the inversion or abandonment of culturally idealized family roles and responsibilities. CONCLUSION: Hispanic adults from immigrant families described several situations in which competing views of familismo likely influenced the interpretation of unanticipated stressors. (PsycINFO Database Record

Correlates of mental health among Latino farmworkers in North Carolina.

PURPOSE: Latino farmworkers are a vulnerable population who confront multiple threats to their mental health. Informed by the stress-process model of psychiatric disorder, the goal of this paper is to determine primary and context-specific stressors of poor mental health among Latino farmworkers. METHODS: Structured interview data were obtained from farmworkers (N = 69) in 6 counties in eastern and western North Carolina. FINDINGS: Results indicated that a substantial number of farmworkers have poor mental health, as indicated by elevated depressive symptoms (52.2%) and anxiety (16.4%). Results also indicated that each mental health outcome had different predictors. CONCLUSION: Addressing the mental health issues of farmworkers requires a comprehensive, multifaceted approach.

Symptoms of heat illness among Latino farm workers in North Carolina.

BACKGROUND: Symptoms of occupational heat illness provide an early warning that workers are in potentially life-threatening environmental conditions. PURPOSE: This analysis was designed to assess the extent to which strategies to reduce the health impact of extreme heat were associated with the prevalence of heat illness among Latino farm workers. METHODS: Between June and September 2009, a total of 300 Latino men and women participated in a cross-sectional survey about farm worker health. Participants reported whether they were employed through the H-2A temporary agricultural worker program and whether they had ever worked in conditions of extreme heat during their work in the U.S. agricultural industry. Workers who had worked in extreme heat also responded to questions about selected activities and behaviors and whether they experienced symptoms of heat illness. Data analysis was conducted in 2009 to assess associations of altering work hours and activities, drinking more water, resting in shaded areas, and going to air-conditioned places during or after work, with the prevalence of symptoms of heat illness among H-2A and non-H-2A workers. RESULTS: Working in extreme heat was reported by 281 respondents (94%), among whom 112 (40%) reported symptoms of heat illness. Changes in work hours and activities during hot conditions were associated with a lower prevalence of heat illness among H-2A workers but not among non-H-2A workers. CONCLUSIONS: These findings suggest the need to improve the understanding of working conditions for farm workers and to assess strategies to reduce agricultural workers' environmental heat exposure.