Gun Violence, mental health, and Connecticut physicians.

While there is a public perception that gun violence is associated with mental illness we present evidence that it is a complex public health problem which defies simple characterizations and solutions. Only a small percentage of individuals with mental illness are at risk for extreme violence and they account for only a small percentage of gun-related homicides. Individuals who are at risk for gun violence are difficult to identify and successfully treat. The incidence, and perhaps the demographics, of gun violence vary substantially from state to state. We make a case for Connecticut physicians to study gun violence at the state level. We recommend that Connecticut physicians promote and expand upon the American Academy of Pediatrics' recommendation for creating a "safe home environment. "We suggest that guns be secured in all homes in which there are children. In addition we suggest that guns be voluntarily removed from homes in which there are individuals with a history of violence, threats of violence, depression, drug and/or alcohol abuse, and individuals with major mental illnesses who are not cooperating with therapy.

Inter-rater concordance of wound classifications in patients undergoing appendectomy.

BACKGROUND: Despite the widespread utilization of a four-stage wound classification system to risk-adjust operations for surgical site infection (SSI) rates, we are not aware of any study evaluating the definitions of the wound classes for clarity. We limited our study of wound classifications to appendectomies and posed the question whether different reviewers classify individual cases differently. METHODS: We evaluated the wound classifications of 105 consecutive appendectomies in our community hospital. Four reviewers graded retrospectively the wound classifications, first after reading the description of the appendix in the operative report and again after reading the pathology report. The wound classifications of the four reviewers were evaluated for concordance with the original operating room nurse (ORN) assignment. RESULTS: The kappa scores for inter-observer concordance of wound classifications among the four reviewers based on their interpretation of the operative report and the ORN who originally classified the operation ranged from 0.1028 to 0.1597. By conventional standards, this represents no better than "slight agreement" for any of the reviewers. We found that 19%, 50%, 94%, 95%, or 96% of our appendectomies would be considered "high risk," Class 3 or 4, operations depending on which rater classified the operation. The additional information contained in the pathology reports did not change the distribution of wound classifications of the four reviewers significantly. CONCLUSIONS: Our study demonstrated considerable differences in the distribution of wound classifications of appendectomies among our ORNs and retrospective reviewers. A review of the surgical literature supports our finding that the incision classification system utilized commonly lacks precision, at least in the rating of appendectomies. We recommend that further studies be performed to determine whether changes in the definitions of wound classes are warranted.

Are complications of transrectal ultrasound-guided biopsies of the prostate gland increasing?

Although transrectal ultrasound-guided biopsies (TRUSB) of the prostate gland are generally considered to be low-risk procedures, a study from Canada reported that there had been a significant increase in the percentage of hospital admissions following TRUSBs between 1996 and 2005 (1.0% to 4.1%). The authors speculated that the increase may be secondary to the emergence of antibiotic-resistant enteric bacteria or the result of an increasing number of cores taken with each TRUSB. In a chart review, we retrospectively evaluated complications from 2,080 consecutive TRUSBs performed by one urology group in Connecticut between January 2003 and August 2010. We identified seven patients (0.34%) who were admitted to an acute-care hospital for infectious complications and three patients (0.14%) who were admitted for bleeding. The risk of serious infections and bleeding did not significantly rise during the study period despite a significant increase in the mean number of biopsy cores taken.

Tasas de ingreso inicial por esquizofrenia en hospitales de Costa Rica / Rates of first hospital admissions for schizophrenia in Costa Rica

Con el objetivo de formular una hipótesis sobre los factores que influyen en los ingresos hospitalarios por esquizofrenia en Costa Rica, se realizó un estudio en personas de ambos sexos internadas por primera vez con ese diagnóstico (grupos 295.0 a 295.9 de la Clasificación internacional de enfermedades, novena revisión) en el período de 1979 a 1981. Se calcularon las tasas de incidencia anuales a partir de los casos hospitalizados y de la población de todo el país. La incidencia anual detectada tuvo un promedio de 48,2 casos por 100 000 habitantes. Se observó una mayor frecuencia de primeros ingresos en hombres de 40 a 44 años y en mujeres de 45 a 49. Tuvieron la mayor incidencia las mujeres solteras, seguidas de las divorciadas. La escolaridad mostró una relación inversa significativa con la tasa de ingresos por esquizofrenia, ya que se observó una mayor incidencia en mujeres sin ocupación y amas de casa. Mediante análisis de regresión logística se estudió la asociación entre la tasa de hospitalización por esquizofrenia y 10 características de los cantones. El análisis reveló que solo dos variables ­la distancia entre el cantón y el hospital y el volumen de la cosecha de café por habitante­ mostraban una asociación directa significativa con las tasas de ingreso por esquizofrenia. Los cantones donde se registró el mayor número de nacimientos de niños con diagnóstico de esquizofrenia en la adultez fueron los más cercanos al hospital psiquiátrico y los que tenían poca actividad industrial o agrícola, poca densidad poblacional y altos porcentajes de personas solteras y divorciadas

The factors that influence hospital admissions for schizophrenia in Costa Rica were investigated in people of both sexes who were admitted for the first time with this diagnosis (codes 295.0 to 295.9 of the International Classification of Diseases, Ninth Revision) in the period 1979 to 1981. Annual incidence rates were calculated using the number of hospitalized cases and the total population of the country. The average annual incidence was found to be 48.2 cases per 100 000 inhabitants. High frequencies of first admissions were seen among males 40 to 44 years of age and females 45 to 49. Incidence was highest among unmarried women, followed by divorced women. There was a significant inverse relationship between educational attainment and rates of admission for schizophrenia, and incidence rates were highest among unemployed women and housewives. The association between rate of hospitalization for schizophrenia and 10 characteristics of the cantons was studied by means of logistic regression. Only two variablel­the distance between the canton's principal town and the hospital and the volume of coffee harvest per resident­showed a direct significant association with admission rates for schizophrenia. The cantons which had the highest number of births of children who were diagnosed as schizophrenic in adulthood were those closest to the psychiatric hospital and those that had a low level of industrial or agricultural activity, low population density, and high proportions of single or divorced persons.