ABSTRACT
BACKGROUND: Although schizophrenic patients have higher mortality than the general nonschizophrenic population, few studies have investigated acute care hospital mortality of schizophrenic patients. METHODS: To assess acute care hospital mortality of schizophrenic patients, we analyzed hospital mortality, the risk factors for hospital mortality, and the causes of death of schizophrenic patients admitted to an acute care hospital in Japan over an 18-year period. RESULTS: We identified 55 deaths among 1108 schizophrenic patients, for a mortality rate of 5.0%. The overall standardized mortality ratio was 1.29 (95% CI, 0.98-1.68) compared with nonschizophrenic hospitalized patients. Significant risk factors for mortality were malignant neoplasm, cardiovascular disease, and admission through the emergency department. The leading causes of death in acute care hospitalizations were suicide (14.5%), malignant lymphoma or leukemia (10.9%), stroke (9.0%), and sepsis (7.3%). CONCLUSIONS: There was a nearly significant trend toward increased mortality of schizophrenic patients receiving acute hospital care compared with that of nonschizophrenic patients. Because suicide was the most frequent cause of death, a focus on suicide prevention is needed in this population.
Subject(s)
Hospital Mortality , Schizophrenia/mortality , Adult , Aged , Cause of Death , Female , Hospital Mortality/trends , Hospitals, Community/statistics & numerical data , Hospitals, Teaching/statistics & numerical data , Humans , Japan/epidemiology , Logistic Models , Male , Middle Aged , Registries , Risk FactorsABSTRACT
OBJECTIVE: Because of an increasing number of case reports of copper deficiency associated with long-term tube feeding nutrition in Japan, we identified patients with copper deficiency associated with long-term tube feeding and described the prevalence, clinical data and cocoa treatment for these patients. MATERIALS AND METHODS: We conducted a retrospective study to identify patients who were referred from long-term care institutions and had copper deficiency associated with tube feeding. We reviewed all serum copper concentration data during a 6-year period. We also compared admission and post-treatment peripheral blood counts. RESULTS: Among 210 consecutive admissions with nutritional tube feeding from long-term care institutions (N=210), we identified 13 (6.2%) patients with copper deficiency (aged 46-91; 12 women). All patients had anemia, while most had neutropenia. The range of serum copper concentrations of these patients was 0.1-2.4 microg/L (normal; 6.8-12.8 microg/L). Their feeding formulas revealed a low copper content (5 to 12 microg per 100 kcal of each formula). Cocoa powder was used as the treatment. With cocoa supplements, the blood leukocyte count and hemoglobin significantly improved in all patients. Median leukocyte counts were 1,800 /mm(3)at admission and 6,300/mm(3) at follow-up (p=0.001). Median hemoglobin were 7.0 g/dl at admission and 10.3 g/dl at follow-up (p=0.001). Two patients developed transient tachycardia as a possible adverse effect of cocoa. CONCLUSION: We identified many cases with copper deficiency associated with tube feeding in Okinawa, Japan. Cocoa supplement appeared to be a safe and effective treatment. Increasing the copper content of Japanese tube feeding formulas should be considered for its prevention.
Subject(s)
Cacao , Copper/deficiency , Deficiency Diseases/diet therapy , Deficiency Diseases/etiology , Dietary Supplements , Enteral Nutrition/adverse effects , Aged , Aged, 80 and over , Cacao/adverse effects , Copper/blood , Deficiency Diseases/blood , Deficiency Diseases/epidemiology , Dietary Supplements/adverse effects , Female , Humans , Japan/epidemiology , Male , Middle Aged , Prevalence , Retrospective Studies , Tachycardia/etiology , Treatment OutcomeABSTRACT
A model to identify adult patients with malignant or granulomatous lymphadenopathy demonstrated a sensitivity/specificity of 0.97/0.91 in the reference sample by Vassilakopoulos and Pangalis. The current study tests the performance of the model in a new sample (n = 151) of patients with peripheral lymphadenopathy. Patient charts were reviewed for the biopsy diagnosis and for the 6 variables in the model (age, tenderness, size, generalized pruritus, supraclavicular lymphadenopathy, and texture). The prevalence rate of malignancy or granuloma in the validation sample was 0.26. When the cutoff point of 1 was used, as in the original description, the model's sensitivity/specificity in the validation sample was 0.97/0.56. The area under the receiver operating characteristic curve was 0.89 (95% confidence interval, 0.83-0.95), which was still statistically significant discrimination. Since the same model performs relatively poorly for the validation sample in terms of low specificity, a more accurate prediction model with better specificity would be needed in our patient population to help physicians identify those patients with peripheral lymphadenopathy who should undergo biopsy.
