Incremental hospital utilization and mortality associated with co-morbid depression in pediatric hospitalizations.

OBJECTIVE: The objective of this study was to evaluate the association between hospital utilization and mortality and the presence of co-morbid depression in pediatric hospitalizations. METHODS: Using the Kids' Inpatient Database (KID) for 2012, a nationally representative database of all inpatient admissions in the United States of America for patients younger than 21 years of age compiled by the Health Care Utilization Project (HCUP), we obtained hospital records for children aged 6-20 years with any one of the 10 most common diagnoses in this population excluding affective disorders. After using one to one propensity score matching on age, race, gender, obesity, insurance type, hospital location and hospital size to ensure exchangeability between the groups, we compared the Length of Stay (LOS), Total Hospital Costs (THC) and mortality in children with and without reported comorbidity depression. We employed descriptive statistics and linear regression methods in our analyses RESULTS: A total of 667,968 discharges were extracted estimating a total of 937,971 discharges for children aged 6 - 20 with a primary diagnosis of any one of the 10 most common non-affective diagnoses in 2012. The prevalence of comorbid depression was about 2.9%. Propensity score matching produced 17,071 pairs. The mean LOS among patients with comorbid depression (4.63 days) was 0.89 days (95% CI: 0.74-1.05 days) higher than among patients without comorbid depression (3.74 days). The mean THC among patients with comorbid depression ($10,643) was $2,961 (95% CI: $2,401-$3,512) higher than among children without comorbid depression ($7,682). The odds of death as an outcome among the depressed was 1.77 (95% CI 1.13-2.77) times the odds among non-depressed patients. CONCLUSIONS: These findings show that comorbid depression significantly increases hospital utilization and mortality in childhood hospitalizations.

Sanitary Worker's Death Unnerves Pakistan's Health Care Ethics to the Core.

Health care ethics is a sensitive domain, which if ignored, can lead to patient dissatisfaction, weakened doctor-patient interaction and episodes of violence. Little importance has been paid to medical ethics within undergraduate medical education in developing countries such as Pakistan. Three doctors in Pakistan are currently facing an official police complaint and arrest charges, following the death of a sanitary worker, who fell unconscious while cleaning a drain and was allegedly refused treatment as he was covered in sewage filth. The medical license of the doctors in question should be cancelled, if found guilty following a thorough investigation into the case. The 'right to life' has been universally assured by all moral, cultural and legal codes and no society can ever argue against the sacredness of a human life. It is quite clear that the aforesaid doctors' actions are not only against the core principles of the physicians' code, but also go against the doctrine of human rights. If serious efforts on an urgent basis are not made by the regulatory and governing bodies, one can definitely expect similar incidents for at least a few more decades before any noticeable change is seen.

Suicide and Its Legal Implications in Pakistan: A Literature Review.

In recent decades, great strides have been made in understanding the science of suicide. Thus, it is imperative that Pakistani legal systems bridge the gap between Pakistani law and science. For instance, recent discoveries in public health, psychology, and neurobiology have shaped the etiological model of suicidal behavior and highlighted the high preponderance of certain psychiatric patients towards suicide. We present here a brief overview of psychiatric evidence implicated in suicides to better inform the Pakistani legal system of advances in the psychiatric literature.

Endosulfan poisoning: An overview.

Endosulfan, an organochlorine (OC) insecticide, is a widely used agricultural pesticide, despite its life threatening toxic effects. In this review, the pharmacokinetics of endosulfan, mechanism of endosulfan toxicity, clinical presentations and management, histopathological findings, and toxicological analysis are described, in addition to its environmental toxicity. The toxic effects of endosulfan can affect many organs and systems presenting in a wide array of signs and symptoms. Although termed a restricted OC-classed pesticide, it continues to be used, especially in the developing world, owing to its beneficial effects on agriculture. Several cases of endosulfan poisoning have been reported from different regions of the world. Whether accidental or intentional, endosulfan ingestion proves to be fatal unless immediate, aggressive treatment is initiated. Management is mainly supportive as no antidote exists for endosulfan poisoning as yet. The use of endosulfan needs to be strictly regulated and eventually banned worldwide altogether to lower the current morbidity and mortality resulting from this pesticide. Additionally, monitoring biological samples, using non-invasive techniques such as breast milk sampling, can provide an effective method of observing the elimination of this environmentally persistent organic pollutant from the general population.