Home care first admissions are different from re-admissions.

Most previous papers on home care client populations, by not distinguishing between first and subsequent admissions, may create the impression that the characteristics of these two groups of patients are similar. When analysing these two groups from this data set separately, however, they show differences demographically, in length of stay, and in use of some services. Although, in many instances, these differences are not large, they are statistically significant, thus implying that type of admission i.e., first or subsequent, should be used routinely as a descriptive or explanatory variable in any analysis.

Hospital effects of maternity early discharge.

Although the programs are of increasing popularity, little has been published on the effects of discharging maternity patients early from the hospital. In particular, there is almost no evidence to date to prove that these programs actually achieve two objectives for which they were designed; to reduce occupancy pressure on maternity beds and to lower hospital costs. Evaluation of the early stages of a relatively small and flexible maternity early discharge program in Alberta, Canada suggests that the program is effective in reducing length of stay in the hospital and hospital costs, but there is little evidence that it is actually used to reduce pressure on bed space in the maternity unit.

Smoking and pregnancy: attributable risks and public health implications.

PIP: A review of the literature from 1957-79 on the pregnancy outcomes associated with smoking yielded estimates of various attributable risk statistics for these outcomes. Rates were extracted for 28 pregnancy outcome variables in smoking and nonsmoking mothers found in cohort studies of pregnancy. Data for similar outcomes were combined to produce average rates of each outcome variable; the relative risk for each type of outcome was then obtained by dividing the rate in smokers by the rate in nonsmokers. The amount of damage to be attributed to smoking was determined by estimating the attributable risk (AR) for the 25 pregnancy outcomes found to occur more often in smokers. The percentage of women reported as smoking during pregnancy has ranged from 14% in American Orientals to 61% in US Whites. Of the total 260,000 women in these studies, approximately 42.1% smoked while pregnant. ARs for various outcomes, expressed as rates per 1000 maternal smokers, vary from 1.2 (congenital abnormalities) to 56.7 (perinatal plus deaths), about 1/2 of all rates lying below 10. These are the measure of the number of events per 1000 smoking mothers that might in theory have been prevented if they did not smoke. An average of estimates of nonfatal events in mothers and fatal events in offspring suggests about 20 nonfatal bleeding episodes per 1000 smoking mothers and 24.1 offspring deaths from conception to the end of the first year of life. On average, between 5% and 25% of unfavorable outcomes in all pregnancies may be attributable to smoking. Although low relative risk values suggest clinical insignificance, the estimates are probably too low because of varying definitions of smokers and nonsmokers. Dose-related outcomes and other possible causes of pregnancy outcome risks must also be considered. A causal relation implies that the portion of pregnancy outcomes attributable to smoking would be prevented if pregnant women did not smoke.^ieng

Alcohol-related disabilities in general hospital patients: a critical assessment of the evidence.

Thirty-one publications containing estimates of the prevalence of alcohol-related problems within general hospitals are assessed critically to determine whether the alcohol dependence syndrome or other alcohol-related disabilities were the subjects of study, and whether these were causal to admission or incidental findings. A classification scheme within which these studies may be fitted is introduced, and an attempt is made to gauge the sizes of the problems by collating results within each classification category. No consistency is found, however; and this is attributed to difficulties of definition as well as to deficiencies in survey techniques. Some suggestions for better-designed studies are made. Until these are carried out it will not be possible to provide valid to reliable estimates of the extent of the problem.