Functional decline following hospitalization remains an important problem in health care, especially for frail older adults. Modifiable factors related to reduction in harms of hospitalization are not well described. One particularly pervasive factor is emergency department (ED) boarding time; time waiting from decision to admit, until transfer to an in-patient medical unit. We sought to investigate how the functional status of frail older adults correlated with the length of time spent boarded in the ED. We found that patients who waited for 24 hours or more exhibited functional decline in both the Barthel Index and Hierarchical Assessment of Balance and Mobility and an increase in the Clinical Frailty Scale from discharge to 6 months post discharge. In conclusion, there is a need for additional investigation into ED focused interventions to reduce ED boarding time for this population or to improve access to specialized geriatric services within the ED.

Following the end of universal testing in the UK, hospital admissions are a key measure of COVID-19 pandemic pressure. Understanding leading indicators of admissions at the National Health Service (NHS) Trust, regional and national geographies help health services plan for ongoing pressures. We explored the spatio-temporal relationships of leading indicators of hospitalisations across SARS-CoV-2 waves in England. This analysis includes an evaluation of internet search volumes from Google Trends, NHS triage calls and online queries, the NHS COVID-19 app, lateral flow devices (LFDs), and the ZOE app. Data sources were analysed for their feasibility as leading indicators using Granger causality, cross-correlation, and dynamic time warping at fine spatial scales. Google Trends and NHS triages consistently temporally led admissions in most locations, with lead times ranging from 5 to 20 days, whereas an inconsistent relationship was found for the ZOE app, NHS COVID-19 app, and LFD testing, which diminished with spatial resolution, showing cross-correlation of leads between –7 and 7 days. The results indicate that novel surveillance sources can be used effectively to understand the expected healthcare burden within hospital administrative areas though the temporal and spatial heterogeneity of these relationships is a key determinant of their operational public health utility.

HIV and severe wasting are associated with post-discharge mortality and hospital readmission among children with complicated severe acute malnutrition (SAM); however, the reasons remain unclear. We assessed body composition at hospital discharge, stratified by HIV and oedema status, in a cohort of children with complicated SAM in three hospitals in Zambia and Zimbabwe. We measured skinfold thicknesses and bioelectrical impedance analysis (BIA) to investigate whether fat and lean mass were independent predictors of time to death or readmission. Cox proportional hazards models were used to estimate the association between death/readmission and discharge body composition. Mixed effects models were fitted to compare longitudinal changes in body composition over 1 year. At discharge, 284 and 546 children had complete BIA and skinfold measurements, respectively. Low discharge lean and peripheral fat mass were independently associated with death/hospital readmission. Each unit Z-score increase in impedance index and triceps skinfolds was associated with 48 % (adjusted hazard ratio 0·52, 95 % CI (0·30, 0·90)) and 17 % (adjusted hazard ratio 0·83, 95 % CI (0·71, 0·96)) lower hazard of death/readmission, respectively. HIV-positive v. HIV-negative children had lower gains in sum of skinfolds (mean difference −1·49, 95 % CI (−2·01, −0·97)) and impedance index Z-scores (–0·13, 95 % CI (−0·24, −0·01)) over 52 weeks. Children with non-oedematous v. oedematous SAM had lower mean changes in the sum of skinfolds (–1·47, 95 % CI (−1·97, −0·97)) and impedance index Z-scores (–0·23, 95 % CI (−0·36, −0·09)). Risk stratification to identify children at risk for mortality or readmission, and interventions to increase lean and peripheral fat mass, should be considered in the post-discharge care of these children.

Patient-important outcomes related to coronavirus disease 2019 (COVID-19) continue to drive the pandemic response across the globe. Various prognostic factors for COVID-19 severity have emerged and their replication across different clinical settings providing health services is ongoing. We aimed to describe the clinical characteristics and their association with outcomes in patients hospitalised with COVID-19 in the University Hospital of Ioannina. We assessed a cohort of 681 consecutively hospitalised patients with COVID-19 from January 2020 to December 2021. Demographic data, underlying comorbidities, clinical presentation, biochemical markers, radiologic findings, COVID-19 treatment and outcome data were collected at the first day of hospitalisation and up to 90 days. Multivariable Cox regression analyses were performed to investigate the associations between clinical characteristics (hazard ratios (HRs) per standard deviation (s.d.)) with intubation and/or mortality status. The participants' mean age was 62.8 (s.d., 16.9) years and 57% were males. The most common comorbidities were hypertension (45%), cardiovascular disease (19%) and diabetes mellitus (21%). Patients usually presented with fever (81%), cough (50%) and dyspnoea (27%), while lymphopenia and increased inflammatory markers were the most common laboratory abnormalities. Overall, 55 patients (8%) were intubated, and 86 patients (13%) died. There were statistically significant positive associations between intubation or death with age (HR: 2.59; 95% CI 1.52–4.40), lactate dehydrogenase (HR: 1.44; 95% CI 1.04–1.98), pO2/FiO2 ratio < 100 mmHg (HR: 3.52; 95% CI 1.14–10.84), and inverse association with absolute lymphocyte count (HR: 0.54; 95% CI 0.33–0.87). These data might help to identify points for improvement in the management of COVID-19 patients.

Influenza virus infections can lead to a number of secondary complications, including sepsis. We applied linear regression models to mortality and hospital admission data coded for septicaemia from 1998 to 2019 in Hong Kong, and estimated that septicaemia was associated with an annual average excess mortality rate of 0.23 (95% CI 0.04–0.40) per 100 000 persons per year and an excess septicaemia hospitalisation rate of 1.73 (95% CI 0.94–2.50) per 100 000 persons per year. The highest excess morbidity and mortality was found in older adults and young children, and during influenza A(H3N2) epidemics.

The study aim was to examine the incidence and risk factors of respiratory syncytial virus (RSV) bronchiolitis hospitalisations and disease severity among infants. We compared demographic and health characteristics of children aged 0–23 hospitalised for RSV bronchiolitis (cases, n = 1227) during 2008–2018 and control children (n = 554) of the same age admitted for non-respiratory disease. RSV antigen was detected in nasal swabs by immunochromatography. Multiple logistic regression models were applied. The average annual incidence of hospitalisation for RSV bronchiolitis was 12.6 per 1000 and 1.7 per 1000 (P < 0.001) among infants and toddlers, respectively, with winter seasonality (November–March). The risk of hospitalisation for RSV bronchiolitis increased among children aged 0–5 months (OR 7.66; 95% CI 5.61–10.45) and 6–11 months (OR 12.88, 95% CI 8.48–19.55), compared to those aged 12–23 months. Additional risk factors were living in low vs. higher socio-economic status towns (OR 1.49; 95% CI 1.14–1.95), having chronic medical conditions (OR 2.75; 95% CI 1.61–4.70), birth month (October–January vs. June–September) (OR 2.19; 95% CI 1.60–2.99) and history of stay in neonatal intensive care unit at birth (OR 2.37; 95% CI 1.27–4.41). Male children and those who had pneumonia were more likely to have severe RSV bronchiolitis. In conclusion, the burden of hospitalisations for RSV bronchiolitis is high, especially in young infants. Effective preventive measures such as RSV active vaccines can reduce the risk of hospitalisations for RSV bronchiolitis among these vulnerable groups.

Our study was conducted to assess the sepsis-associated hospitalisations and antimicrobials prescribed for sepsis inpatients in Hong Kong. Demographic, diagnostic and antimicrobial prescription data were analysed for patients admitted to public hospitals with a diagnosis of septicaemia from 2000 to 2015. A total of 223 250 sepsis hospitalisations were recorded in Hong Kong from 2000 to 2015 during which the hospitalisation rate increased by 85.6%. The majority of the sepsis hospitalisations occurred in adults ≥65 years and children aged 0–4 years. Adults with a secondary diagnosis of sepsis were often admitted with a primary diagnosis of urological conditions or pneumonia; whereas diabetes mellitus was the most common secondary diagnosis among those with primary sepsis. Paediatric sepsis patients aged 0–4 years were often diagnosed with disorders relating to short gestation and low birthweight. Antimicrobial prescriptions increased by 51.1% and 34.4% for primary and secondary sepsis patients, respectively. β-Lactam and β-lactamase inhibitor combinations were the most used antibiotics whereas the usage of carbapenems increased more than 10 times over the study period. A substantial burden of hospitalisations was attributable to sepsis in Hong Kong, particularly in the extremes of age. Broad-spectrum and last-resort antibiotics had been increasingly dispensed for sepsis inpatients.

To investigate temporal trends in coronavirus disease 2019 (COVID-19)-related outcomes and to evaluate whether the impacts of potential risk factors and disparities changed over time, we conducted a retrospective cohort study with 249 075 patients tested or treated for COVID-19 at Michigan Medicine (MM), from 10 March 2020 to 3 May 2021. Among these patients, 26 289 were diagnosed with COVID-19. According to the calendar time in which they first tested positive, the COVID-19-positive cohort were stratified into three-time segments (T1: March–June, 2020; T2: July–December, 2020; T3: January–May, 2021). Potential risk factors that we examined included demographics, residential-level socioeconomic characteristics and preexisting comorbidities. The main outcomes included COVID-19-related hospitalisation and intensive care unit (ICU) admission. The hospitalisation rate for COVID-positive patients decreased from 36.2% in T1 to 14.2% in T3, and the ICU admission rate decreased from 16.9% to 2.9% from T1 to T3. These findings confirm that COVID-19-related hospitalisation and ICU admission rates were decreasing throughout the pandemic from March 2020 to May 2021. Black patients had significantly higher (compared to White patients) hospitalisation rates (19.6% vs. 11.0%) and ICU admission rates (6.3% vs. 2.8%) in the full COVID-19-positive cohort. A time-stratified analysis showed that racial disparities in hospitalisation rates persisted over time and the estimates of the odds ratios (ORs) stayed above unity in both unadjusted [full cohort: OR = 1.98, 95% confidence interval (CI) (1.79, 2.19); T1: OR = 1.70, 95% CI (1.36, 2.12); T2: OR = 1.40, 95% CI (1.17, 1.68); T3: OR = 1.55, 95% CI (1.29, 1.86)] and adjusted analysis, accounting for differences in demographics, socioeconomic status, and preexisting comorbid conditions (full cohort: OR = 1.45, 95% CI (1.25, 1.68); T1: OR = 1.26, 95% CI (0.90, 1.76); T2: OR = 1.29, 95% CI (1.01, 1.64); T3: OR = 1.29, 95% CI (1.00, 1.67)).

This study applied causal criteria in directed acyclic graphs for handling covariates in associations for prognosis of severe coronavirus disease 2019 (COVID-19) cases. To identify non-specific blood tests and risk factors as predictors of hospitalisation due to COVID-19, one has to exclude noisy predictors by comparing the concordance statistics (area under the curve − AUC) for positive and negative cases of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Predictors with significant AUC at negative stratum should be either controlled for their confounders or eliminated (when confounders are unavailable). Models were classified according to the difference of AUC between strata. The framework was applied to an open database with 5644 patients from Hospital Israelita Albert Einstein in Brazil with SARS-CoV-2 reverse transcription – polymerase chain reaction (RT-PCR) exam. C-reactive protein (CRP) was a noisy predictor: hospitalisation could have happened due to causes other than COVID-19 even when SARS-CoV-2 RT-PCR is positive and CRP is reactive, as most cases are asymptomatic to mild. Candidates of characteristic response from moderate-to-severe inflammation of COVID-19 were: combinations of eosinophils, monocytes and neutrophils, with age as risk factor; and creatinine, as risk factor, sharpens the odds ratio of the model with monocytes, neutrophils and age.

COVID-19 has caused a major global pandemic and necessitated unprecedented public health restrictions in almost every country. Understanding risk factors for severe disease in hospitalised patients is critical as the pandemic progresses. This observational cohort study aimed to characterise the independent associations between the clinical outcomes of hospitalised patients and their demographics, comorbidities, blood tests and bedside observations. All patients admitted to Northwick Park Hospital, London, UK between 12 March and 15 April 2020 with COVID-19 were retrospectively identified. The primary outcome was death. Associations were explored using Cox proportional hazards modelling. The study included 981 patients. The mortality rate was 36.0%. Age (adjusted hazard ratio (aHR) 1.53), respiratory disease (aHR 1.37), immunosuppression (aHR 2.23), respiratory rate (aHR 1.28), hypoxia (aHR 1.36), Glasgow Coma Scale <15 (aHR 1.92), urea (aHR 2.67), alkaline phosphatase (aHR 2.53), C-reactive protein (aHR 1.15), lactate (aHR 2.67), platelet count (aHR 0.77) and infiltrates on chest radiograph (aHR 1.89) were all associated with mortality. These important data will aid clinical risk stratification and provide direction for further research.

La période précédant la 2e guerre mondiale a vu le nombre de patients psychiatriques croître, du fait de l’augmentation des durées de séjour; après la période particulièrement dramatique de la guerre, s’est développé un fort mouvement de désinstitutionalisation, qui a donné lieu en France, en 1960, à l’invention du secteur de psychiatrie et à une approche communautaire fixant au centre médico-psychologique un rôle central, de primo-accueil, d’évaluation et d’orientation. La fermeture d’un grand nombre de lits à temps complet, le développement des alternatives à l’hospitalisation et le raccourcissement des durées de séjour, qui ont été divisées par 3,7 entre 1980 (106 journées) et 2011 (29 journées), marquent cette nouvelle période, où les réhospitalisations sont devenues plus nombreuses que les primo-hospitalisations.

Nous avons utilisé les données du Recueil d’informations médicalisé en psychiatrie (RimP) pour étudier les séjours en hospitalisation psychiatrique complète des habitants du Nord – Pas-de-Calais en 2011 et 2012, apprécier la part des réhospitalisations durant la période et décrire leurs bénéficiaires. Sur 21 784 personnes ayant connu une hospitalisation psychiatrique complète en 2011, on enregistre des taux de réhospitalisation, à 3 mois de 22 %, à 6 mois de 33 % et à 12 mois de 43 %. Parmi ces personnes réhospitalisées dans l’année qui suit le premier séjour, 51 % le sont 1 fois, 22 % 2 fois, 11 % 3 fois, 6 % 4 fois et 11 % 5 fois et plus.

À 12 mois, les taux sont plus élevés chez les hommes que chez les femmes, beaucoup plus élevés chez les personnes ayant connu au moins une hospitalisation contrainte et varient inversement à l’âge : de 54,8 % chez les moins de 10 ans à 37,2 % chez les 80 ans et plus. D’importantes variations sont également enregistrées selon les secteurs de psychiatrie (rapport 9e/1er décile = 1,39) et, plus encore, selon les établissements d’hospitalisation (rapport 9e/1er décile = 2,32). Moins de 40 % de réhospitalisation à 12 mois sont enregistrés chez les patients présentant un diagnostic en F4 et en F3; de 40 à 49 % pour les diagnostics F1, F5, et F6; de 50 à 60 % pour les diagnostics F2; de 70 % enfin pour les patients diagnostiqués F8.

Une régression logistique (modèle de Cox) fait également apparaître le rôle important du secteur (service) d’hospitalisation : toutes choses étant égales par ailleurs, le risque de réhospitalisation est significativement inférieur – de 1,4 à 1,6 fois moins – dans 3 secteurs de psychiatrie adulte sur les 60 de la région Nord – Pas-de-Calais, alors que pour 11 autres, il est significativement supérieur – de 1,3 à 2,3 fois plus.

Notre étude confirme la grande fréquence des réhospitalisations, mais aussi la variabilité de leurs taux, selon les variables étudiées. Elle ne permet pas cependant d’apprécier la valeur de ces nouveaux séjours hospitaliers : indispensables et prévisibles ou fâcheux et marqueurs d’une décompensation.

This was a metabolic study of bulimia nervosa required to design short-term cognitive-behavioural therapy (CBT) beginning with a brief admission to a psychiatric ward. The treatment produced significant improvements in eating behaviour and results are compared with those of previously published studies. The comparisons do not suggest that brief admission at the onset of therapy might enhance its effectiveness. In other respects, increase in normal meal intake was found to correlate significantly with decrease in hinging. This supports the notion that appropriate food intake at meal times should be an important issue in CBT for bulimia nervosa.

Nowadays, the rehabilitation of schizophrenic patients is a major issue for psychiatry. Regarding the role of conventional neuroleptics, the following points will be considered in this paper: the role of neuroleptics in the number, length and frequency of hospitalisations; the role of neuroleptics in the number, degree and length of relapses; the clinical effects of neuroleptics focusing particularly on their disinhibitory action, the most controversial and least studied of the clinical effects of these drugs; and the side effects, which have been intensively studied and particularly criticised during these last years, leading to the development of new drugs discussed in the next article. All the published data relating to the psychosocial profile of schizophrenic patients clearly demonstrate the need for further research in order to improve the familial, social and professional rehabilitation of these patients

This study examines the influence of chronic health conditions and socio-economic status on overnight admission and length of stay among Canadian seniors. Incremental multivariate logistic and zero-inflated negative binomial regression models assessed the relationship between selected predictors, overnight admission, and duration of stay. The findings show that all chronic health conditions and socio-economic factors examined were significantly associated with overnight hospital admission. However, seniors with cardiovascular health conditions, the very old, and seniors living in lower-income households had a greater risk of longer stays. Canadian seniors diagnosed with hypertension, cancer, diabetes, and stroke had greater risk of longer overnight hospital stays. Seniors aged 75 to 79 years, 80 years or older, and those living in lower-income households (≤ $39,999) were more likely to have a longer overnight hospital stay. Findings suggest that improving seniors’ health and socio-economic status may reduce the risk of overnight admission and longer stays of hospitalisation.

This study compares the frequency and severity of influenza A/H1N1pdm09 (A/H1), influenza A/H3N2 (A/H3) and other respiratory virus infections in hospitalised patients. Data from 17 332 adult hospitalised patients admitted to Sir Charles Gairdner Hospital, Perth, Western Australia, with a respiratory illness between 2012 and 2015 were linked with data containing reverse transcription polymerase chain reaction results for respiratory viruses including A/H1, A/H3, influenza B, human metapneumovirus, respiratory syncytial virus and parainfluenza. Of these, 1753 (10.1%) had test results. Multivariable regression analyses were conducted to compare the viruses for clinical outcomes including ICU admission, ventilation, pneumonia, length of stay and death. Patients with A/H1 were more likely to experience severe outcomes such as ICU admission (OR 2.5, 95% CI 1.2–5.5, P = 0.016), pneumonia (OR 3.0, 95% CI 1.6–5.7, P < 0.001) and lower risk of discharge from hospital (indicating longer lengths of hospitalisation; HR 0.64 95% CI 0.47–0.88, P = 0.005), than patients with A/H3. Patients with a non-influenza respiratory virus were less likely to experience severe clinical outcomes than patients with A/H1, however, had similar likelihood when compared to patients with A/H3. Patients hospitalised with A/H1 had higher odds of severe outcomes than patients with A/H3 or other respiratory viruses. Knowledge of circulating influenza strains is important for healthcare preparedness.