Appropriateness of admission and days of stay in pediatric hospital in Ancona, Italy

Background: In Italy, hospital admission costs account for nearly 42% of total health expenditure; in the Marche region, this share exceeds 50%. High costs of hospitalization, however, can be partly explained by inappropriate use. The aim of this research was to assess the risk factors associated with inappropriate hospital admissions and stay for acute pediatric patients. Methods: Clinical records of children from 30 days to 14 years of age admitted to the wards of orthopedics, pediatrics, pediatric isolation, pediatric surgery and pediatric oncohematology at Salesi Pediatric Hospital of Ancona throughout 2004 were reviewed. The Italian Pediatric Appropriateness Evaluation Protocol (PRUO) was used as a tool for assessing inappropriateness of admission and days of stay. Results: Overall 21.7% (95% CI = 16.1%–22.4%) of hospital admissions and 30.3% (95% CI = 26.0%–34.9%) of days of stay were judged to be inappropriate. Multiple logistic regression analysis indicated that inappropriate admission was significantly associated with type of admission, discharge ward and place of residence. Inappropriateness of stay was significantly higher if admission was to a medical ward and if admission itself was judged inappropriate. Conclusions: In a socioeconomic context in which reducing waste is necessary, ineffective health care interventions are no longer tolerable. As a tool capable of integrating each patient’s specific features with those of the health care process, the pediatric PRUO could be a valid tool in the hands of managers for monitoring the appropriateness of admission and stay

LGBT ‘Communities’ and the (Self-)regulation and Shaping of Intimacy

This article draws on UK research with over 600 lesbian, gay, bisexual, and trans (LGBT+) people, funded by the Arts and Humanities Research Council (grant AH/J011894/1), which explored understandings and experiences of LGBT ‘community’. I examine the ways in which intimacy is regulated and shaped by and within social interaction, which was apparent in three main ways. First, the research identified how for some people the very concept of ‘LGBT community’ was linked to intimacy. Second, there was strong evidence to suggest that some LGBT+ people self-regulate their practices of intimacy (such as holding hands or kissing in public) so as not to be recognised as enacting a same-gender relationship. This was understood as a form of self-protection or hate crime prevention, though degrees of habit and professed concern for other people’s feelings were also contributing factors. Third, experiences of intimate relations were shaped by intersectional dynamics, particularly relating to various forms of discrimination, including ageism, biphobia, classism, (dis)ableism, racism, and transphobia from and among LGBT+ people. Whilst LGBT ‘communities’ were thought to enable opportunities to seek sexual and/or intimate encounters, this is not without its complexities. Although there have been improvements in relation to legislation and wider social attitudes, there is, for some, persistent apprehension and self-regulation which, whether necessary or not, are significant. LGBT+ people’s experiences thus suggest that intimacy can be shaped by multiple inequalities both within and without LGBT ‘communities’

Facial and dental alterations according to the breathing pattern

There is controversy in the literature about possible interaction of the respiratory mode with the facial and dental structures. OBJECTIVES: The aim of this study was to perform a longitudinal assessment of the changes in facial and dental structures in Angle's Class II, division 1 malocclusion individuals, divided according to the respiratory pattern (predominantly nasal or mouth), at two distinct moments of craniofacial development. MATERIAL AND METHODS: Pogonium and nose measurements were made on the lateral cephalometric tracings (LS'-Pog', LS'-B', B'-Pog', Pog'-PogTeg', Line NB, Pog-NB, N'-Prn, Prn-NPog, N-Prn-Sn, Prn-Sn-LS). Dental measurements were made on the plaster models (distances between the tips of the canine cusps and the tips of mesial cusps of the first molars) of 40 individuals aged 10 to 14 years (moment 1) and 13 to 16 years (moment 2), 23 being nose breathers (NB) and 17 being predominantly mouth breathers (MB). RESULTS: The Student's-t test and two-way ANOVA with repeated measures were applied to indicate differences between the mean values of these variables according to the moments and/or respiratory mode. CONCLUSIONS: There were alterations in the facial measurements, without interference of the breathing pattern. However, the breathing pattern infuenced dental alterations

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Assessing self-perception in patients with chronic low back pain: Development of a back-specific body-perception questionnaire

BACKGROUND: There is considerable interest in the role that disturbance of body-perception may play in long standing pain problems such as chronic low back pain (CLBP), both as a contributor to the clinical condition and as a potential target for treatment. In some chronic pain conditions body-perception has been investigated using self-report questionnaires. There is currently no questionnaire for assessing body-perception in people with CLBP

Retraction: HLA-B35 and dsRNA Induce Endothelin-1 via Activation of ATF4 in Human Microvascular Endothelial Cells.

[Excerpt] Our main purpose in this survey is, therefore, to provide a somewhat unified setting within which the basic features of the theory of income mobility measurement can be outlined. Our aim is to provide a (subjectively) selective introduction to the literature on income mobility, and thereby shed some light on particular aspects of mobility measurement. Consequently, the present study should not be viewed as an exhaustive survey of the related literature. It is rather a very concise account of some key elements of the theory of income mobility measurement.Fields22_The_Measurement_of_Income_Mobility.pdf: 5163 downloads, before Oct. 1, 2020