Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality

Background &amp; aims The confounding effect of disease on the outcomes of malnutrition using diagnosis-related groups (DRG) has never been studied in a multidisciplinary setting. This study aims to determine the impact of malnutrition on hospitalisation outcomes, controlling for DRG. Methods Subjective Global Assessment was used to assess the nutritional status of 818 patients within 48 hours of admission. Prospective data were collected on cost of hospitalisation, length of stay (LOS), readmission and mortality up to 3 years post-discharged using National Death Register data. Mixed model analysis and conditional logistic regression matching by DRG were carried out to evaluate the association between nutritional status and outcomes, with the results adjusted for gender, age and race. Results Malnourished patients (29%) had longer hospital stays (6.9±7.3 days vs. 4.6±5.6 days, p<0.001) and were more likely to be readmitted within 15 days (adjusted relative risk = 1.9, 95%CI 1.1–3.2, p=0.025). Within a DRG, the mean difference between actual cost of hospitalisation and the average cost for malnourished patients was greater than well-nourished patients (p=0.014). Mortality was higher in malnourished patients at 1 year (34% vs. 4.1 %), 2 years (42.6% vs. 6.7%) and 3 years (48.5% vs. 9.9%); p<0.001 for all. Overall, malnutrition was a significant predictor of mortality (adjusted hazard ratio = 4.4, 95%CI 3.3-6.0, p<0.001). Conclusions Malnutrition was evident in up to one third of inpatients and led to poor hospitalisation outcomes, even after matching for DRG. Strategies to prevent and treat malnutrition in the hospital and post-discharge are needed

Menarche age in Iran: A meta-analysis

ABSTRACT Background: Research shows that the age at menarche, as an essential element in the reproductive health of women, had been decreasing in the 19 th and 20 th centuries, and shows a huge variation across different countries. There are numerous studies performed in Iran reporting a range of age at menarche. Thus, this meta-analysis aimed to determine the overall mean age at menarche of the girls in Iran. Materials and Methods: All relevant studies were reviewed using sensitive and standard keywords in the databases from 1950 to 2013. Two raters verifi ed a total of 1088 articles based on the inclusion criteria of this study. Forty-seven studies were selected for this meta-analysis. Cochran test was used for samples&apos; homogeneity (Tau-square). The mean age at menarche of the girls in Iran with 95% confi dence interval (CI) from the random effects was reported. Results: The homogeneity assumption for the 47 reviewed studies was attained (Tau-square = 0.00). The mean (95% CI) menarche age of Iranian girls from the random effects was 12.81 (95% CI: 12.56-13.06) years. Conclusions: The results of this study showed that mean age at menarche was less than that of some European developed countries such as Switzerland, Sweden, and Denmark, more than that reported in some countries such as Greece and Italy, and similar to the values obtained in the United States of America and Colombia. Lower age at menarche in Iran may be largely attributed to the changes in lifestyle and diet of the children

Examining the effect of The Leventhal Self-Regulatory Model on Sexual Satisfaction for Women with Breast Cancer: A Randomized Controlled Trial

Purpose: The main goal of this study was to investigate whether the Self-Regulation Model could improve sexual satisfaction for women diagnosed with breast cancer. Methods: Adult women diagnosed with breast cancer were recruited from a hospital in Qazvin, Iran. Participants were randomly assigned to either an intervention group (n = 40) or a control group (n = 40). All participants were administered a demographic questionnaire and an Index of Sexual Satisfaction (ISS) pre-intervention, immediately post-intervention, and 1, 2, and 3 months following the intervention. The control group completed the assessments along the same time line as the intervention group. Women in the experimental group were provided three sessions of a psychological individual intervention which included psychoeducation regarding their diagnosis and personalized intervention strategies to improve their overall sexual satisfaction with sexual intercourse. Each intervention took between 60 to 90 minutes to administer. Results: The experimental and control group participants were well balance in demographic characteristics and sexual satisfaction scores before the intervention. Interestingly, the intervention group showed a positive increasing trend in the sexual satisfaction scores over time but the controls had a negative trend (p < 0.05). There were also statistical differences in the sexual satisfaction scores at each month (p < 0.05) adjusted for baseline score and relevant demographical variables showing a demonstrated longstanding effects with a significant increase in sexual satisfaction over time.Conclusion: Providing a psychoeducational based intervention provided an increase of sexual satisfaction during intercourse for women diagnosed with breast cancer. The2 psychoeducation based intervention provided an opportunity for participants to dispel common myths regarding their disease and obtain new strategies and skills to improve their sexual satisfaction from intercourse with their partners. Keywords: Breast Cancer, Sexual Satisfaction, Self-Regulation Mode

Irregular meal timing is associated with Helicobacter pylori infection and gastritis

Background Helicobacter pylori (HP) is associated with chronic gastritis and gastric cancer, and more than half of the world’s population is chronically infected. The aim of this retrospective study was to investigate whether an irregular meal pattern is associated with increased risk of gastritis and HP infection. Methods The study involved 323 subjects, divided into three groups: subjects with HP infection and gastritis, with gastritis, and a control group. Subjects were interviewed on eating habits and meal timing. Multivariate logistic regression was used to compare groups. Adjusted odds ratios (OR) were derived controlling for gender, age, stress and probiotic consumption. Results Subjects who deviated from their regular meals by 2 hours or more had a significantly higher incidence of HP infection with gastritis (adjusted OR= 13.3, 95% CI 5.3–33.3, p<0.001) and gastritis (adjusted OR=6.1, 95% CI 2.5–15.0, p<0.001). Subjects who deviated their meals by 2 hours or more, twice or more per week, had an adjusted OR of 6.3 and 3.5 of acquiring HP infection with gastritis (95% CI 2.6–15.2, p<0.001) and gastritis (95% CI 1.5–8.5, p<0.001) respectively. Conclusion Frequent deviation in meal timing over a prolonged period appears associated with increased risk of developing HP infection and gastritis

A Multi-Institutional Survey on Faculty Development Needs, Priorities and Preferences in Medical Education in an Asian Medical School

10.3885/meo.2009.Res00317Medical education online1416

A healthy eating index to measure diet quality in pregnant women in Singapore: a cross-sectional study

10.1186/s40795-015-0029-3BMC Nutrition1391-11GUSTO (Growing up towards Healthy Outcomes

Baveno-VII criteria to predict decompensation and initiate non-selective beta-blocker in compensated advanced chronic liver disease patients

Background/Aims The utility of Baveno-VII criteria of clinically significant portal hypertension (CSPH) to predict decompensation in compensated advanced chronic liver disease (cACLD) patient needs validation. We aim to validate the performance of CSPH criteria to predict the risk of decompensation in an international real-world cohort of cACLD patients. Methods cACLD patients were stratified into three categories (CSPH excluded, grey zone, and CSPH). The risks of decompensation across different CSPH categories were estimated using competing risk regression for clustered data, with death and hepatocellular carcinoma as competing events. The performance of “treating definite CSPH” strategy to prevent decompensation using non-selective beta-blocker (NSBB) was compared against other strategies in decision curve analysis. Results One thousand one hundred fifty-nine cACLD patients (36.8% had CSPH) were included; 7.2% experienced decompensation over a median follow-up of 40 months. Non-invasive assessment of CSPH predicts a 5-fold higher risk of liver decompensation in cACLD patients (subdistribution hazard ratio, 5.5; 95% confidence interval, 4.0–7.4). “Probable CSPH” is suboptimal to predict decompensation risk in cACLD patients. CSPH exclusion criteria reliably exclude cACLD patients at risk of decompensation, regardless of etiology. Among the grey zone, the decompensation risk was negligible among viral-related cACLD, but was substantially higher among the non-viral cACLD group. Decision curve analysis showed that “treating definite CSPH” strategy is superior to “treating all varices” or “treating probable CSPH” strategy to prevent decompensation using NSBB. Conclusions Non-invasive assessment of CSPH may stratify decompensation risk and the need for NSBB in cACLD patients

Atopic dermatitis in early life: evidence for at least three phenotypes? Results from the GUSTO study

10.1159/000381342International Archives of Allergy and Immunology1664273-279GUSTO (Growing up towards Healthy Outcomes