Length of stay and mental health of the immigrant population in Spain: evidence of the healthy immigrant effect

This article analyses the relationship between how long immigrant populations reside in the country of destination and the state of their mental health. The empirical approach to this relationship relies on data from the Spanish National Health Survey 2011–2012. The results confirm a Healthy Immigrant Effect that tends to decline in accordance with how long the immigrant stays. Immigrants who have been residing for less than 10 years in Spain have better mental health than the national population as a whole. It is important to study health disparities among the foreign population and how these evolve to ensure that it has access to health services and that its health care needs are met.     

Length of stay and hospital costs among high-risk patients with hospital-origin Clostridium difficile-associated diarrhea

Abstract

Objective:

Hospital-onset Clostridium difficile-associated diarrhea (HO-CDAD) has been associated with longer length of stay (LOS) and higher hospital costs among patients in general. The burden of HO-CDAD is unknown among patients who may be at particular risk of poor outcomes: older patients, those with complex or chronic conditions (renal disease, cancer, inflammatory bowel disease [IBD]), and those with concomitant antibiotic (CAbx) use during treatment for CDAD.

Research design and methods:

A retrospective analysis (2005–2011) of the Health Facts® database (Cerner Corp., Kansas City, MO) containing comprehensive clinical records from 186 US hospitals identified hospitalized adult patients with HO-CDAD based on a positive C. difficile toxin collected >48?h after admission. Control patients were required to have total hospital LOS ≥2 days. Separate logistic regression models to estimate propensities were developed for each study group, with HO-CDAD vs controls as the outcome. Differences in LOS and costs were calculated between cases and controls for each group.

Results:

A total of 4521 patients with HO-CDAD were identified. Mean age was 70 years, 54% were female, and 13% died. After matching, LOS was significantly greater among HO-CDAD patients (vs controls) in each group except IBD. The significant difference in LOS ranged from 3.0 (95% CI?=?1.4–4.6) additional days in older patients to 7.8 (95% CI?=?5.7–9.9) days in patients with CAbx exposure. HO-CDAD was associated with significantly higher costs among older patients (p?<?0.001) and among those with renal impairment (p?=?0.012) or CAbx use (p?<?0.001).

Limitations:

Missing cost data and potential misclassification of colonized patients as infected.

Conclusions:

Renal impairment, advanced age, cancer, and CAbx use are associated with significantly longer LOS among HO-CDAD patients, with CAbx users being the most resource intensive. Early identification and aggressive treatment of HO-CDAD in these groups may be warranted.     

Exploring the causal relationship between hospital length of stay and re-hospitalization among Japanese AMI patients

We explore the causal relationship between hospital length of stay (LOS) and re-hospitalization for Acute Myocardial Infarction (AMI) patients in Japan, where the average LOS is the longest among OECD countries. Using chart-based data, we address the endogeneity between LOS and re-hospitalization probability by using an exogenous variation based on Rokuyo (the six basic labels allocated to each day), which is found to be irrelevant to admission day but relevant to discharge day. While we do find a significant and positive association between LOS and re-hospitalization probability in the OLS estimation, we do not find a significant relationship once LOS is instrumented by Rokuyo in various instrumental variable estimations. This implies that additional stay that was induced owing to patient’s choice of preferred Rokuyo at discharge has no effect on re-hospitalization probability.     

Length of stay and hospitalization costs for patients undergoing lung surgery with Progel pleural air leak sealant

Aim: Progel Pleural Air Leak Sealant (Progel) is currently the only sealant approved by the FDA for the treatment of air leaks during lung surgery. This study was performed to determine whether Progel use improves hospital length of stay (LOS) and hospitalization costs compared with other synthetic/fibrin sealants in patients undergoing lung surgery.

Methods: The US Premier hospital database was used to identify lung surgery discharges from January 1, 2010 to June 30, 2015. Eligible discharges were categorized as “Progel Sealant” or “other sealants” using hospital billing data. Propensity score matching (PSM) was performed to control for hospital and patient differences between study groups. Primary outcomes were hospital LOS and all-cause hospitalization costs. Clinical outcomes, hospital re-admissions, and sealant product use were also described.

Results: After PSM, a total of 2,670 discharges were included in each study group; baseline characteristics were balanced between groups. The hospital LOS (mean days?±?standard deviation, median) was significantly shorter for the Progel group (9.9?±?9.6, 7.0) compared with the other sealants group (11.3?±?12.8, 8.0; p?<?.001). Patients receiving Progel incurred significantly lower all-cause hospitalization costs ($31,954?±?$29,696, $23,904) compared with patients receiving other sealants ($36,147?±?$42,888, $24,702; p?<?.001).

Limitations: It is not possible to say that sealant type alone was responsible for the findings of this study, and analysis was restricted to the data available in the Premier database.

Conclusions: Among hospital discharges for lung surgery, Progel use was associated with significantly shorter hospital LOS and lower hospitalization costs compared with other synthetic/fibrin sealants, without compromising clinical outcomes.     

Perceptions of empowerment and intent to stay

Investigating why nurses remain in organizations may serve as a stepping stone for future retention strategies. The relationship between intent to stay and workplace empowerment in nurses are described in this continuing education article.     

健康运动，远离肥胖

随着人民生活水平的不断提高,肥胖已经成为全球瞩目的公共健康问题。肥胖以及相关的综合症严重威胁着人类的健康,影响着运动能力和身体素质。通过对肥胖的成因以及诊断标准的分析,论述运动减肥的可能机制,从而确定健康有效的减肥方法,达到健康减肥的目的,并且为全民健身提供参考依据。