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Objective¡G The purpose of this research is (1) to find out the overall trends of the common avoidable hospitalization diseases in Taiwan since the implementation of the National Health Insurance (NHI), (2) to compare the different distributions of the common avoidable hospitalization diseases across age groups, genders, regions, and the hospital¡¦s characters, (3) to make the related useful information and suggestions of improving avoidable hospitalizations to the policy makers, hospitals, and the general public. Method¡G Standardized rates of avoidable hospitalization from 1997 to 2004 were derived from the National Health Insurance database and the Taiwan census data. In this research, we focus on the four main diseases¡GAsthma, Pneumonia, Diabetes, Hypertension as the avoidable hospitalization diseases. Logistic regression and chi-squire tests are used to detect and describes trends in data. Results¡G During the 8-year research period, AHCs (Avoidable Hospitalization Conditions)of Asthma and Hypertension decline overall, conversely, AHCs of Pneumonia and Diabetes show increasing trends overall¡Fin the hospital characters aspects, AHCs are mostly occurred in the local hospitals¡Ffrom the viewpoint of the patients¡¦ characters, AHCs of Asthma and Pneumonia are always occurred in children male, on the other hand, AHCs of Diabetes and Hypertension are always occurred in female and above 65 years old¡Fin the regional aspect, the AHCs of Asthma and Pneumonia are comparatively higher in east Taiwan. Conclusion¡G According to the results of this research, we can find that the avoidable hospitalizations in Taiwan still need to be improved. We suggest the policy makers and the hospitals may use the ¡uavoidable hospitalization¡vas an indicator to monitor the quality of care and the outpatient care quality in Taiwan¡¦s healthcare system. Thus can not only reduce the unnecessary expenditure, but also can offer the general public better quality of healthcare and improve their quality of life.

Asthma is the leading chronic disease of children in industrialized countries. In Canada, it is the most common cause of hospital admissions in children. Data were assembled for all asthma hospitalizations in Canada from 1990 to 2000 by the Canadian Institute for Health Information (CIHI). The annual cycles of asthma hospitalization among Canadian children from 1990 to 2000 were compared. For every year, region and latitude, asthma hospitalizations were lowest in July and August followed by a major peak in September then a rapid decline. Contingency table analyses were done to examine the homogeneity of the distributions of asthma hospitalization counts for the factors age, gender, region and latitude groups. Age, region and latitude groups were found to be significantly different with respect to their distribution of asthma counts. However, the distributions of asthma hospitalization counts did not differ significantly for gender. A nonlinear least squares model was fitted to the asthma hospitalization data for weeks 30 to 42. The primary objective was to obtain estimates of the parameter that describes the timing of the September peak. Next, a likelihood ratio test was done to assess the homogeneity of the September peaks for the factors age, gender, latitude and region. We found that, apart from gender, the September peaks were significantly different. Furthermore, the annual cycle of asthma hospitalization for children aged 2 to 4 was identical to that of children aged 5 to 15 except the peak in hospitalization for 2 to 4 year olds occurred on average 2 days after the older children. We suspect that the increase prevalence of and exposure to viral infections, exposure of school-aged children to allergens at school and the transmission of these factors to younger siblings are responsible for the September asthma epidemic. A Quasi-Poisson log-linear model was also fitted to the data to assess jointly the effects of age, gender, latitude, year and risk group size. The data were overdispersed, after accounting for overdispersion, we found that age, gender, latitude, year and the interactions between age and gender, age and latitude and gender and latitude were significant in explaining the data. Surprisingly, time had a negative effect suggesting a tendency to decline in the number of asthma incidences requiring hospitalization over the years. / Thesis / Master of Science (MSc)

Giraldi, I.M.E. Representações sobre o período da primeira internação hospitalar na perspectiva de mulheres HIV positivas, 2011 A aids foi relatada pela primeira vez em 1981 e atualmente a Organização Mundial da Saúde estima que aproximadamente 36 milhões de pessoas estejam infectadas pelo HIV em todo o mundo. No Brasil, entre as mulheres tem sido verificado o aumento da incidência de infecção a partir da segunda década da epidemia, indicando não apenas as dificuldades para oferecer respostas institucionais ao controle da epidemia, mas também, evidenciando as questões de gênero, em particular nas relações conjugais, como relações sexuais desprotegidas por falta de poder de negociação do preservativo e os comportamentos de risco adotados por seus parceiros, cuja assimetria provoca a vulnerabilização das mulheres à infecção. O adoecimento dessas mulheres leva a uma perspectiva preocupante, pois muitas vezes este adoecimento vem associado a responsabilidade dos cuidados de um parceiro e/ou de possíveis filhos infectados. Porém, quando os sintomas começam a aparecer, surgem ansiedade e medos que estavam aparentemente controlados. O processo de internação pode ocasionar reações que agravam o quadro dos pacientes internados. Neste sentido, este projeto teve por objetivos identificar, entre mulheres soropositivas para o HIV, algumas representações sociais sobre a primeira internação hospitalar motivada por manifestação de sintomas, adoecimento devido a fragilidade do sistema imunológico e/ou efeitos colaterais associados ao tratamento. Este estudo foi realizado com 10 mulheres soropositivas, com idade entre 32 e 46 anos, internadas numa unidade de tratamento específica - UETDI. A análise temática de conteúdo das transcrições de entrevistas individuais, semiestruturadas, audiogravadas foi sintetizada em Categorias e Subcategorias empíricas. Durante a internação, concretiza esta nova fase, sintomática, levando as participantes a encontrar novas formas de enfrentamento, representação do próprio corpo, novas perspectivas e, via contato com uma equipe adequada às suas necessidades e familiares, poder sair dessa hospitalização com novas possibilidades e representações de saúde. Por fim, pode-se indicar algumas reflexões acerca da complexidade da adesão do portador de HIV ao tratamento. / Giraldi, I.M.E. Representations about the first hospitalization period in the perspective of HIV-positive women, 2011 Aids was first reported in 1981; nowadays, the World Health Organization estimates that 36 million people are infected by the HIV worldwide. In Brazil, an increase of the infection\'s incidence has been observed in women since the epidemic\'s second decade. Such phenomenon indicates not only the difficulties for offering institutional responses in order to control the epidemics, but, also, it evidences genderrelated and more specifically conjugal questions, such as unsafe sexual relations occurring due to a lack of negotiation power for the use of condoms and risky behaviors adopted by partners, whose asymmetry leads to the increase of women\'s vulnerability to the infection. Women\'s process of sickening portrays a worrying panorama, for such process is associated to the responsibility for offering care to a partner or possible infected children. With the appearance of initial symptoms, though, anxiety and fears that were apparently under control arise, in contrast to an initial healthy state without weighty worries. In such context, the hospitalizing process can lead to reactions that aggravate the state of patients. The present study aimed to indentify some social representations of HIV-positive women regarding their first hospitalization due to symptom manifestation, immunologic fragility and/or treatment-related side effects. Ten women took part of the study, with ages between 32 and 46 years old, who were hospitalized in a specific treatment unity (UETDI). Thematic analysis of the recorded individual, semi-structured interviews\' contents was synthesized in empirical Categories and Subcategories. During hospitalization, a new, symptomatic stage becomes real, leading participants to find new strategies for coping, representing their own bodies, developing perspectives and, through the contact with health staff and family members, exiting the hospital with new possibilities and health-related representations. At last, some reflections are indicated regarding the complexity of adhesion to treatment process by people with HIV.

Este estudo teve como proposta desvelar o fenômeno da convivência dos pais com a internação de um filho adolescente, considerando ser esta uma das minhas inquietações no cotidiano da minha prática docente assistencial. Utilizando-me do referencial fenomenológico e à luz da analítica existencial de Martin Heidegger, entrevistei quinze pais de adolescentes que no período de agosto a outubro de 2002, habitavam as Unidades de Internação do Hospital das Clínicas da Universidade Federal de Minas Gerais. A análise dos depoimentos, minhas vivências e as leituras realizadas, desvelaram quatro grandes categorias temáticas: o impacto da doença na família, os sentimentos vividos pela família, a adaptação no mundo hospitalar e a religiosidade e a fé no enfrentamento da hospitalização. Ao refletir sobre a experiência dos pais considero a necessidade de pensar o adolescente e sua família, como um ser-aí-no-mundo e sendo-no-mundo-com-os-outros. / The objective of this study was understand the experience of parents of living with a hospitalized adolescent since this was an identified problem in my everyday practice. Fifteen parents of adolescents hospitalized at the University Hosptital were interviewed from August to October of 2002. The phenomenological approach of Martin Heidegger was used to analyse the data. Four themes werw identified: the immpact of the illness on the familiy, the feelings of family members, the adaptation in the hospital world and the religion and faith in the process of coping with hospitalization. The results showed the inportance of thinking the adolescent and his/her family as a being-in-the-world and being-in-the-world-with-others.

Delirium in adults aged 65 and older is a common occurrence in the acute care setting and is often unrecognized by bedside nurses. Delirium can trigger a negative cascade of events resulting in an increase in morbidity and mortality, functional decline, longer length of stay, and high rates of post hospital institutionalization and has a significant socioeconomic impact. The purpose of this quality improvement project was to establish a solid foundation using scholarly literature to support the development of a delirium prevention, recognition, and treatment program in the medical-surgical acute care setting applying the program logic framework. The goal was accomplished by developing a structured program to enhance nurse education (phase 1) using a pretest/posttest design. Phase 2 will be implemented at a later date. The null hypothesis for the project was there is no difference between the pretest group knowledge of delirium scores and the posttest group scores following education. The results of the 36-paired pretests/posttests indicated a significant difference (p < 0.05) following the educational PowerPoint on delirium. Providing education and opportunities for bedside nurses to apply this new knowledge is an effective strategy to increase the identification of delirium, which can lead to improved patient outcomes, reduced socioeconomic burden associated with delirium, and increased positive social change. The economic impact of delirium is considerable with the average cost per day of delirium patients reaching nearly 3 times the cost of patients not having delirium. The elderly population is projected to continue to rise, which will have a profound impact on hospitals and health care as a whole.

This thesis examines hospitalizations for ambulatory care sensitive conditions among persons with an intellectual disability living in Manitoba from 1999 to 2003. Hospitalizations for ambulatory care sensitive conditions are considered an indicator of access to, and the quality of, primary care. Intellectual disability can be defined as a disability originating before age 18 characterized by significant limitations both in intellectual functioning and in adaptive behaviour as expressed in conceptual, social, and practical adaptive skills. Between 1 and 3% of the population has an intellectual disability. This thesis addressed three objectives: 1) To identify ambulatory care sensitive conditions that are applicable to persons with an intellectual disability; 2) To compare hospitalization rates for ambulatory care sensitive conditions between persons with and without an intellectual disability in Manitoba; 3) To identify factors associated with hospitalizations for ambulatory care sensitive conditions among adults with an intellectual disability living in Manitoba. An online survey of primary care providers with experience working with persons with an intellectual disability found consensus on fifteen ambulatory care sensitive conditions applicable to persons with an intellectual disability. Large discrepancies in hospitalization rates for these conditions were found between persons with and without an intellectual disability. Controlling for age, year, sex, and region, persons with an intellectual disability were 6 times more likely to be hospitalized for an ambulatory care sensitive condition. Future research should investigate reasons for the large discrepancy in rates between persons with and without an intellectual disability. Among adults with an intellectual disability, living in a rural area (odds ratio 1.3; 95% CI=1.0, 1.8), living in an area with a high proportion of First Nations people (odds ratio 2.3; 95% CI=1.3, 4.1), and experiencing higher levels of comorbidity (odds ratio 25.2; 95% CI=11.9, 53.0) were all associated with a higher likelihood of being hospitalized for an ambulatory care sensitive condition. Dwelling in higher income areas had a protective effect (odds ratio 0.56; CI=0.37, 0.85). The results suggest that addressing the socioeconomic problems of poorer areas and specifically areas densely populated by First Nations people would likely have an impact on hospitalizations for ACS conditions for persons with an intellectual disability.

The purpose of this study was to describe the obstetric hospitalization rates of northern and registered Indian women from April 1, 1992 to March 30, 1993 and to compare them with those of southern rural women in Saskatchewan.<p> Saskatchewan Health provided hospital separation data for 100% of northern and registered Indian women and for a 10% sample of southern rural and southern urban women hospitalized with obstetric diagnoses and procedures in 1992/93.<p> The crude, age-specific, and age-standardized hospitalization rates were based on the number of women of reproductive age or the number of deliveries or pregnancies. The average length of stay and hospital location were examined. Crude and age-adjusted odds ratios with 95% confidence intervals and chi-square tests were used to compare rates with southern rural women as the reference group. Oneway analysis of variance was used to compare the average length of stay for obstetric episodes among study groups.<p> The rate of obstetric episodes per 100 pregnancies were only 5 to 18% higher for northern women and southern registered Indian women. Northern and registered Indian women had higher rates for deliveries per 1,000 women, for ectopic pregnancies per 1,000 pregnancies, and for antenatal episodes with diabetes or abnormal glucose or with urinary tract infections per 100 pregnancies and lower rates of deliveries with cesarean sections, instrument use and episiotomy. Northern women had higher rates for deliveries with fetal and placental problems and for vaginal birth after cesarean section per 100 deliveries, and lower rates of antenatal episodes with hyperemesis per 100 pregnancies. All registered Indian women had lower rates of labour and delivery complications per 100 pregnancies. The average length of stay for obstetric episodes was similar for all study groups. Over 35% of northern women delivered in northern hospitals.<p> The results support continued northern obstetric practice and provide a baseline for evaluation of health transfer and renewal for northern tribal councils and health districts. The high fertility rates among northern and registered Indian women warrant a high priority on obstetric services, hospital facilities, prenatal care and postnatal care that are age and culture sensitive.<p>