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Objectives: (1) To calculate rates for maxillofacial (MF) injury-related visits in emergency departments (EDs) and hospitals in Ontario; (2) To investigate socio-demographic distribution of MF injuries; (3) To identify common causes for MF injuries. Methods: An 8-year retrospective study design was implemented. Two datasets were used: Discharge Abstract Database and National Ambulatory Care Reporting System. Color-coded maps were created using ArcGIS. Results: From 2004 to 2012 in Ontario, 1,457,990 ED visits and 41,057 hospitalizations due to MF injuries were registered. MF injuries are most frequent in males and occur mainly in evenings (7:00 to 9:00 pm) and weekends. Higher rates of MF injury are seen in rural areas and low-income neighborhoods. The leading cause of MF injuries is falls. Conclusion: 3 out of 100 ED visits and 1 out of 200 hospitalizations were caused by MF injury. Male youth and female older people suffered high rates of MF injury.

Objectives: (1) To calculate rates for maxillofacial (MF) injury-related visits in emergency departments (EDs) and hospitals in Ontario; (2) To investigate socio-demographic distribution of MF injuries; (3) To identify common causes for MF injuries. Methods: An 8-year retrospective study design was implemented. Two datasets were used: Discharge Abstract Database and National Ambulatory Care Reporting System. Color-coded maps were created using ArcGIS. Results: From 2004 to 2012 in Ontario, 1,457,990 ED visits and 41,057 hospitalizations due to MF injuries were registered. MF injuries are most frequent in males and occur mainly in evenings (7:00 to 9:00 pm) and weekends. Higher rates of MF injury are seen in rural areas and low-income neighborhoods. The leading cause of MF injuries is falls. Conclusion: 3 out of 100 ED visits and 1 out of 200 hospitalizations were caused by MF injury. Male youth and female older people suffered high rates of MF injury.

This retrospective cohort study examined risk factors associated with RSV-associated hospitalization (RSV-H) among infants born 32 to 35 weeks gestational age in Nova Scotia. Results were used to develop a clinical instrument (RSV-H scoring tool) that would discriminate between infants at high, moderate and low risk for RSV-H. Identifying the highest-risk infants, (using baseline information to predict RSV-H in the first year of life), would help target cost effective prophylaxis by Palivizumab (Pz), an expensive RSV-specific monoclonal antibody. Significant risk factors, determined by multivariate logistics, included infants born in December, January or February, passive household smoke exposure and household crowding. The scoring tool produced similar RSV-H post-test probabilities (3.1% pre-test probability) between risk groups (5.5% vs. 5.8%) and was unable to target highest risk infants. The tool could be used as an educational guideline for health professionals, outlining the importance of significant risk factors for RSV-H to parents and caregivers.

Bakgrund: Sömnen är en viktig del av en människas liv, man sover bort ca en tredjedel av sin livstid. Med det naturliga åldrandet förändras sömnen och man blir mer känslig för omkringliggande stimuli och vaknar då lättare på natten samt sover färre timmar. På en vårdavdelning finns det mycket som kan påverka sömnen, speciellt hos äldre människor. Ljud som man inte känner igen, en okänd säng att sova i samt andra människor i samma rum. Alla dessa faktorer kan ge uppkomst till sömnrubbningar under en vistelse på en vårdavdelning. Syfte: Syftet med denna litteraturöversikt var att beskriva faktorer som påverkar äldre vuxnas och äldres sömn på en vårdavdelning. Metod: I denna litteraturöversikt har databaserna CINAHL with full text och Medline använts. Totalt elva artiklar har granskats där åtta artiklar har varit kvantitativa och två kvalitativa, den sista artikeln var en mixad kvalitativ och kvantitativ studie. Utifrån resultaten har författarna sammanställt teman. Resultat: Fem teman uppmärksammades: sömnen på en vårdavdelning där sömnen påverkas av den okända miljön. Inre faktorer som påverkar patientens sömn där det emotionella tillståndet grundat i oro, sjukdom och avsaknad av anhöriga kan påverka sömnen. Miljöfaktorer stör sömnen, där ljus, ljud och personalens interaktioner stör sömnen. Skillnader mellan länder och könsskillnader som påverkar sömnen, där män och kvinnors sömnkvalitet ser olika ut i olika länder. Ljudreducerande åtgärder för sömnen, där betydelsen av inplanerad tysthet (Quiet time) tas upp samt vikten av ljus och ljud-reduceringsprogram för att främja sömnen. Diskussion: I metoddiskussionen har vi diskuterat om valen av artiklar och länder kan ha påverkat resultatet negativt, men diskuterar även för varför vi valt att använda dessa. I resultatdiskussionen har vi diskuterat Florence Nightingales teori om miljö och sömn kopplat till resultatet, samt vad som inte har tagits upp i resultatet. / Background: Sleep is an important part of a person’s life, you sleep away a third of your lifetime. With the natural aging there will be changes in the sleep pattern. You will become more sensitive to surrounding stimuli, wake up easier at night and sleep less hours. On a ward, there are a lot that can affect sleep, especially for elderly. Sound that you don’t recognize, an unknown bed to sleep in as well as other people in the same room. All these factors can make you get sleep disorders during sleep in a ward. Aim: The purpose of this literature review was to describe factors impact on older adults and older peoples sleep in a ward. Methods: In this literature review the databases CINAHL with full text and Medline have been used. A total of eleven articles were reviewed, eight articles had quantitative methods and two had qualitative methods, the last article were a mixed method with both qualitative and quantitative design. From the results, the authors had complied themes. Results: Five themes noticed: sleep in a ward, where the sleep is affected by the unfamiliar environment. Inside factors that affect sleep, where the emotional state of the patient caused by worry, disease and absence of relatives can affect the sleep. Environmental factors that disturb sleep, where light, sound and staff interactions contribute to disrupt sleep. Differences between countries and gender differences that affect the sleep, where men and women's sleep quality are different between countries. Noise reducing measures for sleep, where scheduled silence (Quiet Time), light- and sound reduction programs are important factors to promote quality sleep. Discussions: The methodological discussion we have discussed about the choices of articles and countries may have negatively affected the result, but also discusses why we chose to use them. The results discussion, we had discussed Florence Nightingale's theory of environment and sleep related to the result, and what has not been included in the results.

Certain indicators are useful in examining the impact of health care restructuring on the population. Avoidable hospitalization rates are used as an indicator of access to primary care. The purpose of this study was to examine regional, temporal, and age-related trends in avoidable hospitalization rates among older adults during a decade of significant health care restructuring in British Columbia, 1991-2000. The specific objectives of this study were 1) to calculate avoidable hospitalization rates among older adults in British Columbia by regional health authority and health services delivery area, 2) to examine the extent to which avoidable hospitalization rates among older adults in each regional health authority and health service delivery area differ from the provincial avoidable hospitalization rate, and 3) to examine the temporal changes in avoidable hospitalization rates among older adults in British Columbia by regional health authority. Analyses draw on linked administrative health data from the province of British Columbia for the population of health system users age 55 and older. Analyses are stratified by age group (55 to 64, 65 to 74, and 75 and older) and regional health authority and health service delivery area. Age-sex standardized avoidable hospitalization rates for the years 1991 through 2000 were first calculated. Analysis of means for rate data were also undertaken to examine the extent to which avoidable hospitalization rates in each region differed from the provincial average. Additionally, joinpoint regression analyses of annual avoidable hospitalization rates were performed to examine temporal changes in the trends. Comparing the avoidable hospitalization rates observed in the health authorities and health service delivery areas to the avoidable hospitalization rates for the province revealed regional disparities, whereby the most rural and northern health authorities and health service delivery areas tended to have higher avoidable hospitalization rates. Joinpoint regression results showed significantly decreasing trends over time. The results also generally indicated that as age increased, so did the likelihood of encountering an avoidable hospitalization. This was consistent across geographical locations and time. The data suggest that access to primary care services may be problematic in several areas of the province, including northern British Columbia, and rural and remote areas. Although avoidable hospitalization rates decreased over time, it may be the case that health care restructuring initiatives in the 1990s have not completely addressed regional disparities in access to primary care. Additionally, the finding that the oldest adults tend to be more prone to an avoidable hospitalization is of concern. Policy efforts intended to reduce the overall number of avoidable hospitalizations should address the complexities associated with access to the primary care system.

This dissertation involved linking a clinical cystic fibrosis (CF) data registry with administrative databases to evaluate clinical, demographic, and geographical predictors of hospitalization in CF patients living in Ontario over a 10 year period. In addition, this work assessed the ability of administrative data to identify individuals with CF using the clinical registry as the reference standard. Sex was an independent predictor of hospitalization rates for individuals with CF. Females had a significantly higher hospitalization rate compared to males even after adjusting for important clinical factors suggesting that this finding is not simply due to worse CF disease. In those between 7 and 19 years of age, the adjusted hospitalization rate was 38% higher in females (rate ratio[RR] 1.38, 95% confidence interval [CI] 1.11-1.73). Similarly in those over the age of 19, females had a 30% higher hospitalization rate compared to males (RR 1.30, 95% CI 1.06-1.59). Other significant predictors associated with higher hospitalization rates in both age groups were lower lung function, worse nutritional status, pancreatic insufficiency, and the presence of CF-related diabetes. The presence of Burkholderia cepacia complex in the sputum was a significant predictor in those over the age of 19 years (RR 1.54, 95% CI 1.26-1.89). Distance to CF centre, community size and socioeconomic status were not significant predictors of hospitalization rates in either age group. There was no significant trend in hospitalization rates over time once rates were adjusted for markers of disease severity (p=0.08). Comparing administrative data with the CF registry data, administrative data captured hospitalizations more comprehensively. Despite CF being a specific diagnosis, health administrative databases alone were insufficient to reliably and accurately identify individuals with CF unless they had been hospitalized. The reason for the gender disparity seen within this dissertation is likely multifactorial. There may be differences in outpatient management between the sexes, hormonal influences may modulate disease severity causing higher hospitalization rates, and patient and provider-level influences may affect the decision to hospitalize a patient. Further research is needed in this area to elucidate the factors contributing to this gender gap.

Dissertation (Ph.D.) -- University of Texas Southwestern Medical Center at Dallas, 2008. / Vita. Bibliography: p. 154-178.

Thesis (M.H.A.)--University of Michigan, 1974. / Also issued in print.

Thesis (M.S.)--University of Michigan, 1986.