Thesis (D.P.H.)--University of Michigan, 1996.

Thesis (Ph. D.)--University of Washington, 1999. / Vita. Includes bibliographical references (leaves 60-71).

Background Syncope accounts for 0.6% to 1.5% of hospitalizations in the United States. We sought to determine the causes and predictors of 30‐day readmission in patients with syncope. Methods and Results We identified 323 250 encounters with a primary diagnosis of syncope/collapse in the 2013-2014 Nationwide Readmissions Database. We excluded patients younger than 18 years, those discharged in December, those who died during hospitalization, hospital transfers, and those whose length of stay was missing. We used multivariable logistic regression analysis to evaluate the association between baseline characteristics and 30‐day readmission. A total of 282 311 syncope admissions were included. The median age was 72 years (interquartile range, 58-83), 53.9% were women, and 9.3% had 30‐day readmission. The most common cause of 30‐day readmissions was syncope/collapse, followed by cardiac, neurological, and infectious causes. Characteristics associated with 30‐day readmissions were age 65 years and older (odds ratio [OR], 0.7; 95% confidence interval [CI], 0.6-0.7), female sex (OR, 0.9; 95% CI, 0.8-0.9), congestive heart failure (OR, 1.5; 95% CI, 1.2-1.9), atrial fibrillation/flutter (OR, 1.3; 95% CI, 1.3-1.4), diabetes mellitus (OR, 1.2; 95% CI, 1.2-1.3), coronary artery disease (OR, 1.2; 95% CI, 1.2-1.3), anemia (OR, 1.4; 95% CI, 1.4-1.5), chronic obstructive pulmonary disease (OR, 1.4; 95% CI, 1.3-1.4), home with home healthcare disposition (OR, 1.5; 95% CI, 1.5-1.6), leaving against medical advice (OR, 1.7; 95% CI, 1.6-1.9), length of stay of 3 to 5 days (OR, 1.5; 95% CI, 1.4-1.6) or >5 days (OR, 2; 95% CI, 1.8-2), and having private insurance (OR, 0.6; 95% CI, 0.6-0.7). Conclusions The 30‐day readmission rate after syncope/collapse was 9.3%. We identified causes and risk factors associated with readmission. Future prospective studies are needed to derive risk‐stratification models to reduce the high burden of readmissions. / Revisión por pares

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.

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.

Purpose: The purpose of this work was identify key factors associated with inpatient physical therapy utilization and length of stay for patients with low back pain (LBP) in Florida hospitals. Rationale: Little is known about factors associated with inpatient physical therapy or length of hospitalization for patients with LBP. This group of works identified the key factors associated with inpatient physical therapy and long lengths of hospitalization for this patient population. Since physical therapy and reduced length of stay are known cost-reducers, identifying key factors may represent significant cost savings to the health care system. Methods: Several mixed method procedures were utilized to examine physical therapy utilization and length of hospitalization between the years of 1992 and 2014. Policy, patient and hospital characteristics, as well as, hospital procedures during a patient’s stay were examined as contributors to either physical therapy utilization or length of hospitalization. Conclusion: Many factors are associated with inpatient physical therapy utilization and length of stay for patients with LBP in Florida hospitals.

Class of 2016 Abstract / Objectives: The purpose of this study is to assess patients’ perception of the review of basic diabetes self-management skills as administered by nursing staff during hospitalization in our academic medical center to determine if the program should be continued, modified and/or expanded. Methods: This descriptive study included patients 18 years and older with a diagnosis of diabetes admitted for any reason to Banner – University Medical Center Tucson (BUMC-T) - between October- December 2015. A phone interview was conducted within 7 days of the patient’s recorded discharge date to assess each patient’s perception of the review they received during their inpatient stay. The questionnaire collected ratings about helpfulness of the medication instructions, understanding of diabetes, and confidence in hypoglycemia management. Data on the likelihood for an outpatient follow-up appointment were collected too. Results: Of the 96 patients included in this study, 44% (n=42) received the basic diabetes self-management skills review, among them 48% (n=20) reported that the review was very helpful, 43% (n=18) reported being very comfortable with understanding diabetes, and 48% (n=20) reported being very confident with hypoglycemia management. Out of 50% of patients referred for outpatient follow-up for diabetes management, only 38% made an appointment. Conclusions: Most patients that received the basic diabetes self-management skills review feel comfortable with diabetes management and its understanding. Review of basic diabetes self-management skills appeared to be helpful when initiated in a hospital setting; however, measures need to be taken to provide the review to all eligible patients and it needs to be supported by effective planning for outpatient follow-up.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13268号 / 論医博第2182号 / 新制||医||1038(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 佐藤 俊哉, 教授 今中 雄一, 教授 柳田 素子 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

Background The role of statins in patients with heart failure (HF) of different levels of left ventricular ejection fraction (LVEF) remains unclear especially in the light of the absence of prospective data from randomized controlled trials (RCTs) in non-ischemic HF, and taking into account potential statins’ prosarcopenic effects. We assessed the association of statin use with clinical outcomes in patients with HF. Methods We searched PubMed, EMBASE, Scopus, Google Scholar and Cochrane Central until August 2018 for RCTs and prospective cohorts comparing clinical outcomes with statin vs non-statin use in patients with HF at different LVEF levels. We followed the guidelines of the 2009 PRISMA statement for reporting and applied independent extraction by multiple observers. Meta-analyses of hazard ratios (HRs) of effects of statins on clinical outcomes used generic inverse variance method and random model effects. Clinical outcomes were all-cause mortality, cardiovascular (CV) mortality and CV hospitalization. Results Finally we included 17 studies (n = 88,100; 2 RCTs and 15 cohorts) comparing statin vs non-statin users (mean follow-up 36 months). Compared with non-statin use, statin use was associated with lower risk of all-cause mortality (HR 0.77, 95% confidence interval [CI], 0.72–0.83, P < 0.0001, I2 = 63%), CV mortality (HR 0.82, 95% CI: 0.76–0.88, P < 0.0001, I2 = 63%), and CV hospitalization (HR 0.78, 95% CI: 0.69–0.89, P = 0.0003, I2 = 36%). All-cause mortality was reduced on statin therapy in HF with both EF < 40% and ≥ 40% (HR: 0.77, 95% Cl: 0.68–0.86, P < 0.00001, and HR 0.75, 95% CI: 0.69–0.82, P < 0.00001, respectively). Similarly, CV mortality (HR 0.86, 95% CI: 0.79–0.93, P = 0.0003, and HR 0.83, 95% CI: 0.77–0.90, P < 0.00001, respectively), and CV hospitalizations (HR 0.80 95% CI: 0.64–0.99, P = 0.04 and HR 0.76 95% CI: 0.61–0.93, P = 0.009, respectively) were reduced in these EF subgroups. Significant effects on all clinical outcomes were also found in cohort studies’ analyses; the effect was also larger and significant for lipophilic than hydrophilic statins. Conclusions In conclusion, statins may have a beneficial effect on CV outcomes irrespective of HF etiology and LVEF level. Lipophilic statins seem to be much more favorable for patients with heart failure. / Revisión por pares

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