OBJECTIVE: Acute upper respiratory tract infections (AURTIs) are prevalent in the general population. However, studies on the association of short-term exposure to air pollution with the risk of hospital visits for AURTIs in adults are limited. This study aimed to explore the short-term exposure to air pollutants among Chinese adults living in Ningbo.
METHODS: Quasi-Poisson time serious regressions with distributed lag non-linear models (DLNM) were applied to explore the association between ambient air pollution and AURTIs cases. Patients ≥ 18 years who visit three hospitals, being representative for urban, urban-rural junction and rural were included in this retrospective study.
RESULTS: In total, 104,441 cases with AURTIs were enrolled in hospital during 2015-2019. The main results showed that particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5), nitrogen dioxide (NO2) and nitrogen dioxide (SO2), were positively associated to hospital visits for AURTIs, except for nitrogen dioxide (O3), which was not statistically significant. The largest single-lag effect for PM2.5 at lag 8 days (RR = 1.02, 95%CI: 1.08-1.40), for NO2 at lag 13 days (RR = 1.03, 95%CI: 1.00-1.06) and for SO2 at lag 5 days (RR = 1.27, 95%CI: 1.08-1.48), respectively. In the stratified analysis, females, and young adults (18-60 years) were more vulnerable to PM2.5 and SO2 and the effect was greater in rural areas and urban-rural junction.
CONCLUSIONS: Exposure to ambient air pollution was significantly associated with hospital visits for AURTIs. This study provides epidemiological evidence for policymakers to control better air quality and establish an enhanced system of air pollution alerts.

UNASSIGNED: Related studies have found that air pollution is an important factor affecting mental and behavioral disorders. Thus, we performed this time-series study to evaluate the relationship between short-term exposure to ambient air pollutants and visits to hospital by patients with mental and behavioral disorders in northeastern China.
UNASSIGNED: We used quasi-Poisson regression models and generalized additive models to probe the links between air pollution and mental and behavioral disorders. The possible influences were also explored stratified by season, age and gender.
UNASSIGNED: We found that sulfur dioxide (SO2) had a cumulative effect on mental and behavioral disorders at lag04-lag07 and had the greatest effect at lag07 [Relative risk (RR) = 1.068, 95%CI = 1.021-1.117]. Particulate matter of size 2.5 μm (PM2.5) and SO2 had a cumulative effect on depression and both had the largest effect at lag07 (RR = 1.021, 95%CI = 1.002-1.041; RR = 1.103, 95%CI = 1.032-1.178); SO2 also had a cumulative effect on anxiety disorders, with the largest effect at lag06 (RR = 1.058, 95%CI = 1.009-1.110). In the stratified analysis, people are more susceptible in the cold season compared to the warm season and females and the 18-60-year age group are more sensitive to air pollutants. It is suggested to strengthen management and preventive measures to decrease air pollution exposure.
UNASSIGNED: This study found an association between increased concentrations of air pollutants and increased outpatient visits for mental and behavioral disorders. We recommend that preventive and protective measures should be strengthened in an effort to reduce exposure to air pollution in order to maintain physical and mental health.

BACKGROUND: Healthcare utilization is typically adversely affected when the treatment is expensive and requires multiple visits. We examined the determinants of healthcare-seeking for Hepatitis C virus (HCV) infection which is asymptomatic, chronic, and requires costly treatment in an urban tertiary care referral hospital in Vietnam.
METHODS: We conducted a secondary analysis of hospital data for patients attending the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam between 2017 and 2020 specifically for HCV infection treatment. Poisson regression was used to determine the effect of personal factors (age, sex, comorbidities) and structural factors (health insurance, proximity to the facility, seasonality, year of visit) on the number of hospital visits.
RESULTS: From 2017 to 2020 a total of 22,052 eligible patients sought treatment in the hospital. Among the patients, 50.4% were males and 58.7% were > 50 years of age. The mean number of visits per person was 2.17. In the multivariate analysis compared to 2017, the number of hospital visits increased by 4% in 2018 and then significantly decreased in 2019 and 2020. Visit numbers were significantly lower (6%) among South East region residents compared to those from Central Highlands and for those who lived further away from the hospital. The visit numbers were significantly higher among older age groups (5-11%), those with health insurance (6%), and those with comorbidities (5%) compared to others. Although the number of hospital visits by females was higher (7%) than males in 2017, it significantly decreased in subsequent years.
CONCLUSIONS: Our study indicated that there are both structural and individual factors affecting the number of visits for HCV treatment. To meet the global strategy for elimination of HCV, Vietnam Government needs to address the structural and personal barriers to healthcare seeking, with a special focus on women.

OBJECTIVE: Multiple sclerosis (MS) is a disease of the central nervous system (CNS). Several factors, including sex, body mass index (BMI), disease duration, and age of onset, have been identified as predictors of disease severity. This study investigated the association between the aforementioned factors and MS severity, measured by the number of hospital visits and admissions, length of stay, and frequency of methylprednisolone use.
METHODS: This retrospective cross-sectional analysis used data obtained from BESTCare at the King Abdulaziz Medical City (KAMC). A total of 272 patients with MS and their demographic and clinical characteristics were included.
RESULTS: The study population consisted of 68.75% (n = 187) females and 31.25% (n = 85) males. The regression analyses indicated that disease duration was a significant predictor of the number of hospital visits and admissions (p < 0.01). The study found a significant association between BMI (unstandardized beta (B) = -0.25, 95% confidence interval (CI) = -0.47, -0.02, p = 0.033), age at diagnosis (unstandardized beta (B) = 0.15, 95% CI = 0.001, 0.31, p = 0.048), and length of hospital stay. Additionally, there was a significant correlation between disease duration and the number of methylprednisolone doses (unstandardized beta (B) = 0.45, 95% CI = 0.01, 0.89, p = 0.045).
CONCLUSIONS: Disease duration was found to be a significant predictor of hospital visits, admissions, and methylprednisolone use, while sex and BMI did not contribute to the variation in these outcomes. However, BMI and age of onset were significantly associated with length of hospital stay.

This study seeks to elucidate the intricate relationship between various air pollutants and the incidence of rhinitis in Seoul, South Korea, wherein it leveraged a vast repository of data and machine learning techniques. The dataset comprised more than 93 million hospital visits (n = 93,530,064) by rhinitis patients between 2013 and 2017. Daily atmospheric measurements were captured for six major pollutants: PM10, PM2.5, O3, NO2, CO, and SO2. We employed traditional correlation analyses alongside machine learning models, including the least absolute shrinkage and selection operator (LASSO), random forest (RF), and gradient boosting machine (GBM), to dissect the effects of these pollutants and the potential time lag in their symptom manifestation. Our analyses revealed that CO showed the strongest positive correlation with hospital visits across all three categories, with a notable significance in the 4-day lag analysis. NO2 also exhibited a substantial positive association, particularly with outpatient visits and hospital admissions and especially in the 4-day lag analysis. Interestingly, O3 demonstrated mixed results. Both PM10 and PM2.5 showed significant correlations with the different types of hospital visits, thus underlining their potential to exacerbate rhinitis symptoms. This study thus underscores the deleterious impacts of air pollution on respiratory health, thereby highlighting the importance of reducing pollutant levels and developing strategies to minimize rhinitis-related hospital visits. Further research considering other environmental factors and individual patient characteristics will enhance our understanding of these intricate dynamics.

BACKGROUND: The wave-over-wave effect of the COVID-19 pandemic on hospital visits for non-COVID-19-related diagnoses in Ontario, Canada remains unknown.
METHODS: We compared the rates of acute care hospitalizations (Discharge Abstract Database), emergency department (ED) visits, and day surgery visits (National Ambulatory Care Reporting System) during the first five \"waves\" of Ontario\'s COVID-19 pandemic with prepandemic rates (since January 1, 2017) across a spectrum of diagnostic classifications.
RESULTS: Patients admitted in the COVID-19 era were less likely to reside in long-term-care facilities (OR 0.68 [0.67-0.69]), more likely to reside in supportive housing (OR 1.66 [1.63-1.68]), arrive by ambulance (OR 1.20 [1.20-1.21]) or be admitted urgently (OR 1.10 [1.09-1.11]). Since the start of the COVID-19 pandemic (February 26, 2020), there were an estimated 124,987 fewer emergency admissions than expected based on prepandemic seasonal trends, representing reductions from baseline of 14% during Wave 1, 10.1% in Wave 2, 4.6% in Wave 3, 2.4% in Wave 4, and 10% in Wave 5. There were 27,616 fewer medical admissions to acute care, 82,193 fewer surgical admissions, 2,018,816 fewer ED visits, and 667,919 fewer day-surgery visits than expected. Volumes declined below expected rates for most diagnosis groups, with emergency admissions and ED visits associated with respiratory disorders exhibiting the greatest reduction; mental health and addictions was a notable exception, where admissions to acute care following Wave 2 increased above prepandemic levels.
CONCLUSIONS: Hospital visits across all diagnostic categories and visit types were reduced at the onset of the COVID-19 pandemic in Ontario, followed by varying degrees of recovery.

BACKGROUND: COVID-19 pandemic has been challenging for all, particularly for high-risk groups including people with cystic fibrosis (PWCF).
OBJECTIVE: This study aims to examine impact of COVID-19 pandemic on the lives of PWCF in relation to hospital visits, use of telemedicine, employment, and mental well-being.
METHODS: A cross-sectional online survey was developed by the Cystic Fibrosis (CF) Ireland research team and uploaded on SmartSurvey UK. The survey was advertised by CF Ireland via their website and social media in October 2020. The University College Dublin research partner team conducted the analysis. Logistic regression was used for the analysis, using IBM SPSS Version 26.
RESULTS: One hundred nineteen PWCF responded. 47.5% deferred their hospital visits, with delays ranging from 1 to 6 months. Deferrals impacted rehabilitation therapies, medical care at hospital, and diagnostic tests. For many, online consultation was a new experience (51.7%), and 87.8% were satisfied with this method. Among those who worked during lockdown (47.8%), 87.2% (n = 48) worked at home. PWCF aged < 35 years (9.6%) were more likely to work onsite as compared to those > 35 years (1.9%). When adjusted for gender and employment, PWCF aged < 35 years were more likely to feel \"nervous\" (OR: 3.28; P = 0.02), \"nothing could cheer them up\" (OR: 3.24; P = 0.04), and \"tired\" (OR: 2.76; P = 0.02) as compared to those > 35 years.
CONCLUSIONS: COVID 19 pandemic has greatly impacted PWCF in terms of hospital visits, access to tests, CF care, and psychological well-being. Younger PWCF reported greater impact on psychological health. Online consultation and electronic prescription were welcomed and could have a role post-pandemic.

BACKGROUND: The financial and educational status of individuals living with sickle-cell anaemia contributes to their general well-being. It is widely known that education is closely linked with positive health-seeking behaviors i.e., the more educated a person is, the better the person is likely to seek medical attention when needed, and take care of themselves before the crisis. It is considered that a relatively well-educated person with a means of livelihood would purchase the required drugs for prophylactic use. In most African countries where poverty is acute, it becomes a problem when the resource for education and finance needed for the treatment is not available. This study assessed the socioeconomic parameters (financial and educational status) of individuals living with the disorder within the Ibadan metropolis, southwest Nigeria.
METHODS: This study is a descriptive cross-sectional study using quantitative methods that assessed individuals\' financial and educational status with sickle cell anaemia. Respondents were recruited from federal and state hospitals, non-governmental foundations, worship centers, and schools. The individuals\' educational and financial statuses were accessed using standardized data collection and assessment tools, while the data were analyzed using SPSS (v22). Presentation of inferential statistics was done at a 5% level of significance.
RESULTS: The study recruited 253 participants, of which more than half (58.1%) were females. Those between 12-28 years were 64.4%, and the mean age was approximately 27.7±10.3 years. Also, 67.2% had tertiary education, 74.7% were neither engaged nor married at the time of this study, 88.5% were Yoruba, 73.5% of the participants were from a monogamous family, and 73.1% were Christians. A significant directly proportional association was found between financial status, educational status, and general well-being.
CONCLUSIONS: Sociodemographic, as well as educational factors, contributed to the general well-being of the individual participants. Thus, finance, level of exposure, and the environment were found to contribute significantly to well-being. More than half of the participants had tertiary education or are currently in school compared to those without tertiary education. There is an association between those with tertiary education and the number of hospital visits in the selected participants. While no association exists between those with buoyant financial status compared to those without a stable source of income.
BACKGROUND: La situation financière et le niveau d’instruction des personnes vivant avec la drépanocytose contribue à leur bien-être général. Il est largement connu que l’éducation est étroitement liée à des comportements positifs de recherche de santé, c’est-à-dire que plus une personne est éduquée, plus elle est susceptible de rechercher des soins médicaux en cas de besoin et de prendre soin d’elle-même avant la crise. On considère qu’une personne relativementinstruite et disposant de moyens de subsistance achèterait les médicaments nécessaires à des fins prophylactiques. Dans la plupart des pays africains où la pauvreté est aiguë, cela devient un problème lorsque les ressources pour l’éducation et les moyens financiers nécessaires au traitement ne sont pas disponibles. Cette étude a évalué les paramètres socio-économiques (situation financière et d’éducation) des personnes vivant avec la maladie dans la métropole d’Ibadan, au sud-ouest du Nigeria.
UNASSIGNED: Il s’agit d’une étude transversale descriptive utilisant des méthodes quantitatives qui ont permis d’évaluer la situation financière et éducative des personnes atteintes de drépanocytose. Les personnes interrogées ont été recrutés dans des hôpitaux fédéraux et d’État, des fondations non gouvernementales, des centres de culte et des écoles. La situation éducative et financière des individus a été vérifiée à l’aide d’une collecte de données qui est standardisée et des outils d’evaluation tandis que les données ont été analysées à l’aide de SPSS (v22). Les statistiques inférentielles ont été présentées à un niveau de signification de 5%.
UNASSIGNED: L’étude a recruté 253 participants, dont plus de la moitié (58,1 %) étaient des femmes. Les participants âgés de 12 à 28 ans représentaient 64,4 % et l’âge moyen était d’environ 27,7±10,3 ans. En outre, 67,2 % des participants avaient fait des études supérieures, 74,7 % n’étaient ni fiancés ni mariés au moment de l’étude, 88,5 % étaient Yoruba, 73,5 % des participants étaient issus d’une famille monogame et 73,1 % étaient chrétiens. Une association significative directement proportionnelle a été trouvée entre la situation financière, le niveau d’éducation et le bien-être général.
CONCLUSIONS: Les facteurs sociodémographiques et éducatifs, ont contribué au bien-être général des participants. Ainsi, les finances, le niveau d’exposition et l’environnement ont contribué de manière significative au bien-être. Plus de la moitié des participants ont fait des études supérieures ou sont actuellement scolarisés par rapport à ceux qui ne sont pas scolarisés. Il existe un lien entre les participants de l’enseignement supérieur et le nombre de visites à l’hôpital chez les participants sélectionnés. Bien qu’il n’y ait pas d’association entre les personnes ayant une financière par rapport à ceux qui n’ont pas de source de revenus stable.
UNASSIGNED: Anémie drépanocytaire, Éducation, Situation financière, Visites à l’Hôpital, Bilans de santé, Bien-Être.

Although ambient temperature has been linked to asthma exacerbation, impacts associated with extreme temperature events remain unclear. This study aims to identify the events characteristics that elevate risk of asthma hospital visits, and to assess whether healthy behavior changes due to the COVID-19 prevention and control policy may modify the relationships. Data of asthma hospital visits from all medical facilities in Shenzhen, China during 2016-2020 were assessed in relation to extreme temperature events using a distributed lag model. Stratified analysis was conducted by gender, age and hospital department to identify susceptible populations. Through events defined by various duration days and temperature thresholds, we explored the modification by events intensity, length, occurrence time and healthy behaviors. The cumulative relative risk of asthma during heat waves compared to other days was 1.06 (95%CI: 1.00-1.13) and for cold spells was 1.17 (95%CI: 1.05-1.30), and that of males and school-aged children were generally higher than other sub-groups. There were significant effects of heat waves and cold spells on asthma hospital visits when the mean temperature was above 90th percentile (30 °C) and below 10th percentile (14 °C) respectively, and the relative risks were higher when events lasted longer, became stronger, occurred in daytime and in early summer or winter. During the healthy behaviors maintaining period, the risk of heat waves increased whilst the risk of cold spells reduced. Extreme temperatures may pose considerable impact on asthma and the health effect can be modified by the event characteristics and anti-epidemic healthy behaviors. Strategies of asthma control should consider the heightened threats of the intense and frequent extreme temperature events in the context of climate change.

We assessed an educational intervention to reduce the number of emergency department (ED) and inpatient stays for cardiovascular diagnoses, among South Carolina adult Medicaid Members with intellectual and developmental disability and hypertension (Members).
This Randomized Controlled Trial (RCT) included Members or the person who helped them with their medications (Helpers). Participants, who included Members and/or their Helpers, were randomly assigned to an Intervention or Control group.
South Carolina Department of Health and Human Services, which administers Medicaid, identified eligible Members.
412 Medicaid Members - 214 Intervention (54 Members participating directly; 160 Helpers participating in lieu of Members) who received the messages about hypertension and surveys about knowledge and behavior and 198 Controls (62 Members; 136 Helpers) who only received surveys of knowledge and behavior.
Educational intervention about hypertension included a flyer and monthly text or phone messages for one year.
Input measures - characteristics of the Members; Outcome measures - hospital emergency department (ED) and inpatient visits for cardiovascular conditions.
Quantile regression tested the association of Intervention/Control group status with ED and inpatient visits. We also estimated models using Zero-inflated Poisson (ZIP) models for sensitivity analysis.
Participants in the Intervention group with highest baseline hospital use (top 20% ED; top 15% Inpatient) had significant reductions in Year 1 (.57 fewer ED and 2 fewer inpatient days) compared to the Control group. For ED visits, improvement continued in year two.
The intervention reduced the frequency of cardiovascular disease-related ED visits and Inpatient days for participants in the Intervention group in the highest quantiles of hospital use, and the improvement was better for those who had a Helper.