RESUMEN
INTRODUCTION: The "potentially preventable hospitalizations (PPH)'' are hospital admissions that could have been avoided through effective primary care given at the appropriate time. Non-communicable diseases (NCDs), causes of PPH, are the leading cause of death worldwide with significant socioeconomic consequences especially in developing countries. This study aimed to assess the burden of potentially preventable hospitalizations in the St. Louis regional hospital. METHODS: This was a descriptive cross-sectional study. The surveyed population consisted of all patients older than one year, admitted to St. Louis hospital for more than four (04) hours time between January 20 and April 30, 2015. Patients hospitalized in surgery (general surgery, ENT, ophthalmology), maternity and neonatology, as well as those who refused or were unable to participate in the study were excluded. RESULTS: The study included one hundred forty four (144) individuals with an average age of 54.68±15 years (17-88 years) and sex ratio woman/man of 1.21. The PPH represented 54% of all hospitalizations. The main causes of hospitalizations were diabetes with 22.1%, chronic kidney disease 12%, hypertension 10.9%, Stroke 6.4% and finally broncho-pulmonary diseases 2.6%. The average length of stay was 6.68±5.51 days. The average distance between the residence and the hospital was 26.51±60KM with a median of 3.5KM. The average cost of care was Euros 104.583 ±83.51. For 61.10%, it was a first hospitalization and for 30.60%, a second one. The Knowledge about signs of disease severity had changed significantly at the end of hospitalization, from 29% at the beginning to 98% at the end of stay in hospital. As for the means of prevention, 30.55% reported knowing them before their hospitalization and 68% after hospitalization. CONCLUSION: Potentially preventable hospitalizations are a heavy burden for the population of St. Louis. Their negative social and economic impacts may hinder health policies initiated to relieve vulnerable groups. Their prevention should be a national priority.
Asunto(s)
Hospitalización/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Atención Primaria de Salud/organización & administración , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Senegal , Adulto JovenRESUMEN
BACKGROUND: Endothelial dysfunction as assessed by asymmetric dimethylarginine (ADMA) and inflammation has been consistently linked to atherosclerosis, death, and cardiovascular (CV) events in ESRD patients. Inflammation amplifies the effect of ADMA on the severity of atherosclerosis in ESRD patients, but it is still unknown whether inflammation and ADMA interact in the high risk of death and CV events in this population. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In a cohort of 225 hemodialysis patients, we investigated the interaction between inflammatory biomarkers (C-reactive protein and IL-6) and ADMA as predictors of death and CV events over an extended follow-up (13 years). RESULTS: During follow-up, 160 patients died, and 123 had CV events. With crude and multiple Cox regression analyses, an interaction was found between inflammation biomarkers and ADMA for explaining death and CV events in ESRD patients. The adjusted hazard ratios (HRs) for death (HR, 2.18; 95% confidence interval [CI], 1.34 to 3.54) and CV outcomes (HR, 2.59; 95% CI, 1.47 to 4.55) of patients with C-reactive protein and ADMA above the median were higher than expected in the absence of interaction under the additive model (1.15 and 1.97, respectively) and significantly higher than in patients with only one biomarker above the median. Data analyses carried out by stratifying patients according to IL-6 provided similar results. CONCLUSIONS: These data support the hypothesis that inflammation amplifies the risk of death and CV events associated with high ADMA levels in ESRD. These analyses further emphasize the need for intervention studies to attenuate inflammation and high ADMA levels in this population.