BACKGROUND & AIMS: PURPOSE:To determine the association between device-determined diagnostic indices, including intrathoracic impedance, and heart failure (HF) hospitalization. METHODS:Clinical and device diagnostic data of 558 HF patients indicated for CRT-D therapy (In Sync Sentry, Medtronic Inc.) were prospectively collected from 34 centers. Device-recorded intrathoracic impedance fluid index threshold crossing event (TCE), mean activity counts, tachyarrhythmia events, night heart rate (NHR) and heart rate variability (HRV) were compared within patients with vs. without documented HF hospitalization. RESULTS:Mean follow-up was 326 +/- 216 days. Patients hospitalized for HF had significantly higher rates of TCE, a higher percentage of days with the thoracic impedance fluid index above the programmed threshold, a higher percentage of days with low activity, with low HRV or with high NHR. Multivariate analysis showed that TCE resulted in a 36% increased probability of HF hospitalization. Both TCE duration and patient activity were also significantly associated with hospitalization. Kaplan Meier analysis indicated that patients with more TCE events were significantly more likely to be hospitalized (log rank test, p = 0.005). CONCLUSIONS:Decreased intrathoracic impedance, low patient activity and low HRV were all independently associated with increased risk for HF hospitalization in HF patients treated with resynchronization therapy. Device-derived diagnostic data may provide valuable and reliable indices for the prognostic stratification of HF patients.

背景与目标： 目的：确定设备确定的诊断指标（包括胸内阻抗）与心力衰竭（HF）住院之间的关联。
方法：前瞻性地从34个中心收集了558例接受CRT-D治疗的HF患者的临床和设备诊断数据（在Sync Sentry，Medtronic Inc.）。比较有记录和无记录的心衰住院患者的设备记录的胸内阻抗液指数阈值穿越事件（TCE），平均活动计数，心律失常事件，夜间心率（NHR）和心率变异性（HRV）。
结果：平均随访时间为326 /-216天。 HF住院的患者的TCE率显着更高，胸阻抗液指数高于设定的阈值的天数百分比更高，活动量低，HRV较低或NHR较高的天数百分比更高。多变量分析表明，TCE导致HF住院的可能性增加了36％。 TCE持续时间和患者活动均与住院密切相关。 Kaplan Meier分析表明，发生更多TCE事件的患者住院的可能性明显更高（log rank测试，p = 0.005）。
结论：重新同步治疗的心衰患者，胸内阻抗的降低，患者活动度的降低和心率变异性的降低均与心衰住院的风险增加有关。设备衍生的诊断数据可为HF患者的预后分层提供有价值和可靠的指标。

BACKGROUND & AIMS: AIMS:People who have experienced adverse childhood experiences (ACEs) are more susceptible to substance use disorder (SUD) and depression. The present study examined depression prevalence in hospitalized patients with SUD and examined the association of individual ACEs with major depression. Depression rates 3 months after discharge were also examined. METHODS:Medical inpatients with SUD were recruited from Temple University Hospital. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9) at baseline and 3 months post-discharge. Participants were also assessed using an ACE scale at baseline. RESULTS:Of 79 baseline participants, 48% (38) had moderate to severe major depressive disorder (MDD) with PHQ-9 scores ≥15. Among those with baseline MDD, 38% (9/24) continued to have MDD 3 months post discharge, and 42.9% (12/28) of those without MDD at baseline met criteria at 3 months. Sixty-three percent (50/79) of the participants reported 4+ ACEs at baseline. Two ACEs, Household Incarceration and Household Mental Illness, were significantly associated with having MDD at baseline and 3 months (adjusted mean PHQ-9 total score increase (SE) and p-value: 2.97 (1.35), p < .05; 5.32 (1.37), p < .005, respectively). CONCLUSIONS:In this exploratory study, nearly half of medical inpatients with substance use disorder had moderate to severe major depression, with a similar percentage of participants having MDD as outpatients at 3 months. Approximately two thirds of participants reported four or more adverse childhood experiences at baseline. Inpatient medical hospitalization should be utilized as an opportunity to engage people with SUD in multidisciplinary treatment including psychiatric, trauma informed care, and substance abuse treatment.

背景与目标： 目的：经历过不良儿童时期（ACEs）的人更容易患上药物滥用症（SUD）和抑郁症。本研究检查了住院的SUD患者的抑郁症患病率，并检查了个体ACE与严重抑郁症的关联。出院后3个月的抑郁率也进行了检查。
方法：从坦普尔大学医院招募SUD的住院患者。在基线和出院后3个月使用患者健康问卷9（PHQ-9）对抑郁进行评估。在基线时还使用ACE量表对参与者进行了评估。
结果：在79名基线参与者中，有48％（38）患有中度至重度严重抑郁症（MDD），PHQ-9得分≥15。在具有基线MDD的患者中，出院后3个月继续有MDD的比例为38％（9/24），在基线为3个月时没有MDD的患者中有42.9％（12/28）符合标准。百分之六十三（50/79）的参与者在基线时报告了4个ACE。两个ACE，即家庭监禁和家庭精神疾病，与基线和3个月的MDD显着相关（调整后的PHQ-9平均总分增加（SE）和p值：2.97（1.35），p <.05; 5.32（ 1.37），p <.005）。
结论：在这项探索性研究中，近一半的药物滥用障碍住院患者患有中度至重度严重抑郁症，在3个月时患有MDD的参与者与门诊患者的百分比相似。大约三分之二的参与者在基线时报告了四个或更多的不良儿童经历。应该利用住院医疗住院作为机会，使SUD患者参与多学科治疗，包括精神病学，创伤知情护理和药物滥用治疗。

BACKGROUND & AIMS: BACKGROUND:A new pay-for-performance scheme for primary care physicians was introduced in England in 2004 as part of an initiative to link the quality of primary care with physician pay. OBJECTIVE:To investigate the association between the quality of primary care and rates of hospital admissions for coronary heart disease. DESIGN:Ecological cross-sectional study using data from the Quality and Outcomes Framework for family practice, hospital admissions, and census data. PARTICIPANTS:All 303 primary care trusts in England, covering approximately 50 million people. MEASUREMENTS:Rates of elective and unplanned hospital admissions for coronary heart disease and rates of coronary angioplasty and coronary artery bypass grafting were regressed against quality-of-care measures from the Quality and Outcomes Framework, area socioeconomic scores, and disease prevalence. RESULTS:Correlations between prevalence, area socioeconomic scores, and admission rates were generally weak. The strongest relations were seen between area socioeconomic scores and elective and unplanned hospital admissions and revascularization procedures among the age group 45-74 years. Among those aged 75 years and over, the only positive association observed was between area socioeconomic scores and unplanned hospital admissions. CONCLUSIONS:The lack of an association between quality scores and admission rates suggests that improving the quality of primary care may not reduce demands on the hospital sector and that other factors are much better predictors of hospitalization for coronary heart disease.

背景与目标： 摘要背景：2004年在英格兰引入了一种新的针对基层医疗医生的绩效工资计划，该计划是将基层医疗质量与医生薪酬联系起来的一项举措。
目的：探讨基层医疗质量与冠心病住院率之间的关系。
设计：采用横断面质量和结果框架中的数据进行生态横断面研究，以获取家庭执业，住院人数和人口普查数据。
参与者：英格兰所有303个初级保健信托基金，覆盖约5000万人。
测量：根据“质量和结果框架”，区域社会经济得分和疾病患病率，对护理质量指标进行回归分析，得出针对冠心病的选择性和计划外入院率，冠状动脉成形术和冠状动脉搭桥术的发生率。
结果：患病率，地区社会经济得分和入学率之间的相关性通常较弱。在45-74岁年龄段中，地区社会经济得分与选择性和计划外的入院和血运重建程序之间的关系最密切。在75岁及以上的人群中，观察到的唯一正相关是地区社会经济得分与计划外的住院人数之间的关系。
结论：质量得分与入院率之间缺乏关联，表明改善初级保健质量可能不会减少对医院部门的需求，而其他因素则更能预测冠心病住院率。

BACKGROUND & AIMS: BACKGROUND:The assessment of adverse events from a patient-centered view includes patient-reported adverse outcomes. An adverse outcome refers to any suboptimal outcome experienced by the patient; when adverse outcomes are identified through a patient interview these are called patient-reported adverse outcomes. An adverse event is an adverse outcome that is more likely due to the processes of medical care rather than to the mere progression of disease. In the context of a large-scale study assessing post-hospitalization adverse events, we developed a conceptual framework to assess patient-reported adverse outcomes (PRAOs). This methodological manuscript describes this conceptual framework. METHODS:The PRAO framework builds on a validated adverse event ascertainment method including three phases: Phase 1 involves an inquiry to ascertain the occurrence of any patient-reported adverse outcome. It is completed by a structured telephone interview to obtain details - from a patient perspective - on symptoms that developed and/or worsened after hospitalization. Phase 2 involves the classification of PRAOs by physicians not involved in the patient care. Physician-reviewers then rate the PRAOs using well-adopted scales to determine whether the occurrence was the natural progression of the underlying illness or due to medical care. When the PRAO is rated as "due to medical care", it is then classified as an "adverse event". Phase 3 involves the classification of adverse events as preventable or ameliorable. RESULTS:Out of the 1347 patients contacted at 1-month post-discharge, 469 reported AOs and after reviewing 369 cases, 29 were classified as AEs. Observed agreement levels between raters were 87.3, 85.5, and 85.2 % respectively displaying a good agreement (k > 0.60). CONCLUSION:The framework incorporates PRAOs as a way to identify cases that need to be evaluated for adverse events. Further validation of this framework is warrant with the final aim of implementation at larger scale. The implementation of this framework will enable clinicians, researchers and healthcare institutions to compare outcome rates across providers and over time.

背景与目标： 背景：以患者为中心的不良事件评估包括患者报告的不良后果。不良结局是指患者经历的任何次优结局；当通过患者访谈确定不良结果时，这些称为患者报告的不良结果。不良事件是一种不良后果，很可能是由于医疗过程而不是仅仅由于疾病的进展。在评估住院后不良事件的大规模研究的背景下，我们开发了一个概念框架来评估患者报告的不良结局（PRAO）。该方法论手稿描述了此概念框架。
方法：PRAO框架建立在经过验证的不良事件确定方法的基础上，包括三个阶段：第一阶段涉及对患者报告的不良结果进行确认的调查。它可以通过结构化的电话采访来完成，以从患者的角度获取住院后出现和/或恶化的症状的详细信息。第二阶段涉及不参与患者护理的医生对PRAO的分类。然后，内科医生审阅者使用公认的量表对PRAO进行评分，以确定发生的原因是潜在疾病的自然进展还是由于医疗。当PRAO被评定为“由于医疗护理”时，则将其分类为“不良事件”。第三阶段涉及将不良事件分类为可预防或可缓解。
结果：在出院后1个月接触的1347例患者中，有469例报告了AO，在审查369例后，有29例归为AE。评估者之间观察到的协议水平分别为87.3％，85.5％和85.2％，显示出良好的一致性（k> 0.60）。
结论：该框架结合了PRAO，以识别需要评估不良事件的病例。对该框架进行进一步验证是有必要的，其最终目标是大规模实施。该框架的实施将使临床医生，研究人员和医疗保健机构能够比较提供者之间以及随着时间推移的结果率。

BACKGROUND & AIMS: :Congestive heart failure (CHF) is a serious problem, responsible for one of the highest rates of hospitalization in the United States for any medical condition. This study evaluated the effectiveness of a multidisciplinary, outpatient CHF clinic in decreasing the number of hospitalizations that CHF patients required. The clinic combines intensive patient and family education with aggressive follow-up. A major aspect of the research project was developing a computerized database for maintaining the large volume of information generated by the CHF clinic. Once that database was established, records of 20 clinic patients were examined for a 6-month period surrounding each patient's date of enrollment. Characteristics of each patient during the 3-month preclinic period were compared with those of the 3-month postclinic period, including all admissions, all days in the hospital, admissions due to CHF, and days in the hospital due to CHF. There was a mean reduction of 0.733 admissions of all types and a mean reduction of 5.2 inpatient days for all admissions. There was a mean reduction of 0.8 admissions for CHF and a mean reduction of 4.067 inpatient days for CHF. All four reductions were statistically significant (P < .05). Results suggest that the CHF clinic was effective in reducing the number of, and length of stay during, hospitalizations.

背景与目标： ：充血性心力衰竭（CHF）是一个严重的问题，是美国任何医疗条件下最高的住院率之一。这项研究评估了多学科的门诊CHF诊所在减少CHF患者所需住院次数方面的有效性。该诊所将强化的患者和家庭教育与积极的随访相结合。该研究项目的主要方面是开发一个计算机数据库，以维护瑞士法郎诊所产生的大量信息。建立该数据库后，将检查20名临床患者的记录，历时6个月，与每个患者的入院日期相关。将每个患者在3个月的临床前期与3个月的临床后期的特征进行比较，包括所有入院，全天住院，因瑞士法郎入院和因瑞士法郎入院的天数。所有类型的入院人数平均减少0.733，所有住院的住院天数平均减少5.2。 CHF的平均住院人数减少了0.8，而CHF的住院天数平均减少了4.067。所有四个减少均具有统计学意义（P <.05）。结果表明，CHF诊所可有效减少住院次数和住院时间。

BACKGROUND & AIMS: BACKGROUND:The Hospital Consumer Assessment of Healthcare Providers and Systems survey is the most commonly used instrument for measuring patients' perceptions of the quality of inpatient care. OBJECTIVE:To determine if the hospital survey can also be used to measure patients' experience of intensive care as indicated by scores on a parallel questionnaire, the Patient Perception of Quality. METHODS:Scores on both instruments of all adult patients admitted to an intensive care unit from 2007 through 2012 were analyzed. RESULTS:A total of 1766 matching pairs of hospital and critical care surveys were identified. Patients' ratings of the overall hospital and critical care experiences had low correlation: r = 0.32 (95% CI, 0.28-0.37). Using the standard reporting convention, 77% of the participants rated the hospital as 9 or 10 on a 10-point scale, and 65% rated the intensive care unit as 5 on a 5-point scale. Although the hospital survey was always completed by the patient, the critical care survey was completed by a patient's family member or friend in 76% of cases and by the patient in 24%. Patient-completed critical care surveys had more correlation with hospital surveys (r = 0.45) than did critical care surveys completed by family members (r = 0.30), but the overall correlation remained modest. CONCLUSION:Scores on the hospital survey were at best modestly associated with scores on the critical care survey and did not reflect the specific experiences of patients and patients' families in the intensive care unit.

背景与目标： 背景：医院医疗服务提供者和系统的消费者评估是最常用的工具，用于衡量患者对住院护理质量的看法。
目的：为了确定医院调查是否也可以用来衡量患者的重症监护经验，如平行调查表中的得分（患者对质量的看法）所示。
方法：对2007年至2012年期间接受重症监护病房的所有成年患者在两种仪器上的得分进行了分析。
结果：总共找到了1766对匹配的医院和重症监护调查。患者对整体医院和重症监护经历的评价之间的相关性很低：r = 0.32（95％CI，0.28-0.37）。使用标准报告惯例，在10分制中77％的参与者将医院评为9分或10分，在5分制中65％的人将重症监护病房评为5分。尽管医院调查总是由患者完成，但重症监护调查是由患者的家人或朋友（占76％）和患者（占24％）完成的。与家庭成员完成的重症监护调查（r = 0.30）相比，患者完成的重症监护调查与医院调查的相关性更高（r = 0.45），但总体相关性仍然适中。
结论：医院调查的分数充其量仅与重症监护调查的分数适度相关，不能反映重症监护病房患者和患者家属的具体经历。

BACKGROUND & AIMS: OBJECTIVE:This study tested the hypothesis that contraction of regional economies affects the incidence of involuntary admissions to psychiatric emergency services by reducing community tolerance for persons perceived as threatening to others. METHODS:This hypothesis was tested with time-series analyses of the relationship between initial claims for unemployment in Florida between July 4, 1999, and June 28, 2003, and the weekly number of men and women presented by police to be examined for involuntary psychiatric hospitalization because of danger to others. The analyses controlled for admissions presented by mental health professionals because of danger to others and for admissions presented by police because of neglect or disability. RESULTS:When the analyses controlled for autocorrelation and other covariates, claims for unemployment insurance were significantly associated with the number of men presented by police for danger to others. During the study period, police presented 5,897 men for examination because of danger to others. Increased unemployment claims were associated with approximately 309 more men being presented for examination than expected from prior presentation rates and from the number presented by mental health professionals for danger to others and by police for neglect or disability. No such association was found for women. CONCLUSIONS:Consistent with theory, this study found that presentations for involuntary admission to psychiatric services increased after contractions in the labor market. Combining the methods of this study with econometric forecasting may allow providers to anticipate better the need for psychiatric services.

背景与目标： 目的：本研究检验了以下假设，即区域经济收缩会通过降低社区对被视为威胁他人的人的容忍度而影响非自愿性入院精神科急诊服务的发生率。
方法：通过对佛罗里达州1999年7月4日至2003年6月28日期间首次提出失业申请与警察提出的每周男性和女性人数进行非自愿精神病学检查之间的关系的时间序列分析，检验了该假设。因为对他人的危险而住院。这些分析控制的是心理健康专业人士因为对他人的危险而提出的入场券，以及警察由于疏忽或残疾而提出的入场券。
结果：当分析控制了自相关和其他协变量时，失业保险索赔与警察为危害他人而提出的男性人数显着相关。在研究期间，警方对5 897名男子进行了检查，以防对他人造成危险。失业人数增加的原因是，应接受检查的男子人数比以前的出勤率，心理健康专业人员对他人的危险和警察对他人的疏忽或残障所提出的人数超出预期的人数多309人。没有发现与女性有这种关联。
结论：与理论一致，本研究发现在劳动力市场萎缩之后，自愿接受精神病服务的人数有所增加。将本研究的方法与计量经济学的预测相结合，可以使提供者更好地预期对精神病学服务的需求。

BACKGROUND & AIMS: OBJECTIVE:The present study was conducted prospectively to determine i) the length of postnatal hospital stay of healthy newborns and determine the factors facilitating their early discharge (< 48 h) and ii) the frequency and causes of re-hospitalization following early discharge, in a tertiary care hospital. METHODS:Length of hospital stay was recorded for healthy newborns. Factors facilitating Early discharge were determined by both univariate and multivariate (multiple logistic regression) analyses. Of all newborns discharged within 48 h, every third case was called for a follow-up visit 72 hrs later and examined for any medical problem and need of re-hospitalization. RESULTS:A total of 1134 babies were enrolled, of which 861 (76.2%) were discharged at or before 48 hours. The overall mean (SD) length of hospital stay was 46.4 (45.8) h. Factors contributing to early discharge included vaginal delivery (RR: 30.2; 95% CI: 19.0, 47.9; P<0.001), absence of pre-existing maternal disease or obstetric complication (RR: 4.32; 95% CI: 2.27, 8.22; P < 0.001), and birth weight of > 2.5 kg (RR: 1.91; 95% CI: 1.27, 2.89; P = 0.002). Of the 280 neonates called for follow-up, 193 reported. Of these, 61 (31.6%) were normal. Neonatal jaundice was the most frequent problem seen in 105 (54.4%) children on follow-up. Only 16 (8.3%) newborns needed re-hospitalization; the most common indication being neonatal jaundice (n=9). CONCLUSION:Most of the children in our set-up are being discharged within 48 hrs. Early discharge is governed primarily by maternal indications. A follow-up visit after 72 hr is important to assess the need of re-hospitalization in healthy newborns discharged within 48 hrs of birth.

背景与目标： 目的：本研究是前瞻性进行的，以确定i）健康新生儿的产后住院时间，并确定有助于其早期出院（<48 h）的因素，以及ii）早期出院后再次住院的频率和原因。三级医院。
方法：记录健康新生儿的住院时间。通过单因素和多因素（多元逻辑回归）分析确定促进早期出院的因素。在48小时内出院的所有新生儿中，每隔72小时便要求进行第三次随访，并检查是否存在任何医疗问题以及是否需要重新住院。
结果：总共招募了1134名婴儿，其中861名（76.2％）在48小时或之前出院。住院的总平均（SD）时间为46.4（45.8）h。导致早期出院的因素包括阴道分娩（RR：30.2; 95％CI：19.0，47.9; P <0.001），不存在既有的母体疾病或产科并发症（RR：4.32; 95％CI：2.27，8.22; P <0.001）和出生体重> 2.5千克（RR：1.91; 95％CI：1.27，2.89; P = 0.002）。在280名需要随访的新生儿中，有193例被报道。其中61例（31.6％）是正常的。新生儿黄疸是105例（54.4％）接受随访的儿童中最常见的问题。只有16名（8.3％）新生儿需要重新住院治疗；最常见的适应症是新生儿黄疸（n = 9）。
结论：我们机构中的大多数儿童在48小时内出院。早期出院主要由孕产妇适应证决定。 72小时后的随访对评估出生后48小时内出院的健康新生儿是否需要重新住院非常重要。

BACKGROUND & AIMS: :Women in later stages of pregnancy are at increased risk for serious influenza-related morbidity; thus, universal influenza vaccination of pregnant women is recommended. However, vaccine uptake in the United States has been suboptimal. We previously described the burden of severe influenza-related morbidity during pregnancy in the United States by examining hospitalizations of pregnant women with respiratory illness during influenza season. Nondelivery hospitalizations with respiratory illness had significantly longer lengths of stay than those without respiratory illness. Hospitalization characteristics associated with greater likelihood of respiratory illness were the presence of a high-risk condition for which influenza vaccination is recommended, Medicaid/Medicare as primary expected payer, and hospitalization in a rural area. These findings may be explained by these women being at higher risk of influenza-related morbidity or reflect disparities in receipt of influenza immunization. Universal vaccination of pregnant women to decrease influenza-related morbidity should be encouraged.

背景与目标： ：怀孕后期的妇女患严重流感相关疾病的风险增加；因此，建议对孕妇进行通用流感疫苗接种。但是，在美国，疫苗的摄取率不是最理想的。我们先前通过检查流感季节孕妇患有呼吸系统疾病的孕妇的住院情况，描述了美国怀孕期间与流感相关的严重疾病的严重负担。患有呼吸系统疾病的未分娩住院的住院时间比没有呼吸系统疾病的住院时间长得多。与呼吸道疾病可能性更大相关的住院特征是：建议进行流感疫苗接种的高风险病况；作为主要预期付款人的医疗补助/医疗保险；以及在农村地区的住院治疗。这些发现可能是由于这些妇女患流感相关疾病的风险较高，或反映了接受流感疫苗接种的差异。应鼓励孕妇普遍接种疫苗以减少与流感相关的发病率。

BACKGROUND & AIMS: BACKGROUND:The pneumococcal conjugate vaccine (PCV) might prevent hospitalizations in children because of the role of Streptococcus pneumoniae in the complications of influenza infection. We investigated the benefit of PCV vaccination in preventing influenza hospitalization in children <5 years of age during the 2009 to 2010 pandemic wave and the 2010 to 2011 influenza epidemic in Spain. METHODS:A multicenter matched case-control study was undertaken in 27 hospitals from 7 Spanish regions between July 2009 and April 2011. A case was defined as a hospitalized patient between 6 months and 5 years of age with influenza virus infection confirmed by real-time reverse-transcription polymerase chain reaction. We selected 2 matched controls for each case from patients with unplanned hospital admission for reasons other than acute respiratory infection or influenza-like illness. Cases and controls were matched according to age, date of hospitalization and province of residence. Crude and adjusted odds ratios were calculated for associations between influenza hospitalization and PCV vaccination. RESULTS:One hundred ninety-four cases and 342 controls were included in the study. In the 2009 to 2010 pandemic wave, the adjusted benefit in preventing hospitalization was 48% (95% confidence interval: 1 to 76) in fully vaccinated children compared with -79% (95% confidence interval: -341 to 27) in the 2010 to 2011 influenza season. CONCLUSIONS:The results obtained suggest that, in children <5 years of age, PCV vaccination reduced hospitalization during the 2009 to 2010 pandemic wave. By contrast, there was no observed benefit of vaccination in the 2010 to 2011 influenza season.

背景与目标： 背景：肺炎球菌结合疫苗（PCV）可能会阻止儿童住院，因为肺炎链球菌在流感感染并发症中的作用。我们调查了PCV疫苗接种在预防2009年至2010年流感大流行和西班牙2010年至2011年流感大流行期间对5岁以下儿童进行流感住院的益处。
方法：2009年7月至2011年4月之间，在西班牙7个地区的27家医院中进行了多中心匹配的病例对照研究。该病例定义为6个月至5岁之间住院并实时确认流感病毒感染的患者逆转录聚合酶链反应。由于急性呼吸道感染或流感样疾病以外的原因，我们从计划外住院的患者中为每个病例选择2个匹配的对照。根据年龄，住院日期和居住省份对病例和对照进行匹配。计算流感住院和PCV疫苗接种之间的关联的粗略和调整后的优势比。
结果：该研究包括194例和342例对照。在2009年至2010年的大流行浪潮中，完全接种疫苗的儿童在预防住院方面的调整后收益为48％（95％可信区间：1至76），而2010年为-79％（95％可信区间：-341至27）。到2011年流感季节。
结论：获得的结果表明，在5岁以下的儿童中，接种PCV疫苗可减少2009年至2010年大流行浪潮期间的住院率。相比之下，在2010年至2011年的流感季节没有观察到疫苗接种的好处。

BACKGROUND & AIMS: OBJECTIVES:this study examined the association between medically recognized urinary incontinence and risk of several disease conditions, hospitalization, nursing home admission and mortality.

DESIGN:review and abstraction of medical records and computerized data bases from 5986 members, aged 65 years and older, of a large health maintenance organization in northern California.

RESULTS:there was an increased risk of newly recognized urinary incontinence following a diagnosis of Parkinson's disease, dementia, stroke, depression and congestive heart failure in both men and women, after adjustment for age and cohort. The risk of hospitalization was 30% higher in women following the diagnosis of incontinence [relative risk (RR) = 1.3, 95% confidence interval (CI) = 1.2-1.5] and 50% higher in men (RR = 1.5, 95% CI = 1.3-1.6) after adjustment for age, cohort and co-morbid conditions. The adjusted risk of admission to a nursing facility was 2.0 times greater for incontinent women (95% CI = 1.7-2.4) and 3.2 times greater for incontinent men (95% CI = 2.7-3.8). In contrast, the adjusted risk of mortality was only slightly greater for women (RR = 1.1; 95% CI = 0.99-1.3) and men (RR= 1.2; 95% CI= 1.1-1.4).

CONCLUSIONS:urinary incontinence increases the risk of hospitalization and substantially increases the risk of admission to a nursing home, independently of age, gender and the presence of other disease conditions, but has little effect on total mortality.

背景与目标： 目标：这项研究检查了医学上公认的尿失禁与多种疾病状况，住院，疗养院入院率和死亡率之间的关系。

DESIGN ：综述加利福尼亚北部一家大型健康维护组织的5986名年龄在65岁及以上的成员的病历和计算机数据库的摘要和摘要。

结果：患病风险增加调整年龄和队列后，在诊断出帕金森氏病，痴呆，中风，抑郁和充血性心力衰竭后，新发现了一种尿失禁。诊断为失禁后，妇女的住院风险高出30％[相对风险（RR）= 1.3，95％置信区间（CI）= 1.2-1.5]，而男性则高出50％（RR = 1.5，95％CI = 1.3-1.6）调整年龄，同类和合并病状后。失禁女性的调整后入院风险是失禁女性的2.0倍（95％CI = 1.7-2.4），失禁男性是3.2倍（95％CI = 2.7-3.8）。相比之下，女性（RR = 1.1； 95％CI = 0.99-1.3）和男性（RR = 1.2； 95％CI = 1.1-1.4）的调整后死亡风险仅稍高。强有力的结论：尿失禁增加了住院的风险，并显着增加了进入疗养院的风险，而与年龄，性别和其他疾病状况无关，但对总死亡率影响不大。