Hospital Practices and Research
Volume:5 Issue: 1, Winter 2019

Mental disorders are generally a significant reason for increased morbidity. They constitute a serious disease burden. One of the main reasons for this disease burden is long hospitalization periods. The current study investigated the length of hospital stay and the variables affecting it in patients treated in the Gazi University Hospital Psychiatry Department between 2005-2016. Patient diagnoses were analyzed according to the International Classification of Diseases 10th Revision (ICD-10). Data was obtained for 7027 hospitalizations over a 12-year period. Records of repeated hospitalizations, non-psychiatric primary diagnoses, and missing data were not included in the analysis. As a result, data from 5129 hospitalizations were included in the analysis. Mean age of the sample was 45.27±14.69, and 62.5% (n=3204) of the patients were male. Mean hospitalization period was 28.66±17.25 days. Schizophrenia and depressive disorder significantly prolonged hospital stay, while substance addiction shortened the duration of hospitalization (P < 0.001). It was found that the duration of hospitalization decreased significantly over the years (P < 0.001). Advanced age (P < 0.001), recurrent admission (P < 0.001), and female gender (P = 0.029) were other variables affecting this period. Schizophrenia and depression are the most common psychiatric disorders in the inpatient service, and these disorders prolong hospitalization periods. The duration of hospital stay is considerably less in substance addiction than in other psychiatric disorders. Non-clinical variables, such as year of hospitalization, may affect the length of hospital stay.

Three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) techniques are used for the treatment of patients with laryngeal cancer. This study aimed to investigate the effects of these 2 treatment techniques on the planning target volume (PTV) (laryngeal cancer), dose homogeneity, dose of organs at risk (OARs) (parotid glands), and conformity index. This study compared 2 treatment techniques and was conducted from October 2018 to April 2019 at the Zhianawa Cancer Center (ZCC), Sulaimaniyah, Iraq. Eight patients with laryngeal cancer were selected for this study. 3D-CRT and IMRT were used to produce the maximum dose of target volume coverage and minimum dose to the parotid glands. Elekta synergy with a photon beam of 6 MV was used for all measurements. Data analysis was performed using the available statistical package of SPSS 25. The comparison of 3D-CRT with IMRT showed that the mean conformity index value for IMRT was more conformal than the 3D-CRT plan (0.956, 0.945, respectively), but the homogeneity index was better with 3D-CRT than with IMRT (0.175, 0.202, respectively). The mean dose for Rt. parotid glands was higher with IMRT than with 3D-CRT (232.71, 23.26, respectively), and in both plans the mean dose was less than 26 Gy (the standard tolerance value). While in the Lt. parotid gland the mean dose was higher with 3D-CRT than with IMRT (26.95, 23.71, respectively), the mean dose with 3D-CRT was greater than 26 Gy. The amount of PTV was significantly greater with the IMRT technique than with 3D-CRT (52.15±1.61, 51.09.4±0.74 Gy, respectively). This study further supports that IMRT has improved the long-term quality of life of patients with laryngeal cancer.

The literature on Minorities’ Diminished Returns (MDRs) have shown worse than expected health of the members of racial and ethnic minority groups particularly Blacks. Theoretically, this effect can be in part due to weaker effects of educational attainment on preventive care and disease management in highly educated racial and ethnic minorities. The current study explored the racial and ethnic differences in the effect of baseline educational attainment on % adherance to the routine physician visits among middle-aged and older adults in the US. This is a prospective study with 24 years of follow up. The Health and Retirement Study (HRS: 1992-2016) included 10 880 middle-aged and older adults who were Hispanic, non-Hispanic, Black or White. The independent variable was educational attainment. The dependent variable was adherance to the routine physician visits (%). Age, gender, marital status, income, health behaviors (smoking and drinking) and health (depression, self-rated health, and chronic diseases) were the covariates. Race and ethnicity were the focal moderators. Linear regression was used for data analysis. Overall, higher educational attainment was associated with higher % of adherance to the routine physician visits over the course of follow-up, net of all confounders. Race showed a significant statistical interaction with educational attainment suggesting of a smaller effect of high education attainment on % adherance to the routine physician visits for Black than White middle-aged and older adults. Similar interaction could not be found for the comparison of Hispanic and non-Hispanic middle-aged and older adults. Educational attainment is associated with a larger increase in preventive and disease management doctor visits for White than Black middle-aged and older adults. This is a missed opportunity to improve the health of highly educated middle-aged and older adults. It is not race/ethnicity or class that shapes health behaviors but race/ethnicity and class that shape people’s pro-health behaviors. At least some of the racial health disparities is not due to low SES but diminished returns of SES.

Child abuse is defined as any act or omission which causes physical or psychological harassment and lasting effects on children. Injuries resulting from child abuse are widespread, and this trauma can lead to psychological problems in adulthood. The aim of this study was to investigate the correlation between a history of child abuse and suicide attempts. In this case-control and retrospective study, patients admitted in 2016 to the toxicity emergency center in Yazd city, Iran, with symptoms of attempted suicide and patients of other conditions were recruited. Participants in the control and case groups were matched for age, gender, marital status, and place of residence. Each patient was given a questionnaire to collect information on demographics, history of suicide attempt or suicide in other members of the family, and history of child abuse (self-report scale) which investigated five aspects of childhood abuse (sexual, physical, neglect, lack of nutrition, and emotional neglect). The chi-square test and t test were used in the analysis. Mean severity rates of physical, sexual, neglect, nutrition, and emotional child abuse were 8.49, 6.42, 10.4, 6.43, and 9.62, respectively, for the case group and 7.89, 5.52, 7.88, 5.92, and 8.52, respectively, for the control group. Statistical analysis revealed that except for nutritional abuse cases, the incidence rates of all other aspects of child abuse were significantly higher among cases than in the control group. The results of this study showed that a history of child abuse, especially sexual and emotional types, are correlated with the incidence of attempted suicide.

ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI ) are common types of acute coronary syndrome which are associated with the risk factors of age, obesity, hypertension, and diabetes. The present study aimed to examine the effects of age on the risk factors and clinical symptoms of acute coronary syndrome. A cross-section prospective study was conducted on 125 patients with acute coronary syndrome chosen by non-probability convenience sampling method in the coronary care unit in Sulaimani, the Kurdistan region of Iraq. Acute coronary syndrome types were diagnosed through clinical presentations, electrocardiography (ECG), and troponin test. Data was collected using a researcher-based checklist through face-to-face interviews. The results indicated that males were the dominant group. The age group 45-65 had the highest prevalence rate of acute coronary syndrome. The most frequent risk factors for acute coronary syndrome were hypertension (54.4%), dyslipidemia (52%), smoking (42.4%), and diabetes mellitus (38.4%). Typical chest pain was found to be the most frequent clinical presentation (88%). There was a significant difference between the age groups in terms of the effect of age on typical and atypical symptoms; however, neither age nor typical/atypical symptoms had a significant effect on type of acute coronary syndrome. Similarly, family history, hypertension, diabetes mellitus, obesity, smoking, physical inactivity, and dyslipidemia had no effect on type of acute coronary syndrome. Age is a predictive factor for acute coronary syndrome, but family history, hypertension, diabetes mellitus, obesity, smoking, physical inactivity, and dyslipidemia cannot predict acute coronary syndrome.