Deliberate self-harm among pediatric psychiatric inpatients in China:A single-center retrospective study

BACKGROUND For children and adolescents,deliberate self-harm(DSH)is becoming a mental health problem of concern.Despite several studies on the prevalence and factors of DSH in the world,there is little information on DSH among children and adolescents in China.This study explores the prevalence,types,associated risk factors and tendency of DSH in pediatric psychiatric inpatients in China.AIM To understand the situation of DSH among hospitalized children and adolescents and its related factors.METHODS In this study,we retrospectively studied 1414 hospitalized children and adolescents with mental illness at Xiamen Mental Health Center from 2014 to 2019,extracted the demographic and clinical data of all patients,and analyzed clinical risk factors of DSH.RESULTS A total of 239(16.90%)patients engaged in at least one type of DSH in our study.Cutting(n=115,48.12%)was the most common type of DSH.Females(n=171,71.55%)were more likely to engage in DSH than males(n=68,28.45%).DSH was positively associated with depressive disorders[OR=3.845(2.196-6.732);P<0.01],female[OR=2.536(1.815-3.542);P<0.01],parental marital status[OR=5.387(2.254-12.875);P<0.01]and negative family history of psychiatric illness[OR=7.767(2.952-20.433);P<0.01],but not with occupation,substance use and history of physical abuse.CONCLUSION Our findings suggest that for patients with depression,females,an abnormal marriage of parents,and no history of mental illness,attention should be paid to the occurrence of DSH.

Particularities of Anemia in the Elderly: Experience in a Geriatrics Department in Senegal

Background/Objective: Anemias are frequent conditions in geriatric practice. The etiologies are numerous, overlapping chronic and acute pathologies. it is also associated with high morbidity and mortality. In our context, few studies have addressed this issue, and none have been carried out in geriatric units with integrated geriatric dimensions. The aim of this study was to describe the particularities of anemia in old people in a geriatric short-stay service in Senegal. Materials and methods: This was a retrospective, descriptive study from 01 May 2019 to 31 December 2021, involving people aged 60 or over, hospitalized in the geriatrics department of Fann Hospital (Senegal) and presenting with anemia. Epidemiological, clinical and evolutionary characteristics were collected and analyzed using SPSS 24.0 software. Results: The prevalence of anemia was 32.3%. The mean age of our sample was 78.7 ± 8.5 years. Arterial high blood pressure (59.3%), diabetes mellitus (22.8%), prostate disease (12.3%) were the most frequent comorbidities. Clinical manifestations were dominated by physical asthenia (80%) and severe alteration of general condition (72%). The geriatric syndromes were essentially represented by the loss of Activities Daily Living (ADL) autonomy (65%), undernutrition (59%) and frailty (46%). The mean hemoglobin level was 8.4 g/dl ± 2.1. The main etiologies were infections (32.7%), chronic kidney disease (20.9%), iron deficiency (7.4%). The mean hospital stay was 8 days ± 3.7 days and the mortality rate was 19%. Conclusion: Anemia is a frequent occurrence in geriatric medicine, with a high morbidity and mortality rate;its expression is often atypical, with frequent geriatric syndromes;the etiologies are multiple and often interrelated, requiring an exhaustive and multidimensional approach.

Incidence and risk factors of in-hospital venous thromboembolism in non-oncological urological inpatients:A single center experience

Objective To determine incidence and risk factors for venous thromboembolism(VTE)development of in-hospital VTE in urological inpatients who underwent non-oncological surgery in a tertiary hospital in China.Methods Consecutive 1453 inpatients who were admitted to a non-oncological urological ward in the tertiary hospital from January 1,2018 to December 31,2018 were enrolled in the study,and the VTE events were diagnosed by ultrasound or computed tomographic pulmonary angiography.Patients’occurrence of VTE and characteristics which may contribute to the development of VTE were collected and analyzed as incidence and risk factors.Results The incidence of VTE in non-oncological urological inpatients is 2.3%.In our cohort,patients who experienced previous VTE(adjusted odds ratios[aOR]14.272,95%CI 3.620-56.275),taking anticoagulants or antiplatelet agents before admission(aOR 10.181,95%CI 2.453-42.256),D-dimer(max)≥1μg/mL(aOR 22.456,95%CI 6.468-77.967),lower extremity swelling(aOR 10.264,95%CI 2.242-46.994),chest symptoms(aOR 79.182,95%CI 7.132-879.076),operation time of more than or equal to 180 min(aOR 10.690,95%CI 1.356-84.300),and Caprini score(max)of more than or equal to 5(aOR 34.241,95%CI 1.831-640.235)were considered as risk factors for VTE.Conclusion In this study,we found that the incidence of VTE in non-oncological surgery was about 2.3%,which was higher than some previous studies.Risk factors could be used for early detection and diagnosis of VTE.

Evaluation of antibiotic use among inpatients in surgical ward at Mbarara Regional Referral Hospital,South-Western Uganda

Objective The main aim of this study was to evaluate antibiotic use among inpatients in surgical ward at South-Mbarara Regional Referral Hospital,South-Western Uganda.Methodology:A retrospective cross-sectional study was carried out on patients'follow-up forms of Mbarara Regional Referral Hospital,surgical ward from 15th November to 15th December.Data abstraction tool was employed to extracted data,entered in excel version 2010 then imported into SPSS software version 2010 where different variables were analyzed.Results:A total of 136 patient forms were studied.At least one antibiotic was prescribed in 76(56%).Majority(81.58%)of the antibiotics were prescribed for therapeutic purpose while some lacked documented and approved indications.Specific indications were not documented in 15(19.73%)of the forms.Sepsis without culture and sensitivity was the most frequent indication 14(18.42%)for antibiotics followed by prophylactic use 12(15.79%).Ceftriaxone was the most commonly(82.9%)prescribed antibiotic;followed by metronidazole for 31(40.8%)and Ampicillin/Cloxacillin for 8(10.5%)of the patients.Out of the 76 patients who used antibiotics,the overall use was found to be appropriate in only 20(26.3%).Most prescriptions had right doses 57(75.0%)followed by right frequencies 53(69.7%);whereas the duration was the least appropriate with only 46(60.5%)of the 76 patients.Conclusion:More than half of the patients had at least one antibiotic prescribed to them.Ceftriaxone and metronidazole were the most prescribed,the majority of antibiotics were used for treatment and some of the patients were on antibiotics without specific indications.Sepsis was the most common indication for the antibiotics used.Most antibiotics were inappropriately used.Duration of treatment was the most inappropriate parameter and antibiotic use varied greatly with guidelines.

Handgrip Strength as a Predictor of Nutritional Status in Chinese Elderly Inpatients at Hospital Admission

Objective To assess nutritional status and define gender-and age-specific handgrip strength（HGS） cut-point values for malnutrition or nutritional risk in elderly inpatients. Methods A cross-sectional study of 1,343 elderly inpatients was conducted in the Chinese PLA General Hospital. Nutrition Risk Screening（NRS 2002） and Subjective Global Assessment（SGA） were administered. Anthropometric measurements and blood biochemical indicators were obtained using standard techniques. The gender-and age-specific receiver operating characteristic（ROC） curves were constructed to evaluate the HGS for nutritional status by SGA and NRS 2002. Sensitivity, specificity, and areas under the curves（AUCs） were calculated. Results According to NRS 2002 and SGA, 63.81% of elderly inpatients were at nutritional risk and 28.22% were malnourished. Patients with higher HGS had an independently decreased risk of malnutrition and nutritional risk. The AUCs varied between 0.670 and 0.761. According to NRS 2002, the optimal HGS cut-points were 27.5 kg（65-74 years） and 21.0 kg（75-90 years） for men and 17.0 kg（65-74 years） and 14.6 kg（75-90 years） for women. According to SGA, the optimal HGS cut-points were 24.9 kg（65-74 years） and 20.8 kg（75-90 years） for men and 15.2 kg（65-74 years） and 13.5 kg（75-90 years） for women. Conclusion Elderly inpatients had increased incidence of malnutrition or nutritional risk. HGS cut-points can be used for assessing nutritional status in elderly inpatients at hospital admission in China.

Current research status and research hotspots in Chinese geriatric medicine: Data retrieved from the Chinese Journal of Geriatrics

Objective: To investigate the research hotspots and development trends of Chinese geriatric medicine by analyzing the high-frequency keywords, core authors, research institutions and their collaborations in papers published in the Chinese Journal of Geriatrics.Methods: Bibliometric methods and information visualization software(CiteSpace Ⅲ) were used to analyze the following 3 aspects: keywords, institutions and authors.Results: Overall, the number of papers published in the Chinese Journal of Geriatrics grew between 1994 and 2015. The top 3 institutions with the greatest numbers of published papers were Beijing Hospital,People's Liberation Army General Hospital and the Second Xiangya Hospital of Central South University.The authors with high productivity were Pulin Yu, Jianye Wang and Xiaoying Li. The terms "Diabetes","hypertension" and "myocardial infarction" were hotspot words that drew sustained attention in this field.Conclusions: Research on geriatric medicine is growing steadily in China. Hospitals and teaching hospitals are major contributors to publications. The collaboration of authors is more common within the same institutions or in the same regions. Clinical research is still the focus of current research. In the future, basic research should be strengthened, and collaborations between different institutions and regions should be promoted to achieve coordinated and integrated development in Chinese geriatric medicine.

Study on Influence Factors of Pressure Injury Risk in the Elderly Inpatients with Kidney Disease Based on LASSO Regression

Objective: This paper aims to explore clinical status and related influence factors of pressure injury (PI) in the elderly inpatients with kidney disease, so as to provide reference for the prevention and treatment of PI in the elderly inpatients with kidney disease. Methods: Retrospective collection method is adopted to collect 158 clinical cases of the elderly inpatients with kidney disease aged ≥ 60 in the Nephrology Department, the First Affiliated Hospital of Jinan University from January 2017 to December 2019, and then least absolute shrinkage and selection Operator (LASSO) regression analysis is used to analyze 17 possible influence factors;finally Logistic regression model is established to analyze and screen influence factors of risk. Results: 1) Among 158 elderly inpatients with medium and high risk of PI, the incidence of PI is 20.25%;the most common stage of injury is stage I (42.5%);sacrococcygeal (60%) is the high-risk site of pressure injury. 2) LASSO regression analysis shows that history of present respiratory infection/respiratory failure (β = 1.2714. P < 0.05) and hospitalization time (β = 0.4177. P < 0.05) are independent factors influencing PI risk in the elderly inpatients with kidney disease. Conclusion: The elderly patients with kidney disease and PI risk are the high incidence population of hospital acquired PI;for the elderly inpatients with kidney disease and having respiratory infection history or respiratory failure, prolonged hospitalization will significantly increase the risk of PI. Therefore, targeted preventive and control measures should be taken to reduce the incidence of PI.

Analysis of the effect of medical insurance on cancer inpatients: A 10-year retrospective study on a large hospital in Northeast China

Objective The aim of the study was to analyze hospital costs for cancer inpatients availing different methods of payment and the influencing factors, to provide inputs to improve the medical insurance payment policy. Methods We analyzed the information related to length of hospital stay, hospitalization cost, and self-pay cost, collected from one large-scale, Grade A, Class Three hospital in Shenyang, China, during 2004–2013.Results The number of cancer inpatients with different payment types(medical insurance group and non-medical insurance group) presented a rising trend. Further, the ratio of medical insurance inpatients increased rapidly(from 22.2% to 48.7%); however, this group was still a minority. The length of hospital stay became shorter(21 d vs. 17 d; P = 0.000) while the gap got narrower; the hospitalized expense showed an upward trend and the difference was remarkable($24048.6 ± $4376.28 vs. $20544.36 ± $4057.01; P = 0.000). Conclusion Along with normalization of cancer therapy, the influence of payment on treatment has been getting weak, the policy has impact on controlling hospitalization cost, lightening burden of cancer patient, as well as allocating medical resources in a reasonable way, becoming an important defray pattern of hospitalization cost.

Geriatrics intensive care unit: Outcome and risk factors for in hospital mortality

OBJECTIVES: To evaluate outcome and risk factors, particularly the (APATCHE II) score in elderly patients after admission to a geriatrics intensive care unit (ICU). Methods: A cross sectional study of patients ≥ 60 years admitted to the intensive care unit (ICU) of the Geriatrics department at Ain Shams University Hospital over 2 years period. We recorded age, sex, previous medical history, primary diagnosis, date of admission and discharge or death and APACHE II score on admission. Results: 202 patients admitted to the ICU were studied. The mean ICU mortality rates for these patients were (32, 5%), the mean APATCHE II score was (19.07). 27.3% of patients who died had hypokalemia and 43.2% had hyponatremia. Conclusion: ICU mortality rate are higher in elderly patients particularly with long ICU stay and hyponatremia.

Frailty Syndrome Prevalence and Its Correlation with Cognitive Function in Elderly Surgical Inpatients

Background: Frailty is a geriatric syndrome, and a common negative consequence of aging, which shares some obvious characteristics as cognitive impairment. Preventing and relieving frailty may reduce the possibility of developing cognitive impairment. Objective: This study aimed to investigate frailty prevalence and its correlation with cognitive function in elderly surgical inpatients. Methods: We enrolled a random sample of elderly surgical inpatients from Jingzhou from June 2020 to August 2020. We used a self-made registration sheet to collect their demographic data (gender, age, nationality, educational level and monthly income), and used the FRAIL Scale to assess the prevalence of frailty, and used the Mini-Mental State Examination (MMSE) to assess cognitive function. We used multiple linear regression analysis to explore the correlation between frailty level and demographic data, then Pearson correlation analysis was performed to analyze the correlation between frailty and cognitive function. Results: In the 143 elderly surgical inpatients, prevalence of frail was seen in 29 (20.3%), and pre-frail state was found in 64 (44.8%). Only 50 (34.9%) were in healthy state. Cognitive impairment was seen in 28 (19.5%). Pearson correlation analysis showed that the frail scoring was correlated with cognitive function in elderly surgical inpatients (r = -0.378, P < 0.05). Conclusion: The prevalence of frailty is high in elderly surgical inpatients, which is closely related to age and gender. Elderly surgical inpatients have high cognitive impairment, and frailty appears strongly associated with cognitive status. The findings suggest that attention should be paid to the frailty and cognitive function in the elderly surgical inpatients by pro-vision of effective interventions.

C-Reactive protein role in assessing COVID-19 deceased geriatrics and survivors of severe and critical illness

Numerous risk variables,including age,medical co-morbidities,and deranged inflammatory response,lead to higher mortality in a senior population with coronavirus disease 2019.C-reactive protein(CRP),an acute phase inflammatory protein secreted by the liver,was tested in the elderly,showing a diagnostic and prognostic role.However,recent research has shed light on new applications for CRP in geriatrics.It was used as a follow-up marker and as a therapeutic target.Early and accurate identification of patients’ risks may mitigate the devastation of the invading virus in older cases and permit the implementation of a quick treatment plan for those most likely to deteriorate.

Psycho-Social Hazards for Staff in Geriatrics and Geriatric Psychiatry

Context: Exposure to burnout of staff involved with elderly patients is dependent on many factors either personal or linked to the professional environment. Social stress and systemic problems created particularly by difficulties inherent in the French hospital management system and the way people feel it, lead to a risk of burnout. One illustration of this is the rise in suicides at work. Quality of life at work, harassment and psycho-social risks are intimately linked. Affective factors, such as suffering for the medical carers in response to the distress of their patients aggravate the risk of burnout. Methods: We have evaluated these parameters using a self-filled questionnaire form sent to all staff and filled in by computer, anonymously, in 4 establishments, in December 2012 and over the first semester of 2013. After the three factors studied by the ProQOL scale of quality of life at work, to do with burnout, satisfaction compassion and fatigue compassion, 5 other questions were added, connected with a feeling of harassment and several social and demographic matters. Burnout risk was retained on reaching a threshold of 30 for this ProQOL scale item. Results: After multivariate analysis including the parameters of the Stamm scale, harassment and the socio-demographic factors studied, (age, sex, seniority, profession, and work departments) 4 factors are significantly associated with the risk of burnout, one negatively, compassion satisfaction, three positively, compassion fatigue, harassment experience and seniority. Conclusions: The risk of burnout is linked to subjective factors—the way quality of life at work is perceived and harassment experienced. Some professions, such as nurses, are particularly exposed and require these risk factors to be foreseen.

Aerobic exercise improves gastrointestinal motility in psychiatric inpatients

AIM: To evaluate the benefit of aerobic exercise on colonic transit time (CTT) for psychiatric inpatients in a closed ward.

Burden, Health and Sense of Coherence among Relatives of Depressed Inpatients

In Europe, there are an increasing number of persons suffering from depression, which also affects many relatives. The burden and health when being the relative of an inpatient suffering from severe depression has been less examined. The aim of the study was to describe burden, health and sense of coherence among relatives of inpatients with severe depression. Furthermore, the aim was to investigate relatives’ burden in relation to their health and sense of coherence. A cross-sectional design was performed, with a questionnaire consisting of background questions and three instruments;Burden Assessment Scale, General Health Questionnaire and Sense of Coherence scale. The participants consisted of 68 relatives recruited from a sample of inpatients diagnosed with depression in the psychiatric specialist health services in one hospital trust in Norway. The Regional Committee for Medical and Health Research Ethics, Norway South East, gave approval to the study. The relatives reported burden to a various degree, with some reporting a significantly greater burden, poorer health and a weaker sense of coherence than others. With regard to subjective burden eight out of ten relatives reported “Worry about future”, and almost six out of ten were “Upset by change in patient”. Regarding objective burden, more than half the relatives reported having “Less time for friends” and “Reduced leisure time”. In conclusion the relatives with a high level of burden reported more mental distress, poorer health and weaker sense of coherence than those with lower level of burden. Further research should focus on identification of factors predicting burden and health of relatives of inpatients with severe depression.

Development of a psychological first-aid model in inpatients with COVID-19 in Wuhan,China

Background Facing the social panic and substantial shortage of medical resources during the coronavirus disease 2019(COVID-19)outbreak,providing psychological first-aid to inpatients is essential for their rehabilitation and the orderly operating of medical systems.However,the closed-ward environment and extreme shortage of onsite mental health workers have limited the use of traditional face-to-face diagnosis and psychological interventions.Aim To develop a mental health intervention model for inpatients that can be applied during a widespread epidemic,such as COVID-19.Methods In a medical team stationed in Leishenshan Hospital,Wuhan,China,we integrated onsite and online psychological support resources to implement a graded psychological intervention system.The onsite psychiatrist established trust with the patients and classified them into categories according to their symptom severity.While face-to-face evaluation and intervention are critical for effective online support,the online team effectively extended the scope of the'first-aid'to all patients.Conclusion This integrated onsite and online approach was effective and eficient in providing psychological interventions for inpatients during the crisis.Our model provides a realistic scheme for healthcare systems in or after the COVID-19 epidemic and also could be adopted in areas of the world with insufficient mental healthcare resources.

Prevalence of depression and anxiety and associated factors among geriatric orthopedic trauma inpatients:A cross-sectional study

BACKGROUND Common mental disorders such as anxiety and depression in geriatric orthopedic trauma patients have received little attention in research.AIM To investigate the prevalence of emotional disorders among geriatric orthopedic trauma patients and identify demographic,social and clinical risk factors.METHODS This cross-sectional study was performed in geriatric patients(aged≥60 years,both sexes)with orthopedic trauma admitted to a level I trauma center between May 2015 and December 2017.Demographic,social,and clinical characteristics were described.Huaxi Emotional-Distress Index(HEI)was used to evaluate the severity of anxiety and depression status.Differences in continuous variables were tested using the t-test,and differences in categorical variables were assessed using the Pearsonχ2 test.Binary logistic regression analyses were used to identify the factors associated with a HEI score>8.RESULTS Among the 966 patients,487 were male and 479 were female,with a mean age of 70.2±7.1 years.The age ranged from 60 to 90 years.Seventy-five patients had an HEI score>8,accounting for about 7.8%of all patients.A higher Injury Severity Score(4.17±3.10 vs 7.96±6.68,P<0.001),higher Visual Analog Score(5.05±1.09 vs 6.89±1.23,P<0.001),number of chronic diseases(P<0.001),injury type(P=0.038),and education level(P=0.001)were significantly associated with HEI score>8.On logistic regression,a higher education level was a protective factor for emotional disorders(P=0.047),whereas Injury Severity Score(P=0.024),Visual Analog Score(P<0.001),two or more chronic diseases(P<0.001)were the related independent risk factors.CONCLUSION Emotional disorders are common in geriatric patients with orthopedic trauma.Clinicians should remain vigilant of emotional disorders in geriatric patients and screen for anxiety and depression in higher risk groups.

Assessing anxiety,depression,and stress among inpatients with cancer

Objective This study aimed to assess anxiety,depression,and stress among inpatients with cancer.Methods Two hundred thirty-five hospitalized patients with cancer were surveyed with the Depression Anxiety Stress Scales(simplified Chinese Version).The software program SPSS 25.0 was used for statistical analysis of the survey data.Results The average scores of depression,anxiety,and stress of inpatients with cancer were 12.17,11.84,and 13.98 respectively,which were higher than the normal range.The scores of anxiety and stress of inpatients with different caregivers were statistically different(P=0.024/0.036).The anxiety and stress scores of inpatients with spouses as caregivers were higher than those of inpatients with children as caregivers.There was a statistically significant difference in the incidence of stress between inpatients with cancer with religious beliefs and inpatients with cancer without religious beliefs(P=0.026),and those with religious beliefs had greater incidence of stress.The score of anxiety was significantly higher for inpatients with children than for inpatients without children(P=0.040).Conclusion The anxiety,depression,and stress levels of inpatients with cancer are relatively high.It is necessary to pay special attention to the psychological status of these patients during clinical diagnosis and treatment to improve their quality of life.

Preliminary construction of evaluation indicator system for inpatients'nursing service needs in tertiary general hospital

Objectives:To construct a comprehensive evaluation indicator system for inpatients'nursing service needs in tertiary general hospital and to provide evidence for identifying and meeting the needs of inpatients'nursing services.Method:We used the Delphi method to conduct two rounds of expert consultations with 41 experts.Result:The indicator system consisting of 5 first-level indicators and 48 second-level indicators was preliminarily constructed.Conclusions:We formed an evaluation indicator system for inpatients'nursing service needs in tertiary general hospital and classified it into five categories:hospital environment,nursing attitude,nursing skills,information exchange,and emotional support.The indicator system is scientific and reliable.It can provide a basis for nursing staffs to identify and meet the needs of inpatients'care services.

Characteristics of and management strategies for 54 suicidal inpatients in a general hospital

Objective： The aim of this study was to explore the characteristics of and preventive management strategies for suicidal inpatients in a general hospital.Methods： A total of 54 suicide victims were drawn from a patient safety adverse event network reporting system during hospitalization in a general hospital from November 2008 to January 2017.Results： Subjects who committed suicide in the general hospital were women and those who suffered from malignant neoplasms during general hospital treatment. Furthermore, most of the patients who committed suicide used more violent suicide methods. The most common and lethal means was jumping from heights at the windowsill.Conclusions： It is concluded that management straties for suicide prevention can be provided from the aspects of patients, medical staff and the hospital environment. It is not only urgent but also feasible to reduce the suicide rate of inpatients and further improve hospital safety management.

Newly Admitted Psychiatric Inpatients after the 3.11 Disaster in Fukushima, Japan

Background: After the March 2011 “triple” disaster in Japan, the residents of Fukushima Prefecture suffered from serious psychological stress. Aims: This study aimed to elucidate the influence of stressful conditions on psychiatric disorders, as reflected in new psychiatric admissions. Methods: Diagnoses and background conditions among new psychiatric admissions during the 3 months immediately after the disaster in 2011 and the corresponding time periods of 2010 and 2012 were surveyed. Results: In 2011, more patients were admitted in confusional, manic, neurasthenic, and delirious states, whereas there were fewer admissions for depression. In 2012, more admissions pertained to depression. Twenty-four percent of the new admissions in 2011 were associated with concerns about radiation contamination and hospitalization, which declined to 4% in 2012. Conclusions: The diagnoses and background conditions among new psychiatric admissions were affected by the disaster;with the influence differing according to the time elapsed after the disaster.