Risk factors of admission for acute colonic diverticulitis in a population-based cohort study: The North Trondelag Health Study, Norway

AIM To assess risk factors of hospital admission for acute colonic diverticulitis.METHODS The study was conducted as part of the second wave of the population-based North Trondelag Health Study(HUNT2), performed in North Trondelag County, Norway, 1995 to 1997. The study consisted of 42570 participants(65.1% from HUNT2) who were followed up from 1998 to 2012. Of these, 22436(52.7%) were females. The cases were defined as those 358 participants admitted with acute colonic diverticulitis during follow-up. The remaining participants were used as controls. Univariable and multivariable Cox regression analyses was used for each sex separately after multiple imputation to calculate HR.RESULTS Multivariable Cox regression analyses showed that increasing age increased the risk of admission for acute colonic diverticulitis: Comparing with ages < 50 years, females with age 50-70 years had HR = 3.42, P < 0.001 and age > 70 years, HR = 6.19, P < 0.001. In males the corresponding values were HR = 1.85, P = 0.004 and 2.56, P < 0.001. In patients with obesity(body mass index ≥ 30) the HR = 2.06, P < 0.001 in females and HR = 2.58, P < 0.001 in males. In females, present(HR = 2.11, P < 0.001) or previous(HR = 1.65, P = 0.007) cigarette smoking increased the risk of admission. In males, breathlessness(HR = 2.57, P < 0.001) and living in rural areas(HR = 1.74, P = 0.007) increased the risk. Level of education, physical activity, constipation and type of bread eaten showed no association with admission for acute colonic diverticulitis.CONCLUSION The risk of hospital admission for acute colonic diverticulitis increased with increasing age, in obese individuals, in ever cigarette smoking females and in males living in rural areas.

The Culture of Incident Reporting and Feedback: A Cross-Sectional Study in a Hospital Setting

A safety culture where incidents have been reported and feedback given is essential to detect and understand system failures. The aims of this study were to examine the culture of incident reporting and feedback (the incident culture) in a hospital setting, and the associations between the incident culture and other dimensions of the safety culture. A cross-sectional study was carried out with the instrument Hospital Survey on Patient Safety Culture (HSOPSC) within 16 units in six somatic hospitals at a Norwegian Hospital Trust. Units with identical specialities across the hospitals constitute a clinic. HSOPSC measures the health care personnel’s perception of the safety culture, seven safety dimensions at the unit level, three at the hospital level and four outcome measures. The outcome measures “Frequency of event reporting” and the dimension “Feedback and communication about error” were combined into the variable “incident culture”, score 1 - 5. A positive score was defined as ≥ 4.0. This study included 631 health care personnel. The mean score for the incident culture was 3.10 (SD 0.65) with significant differences between the clinics, and the hospitals. The strongest predictors for the incident culture were the dimensions “Communication openness” (linear regression slope B 0.470;95% CI 0.398 to 0.543;p < 0.001), “Manager expectations and actions promoting safety” (B 0.378;95% CI 0.304 to 0.453;p < 0.001), “Organisational learning and continuous improvement” (B 0.374;95% CI 0.293 to 0.455;p < 0.001) and “Teamwork across hospital units” (B 0.360;95% CI 0.261 to 0.459;p < 0.001). In this study, the incident culture needed improvements. To improve the incident culture, the attention may be directed towards developing and maintaining a culture of open communication, management that promotes safety, and a learning organisation and teamwork between the units.