TTIMES WORLD: Health News Report

Monday, July 13, 2020
Washington, DC, USA


Blood Pressure Control is Priority
What You Must Do

Controlling blood pressure has to be a priority.

Why is blood pressure control so important to health?

When your blood pressure is high:

You are 4 times more likely to die from a stroke
You are 3 times more likely to die from heart disease
Even blood pressure that is slightly high can put you at greater risk.

Most people with uncontrolled high blood pressure:

Know they have high blood pressure
See your doctor for control monitor
Take prescribed medicine
Each of these is important, but there is much more to do. What’s needed now is for doctors, nurses and their patients to pay regular and frequent attention to controlling blood pressure.

What is C. Difficile Infection
How the Infection is Growing in the US

C. difficile infections are at an all-time high.

C. difficile infections are linked to 14,000 deaths in the US each year.
Deaths related to C. difficile increased 400% between 2000 and 2007, due in part to a stronger germ strain.
Most C. difficile infections are connected with receiving medical care.
Almost half of infections occur in people younger than 65, but more than 90% of deaths occur in people 65 and older.
Infection risk generally increases with age; children are at lower risk.
About 25% of C. difficile infections first show symptoms in hospital patients; 75% first show in nursing home patients or in people recently cared for in doctors' offices and clinics.
C. difficile germs move with patients from one health care facility to another, infecting other patients.

Half of all hospital patients with C. difficile infections have the infection when admitted and may spread it within the facility.
The most dangerous source of spread to others is patients with diarrhea.
Unnecessary antibiotic use in patients at one facility may increase the spread of C. difficile in another facility when patients transfer.
When a patient transfers, health care providers are not always told that the patient has or recently had a C. difficile infection, so they may not take the right actions to prevent spread.
C. difficile infections can be prevented.

Early results from hospital prevention projects show 20% fewer C. difficile infections in less than 2 years with infection prevention and control measures.
England decreased C. difficile infection rates in hospitals by more than half in 3 years by using infection control recommendations and more careful antibiotic use.

Hospital Emergency Use by Patients with Mental Disorder
A Study by Anne M. Hakenewerth, PhD et al

mergency Department Visits by Patients with Mental Health Disorders — North

Patients with mental health disorders (MHDs) use the emergency department (ED) for acute psychiatric emergencies, for injuries and illnesses complicated by or related to their MHD, or when psychiatric or primary-care options are inaccessible or unavailable (1,2). An estimated 5% of ambulatory-care visits in the United States during 2007–2008 were made by patients with primary mental health diagnoses (3). To measure the incidence of ED visits in North Carolina with MHD diagnostic codes (MHD-DCs), the Carolina Center for Health Informatics (University of North Carolina at Chapel Hill) analyzed ED visits occurring during the period 2008–2010 captured by the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT). This report describes the results of that analysis, which indicated that nearly 10% of ED visits had one or more MHD-DCs assigned to the visit and the rate of MHD-DC-related ED visits increased seven times as much as the overall rate of ED visits in North Carolina during the study period. Those with an MHD-DC were admitted to the hospital from the ED more than twice as often as those without MHD-DCs. Stress, anxiety, and depression were diagnosed in 61% of MHD-DC-related ED visits. The annual rate of MHD-DC-related ED visits for those aged ≥65 years was nearly twice the rate of those aged 25–64 years; half of those aged ≥65 years with MHD-DCs were admitted to the hospital from the ED. Mental health is an important component of public health (4). Surveillance is needed to describe trends in ED use for MHDs to develop strategies to prevent hospitalization, improve access to ambulatory care, and develop new ways to provide ED care for the elderly with MHDs.
ED visit data for the period 2008–2010 were extracted from NC DETECT, a population-based, statewide public health surveillance system that contains ED visit data (5,6) for 99% of ED visits in North Carolina occurring during the study period. ED visits were characterized by sex and age group, ED disposition, and type of MHD. MHD-DCs were identified from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for mental disorders (290–299); symptoms, signs, and ill-defined conditions (787–789.9); and supplementary codes (V11–79). ICD-9-CM codes for poisoning and overdose, metabolic or structural encephalopathies that are classified as psychiatric diagnostic codes by ICD-9-CM, substance abuse disorders, and tobacco use disorder were excluded. For each ED visit, a mental health ICD-9-CM diagnostic code in any one of up to 11 positions classified that visit as MHD-DC-related. Visit records with more than one MHD-DC were counted as a single MHD-DC-related visit. Using the first-listed MHD-DC for the ED visit, MHDs were subcategorized into 11 groups of clinically similar diagnostic categories for calculating rates. For purposes of regression analyses, all MHD-DCs were classified as present or absent for each ED visit. Data were extracted and stratified for univariate and two-way descriptive analyses, and annual rates were calculated per 10,000 population. Risk ratios were computed using log binomial regression with Poisson robust variances.
From 2008 to 2010, the annual number of ED visits in North Carolina increased by 5.1%, from 4,190,911 to 4,405,676, and MHD-DC-related ED visits increased by 17.7%, from 347,806 to 409,276 (Table 1). By 2010, ED visits with MHD-DCs accounted for 9.3% of all ED visits; 31.1% of ED visits with MHC-DCs resulted in hospital admission, compared with 14.1% of all ED visits.
For each ED visit, up to 11 diagnostic codes are captured by NC DETECT. One quarter of first-listed MHD-DCs were in the first-listed diagnostic code position, 56% of the MHD-DCs were within the first three diagnostic code positions, and 77% were within the first five. "Stress/Anxiety/Depressive disorders" was the MHD-DC category with the highest number of ED visits (Table 2).
Increasing age was associated with an increase in hospital admission, with 14% of children aged <15 years admitted and 51% of adults aged ≥65 years admitted (Table 3). The highest admission proportion was for ED visits associated with dementia (60.5%) (Table 2). Population-based rates of MHD-DC related visits for those aged ≥65 years were very high for any MHD diagnosis compared with all other age groups, driven primarily by higher rates of schizophrenia/delusions/psychoses, dementia, and stress/anxiety/depression (Table 4).
Reported by
Anne M. Hakenewerth, PhD, Texas Cancer Registry, Texas Dept of State Health Svcs. Judith E. Tintinalli, MD, Anna E. Waller, ScD, Amy Ising, MSIS, Tracy DeSelm, MD, Carolina Center for Health Informatics, Dept of Emergency Medicine, Univ of North Carolina at Chapel Hill. Corresponding contributor: Anne M. Hakenewerth,, 512-305-8094.

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