OBJECTIVE:To describe the epidemiology of hospital inpatient falls, including characteristics of patients who fall, circumstances of falls, and fall-related injuries. DESIGN:Prospective descriptive study of inpatient falls. Data on patient characteristics, fall circumstances, and injury were collected through interviews with patients and/or nurses and review of adverse event reports and medical records. Fall rates and nurse staffing levels were compared by service. SETTING:A 1,300-bed urban academic hospital over 13 weeks. PATIENTS:All inpatient falls reported for medicine, cardiology, neurology, orthopedics, surgery, oncology, and women and infants services during the study period were included. Falls in the psychiatry service and falls during physical therapy sessions were excluded. MEASUREMENTS AND MAIN RESULTS:A total of 183 patients fell during the study period. The average age of patients who fell was 63.4 years (range 17 to 96). Many falls were unassisted (79%) and occurred in the patient's room (85%), during the evening/overnight (59%), and during ambulation (19%). Half of the falls (50%) were elimination related, which was more common in patients over 65 years old (83% vs 48%; P < .001). Elimination-related falls increased the risk of fall-related injury (adjusted odds ratio, 2.4; 95% confidence interval 1.1 to 5.3). The medicine and neurology services had the highest fall rates (both were 6.12 falls per 1,000 patient-days), and the highest patient to nurse ratios (6.5 and 5.3, respectively). CONCLUSIONS:Falls in the hospital affect young as well as older patients, are often unassisted, and involve eliminationrelated activities. Further studies are necessary to prevent hospital falls and reduce fall injury rates.

Significant increases in the prevalence of alcohol use and of binge drinking over the past 10 to 15 years were observed, but not for all demographic groups. However, the increase in binge drinking among middle-aged and older adults is substantial and may be driving increasing rates of alcohol-related morbidity and mortality.

Purpose-We sought to examine the sentiment and themes of marijuana-related chatter on Twitter sent by influential Twitter users, and to describe the demographics of these Twitter users.Methods-We assessed the sentiment and themes of a random sample (n=7000) of influential marijuana-related Tweets (sent from 2/5 -3/5/2014). Demographics of the users Tweeting about marijuana were inferred using a social media analytics company (DemographicsPro for Twitter).Results-Most marijuana-related tweets reflected a positive sentiment towards marijuana use, with pro-marijuana Tweets outnumbering anti-marijuana Tweets by a factor of over 15. The most common theme of pro-marijuana Tweets included the Tweeter stating that he/she wants/plans to use marijuana, followed by Tweeting about frequent/heavy/or regular marijuana use and stating that marijuana has health benefits and/or should be legalized. Tweeters of marijuana-related content were younger and a greater proportion was African American compared to the Twitter average. Conclusions-MarijuanaTwitter chatter sent by influential Twitter users tends to be promarijuana and popular among African Americans and youth/young adults. Marijuana-related harms may afflict some individuals; therefore, our findings should be used to inform online and offline prevention efforts that work to target individuals who are most at-risk for harms associated with marijuana use. KeywordsMarijuana; Social Media; Youth © 2014 Society of Adolescent Health and Medicine. All rights reserved.Please address correspondence and reprint requests to: Patricia A. Cavazos-Rehg, Ph.D., Campus Box 8134, Department of Psychiatry, 660 South Euclid, St. Louis, MO 63110, Phone: (314) 362-2152, FAX: (314) 362-4247, rehgp@psychiatry.wustl.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.Conflicts of Interest Dr. Bierut is listed as an inventor on Issued U.S. Patent 8,080,371,"Markers for Addiction" covering the use of certain SNPs in determining the diagnosis, prognosis, and treatment of addiction. Implications and ContributionTwitter is a popular social media platform among young people. Results from this study highlight the pervasiveness of pro-marijuana Twitter chatter particularly among youth and African Americans and stress the need for more online marijuana prevention messages to target individuals who are most at-risk for marijuana use-associated harms. Twitter is a free-to-use social media platform that has become very popular among young people in recent years [1,2]. Twitter users can easily and instantly connect to a mass audience via Tweets that are 140 ...

Objective We utilized an updated nationally representative database to examine associations between maternal age and prevalence of maternal morbidity during complications of labor and delivery. Study design We used hospital inpatient billing data from the 2009 United States Nationwide Inpatient Sample (NIS), part of the Healthcare Cost and Utilization Project (HCUP). To determine whether the likelihood that maternal morbidity during complications of labor and delivery differed among age groups, separate logistic regression models were run for each complication. Age was the main independent variable of interest. Results In analyses that controlled for demographics and clinical confounders, we found that complications with the highest odds among women, 11–18 years of age, compared to 25–29 year old women, included preterm delivery, chorioamnionitis, endometritis, and mild preeclampsia. Pregnant women who were 15–19 years old had greater odds for severe preeclampsia, eclampsia, postpartum hemorrhage, poor fetal growth, and fetal distress. Pregnant women who were ≥35 years old had greater odds for preterm delivery, hypertension, superimposed preeclampsia, severe preeclampsia, and decreased risk for chorioamnionitis. Older women (≥40 years old) had increased odds for mild preeclampsia, fetal distress, and poor fetal growth. Conclusions Our findings underscore the need for pregnant women to be aware of the risks associated with extremes of age so that they can watch for signs and symptoms of such complications.

OBJECTIVE: To comprehensively analyze potential risk factors for falling in the hospital and describe the circumstances surrounding falls.DESIGN: Case-control study. Data on potential risk factors and circumstances of the falls were collected via interviews with patients and/ or nurses and review of adverse event reports, medical records, and nurse staffing records.SETTING: Large urban academic hospital.PATIENTS: Ninety-eight inpatients who fell and 318 controls matched on approximate length of stay until the index fall. MEASUREMENTS AND MAIN RESULTS:In a multivariate model of patient-related, medication, and care-related variables, factors that were significantly associated with an increased risk of falling included: gait/balance deficit or lower extremity problem (adjusted odds ratio [aOR], 9.0; 95% confidence interval [CI], 2.0 to 41.0), confusion (aOR, 3.6; 95% CI, 1.6 to 8.4), use of sedatives/hypnotics (aOR, 4.3; 95% CI, 1.6 to 11.5), use of diabetes medications (aOR, 3.2; 95% CI, 1.3 to 7.9), increasing patient-to-nurse ratio (aOR, 1.6; 95% CI, 1.2 to 2.0), and activity level of ''up with assistance'' compared with ''bathroom privileges'' (aOR, 8.7; 95% CI, 2.3 to 32.7). Urinary or stool frequency or incontinence was of borderline significance (aOR, 2.3; 95% CI, 0.99 to 5.6). Having one or more side rails raised was associated with a decreased risk of falling (aOR, 0.006; 95% CI, 0.001 to 0.024).CONCLUSIONS: Patient health status, especially abnormal gait or lower extremity problems, medications, as well as care-related factors, increase the risk of falling. Fall prevention programs should target patients with these risk factors and consider using frequently scheduled mobilization and toileting, and minimizing use of medications related to falling. Due to the risk of significant injury and the increased cost, reduction of falls in hospitals is a major priority for hospital quality and patient safety. While falls have been relatively well studied in community and nursing home settings, less is known about the prevention of hospital falls. Previous research has identified risk factors for falling in the hospital, including impaired balance or gait, history of falling, increasing age, impaired cognition, depression, dizziness or vertigo, orthostatic hypotension, visual impairment, urinary frequency, nocturia, incontinence, specific diagnoses, and use of certain medications, such as benzodiazepines, antipsychotics, and sedatives. 10,[12][13][14][15][16][17][18] Yet comparative studies on hospital falls have been limited in several ways, including variations in study design, setting, patient population, and definitions of risk factors. Some studies have continued to focus solely on the elderly or relied only on data included in hospital incident reports or chart review. Furthermore, environmental and care-related factors, including patient-to-nurse ratio, are often overlooked as potential risk factors for falling in these studies. Because fall prevention programs should be linked to the etiologic factors of fa...

"Patterns and predictors of inpatient falls and fall-related injuries in a large academic hospital." Infection

Background-This study examined gender and racial/ethnic differences in sexual debut.Study Design-We analyzed 1999-2007 data from the Youth Risk Behavior Surveillance System (YRBSS), a cross-sectional, nationally representative survey of students in Grades 9-12 established by the Centers for Disease Control and Prevention. The Kaplan-Meier method was used to compute the probability of survival (not having become sexually active) at each year (age 12 through 17), and separate estimates were produced for each level of gender and racial/ethnic group.Results-African-American males experienced sexual debut earlier than all other groups (all tests of significance at p<.001) and Asian males and females experienced sexual debut later than all groups (all tests of significance at p<.001). By their 17th birthday, the probability for sexual debut was less than 35% for Asians (females 28%, males 33%) and less than 60% for Caucasians (58% females, 53% males) and Hispanic females (59%). The probability for sexual debut by their 17th birthday was greatest for African Americans (74% females, 82% males) and Hispanic males (69%).Conclusions-These results demonstrate a need for sexual education programs and policy to be sensitive to the roles of race and ethnicity in sexual debut.

Background Staphylococcus aureus bacteremia results in substantial mortality. Infectious diseases specialist consultation can improve adherence to evidence-based management of S. aureus bacteremia, but its effect on mortality is unclear. Methods We performed a 2-year prospective cohort study of patients with S. aureus bacteremia at a large, tertiary care hospital. Patients who died within 2 days of diagnosis were excluded. Independent risk factors for 28-day mortality were determined. Results Among 341 patients with S. aureus bacteremia, 189 (55%) were male; 196 (58%) were Caucasian; 185 (54%) had methicillin-resistant S. aureus; 108 (32%) had nosocomial bacteremia; and 231 (68%) had a central venous catheter at the time of diagnosis. The median age was 56 years (range 22-95). One hundred eleven (33%) patients had an infectious diseases consultation. Fifty-four (16%) patients died with 28 days after diagnosis. Factors associated with mortality were intensive care unit admission ≤ 48 hours after the first positive blood culture [adjusted hazard ratio (aHR), 4.65; 95% confidence interval (CI), 2.65-8.18], cirrhosis (aHR, 4.44; 95% CI, 2.40-8.20), and advanced age (aHR, 1.27 per every 10 years of age; 95% CI, 1.08-1.50). Infectious diseases consultation was associated with a 56% reduction in 28-day mortality (aHR, 0.44; 95% CI, 0.22-0.89). Conclusion Only one-third of patients with S. aureus bacteremia in this cohort had an infectious diseases specialist consultation. Infectious diseases consultation was independently associated with a reduction in 28-day mortality. Routine infectious diseases consultation should be considered for patients with S. aureus bacteremia, especially those with higher severity of illness or multiple co-morbidities.