No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Christmas and New Year as risk factors for death
Abstract
This paper poses three questions: (1) Does mortality from natural causes spike around Christmas and New Year? (2) If so, does this spike exist for all major disease groups or only specialized groups? (3) If twin holiday spikes exist, need this imply that Christmas and New Year are risk factors for death? To answer these questions, we used all official U.S. death certificates, 1979-2004 (n = 57,451,944) in various hospital settings to examine daily mortality levels around Christmas and New Year. We measured the Christmas increase by comparing observed deaths with expected deaths in the week starting on Christmas. The New Year increase was measured similarly. The expected number of deaths was determined by locally weighted regression, given the null hypothesis that mortality is affected by seasons and trend but not by holidays. On Christmas and New Year, mortality from natural causes spikes in dead-on-arrival (DOA) and emergency department (ED) settings. There are more DOA/ED deaths on 12/25, 12/26, and 1/1 than on any other day. In contrast, deaths in non-DOA/ED settings display no holiday spikes. For DOA/ED settings, there are holiday spikes for each of the top five disease groups (circulatory diseases; neoplasms; respiratory diseases; endocrine/nutritional/metabolic diseases; digestive diseases). For all settings combined, there are holiday spikes for most major disease groups and for all demographic groups, except children. In the two weeks starting with Christmas, there is an excess of 42,325 deaths from natural causes above and beyond the normal winter increase. Christmas and New Year appear to be risk factors for deaths from many diseases. We tested nine possible explanations for these risk factors, but further research is needed.
... Similar observations were later made in other studies: the peaks in the number of deaths due to heart disease occurred at Christmas and the New Year, and between these holidays, mortality decreased for two to three days (Phillips et al. 2004). Comparison of holiday losses revealed that the largest peak in mortality occurs at Christmas, followed by the New Year, and then, with a significant distinction, four more holidays (Thanksgiving Day, Independence Day, Labour Day and Memorial Day (Phillips et al. 2010)). A similar phenomenon was observed in Europe, for example, in England (Newcastle): in 1986-2000 at the New Year, but not at Christmas, mortality from cardiovascular and respiratory diseases increased. ...
... As noted above, excess mortality during the New Year and Christmas holidays was also recorded in a number of countries of Western culture, including the United States, where cardiovascular mortality, as in Russia, was dominant (Phillips et al. 2004;Phillips et al. 2010). The difference was that the rise in excess mortality in the United States revealed itself in two short peaks of one to two days in length, with declines in between. ...
... In some cases, a small increase in mortality begins a few days before the start of the holiday (such dynamics are observed for external reasons and in the middle age group; Fig. 5 and 7), but a sharp increase is observed only on January 1 (Fig. 2, 4, 5, 7). A similar picture is shown in other studies, both in Russia (Barabash et al. 2010) and abroad (Milne 2005;Phillips et al. 2004;Phillips et al. 2010;Bridges 2004;Bergen and Hawton 2007). Some of the observations are surprising. ...
Statistics show that in many countries of the world holidays are associated with an increase in morbidity and mortality; this is especially pronounced during the New Year and Christmas period. This article presents an estimate of the excess number of deaths in Russia during the January holidays in 2011–2019 by main classes of causes of death and by age groups.
The study relies on the Rosstat dataset of 16.83 million individual non-personalized death records referring to 2011–2019. The authors of the paper estimate excess mortality for each cause and age group as the difference between actually observed mortality and the LOWESS moving average calculated for non-holiday period, extrapolated to the holidays.
The calculations showed that the period of excess mortality lasted from January 1 to January 22 with a maximum on January 1. Over 22 days, excess mortality in 2011–2019 amounted to 89.0 thousand cases or 8.4% in relation to mortality on non-holidays; excess mortality on January 1 amounted to 11.4 thousand cases. In contrast to mortality from diseases of the circulatory, respiratory, and digestive systems, the contribution of which to excess mortality was proportional to their prevalence on non-holidays, proportion of excess mortality from external causes almost doubled (23.6% versus 12.7 % on weekdays). January 1 saw the highest excess mortality from external causes, including that of alcohol poisoning, homicide, and suicide, in all age groups; on January 2 the highest increase was observed in mortality from diseases of the circulatory system; on January 9 and 10 — from the pathologies of the respiratory and digestive systems.
January holidays in Russia are associated with significant excess mortality, primarily as a result of the abuse of strong alcoholic beverages. Informing the population about the fatal consequences of such a consumption regime and a decrease in the availability of strong alcohol, the maximum sales of which falls on December, can reduce the damage during the January holidays.
... Public Health 2020, 17, 35 2 of 10 physical environment, but might also have a social component [3]. This explanation would support the fact that an increase in homicide rates has been reported on and around special dates, such as events or holidays such as Christmas, New Year, and Thanksgiving [4,[6][7][8][9][10]. ...
... This suggests that people tend to have more social interactions along with more recreational activities on those dates, thereby creating more spaces for socializing where violent conflicts that may involve criminal behavior could be generated, which could be reinforced by the presence of other risk conditions such as consumption of more alcoholic beverages [6]. In addition, these events could result in more fatalities, given that the availability and quality of medical care on these days tends to decrease, since many health professionals do not work on holidays [9]. ...
... A change in routine activities could help to explain an increase in homicides during Carnival for both men and women, as well as the association between homicides and other holidays such as Christmas and New Year, which has previously been reported [21]. Other crimes committed on those days have also been reported [20], and these holidays have therefore been considered a risk factor for overall mortality [9], and particularly for deaths from cardiac causes [22,23]. Nevertheless, Mother's Day has only been associated with suicides in Mexico [24]. ...
Homicides are currently the third leading cause of death among young adults, and an increase has been reported during holidays. The aim of the present study was to explore whether an association exists between Carnival in Barranquilla, Colombia, and an increase in homicides in the city. We used mortality records to identify the number of daily homicides of men and women throughout the week of Carnival, and we compared those with records from all of standard days between 1 January 2005 and 31 December 2015. Conditional fixed-effects models were used, stratified by time and adjusted by weather variables. The average number of homicides on Carnival days was found to be higher than on a standard day, with an OR of 2.34 (CI 95%: 1.19–4.58) for the occurrence of at least one male homicide per day during Carnival, and 1.22 (CI 95%: 1.22–7.36) for female homicides, adjusted by weather variables. The occurrence of homicides during Carnival was observed and was similar to findings for other holidays. Given that violence is a multifactorial phenomenon, the identification of the factors involved serves as a basis for evaluating whether current strategies have a positive effect on controlling it.
... A study in Canada also indicated that holidays are a dangerous period for patients with stroke [14]. Various studies have shown that mortality of cardiac patients is higher during New Year holidays [15,16]. Other studies have shown that deaths during holidays in emergency departments [17] and critical care units [18] are more frequent than during normal working days. ...
... In another study, death during Christmas and New Year holidays occurred among men more than women due to accidents and violence [26]. A study found that substance abuse and external causes (accidents, suicide and murder) were the causes of male deaths during holidays [16], which is consistent with the present study. This could be due to the greater number of men on the roads compared to women, carelessness, drowsiness, rush to reach the destination and the prevalence of riskier behaviours among males. ...
... The most deaths were in the 60-79 years age group (29.20%). A study showed that most of the dead were aged 20-39 years [16]. Another study showed that most heart patients died on vacation at the age of 20-30 years [11], which contradicted the results of this study which could be due to crashes during the Nowruz holiday, as most travels are family-related during these days, and people aged between 60 and 79 years are more vulnerable to injury. ...
Background:
Nowruz holidays, as one of the most important holidays in Iran, can lead to changes in the trend of hospital deaths. Due to changes in lifestyle and increased accidents, hospitals become crowded during the holidays. The present study aimed to investigate the effect of Nowruz holidays on hospital deaths at teaching hospitals affiliated with the Kerman University of Medical Sciences in southeast Iran.
Methods:
The research population included all hospital deaths during the period from 23 August 2013 to 21 September 2016. Data on hospital deaths, including age, sex, work shift, cause of death and ward type were collected daily from the Hospital Information System. Data were analysed using t test and time series regression models, in Stata 13.0.
Results:
The holiday deaths primarily occurred in males (57.14%) and people aged 60-79 years (29.20%). More than half of the holiday deaths occurred in the morning shift (59.88%). The leading cause of holiday deaths was injuries, poisoning and other consequences of external causes (25.31%). Most holiday deaths occurred in the ICU (53.88%). Death rate per day during the Nowruz holidays was higher than it was during working days and non-Nowruz holidays (1.36%).
Conclusions:
Reduced quality of services during the holidays is a prominent issue and leads to increased hospital death. Hospital managers can improve the quality of services, by identifying the root causes and by taking measures such as increased and balanced distribution of human resources, equipping hospitals and improving supervision during holidays.
... According to the findings of an American study analyzing data of a 25-year period, both Christmas and New Year's Eve are risk factors for mortality (Phillips et al., 2010). The increase in mortality was observable in a number of disease groups, including circulation disorders, tumors, respiratory diseases, and endocrine and metabolic disorders. ...
... Christmas as a cardiovascular risk factor (Phillips et al., 2004(Phillips et al., , 2010: ...
Objectives
Risk factors for stroke include psychological effects, such as depression. Festive occasions (such as Christmas in Hungary) may carry a significant emotional impact and may therefore contribute to increased cardiovascular risk. Thrombolytic treatment of acute ischemic stroke has a narrow time window and allows for the precise assessment of stroke incidence.
Materials & Methods
We analyzed anonymized national data of the number of thrombolytic treatments for acute ischemic stroke and the number of stroke‐related deaths between 1 January 2007 and 31 December 2016 in Hungary within 2‐day, 5‐day, and 1‐month periods preceding and following 24 December each year. Analysis of subgroups based on age (below and over 65 years) and sex was also performed.
Results
The number of thrombolytic treatments was higher in all three periods preceding Christmas compared to the corresponding period that follows the feast. This increase was particularly prominent in men below 65 years of age. While overall stroke‐associated mortality was increased 1 month after Christmas, the death rate was higher a month before rather than after Christmas in men below 65 years of age and in women both below and over 65 years of age 5 days before Christmas.
Conclusions
These findings may predominantly relate to emotional and psychological factors. In case of women, the anxiety secondary to festive preparations, while in men below 65 years, the increased psychological stress of providing financial security for the celebration may play an important role.
... Christmas and New Year's holidays are known to be risk factors for hospitalized patients. In fact, previous studies showed that this time of the year is associated with unfavorable healthrelated outcomes, and this has in turn been ascribed to factors affecting disease burden and/or to reduced staffing levels, work overload and fragmented care [1][2][3][4]. However, these factors may only partially explain the observed negative outcomes, as their causative effect has never been demonstrated. ...
... This had been evident for particular patient groups. For example, terminally ill patients may prefer to be home, rather than hospitalized, especially around Christmastime and New Year's Eve, and this "displacement" hypothesis [1] has been inferred for cancer patients, on the basis of the lower in-hospital mortality found in these patients over this period [2]. ...
Background:
Christmas and New Year's holidays are risk factors for hospitalization, but the causes of this "holiday effect" are uncertain. In particular, clinical complexity (CC) has never been assessed in this setting. We therefore sought to determine whether patients admitted to the hospital during the December holiday period had greater CC compared to those admitted during a contiguous non-holiday period.
Methods:
This is a prospective, longitudinal study conducted in an academic ward of internal medicine in 2017-2019. Overall, 227 consecutive adult patients were enrolled, including 106 cases (mean age 79.4±12.8 years, 55 females; 15 December-15 January) and 121 controls (mean age 74.3±16.6 years, 56 females; 16 January-16 February). Demographic characteristics, CC, length of stay, and early mortality rate were assessed. Logistic regression analyses for the evaluation of independent correlates of being a holiday case were computed.
Results:
Cases displayed greater CC (17.7±5.5 vs 15.2±5.9; p = 0.001), with greater impact of socioeconomic (3.51±1.7 vs 2.9±1.7; p = 0.012) and behavioral (2.36±1.6 vs 1.9±1.8; p = 0.01) CC components. Cases were also significantly frailer according to the Edmonton Frail Scale (8.0±2.8 vs 6.4±3.1; p<0.001), whilst having similar disease burden, as measured by the CIRS comorbidity index. Age (OR 1.02; p = 0.039), low income (OR 1.97, 95% CI 1.10-3.55; p = 0.023), and total CC (OR 1.06; p = 0.014) independently correlated with the cases. Also, cases showed a longer length of stay (median 15.5 vs 11 days; p = 0.0016) and higher in-hospital (12 vs 4 events; p = 0.021) and 30-day (14 vs 6 events; p = 0.035) mortality.
Conclusions:
Patients hospitalized during the December holiday period had worse health outcomes, and this could be attributable to the grater CC, especially related to socioeconomic (social deprivation, low income) and behavioral factors (inappropriate diet). The evaluation of all CC components could potentially represent a useful tool for a more rational resource allocation over this time of the year.
... Additionally, another study in Los Angeles showed that Christmas and New Year are risk factors for hospital deaths. Several factors, including psychological stress, preferring to be with the family, increased travel, physicians' leave, cold weather, etc., could have affected the results of this research (Phillips et al. 2010). A study in Canada showed that holidays are a dangerous period for stroke (CVA) patients due to different resources, expertise, or the number of health care providers on weekends (Saposnik et al. 2007). ...
... Lack of human resources and access to specialists were other factors that affected the quality of services during the holidays. As shown by one study, deaths during holidays could be due to lower quality of services, reduction in the number of physicians, nurses, and other medical staff, an increase in the number of emergency patients, psychological stress, and lack of prompt treatment follow-up by patients (Phillips et al. 2010). Another study showed that deaths during holidays could be due to reduced medical care (Milne 2005). ...
Aim
Iranian New Year, with long consecutive holidays, although it is celebrated and enjoyed, might influence the quality of services provided by hospitals. The present study explores the quality of hospital services during the New Year holiday.
Subjects and methods
Purposeful semi-structured interviews with 27 nurses working in teaching hospitals of Kerman University of Medical Sciences on the basis of inclusion criteria were used to collect the data. Content analysis through the 7-step Colaizzi approach was used for data analysis.
Results
Eight subthemes under three themes of increased number of patients, factors relating to human resources, and hospital factors were used to assess hospital services status during the Iranian New year holiday.
Conclusion
During long holidays, hospitals are faced with a reduction in manpower and increase in workload, which along with lack of adequate supervision often may lead to an increase in medical errors. Thus, long holidays can be regarded as a risk factor for hospital mortality and morbidity. Hospital authorities around the world should arrange actions in order to reduce the effects.
... There is a smaller body of work on winter peaks in infant mortality before the twentieth century. In particular, the hypothermia hypothesis suggests that neonatal mortality increased in cold periods (Dalla-Zuanna andRosina 2009, 2011;see also Derosas 2009, 2010and Dalla-Zuanna and Rosina 2010. Analyzing historical data from a cold-winter climate, Åström et al. (2016) find that warmer spells are associated with lower mortality. ...
... There may be synergistic effects of temperature and humidity (Lowen et al. 2007, Mäkinen et al. 2009, Shaman and Kohn 2009, te Beest et al. 2013). In the United States, mortality peaks coincide with the Christmas and New Year's holidays, which occur during the northern hemisphere winter (Phillips et al. 2004(Phillips et al. , 2010. However, Christmas effects on cardiovascular mortality also occur in New Zealand, where the holiday falls in the summertime (Knight et al. 2016). ...
In temperate climates, mortality is seasonal with a winter-dominant pattern, due in part to pneumonia and influenza. Cardiac causes, which are the leading cause of death in the United States, are also winter-seasonal although it is not clear why. Interactions between circulating respiratory viruses (f.e., influenza) and cardiac conditions have been suggested as a cause of winter-dominant mortality patterns. We propose and implement a way to estimate an upper bound on mortality attributable to winter-dominant viruses like influenza. We calculate 'pseudo-seasonal' life expectancy, dividing the year into two six-month spans, one encompassing winter the other summer. During the summer when the circulation of respiratory viruses is drastically reduced, life expectancy is about one year longer. We also quantify the seasonal mortality difference in terms of seasonal "equivalent ages" (defined herein) and proportional hazards. We suggest that even if viruses cause excess winter cardiac mortality, the population-level mortality reduction of a perfect influenza vaccine would be much more modest than is often recognized.
... Their research group also expressed that the large scale celebrations at the time of Y2 K were responsible for a higher rate of ischemic deaths seen that year compared to other years [17]. A change in attitude, lack of normal exercise, poor dietary habits, and postponing medical care during the holiday season probably play just as important a role [18][19][20]. Holiday drinking and weekend binge drinking have been associated with arrhythmic episodes whereas chronic alcohol use is associated with development of cardiomyopathy and HF [20][21][22]. ...
... There has been evidence of increased cardiac morbidity and mortality during the winter months [10,[12][13][14][15][16][17][18][19]. Our monthly variations in heart failure shows a similar overall trend with more HF admissions during winter and lesser admissions during warmer months. ...
Introduction
Studies suggest increased cardiac morbidity and heart failure exacerbations during winter months with a peak around the holiday season. Major sporting events and intense encounters in sports have been shown to affect cardiovascular outcomes amongst its fans.
Methods
All patients admitted to Einstein Medical Center between January 1, 2003 and December 31, 2013 with a diagnosis of congestive heart failure were included in the study. They were included on the basis of the presence of an ICD-9CM code representing congestive heart failure as the primary diagnosis. Comparisons were made between the rates of heart failure admissions on the holiday, 4 days following the holiday and the rest of the month for 5 specific days: Christmas day, New Year’s day, Independence day, Thanksgiving day and Super Bowl Sunday.
Results
Our study included 22,727 heart failure admissions at an average of 5.65 admissions per day. The mean patient age was 68 ± 15 years. There was a significant increase in daily heart failure admissions following Independence day (5.65 vs. 5; p = 0.027) and Christmas day (6.5 vs. 5.5; p = 0.046) when compared to the rest of the month. A history of alcohol abuse or dependence did not correlate with the reported+ rise in heart failure admissions immediately following the holidays. The mean number of daily admissions on the holidays were significantly lower for all holidays compared to the following 4 days. All holidays apart from Super Bowl Sunday demonstrated lower admission rates on the holiday compared to the rest of the month.
Conclusion
Christmas and Independence day were associated with increased heart failure admissions immediately following the holidays. The holidays themselves saw lower admission rates. Overeating on holidays, associated emotional stressors, lesser exercise and postponing medical around holidays may be among the factors responsible for the findings.
... 25,26 Increased risk of death has also been reported in relation to some specific time periods, for example when trainee/inexperienced doctors are on duty, at the weekend, and across the Christmas and New Year periods. [27][28][29] These studies confirm the presence of the temporal patterns in deaths; however, to our knowledge, no study has examined whether or not and how these patterns are affecting end-of-life care. ...
... These were consistent with previous studies on seasonal and cyclic patterns in mortality. [24][25][26][27][28] The mechanisms and the drivers of these patterns are beyond the scope of this report but should be topics for future explorations. These newly identified temporal patterns offer opportunities for health-care professionals, policy-makers and decision-makers to rethink our service structure and service organisations. ...
Place of death (PoD) has been used as an outcome measure for end-of-life care. Analysis of variations in PoD can improve understanding about service users’ needs and thus better target health-care services.
Objectives
(1) To describe PoD in England by demographic, socioeconomic and temporal variables; (2) to determine how much of the variation in PoD can be explained by potential explanatory variables at the area level, and building on this to develop individual-level multivariable regression models; and (3) to evaluate factors associated with PoD and to construct risk assessment models to inform practice.
Methods
A population-based study of all registered deaths between 1984 and 2010 in England (
n
= 13,154,705). The outcome was the PoD. Explanatory variables included age, gender, cause of death (CoD), marital status, year of death, whether or not the death was in a holiday period (Christmas, Easter, New Year), season of death, the location of usual residence and area-level deprivation. The proportion of explained variation in PoD was estimated using the weighted aggregate-level linear regression. Factors associated with PoD were investigated using generalised linear models. The risk assessment models were constructed using the 2006–9 data; the performance was evaluated using the 2010 data.
Results
Hospital was the most common PoD in 2001–10 [overall 57.3%; range – cancer 46.1% to chronic obstructive pulmonary disease (COPD) 68.3%], followed by home [overall 19.0%; range – cerebrovascular disease (CBD) 6.7% to cardiovascular disease 27.4%] or care home (overall 17.2%; range – cancer 10.1% to neurological conditions 35.2%), depending on CoD. Over the period, the proportion of hospital deaths for people who died from non-cancer increased (57.1–61.2%) and care home deaths reduced (21.2% down to 20.0%); a reverse pattern was seen for those who died of cancer (hospital: reduced, 48.6–47.3%; care home: increased, 9.3–10.1%). Hospice deaths varied considerably by CoD (range – CBD 0.2% to cancer 17.1%), and increased slightly overall from 4.1% in 1993–2000 to 5.1% in 2001–10. Multivariable analysis found that hospital deaths for all causes combined were more likely for people aged 75+ years [proportion ratios (PRs) 0.863–0.962 vs. aged 25–54 years], those who lived in London (PRs 0.872–0.988 vs. North West), those who were divorced, single and widowed (PRs 0.992–1.001 vs. married), those who lived in more deprived areas (PRs 0.929–1.000 more deprived vs. less deprived) and those who died in autumn, winter or at New Year. We were able to develop risk assessment models but the areas under the receiver operating characteristic curve indicating poor predictive performance, ranging from 0.552 (COPD) to 0.637 (CBD).
Conclusions
Hospital remains the most common PoD, followed by home and care home. Hospices play an important role for people who died from cancer but little for other diseases. Place of death is strongly associated with the underlying CoD. The variation in PoD by region, age, marital status and area deprivation suggests that inequities exist, which services and clinical commissioning groups could seek to address.
Funding
The National Institute for Health Services and Delivery Research programme.
... Several empirical studies have searched for evidence of deviations from expected mortalitydnamely spikes or dipsdon or around holidays and birthdays, and they have found mixed evidence (Phillips and Smith, 1990;Young and Hade, 2004;Williams et al., 2011;Skala and Freedland, 2004;Reulbach et al., 2007;Abel and Kruger, 2009;Phillips et al., 2010;Ajdacic-Gross et al., 2012). Some studies have found mortality dips before holidays and birthdays and spikes on and after those days, while others have found either the opposite or no dips or spikes at all. ...
... Births and deaths are not uniformly distributed throughout the year (Phillips et al., 2010;Healy, 2003;Buckles and Hungerman, 2013). If not properly accounted for, seasonal patterns in births and deaths could be confounded with mortality spikes or dips on or around birthdays (e.g., if more people were born in January, and at the same time, people were more likely to die in January, regardless of their month of birth). ...
This study estimates average excess death rates on and around birthdays, and explores differences between birthdays falling on weekends and birthdays falling on weekdays. Using records from the U.S. Social Security Administration for 25 million people who died during the period from 1998 to 2011, average excess death rates are estimated controlling for seasonality of births and deaths. The average excess death rate on birthdays is 6.7% (p < 0.0001). No evidence is found of dips in average excess death rates in a ±10 day neighborhood around birthdays that could offset the spikes on birthdays. Significant differences are found between age groups and between weekend and weekday birthdays. Younger people have greater average excess death rates on birthdays, reaching up to 25.4% (p < 0.0001) for ages 20–29. Younger people also show the largest differences between average excess death rates on weekend birthdays and weekday birthdays, reaching up to 64.5 percentage points (p = 0.0063) for ages 1–9. Over the 13-year period analyzed, the estimated excess deaths on birthdays are 4590.KeywordsTiming of deathDeath on birthdaysDeath on weekends
... An augmentation of deaths at Christmas, especially due to reasons related to cardiac conditions, was found in several studies. [24][25][26] Phillips et al 24 observed 1023 more deaths from diseases of the circulatory system at Christmas, while cancer deaths declined slightly by 0.8%, when all settings were considered. There was almost no deviation from the expected number of cancer deaths at New Year. ...
... The authors discussed several explanations, such as increased respiratory diseases, emotional stress and staff shortages. [24][25][26] A similar peak at Christmas was not found in the data analysed by Milne, 27 but rather on New Year's Day. Shimizu and Pelham 14 observed a decrease and postponement of deaths at Christmas in adults living in the USA. ...
To determine if people dying from cancer are able to prolong their own life in order to experience a certain biographical event, or whether the appearance of such an occasion leads to increased deaths before the event.
We compared numbers of cancer deaths during a period of 1 week before and after biographically important occasions, which were birthday, Christmas and Easter. As a psychogenic postponement or hastening of death is most likely in chronic diseases (as opposed to accidents or cardiovascular events), we included cancer deaths only. We estimated relative risks (RRs) with their corresponding Bonferroni corrected CIs to assess effects of biographical events. All registered cancer deaths in Germany from 1995 to 2009 were included (3 257 520 individual deaths). Numbers of deaths were corrected for seasonality.
Considering all cases, there were noticeably more deaths than expected in the week preceding Christmas, leading to an RR of dying after the event of 0.987 (CI 0.978 to 0.997). Estimates indicating a hastening of death were consistent over several subgroups. Other occasions showed inconsistent results, especially there was no convincing postponement effect in our data.
While there is no evidence of different death numbers before and after Easter and birthdays, the appearance of Christmas seems to increase deaths.
... Data from daily death certificates (D t ) were combined with population estimates (N t ) to produce daily mortality rates (R t ); Figure 1 illustrates the daily mortality rate during the years 2014-2018 in Puerto Rico. This graph indicates that the first and last months of each year generally have the highest death rates a pattern commonly seen in other locations (Phillips et al., 2010). On the other hand, Figure 1 displays a drastic spike in mortality ...
The Covid-19 pandemic as well as other recent natural emergencies have put the spotlight on emergency planning. One important aspect is that natural disasters or emergencies often lead to indirect
deaths and studying the behavior of indirect deaths during emergencies can guide emergency planning.
While many studies have implied a large number of indirect deaths in Puerto Rico due to Hurricane
Maria; the specific causes of these deaths have not being carefully studied. In this paper, we use a
semiparametric model and mortality data to evaluate cause of death trends. Our model adjusts for cause
of death effect potentially varying over time while also inferring on how long excess deaths occurred.
From September 2017 to March 2018, after adjusting for intra-annual variability and population displacement, we find evidence of significant excess deaths due to Alzheimer's/Parkinson, heart disease, sepsis, diabetes, renal failure, and pneumonia & influenza. In contrast, for the same time period we find
no evidence of significant excess deaths due to cancer, hypertension, respiratory diseases, cerebrovascular disease, suicide, homicide, falling accidents and traffic accidents.
... A holiday effect of hesitancy to seek medical care has previously been supported in the literature [23,24]. In fact, an analysis of 25 years of data from the USA showed that rates of emergency room deaths and dead-on-arrival presentations to emergency rooms consistently spike on Christmas and New Years' day and no other days of the year [25], supporting a hypothesis that many patients choose to avoid/delay medical care at the holiday season at all costs. The COVID-19 pandemic was shown to exert multifaceted effects on mental health. ...
Decreases in acute stroke presentations have been reported during the coronavirus disease 2019 (COVID-19) pandemic surges. A recent study by Bojti et al. (GeroScience. 2021;43:2231–2248) sought to understand the relationship of public health mandates in Hungary as they were implemented with acute ischemic stroke admissions and interventions during two separate COVID-19 waves. We sought to perform a similar analysis of changes in ischemic stroke care at two distinct medical institutions in the USA. Two separate institutions and systems of ischemic stroke care were evaluated through a regional comprehensive stroke center telestroke service and a Veterans Affairs (VA) inpatient stroke and neurorehabilitation service. Telestroke consultations in a single system in Chicago, IL, were significantly decreased during the first COVID-19 wave during severely restricted public health mandates (z-score < − 2), and were less depressed during a subsequent wave with less severe restrictions (z-score approaching − 1), which resembles findings in Hungary as reported by Bojti et al. In contrast, inpatient admissions during the first and second COVID-19 waves to a VA stroke and neurorehabilitation service in Oklahoma City remained unchanged. The Chicago and Hungary patterns of stroke presentations suggest that public perceptions, as informed by regional health mandates, might influence healthcare-seeking behavior. However, the VA experience suggests that specific patient populations may react differently to given public health mandates. These observations highlight that changes in stroke presentation during the COVID-19 pandemic may vary regionally and by patient population as well as by the severity of public health mandates implemented. Further study of COVID-19-related public health policies on acute stroke populations is needed to capture the long-term impact of such policies. Learning from the real-time impact of pandemic surges and public health policy on presentation of acute medical conditions, such as ischemic stroke, may prove valuable for designing effective policies in the future.
... Besides, many individuals may engage in "comfort eating", alcohol consumption, and sedentary activities in a holiday to cope with their stress levels, and these unhealthy behaviors are closely related to deterioration of tumor conditions [32]. Third, Phillips et al. reported that the top three disease groups with a spiking mortality during Christmas and New Year holidays are circulatory diseases, neoplasms, and respiratory diseases [33]. This observation is in accordance with our findings that the Spring Festival may be a risk factor for death and treatment failure for patients with NPC. ...
Abstract Background The impact of radiotherapy interruption due to the Spring Festival holidays in China on the survival of patients with nasopharyngeal carcinoma (NPC) is unclear. Methods Nontrial patients with locoregionally advanced NPC receiving radiotherapy plus induction chemotherapy (IC) and/or concurrent chemotherapy (CC) were included (N = 5035) and divided into two groups based on the Spring Festival-induced radiotherapy interruption. Kaplan–Meier curves for overall survival (OS) and failure-free survival (FFS) were compared between rival groups. Impact of the timing of radiotherapy interruption (during or outside the Spring Festival) on survival was investigated in a propensity score-matched dataset. We adopted ordination correspondence analysis to determine the cut-off of radiotherapy prolongation for prognostic prediction, and accordingly performed subgroup analysis based on delayed days and chemotherapy details. Individual patient data of three phase III NPC trials (NCT00677118, NCT01245959, NCT01872962) were used for validation (N = 1465). Results Radiotherapy interruption was most frequently observed between December to January of the following year. Significantly lower OS and FFS were associated with the Spring Festival-induced interruption of radiotherapy (P = 0.009 and 0.033, respectively), but not that interruption of IC. In two matched comparison groups, the timing of radiotherapy interruption during the Spring Festival was more likely to lead to a decrease in FFS than outside the Spring Festival (P = 0.046), which was not observed in the validation using clinical trial data or in the subgroup analysis based on the 5-day delayed time. The absence of CC and the accumulated dose of cisplatin
... One example pertains to individuals at the end of their lives who form intentions to survive up to certain events, such as the holiday of Passover, Thanksgiving, Christmas, their birthdays, or the beginning of the 20 th century. Whereas some research shows that such intentions could indeed result in survival up to the respective events (Phillips & King, 1988;Shimizu & Pelham, 2008;Sinard, 2001), other research does not support this claim (Phillips et al., 2010). ...
The rapid increase in human life expectancy during the last decades sees many individuals confronted with the prospect of living a very long life. Whereas advances in life expectancy are often being celebrated in scientific communities, it is still largely unclear to what extent individuals embrace the prospect of a long life and wish to reach a very old age. To address this issue, the present dissertation focuses on the construct of ideal life expectancy, which can be defined as a personal desire regarding the length of one’s life. Understanding personal ideal life expectancies, and the antecedents, processes, and consequences surrounding them, is particularly important when assuming that individuals’ beliefs, choices, and behavior can affect their aging process and actual length of life. Within the general introduction of this dissertation (see Chapter 1), the construct of ideal life expectancy is embedded in the theoretical frameworks of self-discrepancy theory and the psychology of life-longings. With this, it is highlighted that individual ideal life expectancies constitute self-related ideals, which can and often do diverge from perceptions of reality (i.e., perceived life expectancies). Indeed, many individuals seem to wish for a life longer than the one they anticipate, express a certain dissatisfaction with the length of their life, and experience a phenomenon we have labeled as subjective life expectancy discordance (i.e., the discordance between ideal and perceived life expect-ancy). In all this, ideal life expectancy is however a construct with considerable interindividual differences and it is scarcely understood why some individuals consider their perceived life expectancy ideal, whereas others would opt for rather short or unrealistically long lives. The central research questions of this dissertation focus on the contexts and experiences (i.e., culture, age, health, and the coronavirus pandemic) as well as personal belief systems and mindsets regarding living, aging, and death that can determine individual ideal life expectancies. Furthermore, it is addressed how processes of anticipation, evaluation, and contrasting likely surround the immediate formation of ideal life expectancies. When forming their ideal life expectancy, individuals need to rely on more general anticipations of their personal life in old age as well as the specific anticipation of perceived life expectancy. Individuals can then evaluate those anticipations as (un-)desirable, (un-)acceptable, or even threatening (cf. aging-related fears) and can be encouraged or discouraged to wish for a certain life expectancy. Consequently, individuals are free to actively decide on an ideal life expectancy that is in concordance and acceptance of their anticipations, or in discordance and in contrast to their anticipations. Here, it is studied how certain aging-related fears as well as general anticipations of the future relate to ideal life expectancies. Lastly, affective and behavioral consequences of individual ideal life expectancies are investigated. Particularly, it is assumed that (strong) discordances between perceived and ideal life expectancies can stimulate health behavior change, but also negatively affect psychological well-being and foster experiences of dissatisfaction and despair. The specific research questions have resulted in four empirical research papers gathered in this cumulative dissertation. Paper #1 (see Chapter 2) summarizes prior research on longevity motivation and identifies three common belief systems and mindsets: The essentialist mindset idealizes an infinite life and aims at conquering or halting a biologically determined aging process. The medicalist mindset evaluates aging based on health and sees longevity as burdened only when pathology occurs. The stoicist mindset is a mindset of acceptance, which tolerates the challenges and vulnerabilities of the aging process as long as dignity and meaning can be preserved. The mindsets are then empirically explored in regard to the construct of ideal life expectancy. Results indicate that culture, self-rated health, and death acceptance act as potential determinants of ideal life expectancy. Additionally, the interplay of perceived and ideal life expectancy is able to predict health behavior change. Lastly, ideal life expectancy and its discordance to perceived life expectancy are established as stable and reliable constructs. Paper #2 (see Chapter 3) targets the relationship between ideal and perceived life expectancy more explicitly. Results indicate that average ideal life expectancies lie cleary above average perceived life expectancies and that most individuals would strive for a longer life than they anticipate. This experience of subjective life expectancy discordance seems to ease in old age, when ideal and perceived life expectancies become more concordant. In line with predictions of self-discrepancy theory, a stronger subjective life expectancy discordance was negatively related to different aspects of psychological well-being. Over the time span of two years, subjective life expectancy discordance predicted increases in negative affect. Additionally, subjective life expectancy discordance contributed to another form of subjective aging discordance: Individuals wishing to live longer than they anticipated to, also wished to be younger again than they perceived themselves to be. Thus, a discordance and dissatisfaction regarding the future aging process and length of life seemed to predict a discordance and dissatisfaction regarding the current aging process. Paper #3 (see Chapter 4) investigates a number of psychological constructs targeting the finitude of life (i.e., future time perspective with its three subcomponents future time opportunity, extension, and constraint, fear of death, and ideal life expectancy) in times of the coronavirus pandemic. Whereas the research indicates that future time perspectives decreased over the course of the pandemic and that fear of death peaked at its beginning, ideal life expectancies remained surprisingly stable throughout the pandemic. Ideal life expectancies thus seem to be shaped by more enduring contexts and experiences (e.g., health state and socioeconomic status) rather than momentary and transitory ones. Furthermore, it is explored how ideal life expectancy relates to the other psychological constructs of finitude: Next to the respective cross-sectional relations, higher ideal life expectancy seemed predictive of increases in future time opportunity, future time extension, and fear of death, leading up to the topic of the fourth publication. Paper #4 (see Chapter 5) focuses on the role of aging-related fears for individual ideal life expectancies. Following predictions of terror management theory, it is assumed that a strong fear of death is related to pushing death into the more distant future and wishing for a longer life. In contrast, fears regarding the aging process, such as the fear of loneliness in old age and the fear of aging-related diseases could color anticipations of aging in such negative and threatening ways that individuals may prefer to avoid those by wishing for a shorter life. Results indicate that differentiations mainly occur in regard to whether individuals would like to reach a very old age. Indeed, a stronger fear of death was related to higher ideal life expectancies and the wish to reach a very old age across two studies. Additionally, individuals fearing loneliness in old age or aging-related diseases while being unafraid of death, wished for particularly short lives. Explicitly negative anticipations of the aging process such as aging-related fears can thus partly explain why individuals wish for longer or shorter lives. In the general discussion (see Chapter 6), the findings of the four research papers are summarized and synthesized. In regard to contexts and experiences, aspects of an individual’s biography such as culture, gender, age, socioeconomic status, and health state seemed decisive for individual ideal life expectancies. In contrast, ideal life expectancies seem rather unaffected by temporary contexts such as the coronavirus pandemic. Three overarching belief systems and mindsets for longevity motivation were identified. Additionally, individuals’ views on death (i.e., fear of death and death acceptance) were associated with ideal life expectancies. Regarding the more immediate formation of ideal life expectancies, reciprocal processes between anticipations of the own aging process and future (e.g., future time perspective) and personal ideal life expectancies can be assumed. Research furthermore supports the assumption that individuals actively differentiate between the more rational anticipation that is perceived life expectancy and the personal desire that is ideal life expectancy. Whereas most individuals wish to live longer than they anticipate, particularly older adults also experience concordance between their ideal and perceived life expectancy. The general discussion also highlights and discusses the finding that a subgroup of individuals wishes to live less long than they anticipate to. Lastly, next to ideal life expectancy’s impact on health behaviors and psychological well-being, there seem to be cognitive consequences in regard to states of acceptance, the envisioning of the future, and potentially, active goal-setting and intention-building. The discussion concludes in an expanded research model and highlights social contexts and relationships, aspects of subjective aging, and the end of life as potential areas for future research surrounding ideal life expectancy. The main implications of this dissertation refer to the reliability and stability of the construct of ideal life expectancy, its embeddedness in the research on self-related ideals and the research on subjective aging, and the more far-reaching content of the identified mindsets of longevity motivation. On a practical level, individual and average ideal life expectancies could affect research questions, medical treatment and decision making, as well as societal views on old and very old individuals. Due to relations to negative psychological well-being and fear of death, the constructs of ideal life expectancy and subjective life expectancy discordance may furthermore be of importance for overall psychopathology. Most importantly, however, this dissertation is able to show that many individuals indeed appreciate the prospect of a long life—a finding that could be utilized to foster a positive but realistic approach to living into very old age.
... In our study, winter was an independent risk factor for death. A previous USA study showed death from all natural causes increased in winter [25], which supports our results. ...
Background
Urinary tract infections (UTI) are common and can have severe consequences. However, there are few recent large-scale studies about them. We aimed to determine the incidence of hospitalization for UTI and to elucidate patient characteristics, clinical practice, and clinical outcomes by drawing on a Japanese nationwide database.
Methods
This was a retrospective observational study using a national database that covers half the acute care inpatients in Japan. Patients aged ≥ 15 years who were hospitalized for UTI were eligible. We did not include patients with lower UTI such as cystitis. We investigated the annual number of patients hospitalized in Japan, those patients’ characteristics, and risk factors for in-hospital mortality.
Results
We identified 232,396 eligible patients from 31 million records of discharge between April 2010 and March 2015. The average age was 73.5 years and 64.9% of patients were female. The estimated annual number of hospitalizations because of UTI was 106,508. The incidence was 6.8 per 10,000 for men and 12.4 for women. The median medical care cost was 4250 USD. In-hospital mortality was 4.5%. Risk factors of poor survival included male sex, older age, lower bed capacity, non-academic hospital, admission in winter, higher Charlson Comorbidity Index score, low body mass index, coma on admission, ambulance use, disseminated intravascular coagulation, sepsis, renal failure, heart failure, cerebrovascular diseases, pneumonia, malignancies, use of anti-diabetic drugs, and use of corticosteroid or immunosuppressive drugs.
Conclusions
We found that older patients of both sexes accounted for a significant proportion of those hospitalized for UTI. The clinical and economic burden of UTI is considerable.
... This last time point occurred during the month of December, which coincides with important family and religious holidays. Within the pediatric oncology setting, healthcare providers often attempt to give patients and families a short respite from hospitalization over such holidays (Phillips, & Brewer, 2010). Patients who are hospitalized during the holidays likely require more time-sensitive or emergent services and close monitoring. ...
Objectives:
To develop an evidence-based compassion fatigue program and evaluate its impact on nurse-reported burnout, secondary traumatic stress, and compassion satisfaction, as well as correlated factors of resilience and coping behaviors.
Sample & setting:
The quality improvement pilot program was conducted with 59 nurses on a 20-bed subspecialty pediatric oncology unit at the St. Jude Children's Research Hospital in Memphis, Tennessee.
Methods & variables:
Validated measures of compassion fatigue and satisfaction (Professional Quality of Life Scale V [ProQOLV]), coping (Brief COPE), and resilience (Connor-Davidson Resilience Scale-2) were evaluated preprogram and at two, four, and six months postprogram, with resilience and coping style measured at baseline and at six months postprogram.
Results:
Secondary traumatic stress scores significantly improved from baseline to four months. Select coping characteristics were significantly correlated with ProQOLV subscale scores.
Implications for nursing:
Ongoing organizational support and intervention can reduce compassion fatigue and foster compassion satisfaction among pediatric oncology nurses.
... [3] Medical care may become worse during the holidays due to decrease in the number of physicians accompanied by increase in the number of patients admitted at this period, these may explain holiday spikes in deaths in the emergency department. [4] It is also found that, patients admitted to the ICU on the weekends and holidays, have a modestly more duration of stay in the ICU, than those admitted on other week days. [5] While overall mortality was similar for patients admitted to many hospitals, the holiday & weekend effect seems to be greater in main teaching hospitals. ...
Background: Medical care may become worse during holidays and weekends, probably, due to decrease in the number of physicians, other health staff, or medical resources, in addition to increase in the number of patients admitted at this period. This may explain the negative impacts on the outcome of patients admitted to the hospital at weekends and holidays.
Aim of study: It is to shed light on the impact of holidays and weekends on the death rates among admissions in the main hospital in the governorate of Misan governorate.
Patients and methods: In this cross-sectional stud, records of all patients admitted to the Al-Sadder teaching hospital in Misan, from the first January 2015 to end December 2015 were reviewed with particular concern of, site and day of admission to the hospital, day of death, and the number of dead individuals, among admissions during holidays and other week days.
Results: A total of 34983 patients admitted to the hospital during one year, (25.4%) of them were admitted on the weekends and public holidays. Among patients in the hospital wards other than labor room & ICU, there was a statistically significant increase in death rate among admissions on the weekends and holidays compared to that on other week days, (3.5% versus 1.9%, P value > 0.0001).All-cause death, in the hospital as a whole, was found to be significantly higher on weekends and holidays than that on the other weekdays. (4.3% versus 2.6% P value > 0.0001).
Conclusion: weekends and holidays have a negative impact on the outcome of hospital admissions as reflected by higher death rates compared to that on the other week days.
... [16][17][18][19][20] Furthermore, studies have shown a peak in cardiac mortality in the Western world on Christmas Day and New Year's holiday, and during Islamic holidays in countries where these are widely celebrated. [21][22][23][24] Sir Winston Churchill is thought to have experienced myocardial infarction while visiting the White House during Christmas 1941. 25 However, most studies have used surrogate variables, such as ...
Objectives
To study circadian rhythm aspects, national holidays, and major sports events as triggers of myocardial infarction.
Design
Retrospective observational study using the nationwide coronary care unit registry, SWEDEHEART.
Setting
Sweden.
Participants
283 014 cases of myocardial infarction reported to SWEDEHEART between 1998 and 2013. Symptom onset date was documented for all cases, and time to the nearest minute for 88%.
Interventions
Myocardial infarctions with symptom onset on Christmas/New Year, Easter, and Midsummer holiday were identified. Similarly, myocardial infarctions that occurred during a FIFA World Cup, UEFA European Championship, and winter and summer Olympic Games were identified. The two weeks before and after a holiday were set as a control period, and for sports events the control period was set to the same time one year before and after the tournament. Circadian and circaseptan analyses were performed with Sunday and 24:00 as the reference day and hour with which all other days and hours were compared. Incidence rate ratios were calculated using a count regression model.
Main outcome measures
Daily count of myocardial infarction.
Results
Christmas and Midsummer holidays were associated with a higher risk of myocardial infarction (incidence rate ratio 1.15, 95% confidence interval 1.12 to 1.19, P<0.001, and 1.12, 1.07 to 1.18, P<0.001, respectively). The highest associated risk was observed for Christmas Eve (1.37, 1.29 to 1.46, P<0.001). No increased risk was observed during Easter holiday or sports events. A circaseptan and circadian variation in the risk of myocardial infarction was observed, with higher risk during early mornings and on Mondays. Results were more pronounced in patients aged over 75 and those with diabetes and a history of coronary artery disease.
Conclusions
In this nationwide real world study covering 16 years of hospital admissions for myocardial infarction with symptom onset documented to the nearest minute, Christmas, and Midsummer holidays were associated with higher risk of myocardial infarction, particularly in older and sicker patients, suggesting a role of external triggers in vulnerable individuals.
... Of this figure, 20 died between June 1 and August 2 (significant p < .01). The true significance may be higher because ordinary US citizens are most likely to die in winter (Bartol, 2011), especially in the two weeks after Christmas (Phillips et al, 2010). This was evident for recent decades and presumably also applied in the 19th and earlier 20th centuries. ...
... As with all routinely acquired data, there is the potential for some miscoding, for example the Paediatric Intensive Care Network Audit reports that there were 1714 unplanned admissions to ITU in Scotland [14] and this compares with 1374 in our study. Deaths out-of-hospital and in emergency departments are increased over Christmas Day, Boxing Day and New Year's Day [15] and we were not able to consider this on our analysis since the date of admission was not available to us, but there are only ten public holidays in Scotland so this is unlikely to have substantially affected the outcomes reported. ...
Mortality is higher for adults admitted to hospital and for babies born on weekends compared to weekdays. This study compares in-hospital mortality and in children admitted to hospital on weekends and weekdays. Details for all acute medical admissions to hospitals in Scotland for children aged ≤16 years between 1st January 2000 and 31st December 2013 were obtained. Death was linked to day of admission. There were 570,403 acute medical admissions and 334 children died, including 83 who died after an admission on Saturday or Sunday and 251 who died following admission between Monday and Friday. The adjusted odds ratio (aOR) for a child dying after admission on a weekend compared to weekday was 1.03 [95% CI 0.80 to 1.32]. The OR for a child admitted over the weekend requiring intensive care unit (ICU) or high dependency unit (HDU) care was 1.24 [1.16 to 1.32], but the absolute number of admissions to HDU and ICU per day were similar on weekends and weekdays. We see no evidence of increased in-hospital paediatric mortality after admission on a weekend. The increased risk for admission to ITU or HDU with more serious illness over weekends is explained by fewer less serious admissions.
... Many factors may contribute to seasonality, including acute respiratory tract infections and death from cardio-vascular diseases in the winter, a direct impact of periods with extreme temperature, and possibly mental and physiological effects (e.g. D-vitamin) related to absence of day-light in winter, as well as social and psychological factors related to Christmas and New Year holidays [1]. However, influenza is recognised as one of the main contributing factors of winter excess mortality. ...
Background
In temperate zones, all‐cause mortality exhibits a marked seasonality, and influenza represents a major cause of winter excess mortality. We present a statistical model, FluMOMO, which estimate influenza associated mortality from all‐cause mortality data and apply it to Danish data from 2010/11 to 2016/17.
Methods
We applied a multivariable time‐series model with all‐cause mortality as outcome, influenza activity and extreme temperatures as explanatory variables while adjusting for time‐trend and seasonality. Three indicators of weekly influenza activity (IA) were explored: Percentage of consultations for influenza‐like illness (ILI) at primary health care, national percentage of influenza‐positive samples, and the product of ILI percentage and percentage of influenza positive specimens in a given week, i.e., the Goldstein index.
Results
Independent of the choice of parameter to represent influenza activity, the estimated influenza associated mortality showed similar patterns with the Goldstein index being the most conservative. Over the seven winter seasons the median influenza associated mortality per 100,000 population was 17.6 (range 0.0‐36.8), 14.1 (0.3 to 31.6) and 8.3 (0.0 to 25.0) for the three indicators, respectively, for all ages.
Conclusion
The FluMOMO model fitted the Danish data well and has the potential to estimate all‐cause influenza associated mortality in near real time, and could be used as a standardised method in other countries. We recommend using the Goldstein index as the influenza activity indicator in the FluMOMO model. Further work is needed to improve the interpretation of the estimated effects.
This article is protected by copyright. All rights reserved.
... was higher than other days. Finally, the researchers concluded that holidays can be considered as a risk factor for many diseases in some age groups(28). A study was conducted in 2010 which examined 24 studies in America, Europe, and Asia. ...
... However, separating them from the longer 3-week period under study would imply that these spikes would be independent of stress, which is highly unlikely. The winter holiday increase in both mortality and MI has been extensively studied, 7,8,11,12,31,32 for which psycho-social stress is probably a partial explanatory factor. Third, the predicted turn of the month increase was consistently nonsignificant. ...
BACKGROUND:
Psychosocial stress might trigger myocardial infarction (MI). Increased MI incidence coincides with recurrent time-periods during the year perceived as particularly stressful in the population.
METHODS:
A stress-triggering hypothesis on the risk of MI onset was investigated with Swedish population data on MI hospital admission date and symptom onset date (N = 156,690; 148,176) as registered from 2006 through 2013 in the national quality registry database Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART). Poisson regression was applied to analyze daily MI rates during days belonging to the Christmas and New Year holidays, turn of the month, Monday, weekend, and summer vacation in July, compared to remaining control days.
RESULTS:
Adjusted Incidence Rate Ratios (IRR) for MI rates were higher during Christmas and New Year holidays (IRR = 1.07 [1.04, 1.09], P < .001) and on Mondays (IRR = 1.11 [1.09, 1.13], P < .001) and lower in July (IRR = 0.92 [0.90, 0.94], P < .001) and over weekends (IRR = 0.88 [0.87, 0.89], P < .001), yet not during the turn of the Month (IRR = 1.01 [1.00–1.02], P = .891). These findings were also predominantly robust with symptom onset as alternative outcome, when adjusting for both established and some suggested-but-untested confounders, and in seven out of eight subgroups.
CONCLUSIONS:
Fluctuations in daily MI incidence rates are systematically related to time periods of presumed psychosocial stress. Further research might clarify mechanisms that are amenable to clinical alteration.
... The first is the excess death rates at Christmas and New Year's Day. The explanation by Phillips and colleagues [1] that the rates may be due to overworked staff at hospital emergency departments seems plausible, but that requires investigation. A second anomaly occurs over days (approximately January . ...
Death rates in the U.S. show a pronounced seasonality. The broad seasonal variation shows about 25% higher death rates in winter than in summer with an additional few percent increase associated with the Christmas and New Year’s holidays. A pronounced increase in death rates also starts in mid-September, shortly after the school year begins. The causes of death with large contributions to the observed seasonality include diseases of the circulatory system; the respiratory system; the digestive system; and endocrine, nutritional, and metabolic diseases. Researchers have identified several factors showing seasonal variation that could possibly explain the seasonal variations in mortality rate. These factors include seasonal variations in solar ultraviolet-B(UVB) doses and serum 25-hydroxyvitamin D [25(OH)D] concentrations, gene expression, ambient temperature and humidity, UVB effects on environmental pathogen load, environmental pollutants and allergens, and photoperiod (or length of day). The factors with the strongest support in this analysis are seasonal variations in solar UVB doses and 25(OH)D concentrations. In the U.S., population mean 25(OH)D concentrations range from 21 ng/mL in March to 28 ng/mL in August. Measures to ensure that all people had 25(OH)D concentrations >36 ng/mL year round would probably reduce death rates significantly.
... Of this figure, 20 died between June 1 and August 2 (significant p < .01). The true significance may be higher because ordinary US citizens are most likely to die in winter (Bartol, 2011), especially in the two weeks after Christmas ( Phillips et al, 2010). This was evident for recent decades and presumably also applied in the 19th and earlier 20th centuries. ...
... In the USA, mortality from natural causes spikes around Christmas and New Year (e.g. Phillips et al. 2010). These are some examples from the literature that demonstrate the role of the calendar in the timing of demographic events. ...
BACKGROUND Calendar time, age and duration are chronological objects. They represent an instant or a time period. Age and duration are usually expressed in units with varying lengths. The number of days in a month or a year depends on the position on the calendar. The units are also not homogeneous and the structure influences measurement. One solution, common in demography, is to use units that are large enough for the results not to be seriously affected by differences in length and structure. Another approach is to take the idiosyncrasy of calendars into account and to work directly with calendar dates. The technology that enables logical and arithmetic operations on dates is available. OBJECTIVE To illustrate logical and arithmetic operations on dates and conversions between time measurements. METHOD Software packages include utilities to process dates. I use existing and a few new utilities in R to illustrate operations on dates and conversions between calendar dates and elapsed time since a reference moment or a reference event. Three demographic applications are presented. The first is the impact of preferences for dates and days on demographic indicators. The second is event history analysis with time-varying covariates. The third is microsimulation of life histories in continuous time. CONCLUSION The technology exists to perform operations directly on dates, enabling more precise calculations of duration and elapsed time in demographic analysis. It eliminates the need for (a) approximations and (b) transformations of dates, such as Century Month Code, that are convenient for computing durations but are a barrier to interpretation. Operations on dates, such as the computation of age, should consider time units of varying length.
... [19] Phillips et al. observed that experienced medical staff often refrains from weekend duties and discourages patients from visiting the hospitals during the weekends. [20] As previously mentioned, religious festivals coinciding with weekdays extend the duration of public holidays in our country, and therefore, their impact becomes more significant due to their extended length. We emphasize that although there is an increase in the volume of patients visiting the emergency department during the holiday period, this increase is not reflected in physicians' requests for laboratory tests and consultations. ...
Objectives
The purpose of this study is to determine the impact of the expected increase in the volume of patient visits in the emergency department during holiday periods on physicians' tendencies regarding test and consultation requests as well as on the length of time patients stay in the emergency department.
Methods
The study groups included all of the patients who visited the emergency department during the nine-day public holiday (Eid al-Adha, a religious festival of sacrifice) celebrations and a nine-day non-holiday “normal” period. The patients' demographic information, reasons for their visits, comorbid diseases, whether or not they had undergone laboratory and screening tests, consultations, length of stay, and the way their visits ended were compared statistically.
Results
Of the 6353 patients enrolled in the study, 3523 (55.5%) were seen in the emergency department during the holiday period, while 2830 (45.5%) were seen during the non-holiday period (p≤0.001). During the holiday period, there was a 1.9% decrease in laboratory test requests (p=0.108), a 7.7% increase in radiology examination requests (p≤0.001), and a 1.2% increase in consultation requests (p=0.063). The patients' length of stay during the holiday period was 55.9±75.3 minutes and was 56.3±71.9 minutes during the non-holiday period (p=0.819). The length of time for the patients who underwent tests or consultations was 88.6±92.8 minutes during the holiday period and 92.6±87.5 minutes during the non-holiday period (p=0.224).
Conclusions
As expected, the number of patient visits to the emergency department increased during the holiday period, but this increase did not lead to a similar increase in test and consultation requests by the physicians, except for radiology examination requests. In addition, the length of time that patients stayed in the emergency department was not affected by the increase in the volume of patient visits during the holiday period.
... " , Santa asks. This is unlikely, as Phillips et al. (2010) show. They measure the Christmas increase of death based on US death certi…cates. ...
Do you believe that at Christmas time the gas prices, the economy and the number of suicides peak? Do you think that the value of presents you are giving to your beloved is of importance? We show in this paper that conventional wisdom about Christmas is often doubtful. Furthermore, we give an idea of how Santa Claus -- and maybe you -- is able to finance Christmas celebrations, why emergency departments are a place to especially avoid during this time of the year and why Christmas tree growers might care to explain the differences across species to you this year. We cannot clearly establish whether Christmas entails a welfare loss or gain, however, we give you an idea as to which institutional settings might reduce a potential welfare loss. Also, we give advice about which behaviours might get you more Christmas presents from Santa this year. Finally, we find that more research is needed to give conclusive reasons why Santa Claus actually brings presents to (nearly) everyone.
... Santa asks. This is unlikely, as Phillips et al. (2010) show. They measure the Christmas increase of death based on US death certi…cates. ...
Do you believe that at Christmas time the gas prices, the economy and the number of suicides peak? Do you think that the value of presents you are giving to your beloved is of importance? We show in this paper that conventional wisdom about Christmas is often doubtful. Furthermore, we give an idea of how Santa Claus –and maybe you –is able to finance Christmas celebrations, why emergency departments are a place to especially avoid during this time of the year and why Christmas tree growers might care to explain the differences across species to you this year. We cannot clearly establish whether Christmas entails a welfare loss or gain, however, we give you an idea as to which institutional settings might reduce a potential welfare loss. Also, we give advice about which behaviors might get you more Christmas presents from Santa this year. Finally, we find that more research is needed to give conclusive reasons why Santa Claus actually brings presents to (nearly) everyone.
... Although a significant reduction in cardiac arrest rates and ICU admissions was found, a major drawback of the study was comparison to historical populations. 20 Of note 73% of the ICU admissions had prior recorded abnormal observations that had warranted a trigger, yet no trigger had been activated. The authors speculated that a lack of "nurse empowerment" may be the reason for this. ...
For critical care to be effective it must have a system in place to achieve optimal care for the deteriorating ward patient. Objectives To systematically review the available literature to assess whether either early warning systems or emergency response teams improve hospital survival. In the event of there being a lack of evidence regarding hospital survival, secondary outcome measures were considered (unplanned ICU admissions, ICU mortality, length of ICU stay, length of hospital stay, cardiac arrest rates).
The Ovid Medline, EMBASE, CINAHL, Web of Science, Cochrane library and NHS databases were searched in September 2012 along with non-catalogued resources for papers examining the effect of early warning systems or emergency response teams on hospital survival. Inclusion criteria were original clinical trials and comparative studies in adult inpatients that assessed either an early warning system or emergency response team against any of the predefined outcome measures. Exclusion criteria were previous systematic reviews, non-English abstracts and studies incorporating paediatric data. Studies were arranged in to sections focusing on the following interventions:Emergency response teams In each section an appraisal of the level of evidence and a recommendation has been made using the SIGN grading system.
[43] studies meeting the review criteria were identified and included for analysis. 2 studies assessed single parameter scoring systems and 4 addressed aggregate weighted scoring systems. A total of 20 studies examined medical emergency teams and 22 studies examined multidisciplinary outreach teams.
The exclusion of non English studies and those including paediatric patients does limit the applicability of this review.
Much of the available evidence is of poor quality. It is clear that a 'whole system' approach should be adopted and that AWSS appear to be more effective than single parameter systems. The response to deterioration appears most effective when a clinician with critical care skills leads it. The need for service improvement differs between health care systems.
... Although it is difficult to pin down why this was happening, there is some previous evidence suggesting that Christmas holidays may actually be associated with decreases in happiness (Kasser & Sheldon, 2002). Christmas and New Year holidays appear to be risk factors for deaths from many diseases (Phillips, Barker, & Brewer, 2010), for higher psychiatric admissions (Velamoor, Cernovsky, & Voruganti, 1999), and suicide attempts (Jessen et al., 1999). Although we can only speculate about the reason for this drop in happiness among the control group, it does not undermine our central finding that meditators did look happier at T2, as observed by strangers. ...
The last decade has witnessed an enormous increase in research examining the effects of mindfulness meditation. One of the basic assumptions guiding this research is that meditation ultimately makes people happier. In this article, in two studies we tested whether meditators actually look happier. To address this question, outside raters judged the happiness of meditators and non-meditators based on a 15-s video clip of their behaviour. Study 1 demonstrated that novice meditators looked happier after an intensive 9-day meditation retreat (as compared to before the retreat), while Study 2 demonstrated that experienced mindfulness meditators looked happier as compared to controls. The interpersonal implications of these findings are discussed.
... The specific timing of the United States mortality curve seems to refute several studies that suggest a rapid increase in mortality occurs during the holiday season [18,19]. In this analysis, the average nationwide date of maximum mortality is 15 January, nearly three weeks after Christmas, and even later in many cities. ...
Human mortality exhibits a strong seasonal pattern with deaths in winter far exceeding those in the summer. While the pattern itself is clear, there have been very few studies examining whether the magnitude or timing of seasonal mortality varies considerably across space. Thus, the goal of this study is to conduct a comprehensive geographic analysis of seasonal mortality across the United States and to uncover systematic regional differences in such mortality. Unique seasonal mortality curves were created for 28 metropolitan statistical areas across the United States, and the amplitude and timing of mortality peaks were determined. The findings here indicate that the seasonality of mortality exhibits strong spatial variation with the largest seasonal mortality amplitudes found in the southwestern United States and the smallest in the North, along with South Florida. In addition, there were strong intra-regional similarities that exist among the examined cities, implying that environmental factors are more important than social factors in determining seasonal mortality response. This work begins to fill a large gap within the scientific literature concerning the geographic variation and underlying causes of seasonal mortality across the United States.
... ed in a day-by-day analysis (Phillips et al., 2004) of all US deaths from mid-1973 to mid-2001. That study found that daily US cardiac sudden deaths peaked on the specific days of Christmas and New Years, with a pronounced dip between the two. A study of deaths in Newcastle, UK, by Milne (2005) found a peak on New Years but not Christmas or Easter.Phillips et al. (2010)looked at all US deaths, this time from 1979 to 2004, reconfirming Christmas and New Years Day as the two largest mortality spikes on the basis of dead-on-arrival or emergency department deaths. These days were closely followed by Thanksgiving and Independence Day, whereas the less-celebratory holidays of Labor Day and Memorial Day had l ...
Sudden cardiac death is a significant health issue, causing millions of deaths worldwide annually. Studies have found that the likelihood of such death is higher in winter. Further studies identified that the highest likelihood occurs on Christmas Day and New Years Day, but not the interim period. Thanksgiving, Independence Day and the Islamic holiday Eid Al-Fitr also show significant increases in the rate of cardiac events or death. A number of mechanisms have been proposed, but none have satisfactorily explained the evidence. This article reviews the data supporting the existence of a holiday cardiac death phenomenon, the involvement of catecholamines and the normal modes of human catecholamine deactivation. Further evidence is reviewed that supports a hypothesized mechanism whereby critical SULT1A catecholamine deactivation enzymes can in some patients be inhibited by naturally-occurring phenols and polyphenols in foods and alcohols. If deactivation is inhibited by holiday consumption excesses, holiday stress or excitement could lead to a buildup of catecholamines that can cause fatal arrhythmias. Awareness of this mechanism could reduce deaths, both through doctor/patient education leading to a moderation in consumption and through the potential identification of patients with a predisposition to SULT1A inhibition. This hypothesis also raises parallels between sudden cardiac death in adults and Sudden Infant Death Syndrome (SIDS). The possible involvement of SULT1A inhibition in SIDS is discussed.
... Nie ma żadnych pozycji literatury na temat wpływu Świąt Wielkanocnych na zmianę masy ciała ani w literaturze światowej, europejskiej, ani w polskiej. W okresie świąt Bożego Narodzenia i Nowego Roku w populacji amerykańskiej obserwuje się wzrost śmiertelności z powodów kardiologicznych oraz innych, takich jak: wypadki, samobójstwa, przyczyny naturalne oraz opóźnianie podjęcia odpowiedniego leczenia przez lekarzy i pacjentów[14,15]. Liczba zgonów zaczyna się zwiększać w okresie Święta Dziękczynienia, następnie rośnie do okresu bożonarodzeniowego, aby osiągnąć szczyt w Nowy Rok[16,17]. ...
... Many factors may contribute, including increased rates of acute respiratory tract infections and death from cardio-vascular diseases in the winter months, periods with extreme temperature, and possibly mental and physiological effects (e.g. D-vitamin) related to daylight as well as social and psychological factors related to Christmas and New Year holidays [1]. However, it is well recognised that one of the main causes of winter excess mortality is influenza. ...
In temperate zones, all-cause mortality exhibits a marked seasonality, and one of the main causes of winter excess mortality is influenza. There is a tradition of using statistical models based on mortality from respiratory illnesses (Pneumonia and Influenza: PI) or all-cause mortality for estimating the number of deaths related to influenza. Different authors have applied different estimation methodologies. We estimated mortality related to influenza and periods with extreme temperatures in Denmark over the seasons 1994/95 to 2009/10.
We applied a multivariable time-series model with all-cause mortality as outcome, activity of influenza-like illness (ILI) and excess temperatures as explanatory variables, controlling for trend, season, age, and gender. Two estimates of excess mortality related to influenza were obtained: (1) ILI-attributable mortality modelled directly on ILI-activity, and (2) influenza-associated mortality based on an influenza-index, designed to mimic the influenza transmission.
The median ILI-attributable mortality per 100,000 population was 35 (range 6 to 100) per season which corresponds to findings from comparable countries. Overall, 88% of these deaths occurred among persons ≥ 65 years of age. The median influenza-associated mortality per 100,000 population was 26 (range 0 to 73), slightly higher than estimates based on pneumonia and influenza cause-specific mortality as estimated from other countries. Further, there was a tendency of declining mortality over the years. The influenza A(H3N2) seasons of 1995/96 and 1998/99 stood out with a high mortality, whereas the A(H3N2) 2005/6 season and the 2009 A(H1N1) influenza pandemic had none or only modest impact on mortality. Variations in mortality were also related to extreme temperatures: cold winters periods and hot summers periods were associated with excess mortality.
It is doable to model influenza-related mortality based on data on all-cause mortality and ILI, data that are easily obtainable in many countries and less subject to bias and subjective interpretation than cause-of-death data. Further work is needed to understand the variations in mortality observed across seasons and in particular the impact of vaccination against influenza.
Winter brings a spike in mortality rates, but rather than simply having more parties to divert our attention, Bruce Gibb suggests that perhaps we should be looking to the misunderstood mushroom to give us a boost.
The proportion of single person households is increasing with population ageing. At older ages living in a single person household is more likely to be due to bereavement or separation than at younger ages. We examine the association between marital status and the likelihood and the length of hospitalisations, with particular emphasis on whether and how this association varies by different types of hospitalisations with a distinct nature of care. Using a large survey linked to multiple years of detailed administrative records enables us to better control for individual heterogeneity and allows us to conduct a finer classification of hospitalisations. A two‐part model is used for estimation. We also investigate the relationship between marital status and the presentations to emergency department. The results show singles have an increased probability of hospitalisation and length of stay, with a substantial heterogeneity revealed in the association between marital status and different types of hospitalisations. The findings are consistent with the lesser availability of informal care for those being single and point to the need to develop appropriate and targeted strategies to reduce hospitalisation in this group.
Formulation of the problem. It is known that holidays are accompanied by an increase in morbidity and mortality. The aim of this study was to summarize the experience of previous studies examining therelationship between national holidays and the time of death, as well as to analyze the Russian characteristics of mortality during holidays. The article poses the following questions: 1) Is the risk of dying on holidays increasing in Russia? 2) If so, on which ones? 3) Is this related to alcohol abuse? 4) To what extent are men and women involved? 5) What is theestimate of excess deaths on holidays?Methods. The study used daily data on the number of deaths in Russia from all causes and from alcohol poisoning, disaggregated by sex for 2000-2017. In total, 35.4 million people died during the period under review. We studied 9 public holidays in Russia. The LOWESS moving average, calculated for non-holidays and extrapolated to holidays, was taken as zero. We took into account holidays that exceeded the LOWESS confidence interval. To estimate losses on a birthday, linear regression and its confidence interval were taken as zero. We used data from Rosstat and Google Trends to indirectly estimate legal and illegal alcohol consumption as well.Results. Five out of nine public holidays in Russia are accompanied by an increase in the number of deaths. The greatest increase is observed in connection with the New Year on January 1-15. At this time, the excess number of deaths amounted to 113.6 thousand people over 18 years, or 6.3 thousand people per year, with a maximum on January 1 (2.0 thousand per day). This is 14.0% more deaths than on weekdays. The excess number of deaths on the holidays on February 23, March 8 and May 9 amounted to 1.7 thousand per year. 80.9% of excess deaths in January are of men. The all-cause mortality and mortality from alcohol poisoning coincides with the maximum on January 1. After 2005, when the duration of the New Year holidays increased, the maximum on January 1 and the subsequent dynamics of mortality did not change. The annual maximum sales of alcoholic beverages are in December. Birthdays are also accompanied by an increase in total mortality by 9.1 thousand per year, and this is also associated with alcoholism.Conclusion. In Russia, on holidays, mainly on New Year's and birthdays, there is a significant increase in mortality, which is mainly due to alcohol abuse and does not depend on the duration of the holidays in January. This damage can be reduced by a decrease in the availability of strong alcohol, the maximum sales of which occur in December.
Objective: Cardiovascular disease (CVD) is the leading cause of hospitalisations and deaths in Australia. This study estimates the excess CVD hospitalisations and deaths across seasons and during the December holidays in Queensland, Australia. Methods: The study uses retrospective, longitudinal, population-based cohort data from Queensland, Australia from January 2010 to December 2015. The outcomes were hospitalisations and deaths categorised as CVD-related. CVD events were grouped according to when they occurred in the calendar year. Excess hospitalisations and deaths were estimated using the multivariate ordinary least squares method after adjusting for confounding effects. Results: More CVD hospitalisations and deaths occurred in winter than in summer, with 7811 (CI: 1353, 14,270; p < 0.01) excess hospitalisations and 774 (CI: 35, 1513; p < 0.01) deaths compared to summer. During the coldest month (July), there was an excess of 42 hospitalisations and 7 deaths per 1000 patients. Fewer CVD hospitalisations (−20 (CI: −29, −9; p < 0.01)) occurred during the December holidays than any other period during the calendar year. Non-CVD events were mostly not statistically significant different between periods. Conclusion: Most CVD events in Queensland occurred in winter rather than during the December holidays. Potentially cost-effective initiatives should be explored such as encouraging patients with CVD conditions to wear warmer clothes during cold temperatures and/or insulating the homes of CVD patients who cannot otherwise afford to.
Постановка проблемы. Известно, что праздники сопровождаются ростом заболеваемости и смертности. Целью данного исследования являлось обобщение опыта предыдущих работ, изучающих связь между национальными праздниками и временем смерти, а также анализ российских особенностей смертности в праздничные дни. Мы ставили следующие вопросы: 1) «увеличивается ли в России риск умереть в праздники?»; 2) «если да, то в какие?»; 3) «связано ли это со злоупотреблением алкоголем?»; 4) «в какой степени в это вовлечены мужчины и женщины?»; 5) «какова оценка избыточного числа смертей в праздничные дни?».
Методы. В исследовании использованы ежедневные данные о числе умерших в России от всех причин и от алкогольных отравлений с разделением по полу за 2000-2017 гг. Всего в рассматриваемый период умерло 35,4 млн человек. Исследовали 9 государственных праздников в России. За ноль отсчета принимали скользящую среднюю LOWESS, рассчитанную для непраздничных дней и экстраполированную на праздничные дни. Учитывали праздничные дни, которые превышали доверительный интервал LOWESS. Для оценки потерь в день рождения за ноль отсчета принимали линейную регрессию и ее доверительный интервал. Для косвенной оценки легального и нелегального потребления алкоголя использовали данные Росстата о помесячных продажах алкогольной продукции и данные Google Trends о популярности поисковых запросах на алкогольную продукцию.
Результаты. Пять из девяти государственных праздников в России сопровождаются ростом числа смертей. Наибольший рост наблюдается 1-15 января в связи с Новым годом. В это время избыточное число смертей составило 113,6 тыс. человек за 18 лет или 6,3 тыс. человек в год с максимумом 1 января (2,0 тысячи в день). Это на 14,0% больше, чем в будни. В праздники 23 февраля, 8 марта и 9 мая избыточное число смертей составило в сумме 1,7 тыс. в год. 80,9% избыточных смертей в январе приходится на мужчин. Общая смертность и смертность при отравлении алкоголем совпадает по максимуму 1 января и в последующей динамике. После 2005 г., когда увеличилась продолжительность новогодних праздников, максимум 1 января и последующая динамика смертности не изменилась. Годовой максимум продаж алкогольных напитков приходится на декабрь. Дни рождения также сопровождаются приращением общей смертности на 11,1 тыс. в год, и это также связано с алкоголизацией.
Заключение. В России в праздники, главным образом новогодние и дни рождения, происходит значительный прирост смертности, который обусловлен преимущественно злоупотреблением алкоголем и не зависит от продолжительности праздников в январе. Снизить этот урон может уменьшение доступности крепкого алкоголя, максимум продаж которого приходится на декабрь.
Motivated by psychological evidence that shows the public experiences emotional distress in response to the deaths of popular figures, I employ the deaths of 1,391 Hollywood Walk of Fame celebrities as natural experiments to identify exogenous public mood changes over the period 1926–2009. Consistent with the psychological theories which maintain that sadness encourages individuals to favor high‐risk/high‐reward investments, I find that U.S. stock returns are abnormally high immediately after the death of a major celebrity. This effect is particularly large during periods of high market‐level uncertainty (+0.40%) and for stocks headquartered in the city where the celebrity died (+0.26%).
This thesis is compiled from four studies dealing with the prediction of myocardial infarction (MI) and some associated risk behaviours post MI.
Study 1 extends the field of possible psychosocial stress-triggering of MI to Sweden, and to the phenomenon of temporal crests and troughs in national MI rates. These findings are in the present thesis integrated into a more comprehensive theoretical framework than provided by previous studies. By controlling for different confounders, analysis in subgroups, and more, the probable effect of psychosocial stress on the triggering of MI producing slight oscillations in daily MI rates at different temporal cycles was supported.
Study 2 extends the existing literature of cognitive epidemiology to secondary preventive cardiology. Males with higher cognitive ability (CA), as assessed at mandatory military conscription in young adulthood, were found to be more adherent to their statin medication post MI, approximately 30 years later. The association is likely causal, given the fundamental importance of CA as a predictor for our individual ability to understand, plan, and execute everyday behaviour, including such health promoting behaviour as adhering to statin medication after MI.
Study 3 continues the thesis thread of predicting clinically relevant health-promoting behaviour. It generated important hypotheses of what predicts adherence to internet-based cognitive behaviour therapy (ICBT) for symptoms of anxiety and/or depression after MI. In particular, the linguistic variables which were derived from what the patients actually wrote online to their ICBT therapist, predicted adherence. Using a flexible random forest model with a moderately sized sample, the aim was to handle a range of predictors and possible higher order effects in the relative strength estimation of these predictors.
Study 4 presents the derivation and external validation of a new risk model, STOPSMOKE. Developed as a linear support vector machine with robust resampling, STOPSMOKE proved accurate in the unseen validation cohort for predicting one-year smoking abstinence at the start of cardiac rehabilitation (CR) post MI. STOPSMOKE predictions may inform the targeting of more elaborate interventions to high risk patients. Today, such intervention is not systematic as standard counselling does not account for the individual probability of future smoking abstinence failure. STOPSMOKE thus provides a novel real-world probabilistic basis for the risk of future smoking abstinence failure after MI. This basis may then be used by clinicians, patients, and organisations to tailor smoking intervention as best suited the particular individual or high-risk group. Implemented as part of a spectrum of models in a semi-automatic system, cost-effective tailored risk assessment could allow for augmented CR for future patients.
Background
The national catalog for indications of emergency medical service (EMS) physicians represents the framework for their dispatching and do not actually regard improvements of the EMS due to the introduction of the “Notfallsanitäter” law. Furthermore, the implementation of telemedicine and significantly extended ambulance equipment are increasing the ability of rescue services to offer staged emergency treatment. Consequently, the question arises how often the EMS physician is actually needed on the scene. The major objective of this study is an initial assessment of the requirement of an EMS physician on scene based on a self-assessment by EMS physicians.
Methods
The need for an EMS physician as well as the number of given i.v. drugs and the respective suspected diagnosis were analyzed by a survey and by the evaluation of the protocols of EMS physicians in the EMS of the city of Aachen from 01 December 2017 to 28 February 2018. Furthermore, consultations of an ambulance with the tele-EMS physician were evaluated regarding suspected diagnosis and administration of drugs.
Results
In a total of 6851 missions, 20.6% (n = 1410) were supported by the EMS physician on the scene and 10.5% (n = 721) by the tele-EMS physician. The EMS physicians did not consider themselves necessary in 46.7% (n = 654) of all missions with an EMS physician on the scene, but still spent an average of 25 min on the scene. The most common reason for requiring an EMS physician on the scene were patients with unstable vital signs in 29.8% (n = 225).
Conclusion
Overall, the EMS physicians consider themselves necessary in 11% of all emergency missions. A precise indication can improve availability and target-oriented disposition. Necessary physician contact could be realized with the support of a tele-EMS physician in over 10.5% of all missions.
Background: Previous studies have investigated the impact of the Christmas and New Year holiday on suicide rates. However, no such data has yet been published on Swedish suicides.
Aims: To examine the occurrence of suicides on these dates in Sweden between 2006 and 2015.
Methods: The suicide count for each date between December 15th and January 15th was obtained from the Swedish cause of death registry. The observations were transformed to Z-scores to enable calculation of p-values.
Results: A small but non-significant decrease in suicides was observed on Christmas and New Year’s Eve. A significant spike was found on New Year’s Day (NYD) (Z = 3.40; p < .001), and these excess suicide occurred mainly among men aged 15–24 and 45–64. However, the number of suicides were somewhat lower than expected on the 31st of December (Z = −1.58; p = .115).
Discussion: The noted increase in suicide on NYD is in line with previous research from other countries. However, the decrease in suicides on the day before NYD suggests a delay rather than a spontaneous increase of suicides. Possible mechanisms to explain this phenomenon are discussed, such as the “broken promise effect”, increased alcohol consumption, or lower help-seeking and accessibility to care.
Religiosity is inherent in human cultures. Being different in many aspects, all have rules regarding appropriate behavior and rituals. Celebrations of social events and of holidays prevail in all major religions. These include code of dress, prayers, special food and activities which may have negative health implications. The Jewish religion is 'blessed' with an abundance of holidays each with its unique health implications. In this paper we provide an outline of the character of these festivals and possible medical repercussions on those celebrating them. Observant members of the Jewish religion and teams treating this population should be knowledgeable of potentially associated risks. Pre-holiday periods should be specifically targeted for educational and preventive activity in order diminish injury or morbidity.
Media communication scholars document that the general public exhibits a psychological attachment to celebrities and may emotionally react to their death. In this paper, I take advantage of this insight and I adopt an event study approach to test the impact of exogenous and incidental negative affect (i.e. grief, proxied by the death of Hollywood Walk of Fame celebrities) on people’s willingness to invest in risky assets (proxied by the daily performance of the U.S. stock market). Using a sample of 1,374 celebrity deaths over the period 1926-2009 and controlling for seasonalities, economic/environmental factors, and market liquidity, I find that the death of popular and beloved celebrities is immediately followed by a 16 basis point increase in stock returns, which is consistent with a rise in the net demand for risky instruments. I also find evidence that the size of this celebrity-death effect is increasing in the popularity/media coverage of the celebrity in question, and is larger for stocks that are more affected by investor sentiment. Overall, my findings are consistent with the lab research on the affect management model, which maintains that incidental negative affect promotes risk-prone behavior.
Objectives:
This report describes ambulatory care visits to hospital emergency departments (EDs) in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in ED utilization from 1992 through 2002 are also presented.
Methods:
The data presented in this report were collected from the 2002 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is part of the ambulatory care component of the National Health Care Survey that measures health care utilization across various types of providers. NHAMCS is a national probability sample survey of visits to emergency and outpatient departments of non-Federal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates.
Results:
During 2002, an estimated 110.2 million visits were made to hospital EDs, about 38.9 visits per 100 persons. From 1992 through 2002, an increasing trend in the ED utilization rate was observed for persons over 44 years of age. In 2002, abdominal pain, chest pain, fever, and cough were the leading patient complaints accounting for nearly one-fifth of all visits. Acute upper respiratory infection was the leading illness-related diagnosis at ED visits. From 1992 through 2002, decreases in ED visit rates were observed for intracranial injuries in children, and increases were found for depression in young adults and arthropathies among middle-aged and elderly patients. There were an estimated 39.2 million injury-related visits during 2002, or 13.8 visits per 100 persons. Diagnostic/screening services, procedures, and medications were provided at 86.8 percent, 43.2 percent, and 75.8 percent of visits, respectively. In 2002, approximately 12 percent of ED visits resulted in hospital admission. On average, patients spent 3.2 hours in the ED.
Numerous reports have questioned the ability of United States emergency departments to handle the increasing demand for emergency services. Emergency department (ED) overcrowding is widespread in US cities and has reportedly reached crisis proportions. The purpose of this review is to describe how ED overcrowding threatens patient safety and public health, and to explore the complex causes and potential solutions for the overcrowding crisis. A review of the literature from 1990 to 2002 identified by a search of the Medline database was performed. Additional sources were selected from the references of the articles identified. There were four key findings. (1) The ED is a vital component of America's health care "safety net". (2) Overcrowding in ED treatment areas threatens public health by compromising patient safety and jeopardising the reliability of the entire US emergency care system. (3) Although the causes of ED overcrowding are complex, the main cause is inadequate inpatient capacity for a patient population with an increasing severity of illness. (4) Potential solutions for ED overcrowding will require multidisciplinary system-wide support.
To assess changes in emergency department (ED) activity and visits to EDs that could have been managed by general practitioners (GP-type visits) in the Christmas and New Year holiday period compared with the rest of the year.
Retrospective descriptive and analytical comparison of New South Wales ED visits in the holiday period and the rest of the year; data were obtained from the NSW Emergency Department Data Collection database for the period 2001 to early 2006. More detailed information in 2005-2006 allowed GP-type visits to be assessed in this period only.
The change in the number and percentage of weekly ED visits during the holiday period.
Between 2001 and 2006, average weekly counts of ED visits increased by 9% (95% CI, 7%-11%) during the holiday period. The holiday increase was largely accounted for by visits that were less urgent, and for patients who were not admitted, did not arrive by ambulance, had a shorter treatment time and arrived between 08:00 and midnight. In 2005-2006, average weekly counts of GP-type visits increased by 21% (95% CI, 15%-28%) compared with 8% (95% CI, 4%-12%) for ED visits overall. However, GP-type visits accounted for only 39% of the additional holiday visits. GP-type visits increased mainly for adults and more in urban than rural areas.
The Christmas and New Year period is the busiest time of year for NSW EDs. However, only some of the additional holiday visits can be attributed to GP-type visits. Improving access to GPs, but also to broader hospital and community-based health care services over the holiday period, should be considered for managing the excess demand.
A technique entitled robust baseline estimation is introduced, which uses techniques of robust local regression to estimate baselines in spectra that consist of sharp features superimposed upon a continuous, slowly varying baseline. The technique is applied to synthetic spectra, to evaluate its capabilities, and to laser-induced fluorescence spectra of OH (produced from the reaction of ozone with hydrogen atoms). The latter example is a particularly challenging case for baseline estimation because the experimental noise varies as a function of frequency.
We examined the relation between 38 nationally televised news or feature stories about suicide from 1973 to 1979 and the fluctuation of the rate of suicide among American teenagers before and after these stories. The observed number of suicides by teenagers from zero to seven days after these broadcasts (1666) was significantly greater than the number expected (1555; P = 0.008). The more networks that carried a story about suicide, the greater was the increase in suicides thereafter (P = 0.0004). These findings persisted after correction for the effects of the day of the week, the month, holidays, and yearly trends. Teenage suicides increased more than adult suicides after stories about suicide (6.87 vs. 0.45 percent). Suicides increased as much after general-information or feature stories about suicide as after news stories about a particular suicide. Six alternative explanations of these findings were assessed, including the possibility that the results were due to misclassification or were statistical artifacts. We conclude that the best available explanation is that television stories about suicide trigger additional suicides, perhaps because of imitation.
This paper presents evidence that there are fewer deaths than expected before three ceremonial occasions: the birthday, Presidential elections, and the Jewish Day of Atonement. The investigation of mortality before the birthday was based on biographical information on 1,333 famous persons; official vital statistics tables were used to study mortality before the other two occasions. Alternative explanations of our findings are examined; the evidence suggests that the dip in deaths before ceremonies results from some persons' postponement of death. These results are interpreted in terms of Durkheim's discussion of social integration and ceremonies.
Between 1983 and 1993 the number of outpatient visits in the USA increased by 75%, while the number of inpatient days fell by 21%. 1 This shift to outpatient treatment implies that more medications are taken with the patient, not medical personnel, exercising quality control. In addition, it is thought to be increasingly difficult for physicians to maintain the continuity and quality of their relationships with patients. 2 Both trends could increase medication errors (ME), particularly among outpatients. ME are "accidental poisoning by drugs, medicaments, and biologicals" 3 and have resulted from acknowledged errors, by patients or medical personnel. US studies of ME have typically been conducted in hospital settings, and have not tracked nationwide trends. We examined all US death certificates between 1983 and 1993 (the latest year available). 3 These
Editor—Accident and emergency departments were overwhelmed with patients during the Christmas period. The health minister, Frank Dobson, believes that a flu epidemic precipitated this problem. A more likely explanation is that the general practice service in England and Wales broke down; people could not contact their general practitioners during the holiday period.
As part of a pharmacological research project, I was involved with a telephone survey of general practitioners. We selected a simple random sample of general practitioners and hired a researcher to make phone calls to 200 of them. She attempted to contact 91 surgeries by phone before Christmas and 93 after Christmas. The table shows the number of times that she phoned each general practitioner’s surgery before the phone was answered.
The results show that more phone calls had to be made to get through to a surgery before Christmas than after Christmas. It took up to nine attempts to get through to the 89 of 91 surgeries that were reached before Christmas, but after Christmas all calls to the 90 of 93 surgeries that were reached were answered within six attempts. These findings suggest that the general practice system in England responded poorly to patients’ needs before Christmas, and patients would have had extreme difficulty in getting advice from a general practitioner. Many patients would probably therefore have attended a hospital casualty department.
The general practice system may have failed because the general practitioners on duty were overstretched because of a flu epidemic, adverse weather, or other reasons. A more likely explanation, however, is that the general practice service was understaffed over the Christmas period.
To prevent another fiasco it would be prudent for Mr Dobson to ensure that general practitioners keep their surgery doors open over the Christmas period. It makes little sense that, each year, even though a mid-winter hospital bed crisis is inevitable, general practitioners provide only a skeleton service at Christmas time. The effects of a failure of the general practice system cannot be immediately corrected and have a dramatic effect on the provision of beds, nurses, and medical staff for the rest of the year.
There are regular changes in mortality rates, such as increased rates of death from influenza in the winter and from motor vehicle accidents on long holiday weekends. Previous research has shown that among persons with schizophrenia, the rates of cocaine use and hospital admissions increase at the beginning of the month, after the receipt of disability payments. Using computerized data from all death certificates in the United States between 1973 and 1988, we compared the number of deaths in the first week of the month with the number of deaths in the last week of the preceding month.
The average number of deaths was about 5500 per day, or about 165,000 in a 30-day month. There were 100.9 deaths (95 percent confidence interval, 100.8 to 101.0) in the first week of the month for every 100 deaths in the last week of the preceding month. This was equivalent to about 4320 more deaths in the first week of each month than in the last week of the preceding month in an average year. Between 1983 and 1988, for deaths involving substance abuse and an external cause (such as suicides, accidents, and homicides), there were 114.2 deaths (95 percent confidence interval, 110.5 to 117.9) in the first week of the month for every 100 in the last week of the preceding month. There were significant increases in the number of deaths in the first week of the month for many causes of death, including substance abuse, natural causes, homicides, suicides, and motor vehicle accidents.
In the United States, the number of deaths is higher in the first week of the month than in the last week of the preceding month. The increase at the beginning of the month is associated with substance abuse and other causes of death.
Previous studies have suggested that there is an increase in cardiac events in the morning. Fewer data relate cardiac events to months of the year and season.
We analyzed all monthly death certificate data from Los Angeles County, California, for death caused by coronary artery disease from 1985 through 1996 (n=222 265). The mean number of deaths was highest in December at 1808 and January at 1925; the lowest rates were in June, July, August, and September at 1402, 1424, 1418, and 1371, respectively. December and January had significantly higher rates than would be expected from a uniform distribution of monthly deaths (P=0.00001). The percent of yearly coronary deaths was defined by the quadratic U-shaped equation [percent=13.1198-1.5238(month)+0. 0952(month(2)), where January=1, February=2, etc]. When monthly deaths were plotted by year, there was a decrease from 1985 through 1996. Monthly mortality correlated inversely with temperature. During the months with the highest frequency of death (December, January), however, there was an increase in deaths that peaked around the holiday season and then fell, which could not be explained solely on the basis of the daily temperature change.
Even in the mild climate of Los Angeles County, there are seasonal variations in the development of coronary artery death, with approximately 33% more deaths occurring in December and January than in June through September. Although cooler temperatures may play a role, other factors such as overindulgence or the stress of the holidays might also contribute to excess deaths during these peak times.
Paid holiday and vacations are a wonderful employee benefit for your staff. However, without some firm policies in place that anticipate and avoid problems, holidays and vacations can backfire in a medical practice and become a source of problems both for the practice and for the staff. This article provides concrete tips for reducing vacation and holiday conflicts and particularly for structuring a firm-but-fair vacation policy for new employees. It provides guidance for solo practitioners' vacation scheduling and offers a list of the most common paid holidays in professional practices today. In addition, this article offers answers to common holiday and vacation scheduling questions such as how to handle holidays that fall during a vacation and weekend holidays. Finally, this article offers specific advice for making the December holiday season a pleasant and trouble-free one for your staff.
In the United States, 12 400 000 people live with a history of heart attack, angina pectoris, or both. Of this population, an estimated 1 100 000 will suffer a new or recurrent coronary attack this year.1 According to the World Health Organization, cardiovascular disease (CVD) will be the leading cause of death worldwide by 2020.2
Infectious agents have been implicated in the etiology of atherosclerosis and its complications since the early 1900s.3 Clinicians have long noticed that ≈30% of myocardial infarctions (MIs) are preceded by an upper respiratory infection.4,5
Agents implicated in atherosclerosis include cytomegalovirus (CMV), Chlamydia pneumoniae , Herpes simplex viruses 1 and 2 (HSV-1 and HSV-2), Helicobacter pylori , Mycoplasma pneumoniae , Porphyromonas gingivalis , and Enterovirus.6–13 Antibiotic therapy for C. pneumoniae in CVD patients has been tried with transient or no benefit to date.14,15 Ongoing studies may give a definitive answer by late 2003.16
Here, we review recent studies suggesting influenza may play a role in atherogenesis or atherothrombosis. In 2000, we reported a case-control study in patients with known coronary artery disease; influenza vaccination was associated with a 67% reduction (OR 0.33, 95% CI 0.13 to 0.82, P =0.017) in risk of MI in the subsequent influenza season.17 In a simultaneous population-based case-control study, Siscovick et al18 found that after adjusting for demographic, clinical, and behavioral risk factors, influenza vaccination was associated with a 49% reduction (OR 0.51, 95% CI 0.33 to 0.79) in risk of out-of-hospital primary cardiac arrest. Another case-control study reported a 50% risk reduction (OR 0.50, 95% CI 0.26 to 0.94, P =0.033) in stroke risk in subjects vaccinated during the year of the study and a 48% (OR 0.42, 95% CI 0.21 to 0.81, P =0.009) risk reduction in those vaccinated …
This report describes ambulatory care visits to hospital emergency departments (EDs) in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in ED utilization from 1992 through 2002 are also presented.
The data presented in this report were collected from the 2002 National Hospital Ambulatory Medical Care Survey (NHAMCS). NHAMCS is part of the ambulatory care component of the National Health Care Survey that measures health care utilization across various types of providers. NHAMCS is a national probability sample survey of visits to emergency and outpatient departments of non-Federal, short-stay, and general hospitals in the United States. Sample data are weighted to produce annual national estimates.
During 2002, an estimated 110.2 million visits were made to hospital EDs, about 38.9 visits per 100 persons. From 1992 through 2002, an increasing trend in the ED utilization rate was observed for persons over 44 years of age. In 2002, abdominal pain, chest pain, fever, and cough were the leading patient complaints accounting for nearly one-fifth of all visits. Acute upper respiratory infection was the leading illness-related diagnosis at ED visits. From 1992 through 2002, decreases in ED visit rates were observed for intracranial injuries in children, and increases were found for depression in young adults and arthropathies among middle-aged and elderly patients. There were an estimated 39.2 million injury-related visits during 2002, or 13.8 visits per 100 persons. Diagnostic/screening services, procedures, and medications were provided at 86.8 percent, 43.2 percent, and 75.8 percent of visits, respectively. In 2002, approximately 12 percent of ED visits resulted in hospital admission. On average, patients spent 3.2 hours in the ED.
Rates of U.S. homicides and suicides during 1972-1979 were higher on 7 major national holidays except one for homicides and were lower for suicides, except New Year's Day as Lester noted for 1972-1979.
Research published in Circulation has shown that cardiac mortality is highest during December and January. We investigated whether some of this spike could be ascribed to the Christmas/New Year's holidays rather than to climatic factors.
We fitted a locally weighted polynomial regression line to daily mortality to estimate the number of deaths expected during the holiday period, using the null hypothesis that natural-cause mortality is unaffected by the Christmas/New Year's holidays. We then compared the number of deaths expected during the holiday period, given the null hypothesis, with the number of deaths observed. For cardiac and noncardiac diseases, a spike in daily mortality occurs during the Christmas/New Year's holiday period. This spike persists after adjusting for trends and seasons and is particularly large for individuals who are dead on arrival at a hospital, die in the emergency department, or die as outpatients. For this group during the holiday period, 4.65% (+/-0.30%; 95% CI, 4.06% to 5.24%) more cardiac and 4.99% (+/-0.42%; 95% CI, 4.17% to 5.81%) more noncardiac deaths occur than would be expected if the holidays did not affect mortality. Cardiac mortality for individuals who are dead on arrival, die in the emergency department, or die as outpatients peaks at Christmas and again at New Year's. These twin holiday spikes also are conspicuous for noncardiac mortality. The excess in holiday mortality is growing proportionately larger over time, both for cardiac and noncardiac mortality.
Our findings suggest that the Christmas/New Year's holidays are a risk factor for cardiac and noncardiac mortality. There are multiple explanations for this association, including the possibility that holiday-induced delays in seeking treatment play a role in producing the twin holiday spikes.
Articles in the medical literature and lay press have supported a belief that individuals, including those dying of cancer, can temporarily postpone their death to survive a major holiday or other significant event, but results and effects have been variable.
To determine whether, for the patient dying of cancer, a "death takes a holiday" effect showing a reduction in deaths in the week before a significant event was associated with Christmas, the US holiday of Thanksgiving, or the date of the individual's birthday.
Analysis of death certificate data for all 1,269,474 persons dying in Ohio from 1989-2000, including 309,221 persons dying with cancer noted as the leading cause of death.
We measured the total number of cancer deaths in the 2 weeks centered on the event of interest and the proportion of these deaths that occurred in the week before the event to determine whether this proportion was significantly different from 0.5 by using an exact binomial test.
The proportion of persons dying of cancer in the week before Christmas, Thanksgiving, and the individual's birthday was not significantly different from the proportion dying in the week after the event (P = .52, .26, and .06, respectively). However, among black individuals there was an increase in cancer deaths in the week before Thanksgiving (P = .01), whereas women showed an increase in cancer deaths in the week before their birthday (P = .05). There was no statistically significant excess of deaths in the postevent week in any subgroup.
We found no evidence, in contrast to previous studies, that cancer patients are able to postpone their deaths to survive significant religious, social, or personal events.
Three sources of data (general practice episode data from the Weekly Returns Service of the Royal College of General Practitioners, national hospital admission data for England and national mortality data by date of death) were examined separately in each winter (1994/1995 to 1999/2000) to investigate the impact of influenza on circulatory disease. Weekly data on incidence (clinical new episodes) hospital emergency admissions and deaths certified to circulatory disorders and to respiratory diseases (chapters VII and VIII of ICD9) during influenza epidemic periods (defined from combined clinical/virological surveillance) were examined in age groups 4574 and [gt-or-equal, slanted]75 years. Data collected in the four winters in which there were substantial influenza A epidemics were consolidated for the period 6 weeks before to 6 weeks after each peak of the epidemic, and associations between the variables at different time lags examined by calculating cross-correlation coefficients. We also examined deaths due to ischaemic heart disease (IHD) as a proportion of all circulatory deaths and deaths due to influenza/pneumonia as a proportion of all respiratory deaths. There were no increases of GP episodes nor of emergency admissions for circulatory disorders in any of the three age groups during epidemic periods. Increased circulatory deaths occurred in all age groups and particularly in the oldest group. The large cross-correlation coefficients of deaths (circulatory and respiratory) with GP respiratory episodes at weekly lags of 0, 64), 0·72 (65–74) and 0·57 ([gt-or-equal, slanted]75 years). Increased circulatory deaths contemporary with new incident cases of respiratory episodes but with no concomitant increase in admissions suggests rapid death during the acute phase of illness. Influenza contingency planning needs to take account of these deaths in determining policy for prophylaxis and in providing facilities for cardio-respiratory resuscitation.
To see whether net mortalities increase during and after reductions in medical services, either at average weekends, or at Christmas when pressure from illness is unusually high.
(1) Paired t-tests to compare mean daily deaths and hospital admissions during and after weekends (Saturday-Tuesday) with means for the week, in south-east England; (2) Linear regressions to see whether trends of daily deaths change when admissions are reduced at Christmas.
Neither mean daily all-cause, respiratory or ischaemic heart deaths exceeded weekly averages during weekends, or during Saturday-Monday or Saturday-Tuesday, despite falls in daily elective and daily emergency hospital admissions at weekends that averaged 61-72% and 14-22%, respectively. During 19-24 December, daily deaths were above annual means, respiratory deaths by 49% (29, 1-58), but elective admissions fell and although emergency admissions tended to rise, total admissions rose only for respiratory disease, and only by 33% (376, -47 to 799). On Christmas Day (25 December), even emergency admissions fell sharply below previous trends, respiratory emergency admissions by 18% (P<0.01). Respiratory deaths alone then immediately increased (P<0.01) above trend, by 5.9% (5.8 deaths/day) on 26 December and by 12.9% (12.9) on 27 December.
No adverse effect on mortality was apparent within 2 days from reduction in medical services at weekends. However, respiratory deaths accelerated sharply after reduction in elective and emergency admissions at Christmas, when rates of infection and mortality from respiratory disease were high. Implications for medical services during respiratory epidemics are discussed.
Mortality in the USA has been shown to spike on Christmas and New Year's Day. No comparable analyses are available for European data despite recognised seasonal mortality variations. Deaths for 1986-2000 were analysed by date for Newcastle and North Tyneside (NNT) to examine the Christmas period and the weeks surrounding Easter. A spike in mortality attributable to increases in cardiac and respiratory deaths was seen on New Year's Day but not on Christmas Day. No disturbance of trend was seen at Easter. The causes of the 'holiday phenomenon' are not understood, but absence of a Christmas spike in NNT may indicate that it is preventable.
Previous research on the determinants of pneumonia and influenza has focused primarily on the role of individual level biological and behavioural risk factors resulting in partial explanations and largely curative approaches to reducing the disease burden. This study examines the geographic patterns of pneumonia and influenza hospitalizations and the role that broad ecologic-level factors may have in determining them. We conducted a county level, retrospective, ecologic study of pneumonia and influenza hospitalizations in the province of Ontario, Canada, between 1992 and 2001 (N=241,803), controlling for spatial dependence in the data. Non-spatial and spatial regression models were estimated using a range of environmental, social, economic, behavioural, and health care predictors. Results revealed low education to be positively associated with hospitalization rates over all age groups and both genders. The Aboriginal population variable was also positively associated in most models except for the 65+-year age group. Behavioural factors (daily smoking and heavy drinking), environmental factors (passive smoking, poor housing, temperature), and health care factors (influenza vaccination) were all significantly associated in different age and gender-specific models. The use of spatial error regression models allowed for unbiased estimation of regression parameters and their significance levels. These findings demonstrate the importance of broad age and gender-specific population-level factors in determining pneumonia and influenza hospitalizations, and illustrate the need for place and population-specific policies that take these factors into consideration.
Seasonal and temporal variations in suicide by patient and demographic groups, though important, have been investigated infrequently. This study examined patterns of non-fatal deliberate self-harm (DSH) during Christmas and New Year (from December 16th to January 6th) by specific patient and demographic group. The sample comprised 19,346 people who presented with 31,369 episodes of DSH to a general hospital Emergency Department in Oxford, UK. Autoregression analysis of all episodes from 1976 to 2003 (controlling for day of the week, month and year) revealed significant reductions (-30% to -40%) in the occurrence of DSH compared with expected numbers on each day from December 19th to 26th (except the 23rd), though no significant increase was found on any of the subsequent 11 days. When analysed separately, young people aged under 25 years showed decreases (-60%) in the occurrence of DSH on several days throughout Christmas (p<0.001) and New Year (p<0.01). Patients with partner relationship problems showed a decrease 3 days before Christmas Day (-80%, p<0.001) and an increase on New Year's Day (+100%, p<0.01). Patients with family relationship problems showed decreases before Christmas and after New Year (-60%, p<0.01). Patients with social isolation problems, or a previous history of DSH showed decreases (-60%, p<0.01) before Christmas only. Patients who used alcohol at the time of DSH or in the 6h beforehand, but did not chronically misuse alcohol, showed an increase (+250%, p<0.01) on New Year's Day. There was no significant variation in the occurrence of DSH for patient groups with either low/medium or high suicide intent. The findings elucidate how social and individual factors may interact in contributing to DSH. They are of theoretical interest, and have important clinical implications regarding identification of patient groups especially susceptible to DSH at New Year.
Emergency department (ED) crowding represents an international crisis that may affect the quality and access of health care. We conducted a comprehensive PubMed search to identify articles that (1) studied causes, effects, or solutions of ED crowding; (2) described data collection and analysis methodology; (3) occurred in a general ED setting; and (4) focused on everyday crowding. Two independent reviewers identified the relevant articles by consensus. We applied a 5-level quality assessment tool to grade the methodology of each study. From 4,271 abstracts and 188 full-text articles, the reviewers identified 93 articles meeting the inclusion criteria. A total of 33 articles studied causes, 27 articles studied effects, and 40 articles studied solutions of ED crowding. Commonly studied causes of crowding included nonurgent visits, "frequent-flyer" patients, influenza season, inadequate staffing, inpatient boarding, and hospital bed shortages. Commonly studied effects of crowding included patient mortality, transport delays, treatment delays, ambulance diversion, patient elopement, and financial effect. Commonly studied solutions of crowding included additional personnel, observation units, hospital bed access, nonurgent referrals, ambulance diversion, destination control, crowding measures, and queuing theory. The results illustrated the complex, multifaceted characteristics of the ED crowding problem. Additional high-quality studies may provide valuable contributions toward better understanding and alleviating the daily crisis. This structured overview of the literature may help to identify future directions for the crowding research agenda.
Influenza and cardiovascular disease: a new opportunity for prevention and the need for further studies. Circulation, 108, 2730e2736 National hospital ambulatory medical care survey: 2002 emergency department summary Mortality spike at New Year but not Christmas in North East England
- M Madjid
- M Naghavi
- S Litovsky
- S W Casscells
- L F Mccaig
- C W Burt
Madjid, M., Naghavi, M., Litovsky, S., & Casscells, S. W. (2003). Influenza and cardiovascular disease: a new opportunity for prevention and the need for further studies. Circulation, 108, 2730e2736. McCaig, L. F., & Burt, C. W. (2004). National hospital ambulatory medical care survey: 2002 emergency department summary. Vital and Health Statistics, 340, 33. Milne, E. M. G. (2005). Mortality spike at New Year but not Christmas in North East England. European Journal of Epidemiology, 20, 849e854. Mortality detail file. (1979e2004). Hyattsville, MD: National Center for Health Statistics. (Computer Data File).
Home Christmas tree and holiday light firesdfactsheet. Quincy, Massachusetts: Fire Analysis and Research Division
- M Ahrens
Ahrens, M. (2007). Home Christmas tree and holiday light firesdfactsheet. Quincy, Massachusetts: Fire Analysis and Research Division, National Fire Protection Association.
Emergency department overcrowding in the United States: an emerging threat to patient safety and public health Holidays, birthdays, and postponement of cancer deaths Deck the halls with rows of trolleys. Emergency departments are busiest over the Christmas holiday period
- S Trzeciak
- E P Rivers
- D C Young
- E M Hade
Trzeciak, S., & Rivers, E. P. (2003). Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emer-gency Medicine Journal, 20, 402e405. Young, D. C., & Hade, E. M. (2004). Holidays, birthdays, and postponement of cancer deaths. Journal of the American Medical Association, 292, 3012e3016. Zheng, W., Muscatello, D. J., & Chan, A. C. (2007). Deck the halls with rows of trolleys. Emergency departments are busiest over the Christmas holiday period. Medical Journal of Australia, 187, 630e633. D. Phillips et al. / Social Science & Medicine 71 (2010) 1463e1471
National Center for Health Statistics http://www.cdc.gov/nchs/ ahcd.htm. National Highway Traffic Safety Administration Fatal accident reporting system encyclopedia, 1994e2008. Available at
- Md Hyattsville
Hyattsville, MD: National Center for Health Statistics http://www.cdc.gov/nchs/
ahcd.htm.
National Highway Traffic Safety Administration. (2009). Fatal accident reporting
system encyclopedia, 1994e2008. Available at. Washington DC: US Department
of Education http://www-fars.nhtsa.dot.gov.
National hospital ambulatory medical care survey, emergency department, multi-year computer data file
National Center for Health Statistics. (2007). National hospital ambulatory medical
care survey, emergency department, multi-year computer data file. Available at.
Mortality, part A. Government Printing Office Vital statistics of the United States 1990. Section 7, Technical Appendix
National Center for Health Statistics. Vital statistics of the United States, yearly
volumes: Vol. 2, Mortality, part A. Government Printing Office, Washington, DC.
National Center for Health Statistics. (1994). Vital statistics of the United States 1990.
Section 7, Technical Appendix. In Mortality part A, Vol. 2. Hyattsville, Md: US
Department of Health and Human Services.
Annual and New Year's Day alcohol-related traffic fatalitiesdUnited States Fall-related injuries during the holiday season e United States
- Disease Centers
- Control
- Prevention
Centers for Disease Control and Prevention. (1991). Annual and New Year's Day
alcohol-related traffic fatalitiesdUnited States, 1982e1990. MMWR. Morbidity
and Mortality Weekly Report, 40, 821e825.
Centers for Disease Control and Prevention. (2004). Fall-related injuries during the
holiday season e United States, 2000e2003. MMWR. Morbidity and Mortality
Weekly Report, 53, 1127e1129.
The Canadian triage and acuity scale (CTAS) for emergency departments
Canadian Association of Emergency Physicians (CAEP). (2002). The Canadian triage
and acuity scale (CTAS) for emergency departments. Available at: http://www.
ahrq.gov/research/esi/esi2.htm#CAEP.
Systematic review of emergency department crowding: causes, effects, and solutions. Annals of Emergency Medicine, 52,126e136 Clinical modification Sydney, Australia: Public Health Division within NSW Health
- N R Hoot
- D Aronsky
Hoot, N. R., & Aronsky, D. (2008). Systematic review of emergency department
crowding: causes, effects, and solutions. Annals of Emergency Medicine, 52,126e136.
International Classification of Disease. (1995). Clinical modification. Ninth Revision
(5th ed.). Sydney, Australia: Public Health Division within NSW Health. http://
www.health.nsw.gov.au/public-health/icd/icd9.htm Retrieved from.
A Brief history of Martin Luther king Jr day Available at: Time http://www.time.com/time
- F Romero
Romero, F. (2010). A Brief history of Martin Luther king Jr day. Available at: Time
http://www.time.com/time/nation/article/0,8599,1872501,00.html.
Increase in U.S. medicationerror deaths between
- D P Phillips
- N Christenfeld
- L M Glynn
Phillips, D. P., Christenfeld, N., & Glynn, L. M. (1998). Increase in U.S. medicationerror deaths between 1983 and 1993. Lancet, 351, 643e644.
Fall-related injuries during the holiday season – United States, 2000–2003
- Centers for Disease Control and Prevention
Increase in U.S. medication-error deaths between 1983 and 1993
- Phillips
Annual and New Year’s Day alcohol-related traffic fatalities—United States, 1982–1990
- Centers for Disease Control and Prevention
Vital statistics of the United States 1990
- National Center for Health Statistics