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Appropriateness of emergency department visits in a Portuguese University Hospital

ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 580-586页

作者： Pereira, S Silva, AOE Quintas, M Almeida, J Marujo, C Pizarro, M Angélico, V Fonseca, L Loureiro, E Barroso, S Machado, A Soares, M de Costa, AB de Freitas, AF Hosp Sao Joao Serv Med 2 P-4200 Porto Portugal

Study objective: There are no studies in Portugal supporting a common claim that most emergency department visits are inappropriate. The aim of this study was to determine the prevalence of and to evaluate factors associated with an appropriate ED visit in a major public hospital. Methods: A cross-sectional prospective study was performed at a public university hospital ED. Data for demographic variables, duration of complaint, transfer from other medical sources, and previous medical care for the same complaints were collected by interviewing all patients who arrived at the ED within a consecutive period of at least 24 hours. Data for diagnostic tests, treatment performed, and final patient destination were collected by triage records review. An appropriate ED visit was defined by explicit criteria: interhospital transfer, patient death at the ED, hospitalization, and diagnostic tests or treatments performed. Results: The study included 5,818 adult patients. The prevalence of an appropriate ED visit, by use of our criteria, was 68.7%. Sex was an effect modifier, According to this study, determinants of an appropriate visit for men and women were age 60 years or older and complaints of 24 hours or less and in women but not in men, retired from work and with arrival between midnight and 8 AM. Conclusions: In a university hospital in Oporto, the majority of ED visits were appropriate according to explicit criteria. Some variables may be associated with appropriateness of ED visits. A duration of the complaint 24 hours or less along with an arrival between midnight and 8 AM in women and age 60 years or older in men were the most important determinants.

关键词：年龄因素方差分析横断面研究教育程度急诊室医院/统计学和数值数据就业/统计学和数值数据卫生服务滥用/统计学和数值数据卫生服务研究医院公立/统计学和数值数据医院大学/统计学和数值数据 Logistic模型病人接受卫生保健的程度/心理学病人接受卫生保健的程度/统计学和数值数据葡萄牙/流行病学患病率前瞻性研究危险因素性别因素时间因素利用情况审核成年人老年人女(雌)性人类男(雄)性中年人

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Which patients stop working because of rheumatoid arthritis? Results of five years' follow up in 732 patients from the Early RA Study (ERAS)

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ANNALS OF THE RHEUMATIC DISEASES 2002年第4期61卷 335-340页

作者： Young, A Dixey, J Kulinskaya, E Cox, N Davies, P Devlin, J Emery, P Gough, A James, D Prouse, P Williams, P Winfield, J City Hosp Rheumatol Unit St Albans AL3 5PN Herts England Orthoped Hosp Oswestry TF6 6TF Shrops England Univ Hertfordshire Hlth Res & Dev Support Unit Hatfield AL10 9AB Herts England Royal S Hants Hosp Winchester SO22 5DG Hants England Broomfield Hosp Chelmsford CM1 6ET Essex England Selly Oak Hosp Birmingham B29 6JD W Midlands England Rheumatol Res Unit Leeds LS2 9NZ W Yorkshire England Diana Princess Wales Hosp Grimsby DN33 2BA England Basingstoke Dist Gen Hosp Basingstoke RG24 9NA Hants England Medway Hosp Gillingham ME7 5NY England Royal Hallamshire Hosp Sheffield S11 9EL S Yorkshire England

Objectives: To assess the occurrence and prognostic factors for the ability to maintain paid work in patients with rheumatoid arthritis (RA). Setting: Inception cohort of patients with RA recruited from rheumatology departments in nine NHS Hospital Trusts in England. Patients: All consecutive patients with RA of less than two years' duration, before any second line (disease modifying) drug treatment, and followed up for five years. Methods: Clinical, laboratory, and radiological assessments, and all treatments were recorded prospectively using a standardised format at presentation and yearly. Outcome measures: Changes in, and loss of paid work by five years' follow up. Results: 732 patients completed the five year follow up. 353/721 (49%) were gainfully employed at the onset of RA, 211 (60%) were still working at five years, 104 (29%) stopped because of the disease, and 31 (9%) retired for reasons other than RA. Work disability at five years was more likely in manual workers (odds ratio (OR) 2.3, 95% confidence interval (CI) 1.4 to 3.8) and worse baseline Health Assessment Questionnaire (HAQ>1.5, OR 2.26, 95% Cl 1.38 to 3.7). In combination with other baseline variables (erythrocyte sedimentation rate, sex, age of onset, and radiological erosions), employment outcome was predicted in 78% using multivariate analysis. Conclusions: Nearly half of the patients with RA were in paid employment at onset, work disability was an adverse outcome for a third of these patients by five years, and manual work and high baseline HAQ were important predictors for this. These details are likely to be useful to clinicians, health professionals, and patients in order to plan medical, orthopaedic, and remedial treatments in early RA. Future disease modifying treatments could be compared with this cohort of patients who were treated with conventional second line drugs.

关键词：抗风湿药/治疗应用关节炎类风湿/药物疗法关节炎类风湿/流行病学队列研究残疾鉴定残疾人/统计学和数值数据就业/统计学和数值数据英格兰/流行病学随访研究发病率比例危险度模型回归分析危险因素成年人老年人女(雌)性人类男(雄)性中年人

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Strategy and actions for achieving productive aging in Japan

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EXPERIMENTAL AGING RESEARCH 1999年第4期25卷 461-470页

作者： Kumashiro, M Univ Occupat & Environm Hlth Inst Ind Ecol Sci Dept Ergon Yahatanishi Ku Kitakyushu Fukuoka 8078555 Japan

The objective of this study was to develop basic strategies for determining the ideal form of corporate management that meets the needs of an aging work force, specifically with the intent to develop a method of calculating functional age, one of the determining factor's of such strategies. A literature search was made of annual reports of research conducted jointly by the Association of Employment for Senior Citizens and Japanese corporations. We tested the physical, physiological, anti psychomotor functions of 271 male workers ranging in age from 20 to 59, and we used the results to examine the means of creating a formula tor calculate functional age. Many of the measures adopted by Japanese corporations to deal with aging involve job redesign. This category accounts for 58.5% of stick measures in all research fields. Night vision, standing trunk flexion, timed vital capacity, systolic blood pressure, and jumping reaction time each have an important influence on functional age calculation.

关键词：衰老/生理学联想效率就业/统计学和数值数据政府规划日本模型理论工作场所人类

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Women's health after childbirth: A longitudinal study in France and Italy

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BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 2000年第10期107卷 1202-1209页

作者： Saurel-Cubizolles, MJ Romito, P Lelong, N Ancel, PY INSERM U149 F-94807 Villejuif France Univ Trieste Dept Psychol Trieste Italy

Objective To describe the prevalence of various symptoms five months and twelve months after childbirth in two European countries, according to employment, financial difficulties and relationship with partner. Design Longitudinal multicentre survey with a similar design in France and Italy. Women were interviewed three times: at birth and twice after childbirth. At 12 months after childbirth, the survey was postal in both countries. Population Women who had been delivered of their first or second baby in three maternity units in France and five units in Italy. Women who had multiple pregnancies, a stillbirth or known neonatal death were excluded. Results The response rates were 83% in France and 88% in Italy. Fifteen symptoms were considered. The results were similar in the two countries and showed that the prevalence of most symptoms was higher at 12 months than at five months after childbirth. When their baby was one year old, more than half of the women reported backache, anxiety and extreme tiredness. Around one-third of women reported headache, lack of sexual desire, sleep disorders and depression. Piles, constipation and painful intercourse were also common. One year postpartum women with financial problems or a difficult relationship reported poor psychological health more frequently. Conclusion Physical and emotional problems are common after birth, and they tend to increase over time. Backache, headache and piles can seriously interfere with day-to-day Life. Sexual problems also may be a source of unhappiness for the woman and her partner. Extreme tiredness, anxiety and depression may make a woman feel guilty for not corresponding to the image of a healthy, happy and well-coping mother. There is a link between financial problems or a difficult relationship with her partner and her own wellbeing. Health professionals should be aware of the high prevalence of health problems among new mothers, and of the social context of women who are more likely to suffer f

关键词：队列研究就业/统计学和数值数据法国/流行病学健康状况人际关系意大利/流行病学纵向研究母亲福利/统计学和数值数据患病率社会经济因素女(雌)性人类

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Pregnancy, parenthood, and family leave during residency

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ANNALS OF EMERGENCY MEDICINE 2003年第4期41卷 568-573页

作者： Lewin, MR Univ Calif San Francisco Dept Emergency Med Fresno Emergency Med Residency Program Fresno CA 93702 USA

[ Ann Emerg Med . 2003;41:568-573.]

关键词：适应心理学职业选择急救医学/教育计划生育服务/组织和管理实习医师和住院医师职务/组织和管理组织方针双亲假/立法和法学行使父母职责/心理学人员选用/组织和管理人员配备和时间安排/组织和管理医师女/心理学医师女/统计学和数值数据孕妇/心理学学会医学/组织和管理美国妇女就业/教育妇女就业/心理学妇女就业/统计学和数值数据工作负荷量人类

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Access to employment for people with disabilities: findings of a consumer-led project

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DISABILITY AND REHABILITATION 2000年第5期22卷 246-253页

作者： Robinson, JE UniversityCollegeSuffolk UK.jill.robinson@uea.ac.uk

Purpose: A consumer led initiative which aimed to gather Information from local employers and disabled people which might inform future action to improve work opportunities for disabled people. Method: (1) A survey of 500 companies with more than 20 employees randomly sampled from 4 locations across Suffolk was undertaken. The survey generated both numerical and verbal data. Response rate was low (25 %) but achieved a reasonable spread of organizations in terms of size, type of industry and geographical location. (2) Semi-structured interviews were carried out with nine disabled people. Open-ended questions were used to elicit information about the nature of their disability, experiences of education and experiences of seeking and/or maintaining work. Results: 43% of respondents had one or more disabled employees. Evidence of obstacles to employment included a lack of understanding about the capability of disabled people, lack of knowledge about financial and technical assistance and undifferentiated approaches to access and accommodation. Interview data supported the importance of paid employment to self esteem and quality of life and showed high levels of frustration in their starch for work. Conclusions: This study demonstrates the need for better interagency communication and a more effective information distribution strategy for employers, particularly in relation to the availability of systems of support and the capability of disabled employees.

关键词：健康态度残疾人/统计学和数值数据就业/统计学和数值数据英格兰人类

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Factors conditioning the return to work of upper limb amputees in Asturias, Spain

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PROSTHETICS AND ORTHOTICS INTERNATIONAL 2000年第2期24卷 143-147页

作者： Fernández, A Isusi, I Gómez, M Hosp Cent Asturias Dept Rehabil Serv Protesis Oviedo 33006 Spain

Reintegration into a social and work environment, as the final objective of rehabilitation therapy, is one of the greatest challenges faced in this speciality. The aim of this study was to analyse the reintegration into the workforce of 43 upper-limb amputees in Asturias, Spain (1,100,000 inhabitants) whose amputations were as a result of accidents at work. For this purpose various factors related to their return to work were studied. The most important factor was the year in which the amputation was carried out, since reintegration was more likely to occur in those amputees whose accident at work took place before the 1980s.

关键词：事故职业截肢创伤性/康复臂人工四肢卡方分布数据收集就业/统计学和数值数据患病率概率危险性评估危险因素西班牙统计学非参数成年人老年人老年人 80以上人类男(雄)性中年人

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Three-year outcome of first-episode psychoses in an established community psychiatric service

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BRITISH JOURNAL OF PSYCHIATRY 2000年第3期176卷 210-216页

作者： Singh, SP Croudace, T Amin, S Kwiecinski, R Medley, I Jones, PB Harrison, G Univ Nottingham Div Psychiat Nottingham NG7 2RD England Univ Bristol Div Psychiat Bristol BS8 1TH Avon England

Background Changes inservice provision, secular trends in substance misuse and changing social structures might affect outcome in psychosis. Aims To assess the three-year outcome of an inception cohort of first-episode psychoses treated ina modern, community oriented service;to compare outcomes with an earlier cohort treated in hospital-based care;and to examine-the predictive validity of ICD-10 diagnostic criteria. Method Three-year follow-up (1995-1997) of an inception cohort of first-episode psychoses and comparison with two-year follow-up (1980-1982) of the Determinants of Outcome of Severe Mental Disorders (DOSMED) Nottingham cohort. Results On most outcome measures, non-affective psychoses had a worse outcome than affective psychoses. Affective psychoses had better outcome than previously reported. Substance related psychoses had very poor occupational outcome. Similar proportions of the current and DOSMED cohort were in remission but the former were rated as having greater disability. Conclusions Ina modern community service, 30-60% of patients with first-episode psychoses experience a goad three-year outcome. The ICD-10 criteria have good predictive validity.

关键词：日常生活活动队列研究社区精神卫生服务/组织和管理就业/统计学和数值数据随访研究住院/统计学和数值数据结果评价(卫生保健) 病人满意度试验预期值精神病/分类精神病/诊断精神病/康复青少年成年人女(雌)性人类男(雄)性中年人

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Age and occupational activity status of 45-59-year-old Danes from 1984 to 1994

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EXPERIMENTAL AGING RESEARCH 1999年第4期25卷 435-439页

作者： Eskelinen, L Andersen, D AKF Inst Local Govt Studies Denmark DK-1602 Copenhagen V Denmark

Analyses of the occupational activity of the 45-59-year-old Danes in the 10-year period 1984-1994 show that the decrease in occupational activity status is marked for women at the age of 50 and for men about 5 years later. Moreover, it is not possible to detect an increase in the occupational activity, as far as the employment rate is concerned, of the 45-59-year-olds during the same 10-year period.

关键词：年龄因素衰老丹麦就业/统计学和数值数据性别因素工作青少年成年人老年人女(雌)性人类男(雄)性中年人

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From State to market: the Nicaraguan labour market for health personnel

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HEALTH POLICY AND PLANNING 2000年第3期15卷 312-318页

作者： Nigenda, G Machado, MH Natl Inst Publ Hlth Ctr Hlth Syst Res Cuernavaca 62508 Morelos Mexico Osvaldo Cruz Fdn Natl Sch Publ Hlth Rio De Janeiro Brazil

Few countries in Latin America have experienced in such a short period the shift From a socialist government and centrally planned economy to a liberal market economy as Nicaragua. The impact of such a change in the health field has been supported by the quest for reform of the health system and the involvement of external financial agencies aimed at leading the process. However, this change has not been reflected in the planning of human resources for health. Trends in education reflect the policies of past decades. The Ministry of Health is the main employer of health personnel in the country, but in recent years its capacity to recruit new personnel has diminished. Currently, various categories of health personnel are looking for new opportunities in a changing labour environment where new actors are appearing and claiming an influential role. It may take more than political willingness from the government to redefine the new priorities in the field of human resources for health and subsequently turn it into positive action.

关键词：卫生保健辅助人员/供应和分配牙医师/供应和分配就业/统计学和数值数据政府卫生保健改革/组织和管理卫生保健部门/发展趋势职业满意尼加拉瓜组织改革药剂师/供应和分配医师/供应和分配政治成年人女(雌)性人类男(雄)性中年人

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