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Effect of socioeconomic status on out-of-hospital transport delays of patients with chest pain

ANNALS OF EMERGENCY MEDICINE 2003年第4期41卷 481-490页

作者： Govindarajan, A Schull, M Sunnybrook & Womens Coll Hlth Sci Ctr Clin Epidemiol Unit Toronto ON M4N 3M5 Canada Univ Toronto Fac Med Toronto ON Canada

Study objective: The effect of socioeconomic status on out-of-hospital care has not been widely examined. We determine whether socioeconomic status was associated with out-of-hospital transport delays for patients with chest pain. Methods: A retrospective study of patients with chest pain transported by means of ambulance in Toronto, Ontario, Canada, in 1999 was conducted. The primary outcome measure was the 90th percentile system response interval, with secondary outcomes being the 90th percentile on-scene interval, transport interval, and total out-of-hospital interval. Socioeconomic status was the primary independent variable. Covariates were age, sex, case severity, dispatch and return priority, time and day of transport, paramedic training, and percentage of high-rise apartments in the region. Results: Four thousand three hundred fifty-six patients met the inclusion criteria. The 90th percentile system response interval and total out-of-hospital interval were 11 minutes and 49 minutes, respectively. In multivariate analyses, the highest socioeconomic status neighborhoods were significantly associated with decreased system response interval (34.0 seconds;95% confidence interval [Cl] 6.2 to 70.9 seconds) and transport interval (132.3 seconds;95% Cl 24.1 to 229.6 seconds). In addition, age (+45.3 seconds per 10 years;95% Cl 13.3 to 75.1 seconds), female sex (+205.0 seconds;95% C1 78.1 to 287.7 seconds), and advanced care paramedic crews (+371.6 seconds;95% Cl 263.3 to 490.1 seconds) were associated with delays in total out-of-hospital interval. Lastly, calls originating from the highest socioeconomic status neighborhoods were dispatched the highest proportion of advanced care paramedic crews, despite similar dispatch priorities and case severities. Conclusion: High socioeconomic status neighborhoods were associated with shorter out-of-hospital transport intervals for patients with chest pain. In addition, out-of-hospital delays were associated with age, sex, and a

关键词：急救医疗服务/经济学急救医疗服务/统计学和数值数据卫生服务研究收入/统计学和数值数据安大略贫困区试验预期值回归分析居住特征/统计学和数值数据回顾性研究疾病严重程度指数性别因素社会阶级时间因素病人转送/经济学病人转送/统计学和数值数据女(雌)性人类男(雄)性中年人

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Socioeconomic status and out-of-hospital delay

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ANNALS OF EMERGENCY MEDICINE 2003年第4期41卷 491-493页

作者： Brice, JH Yealy, DM Univ N Carolina Dept Emergency Med Chapel Hill NC 27599 USA Univ Pittsburgh Dept Emergency Med Pittsburgh PA USA

[ Ann Emerg Med . 2003;41:491-493.]

关键词：年龄因素急救医疗服务/统计学和数值数据贫困区居住特征/统计学和数值数据性别因素社会阶级时间因素病人转送/统计学和数值数据老年人女(雌)性人类男(雄)性中年人

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Invited commentary: Advancing theory and methods for multilevel models of residential neighborhoods and health

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AMERICAN JOURNAL OF EPIDEMIOLOGY 2003年第1期157卷 9-13页

作者： O'Campo, P Johns Hopkins Bloomberg Sch Publ Hlth Dept Populat & Family Hlth Sci Baltimore MD 21205 USA Johns Hopkins Bloomberg Sch Publ Hlth Dept Epidemiol Baltimore MD 21205 USA

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Addressing cultural competency in research: Integrating a community-based participatory research approach

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ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH 2003年第8期27卷 1361-1364页

作者： Shiu-Thornton, S Univ Washington Sch Publ Hlth & Community Med Dept Hlth Serv Seattle WA 98195 USA

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Role of parkin mutations in 111 community-based patients with early-onset parkinsonism

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ANNALS OF NEUROLOGY 2002年第5期51卷 621-625页

作者： Kann, M Jacobs, H Mohrmann, K Schumacher, K Hedrich, K Garrels, J Wiegers, K Schwinger, E Pramstaller, PP Breakefield, XO Ozelius, LJ Vieregge, P Klein, C Med Univ Lubeck Neurol Klin Dept Neurol D-23538 Lubeck Germany Med Univ Lubeck Dept Human Genet D-23538 Lubeck Germany Hosp Rothenburg Wumme Dept Neurol Rothenburg Germany Gen Reg Hosp Bolzano Dept Neurol Bolzano Italy Massachusetts Gen Hosp Dept Neurol Mol Neurogenet Unit Boston MA 02114 USA Harvard Univ Sch Med Dept Neurol Boston MA 02115 USA Albert Einstein Coll Med Dept Mol Genet Bronx NY 10467 USA Lippe Lemgo Hosp Lemgo Germany

Early-onset parkinsonism is frequently reported in connection with mutations in the parkin gene. In this study, we present the results of extensive genetic screening for parkin mutations in 111 community-derived early-onset parkinsonism patients (age of onset <50 years) from Germany with an overall mutation rate of 9.0%. Gene dosage alterations represented 67% of the mutations found, underlining the importance of quantitative analyses of parkin. In summary, parkin mutations accounted for a low but significant percentage of early-onset parkinsonism patients in a community-derived sample.

关键词：发病年龄外显子/遗传学连接酶类/遗传学突变/遗传学帕金森障碍/遗传学居住特征/统计学和数值数据泛素蛋白连接酶类成年人女(雌)性人类男(雄)性中年人

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Inappropriate use of an accident and emergency department:: Magnitude, associated factors, and reasons -: An approach with explicit criteria

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ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 568-579页

作者： Sempere-Selva, T Peiró, S Sendra-Pina, P Martínez-Espín, C López-Aguilera, I Fdn Inst Invest Serv Salud Valencia 46008 Spain Hosp Morales Meseguer Serv Urgencias Murcia Spain Hosp Gen Univ Serv Urgencias Elche Spain

Background: We evaluate the appropriateness of medical visits to the accident and emergency department (A&ED) of a university hospital using an instrument based on explicit and objective criteria, analyze the association between inappropriate visits and certain factors, and identify reasons for inappropriate use. Methods: This concurrent review of a random sample of 2,980 adult medical patients' visits to the A&ED of the hospital of Elche uses the Hospital Urgencies Appropriateness Protocol, an instrument based on explicit criteria. We analyze the association between inappropriate use and specific factors, and provide a descriptive analysis of reasons for inappropriate use assigned by A&ED staff. Results: Of the total number, 882 (29.6%) of the visits were evaluated as inappropriate. Inappropriate use was associated with younger patients, use of own means of transportation, referral by the hospital, certain months of the year, and certain diagnostic groups of lesser severity. The most frequent reasons for inappropriate use were the patients' greater trust in the hospital than primary care (451 [51.1%]), inappropriate use of services by patients (160 [18.1%]), and inappropriate referrals by primary care physicians (142 [16.1%]). Conclusion: Inappropriate use represents an important percentage of use of the A&ED. Many reasons contribute to it, although foremost among them is patient preference (and the convenience and accessibility) of these services compared with primary care.

关键词：年龄因素住院期间审核交叉研究诊断相关患者组/分类诊断相关患者组/统计学和数值数据急诊室医院/利用卫生服务滥用/统计学和数值数据卫生服务研究医院公立/利用医院大学/利用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/统计学和数值数据初级卫生保健/利用问卷调查转诊和会诊/组织和管理居住特征/统计学和数值数据危险因素疾病严重程度指数西班牙/流行病学运输/统计学和数值数据成年人老年人女(雌)性人类男(雄)性中年人

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The relationship between the geographic density of alcohol outlets and alcohol-related hospital admissions in San Diego County

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JOURNAL OF COMMUNITY HEALTH 2000年第1期25卷 79-88页

作者： Tatlow, JR Clapp, JD Hohman, MM San Diego State Univ Sch Social Work San Diego CA 92182 USA San Diego State Univ Sch Publ Hlth San Diego CA 92182 USA

Increasing concerns regarding the cost of medical care have led to research that has found a relationship between alcohol abuse, increased medical problems, longer hospital stays, and higher medical costs. Research has also found a positive relationship between alcohol availability and crime, car accidents, and liver cirrhosis deaths. One area of interest is how alcohol availability, as measured by the number of alcohol outlets, is related to medical care needs. The purpose of this study was to examine the relationship between the geographic density of alcohol outlets and the number of alcohol-related hospital admissions. alcohol-related ICD-9 codes were selected based on epidemiologic research in the literature to determine alcohol-related morbidity from the California Discharge Data System, which collects information on all hospital admissions and discharges in California. In San Diego County, in 1996, 3,759 admissions were alcohol-related. Alcohol-related admissions for each zip code were compared to the number of liquor licenses that were held by each zip code through a multiple regression analysis. The regression model demonstrated that the number of liquor outlets was a significant predictor of alcohol-related hospital admissions, net of other predictors. Implications are discussed, including regulation of alcohol availability, which may have a beneficial impact on alcohol morbidity.

关键词：年龄分布酒精性饮料/供应和分配酒精中毒/流行病学酒精中毒/病因学加利福尼亚/流行病学商业/统计学和数值数据诊断相关患者组/统计学和数值数据最小二乘法分析许可证/统计学和数值数据年患病率多元分析需求估价病人入院/统计学和数值数据试验预期值居住特征/统计学和数值数据危险因素性别分布成年人老年人女(雌)性人类男(雄)性中年人

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What we say and what we do: County-level public spending for health care

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JOURNAL OF RURAL HEALTH 1999年第4期15卷 421-430页

作者： Zimmerman, MK McAdams, R Univ Kansas Dept Hlth Policy & Management Overland Pk KS 66213 USA

The purpose oft his study is to examine county-level public spending for health care services in Kansas and to explain variation in spending levels with a model composed of population density population age and per capita income. Data are abstracted from budget documents for all 105 counties in Kansas for the years 1994, 1995 and 1996. Health care expenditures are defined as county tax revenues spent for ambulance, hospitals, ambulatory care, home health services, nursing homes, and mental health and substance abuse services. Results show that Kansas counties spent between 12.1 percent and 13.6 percent of their budgets to fund local health care services between 1994 and 1996, spending more than $133 million in 1996 alone. In 10 counties, one-quarter to one-third of the budget went for health services. Low population density and relatively high per capita income explained nearly one-third of the variation in how much counties spent and an even greater proportion when analysis was limited to the most rural counties. Findings from this study suggest there may be a significant local commitment in the United States to publicly supported health care services, more support than typically recognized and perhaps more than is estimated in national health care spending data. Future research on the economic effects of the health sector on local communities should take account of local spending for health care, especially at the county level.

关键词：预算筹资政府/经济学卫生卫生经费支出/统计学和数值数据卫生服务/经济学收入堪萨斯模型经济计量学人口密度问卷调查居住特征/统计学和数值数据人类

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Transitions and inequalities in acute myocardial infarction mortality in New South Wales, 1969-94

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AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH 1999年第4期23卷 343-351页

作者： Burnley, IH Univ New S Wales Sch Geog Kensington NSW 2052 Australia

Objective: To chart the transition in myocardial infarction mortality in NSW between 1969 and 1994 and to determine whether spatial, marital and occupational status differentials increased over time, despite overall mortality decline. Method: The study was undertaken in NSW for the 25-year period from 1969 when mortality from ischaemic heart disease declined. The demographic and spatial analysis involved descriptive epidemiology and utilised the unit list mortality fifes of the Australian Bureau of Statistics which are based on detailed death certificate information. Results: Spatial, marital and occupational status differentials in myocardial infarction mortality increased over time, more especially variations by occupational status, inland/metropolitan differences, and married/divorced or widowed variation. Spatial variations in mortality were not simply the result of occupational status differences as mortality from white collar groups was also elevated in inland areas. Spatial variation in mortality was not diluted due to the impact of immigration. Conclusion: Particular subgroups of people remained at risk and it is likely that differential access to ambulance services and travel time contribute, more particularly in inland rural areas. Implications: Groups at risk need to be more precisely targeted for preventative measures and public health initiatives, with particular implications for groups in inland rural areas. the Hunter Region, and outer lower income areas of Sydney.

关键词：年龄分布卫生服务易得程度/标准婚姻状况/统计学和数值数据心肌梗死/死亡率新南威尔士/流行病学职业/统计学和数值数据人群监测居住特征/统计学和数值数据危险因素性别分布社会经济因素成年人老年人女(雌)性人类男(雄)性中年人

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Enhancing dental attendance rates for children from deprived areas in the UK

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BRITISH DENTAL JOURNAL 1999年第6期187卷 323-326页

作者： Davies, JA Univ Dundee Dundee Dent Hosp & Sch Dent Hlth Serv Res Unit Dundee DD1 4HR Scotland

Objectives To compare different methods being used to determine eligibility for enhanced capitation registration payments, which were introduced in the UK in April 1998 with the intention of improving the numbers of children aged 0-5 years from deprived areas registering with General Dental Service practitioners. Design Comparative study of the enhanced capitation registration payment schemes;data from a longitudinal study of Scottish children used to compare patient and dentist postcodes. Outcome measures Published registration rates;levels of agreement between patient and dentist postcodes. Results Quarterly registration rates for 3-5-year-olds show little improvement as yet;Scottish figures for 0-2-year-olds indicate a more substantial increase which may have been influenced by other initiatives. In Scotland, the degree of agreement between the deprivation scores of patient's and their dentist's postcode was less good among patients from deprived areas than for the sample as a whole. Conclusions More detailed breakdown, using the same criteria as for the enhanced payments, may eventually offer more definitive results. Patient postcodes enable better targeting than practice postcodes, but both may omit a substantial number from the target group if area measures of deprivation are used.

关键词：按人收费/统计学和数值数据龋失补指数儿童口腔保健/统计学和数值数据纵向研究贫困/统计学和数值数据居住特征/统计学和数值数据儿童学龄前人类婴儿

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