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Sample records for absence register study

  1. Predictors of sickness absence in college and university educated self-employed: a historic register study.

    PubMed

    Wijnvoord, Liesbeth E C; Van der Klink, Jac J L; De Boer, Michiel R; Brouwer, Sandra

    2014-05-02

    Despite a large proportion of the workforce being self-employed, few studies have been conducted on risk factors for sickness absence in this population. The aim of this study is to identify risk factors for future sickness absence in a population of college and university educated self-employed. In a historic register study based on insurance company files risk factors were identified by means of logistic regression analysis. Data collected at application for private disability insurance from 634 applicants were related to subsequent sickness absence periods of 30 days or more during a follow-up period of 7.95 years. Variables studied were self-reported lifestyle variables, variables concerning medical history and present health conditions and variables derived from the general medical examination including blood tests and urinary analysis. Results from analysis of data from 634 applicants for private disability insurance show that previous periods of sickness absence (OR 2.07), female gender (OR 2.04), health complaints listed in the health declaration (OR 1.88), elevated erythrocyte sedimentation rate (ESR) (OR 4.05) and the nature of the profession were related to a higher risk of sickness absence. Sickness absence was found to be related to demographic variables (gender, profession), medical variables (health complaints and erythrocyte sedimentation rate) and to variables with both a medical and a behavioural component (previous sickness absence).

  2. Sleep and Sickness Absence: A Nationally Representative Register-Based Follow-Up Study

    PubMed Central

    Lallukka, Tea; Kaikkonen, Risto; Härkänen, Tommi; Kronholm, Erkki; Partonen, Timo; Rahkonen, Ossi; Koskinen, Seppo

    2014-01-01

    Study Objectives: We aimed to examine various sleep measures as determinants of sickness absence while considering confounders. Design: Nationally representative Health 2000 Survey linked with sickness absence data from the Finnish Social Insurance Institution. Setting: Finland. Participants: Working-aged women (n = 1,875) and men (n = 1,885). Interventions: N/A. Measurements and Results: Insomnia-related symptoms, early morning awakenings, being more tired during daytime than other people of same age, use of sleeping pills, excessive daytime sleepiness, probable sleep apnea (4 items about snoring/apnea), and reporting that sleep duration varies between different seasons were examined as determinants of sickness absence over a 7.2 year follow-up. Poisson and gamma regression models were fitted. After adjusting age, all examined sleep disturbances except excessive daytime sleepiness were associated with sickness absence among men (RRs 1.3-2.5). Among women, after adjusting for age, insomnia-related symptoms, early morning awakenings, being more tired than others, and use of sleeping pills were associated with sickness absence (RRs 1.4-1.8). After further adjustments for education, working conditions, health behaviors, and objectively measured mental and somatic health, the associations somewhat attenuated but mainly remained. The optimal sleep duration with the lowest risk of sickness absence was 7.6 hours for women and 7.8 hours for men. Although persistence of other health problems could affect the estimates, direct costs due to sickness absence could decrease by up to 28% if sleep disturbances could be fully addressed. Conclusions: This study highlights the need for prevention of sleep disturbances and promotion of optimal sleep length to prevent sickness absence. Citation: Lallukka T, Kaikkonen R, Härkänen T, Kronholm E, Partonen T, Rahkonen O, Koskinen S. Sleep and sickness absence: a nationally representative register-based follow-up study. SLEEP 2014

  3. Sickness absence in gender-equal companies: a register study at organizational level.

    PubMed

    Sörlin, Ann; Ohman, Ann; Lindholm, Lars

    2011-07-11

    The differences in sickness absence between men and women in Sweden have attracted a great deal of interest nationally in the media and among policymakers over a long period. The fact that women have much higher levels of sickness absence has been explained in various ways. These explanations are contextual and one of the theories points to the lack of gender equality as an explanation. In this study, we evaluate the impact of gender equality on health at organizational level. Gender equality is measured by an index ranking companies at organizational level; health is measured as days on sickness benefit. Gender equality was measured using the Organizational Gender Gap Index or OGGI, which is constructed on the basis of six variables accessible in Swedish official registers. Each variable corresponds to a key word illustrating the interim objectives of the "National Plan for Gender Equality", implemented by the Swedish Parliament in 2006. Health is measured by a variable, days on sickness benefit, also accessible in the same registers. We found significant associations between company gender equality and days on sickness benefit. In gender-equal companies, the risk for days on sickness benefit was 1.7 (95% CI 1.6-1.8) higher than in gender-unequal companies. The differences were greater for men than for women: OR 1.8 (95% CI 1.7-2.0) compared to OR 1.4 (95% CI 1.3-1.5). Even though employees at gender-equal companies had more days on sickness benefit, the differences between men and women in this measure were smaller in gender-equal companies. Gender equality appears to alter health patterns, converging the differences between men and women.

  4. The regular general practitioner and sickness absence--a register-based study.

    PubMed

    Winde, Lee; Haukenes, Inger; Hetlevik, Øystein; Gjesdal, Sturla

    2013-01-08

    Undertaking research on the role of regular GPs with regard to rates of sickness absence is methodologically challenging, and existing results show a wide divergence. We investigated how long-term sickness absence is affected by the characteristics of doctors and their patient lists. The study encompassed all those vocationally active residents of Oslo and Bergen in 2005-2006 who had the same regular GP throughout 2006 (N = 298,039). Encrypted data on sickness absence for each individual in 2006, as well their age, gender and level of education were merged with data on the regular GPs (N = 568) and their patient lists, and subsequently analysed with the aid of logistic regression. The outcome variable was at least one period of sickness absence which had been paid for by the Norwegian Labour and Welfare Administration (NLWA). The explanatory variables included the age, gender, list length and list status (open/closed) of the regular GPs, as well as variables that characterised the composition of the patient lists. The analyses were stratified by gender and controlled for individual age and education. The age, gender and list length of the regular GPs were not associated with sickness absence paid for by the NLWA. The odds ratio for sickness absence > 16 days was reduced for both women and men when the list contained many highly educated patients, a high proportion of elderly people and few disability pensioners. Men on lists with a high proportion of men and lists with a high proportion of vocationally active patients also had lower odds rates for sickness absence > 16 days. Among women, the rate of sickness absence was lower for those on open lists than for those on closed lists. In addition to well-known individual factors, the study shows that the likelihood of sickness absence is affected by the socio-demographic composition of the patient list to which one belongs.

  5. Sleep and sickness absence: a nationally representative register-based follow-up study.

    PubMed

    Lallukka, Tea; Kaikkonen, Risto; Härkänen, Tommi; Kronholm, Erkki; Partonen, Timo; Rahkonen, Ossi; Koskinen, Seppo

    2014-09-01

    We aimed to examine various sleep measures as determinants of sickness absence while considering confounders. Nationally representative Health 2000 Survey linked with sickness absence data from the Finnish Social Insurance Institution. Finland. Working-aged women (n = 1,875) and men (n = 1,885). N/A. Insomnia-related symptoms, early morning awakenings, being more tired during daytime than other people of same age, use of sleeping pills, excessive daytime sleepiness, probable sleep apnea (4 items about snoring/apnea), and reporting that sleep duration varies between different seasons were examined as determinants of sickness absence over a 7.2 year follow-up. Poisson and gamma regression models were fitted. After adjusting age, all examined sleep disturbances except excessive daytime sleepiness were associated with sickness absence among men (RRs 1.3-2.5). Among women, after adjusting for age, insomnia-related symptoms, early morning awakenings, being more tired than others, and use of sleeping pills were associated with sickness absence (RRs 1.4-1.8). After further adjustments for education, working conditions, health behaviors, and objectively measured mental and somatic health, the associations somewhat attenuated but mainly remained. The optimal sleep duration with the lowest risk of sickness absence was 7.6 hours for women and 7.8 hours for men. Although persistence of other health problems could affect the estimates, direct costs due to sickness absence could decrease by up to 28% if sleep disturbances could be fully addressed. This study highlights the need for prevention of sleep disturbances and promotion of optimal sleep length to prevent sickness absence. © 2014 Associated Professional Sleep Societies, LLC.

  6. Pupils with special educational needs in basic education schools and teachers' sickness absences--a register-linkage study.

    PubMed

    Ervasti, Jenni; Kivimäki, Mika; Kawachi, Ichiro; Subramanian, S V; Pentti, Jaana; Ahola, Kirsi; Oksanen, Tuula; Pohjonen, Tiina; Vahtera, Jussi; Virtanen, Marianna

    2012-05-01

    We examined whether having a high percentage of pupils with special educational needs (SEN) in basic education schools increases the risk of sickness absence among teachers and whether this risk is dependent on the pupil-teacher ratio (PTR), an indicator of teacher resources at school. We obtained register data on 8089 teachers working in 404 schools in 10 municipalities in Finland during the school year 2004-2005. We used multilevel multinomial regression models to examine the risk of teachers' short- and long-term sickness absence in relation to the percentage of SEN pupils and the PTR at school. We tested the equality of trends in groups with high and low PTR using PTR × SEN interaction term. After adjustment for teacher and school characteristics, the risk for long-term absences was higher among teachers at schools with a high percentage of SEN pupils than among teachers at schools with a low percentage of SEN pupils [odds ratio (OR) 1.5, 95% confidence interval (95% CI) 1.2-1.8). This was also the case for short-term absences (OR 1.4, 95% CI 1.2-1.7). In analyses stratified by the PTR levels, the association between the percentage of SEN pupils and long-term absences was 15% higher among teachers with a high PTR than among those with a low PTR (P for interaction=0.10). Teachers' sickness absenteeism seems to increase with a higher percentage of SEN pupils, especially when the PTR is high. Teacher resources at schools that have a high percentage of SEN pupils should be well maintained to ensure the health of teachers.

  7. Effects of multidisciplinary inpatient rehabilitation for chronic back or neck pain: a register-linkage study of sickness absences and analgesic purchases in an occupational cohort.

    PubMed

    Suoyrjö, H; Hinkka, K; Oksanen, T; Kivimäki, M; Klaukka, T; Pentti, J; Vahtera, J

    2008-03-01

    To determine the effects of multidisciplinary in-patient rehabilitation for chronic back or neck pain on sickness absences and analgesic purchases. A prospective observational study. 10 towns in Finland. 34 838 local government employees, including 418 participants in rehabilitation for chronic back pain and 195 participants in rehabilitation for chronic neck pain between 1994 and 2002. The annual rates of short (1-3 days), long (>3 days), and very long (>21 days) sickness absences and the defined daily doses (DDD) of prescribed analgesics. The rate of very long (>21 days) sickness absence among the chronic back pain rehabilitees was 3.03-fold (95% CI 2.55 to 3.60) compared to the non-rehabilitees in the year before rehabilitation. This ratio declined to 1.88 (95% CI 1.65 to 2.37) three years after rehabilitation. No further decline in the rate of very long sickness absence was observed in the subsequent years. For chronic neck pain rehabilitees, no evidence of the effectiveness of rehabilitation on sickness absence was found. In relation to consumption of analgesics, the mean rate of DDDs declined among the back and neck pain rehabilitees after rehabilitation compared to the non-rehabilitees. Multidisciplinary in-patient rehabilitation for chronic back pain may decrease the risk of very long sickness absence for three years. In relation to rehabilitation for chronic neck pain, no changes in sickness absences were found.

  8. Increased risk of long-term sickness absence, lower rate of return to work, and higher risk of unemployment and disability pensioning for thyroid patients: a Danish register-based cohort study.

    PubMed

    Nexo, M A; Watt, T; Pedersen, J; Bonnema, S J; Hegedüs, L; Rasmussen, A K; Feldt-Rasmussen, U; Bjorner, J B

    2014-09-01

    Little is known about how thyroid diseases affect work ability. The objective of this study was to evaluate the risk of work disability for patients with thyroid disease compared with the general population. In a longitudinal register study, outpatients (n = 862) with nontoxic goiter, hyperthyroidism, Graves' orbitopathy (GO), autoimmune hypothyroidism, or other thyroid diseases and their matched controls (n = 7043) were observed in the years 1994-2011 in Danish national registers of social benefits, health, and work characteristics. Cox regression analyses estimated adjusted hazard ratios (HRs) for the first year after diagnosis and subsequent years. Transitions between work, long-term sickness absence, unemployment, and disability pension were measured. Patients differed significantly from the general population with regard to sickness absence, disability pension, return from sickness absence, and unemployment. In the first year after diagnosis, higher risks of sickness absence was seen for GO (HR 6.94) and other hyperthyroid patients (HR 2.08), who also had lower probability of returning from sickness absence (HR 0.62) and higher risk of disability pension (HR 4.15). Patients with autoimmune hypothyroidism showed a lower probability of returning from sickness absence (HR 0.62). In subsequent years, GO patients had significantly higher risk of sickness absence (HR 2.08), lower probability of return from sickness absence (HR 0.51), and unemployment (HR 0.52) and a higher risk of disability pension (HR 4.40). Hyperthyroid patients also had difficulties returning from sickness absence (HR 0.71). Thyroid patients' risk of work disability is most pronounced in the first year after diagnosis and attenuates in subsequent years. GO patients have the highest risk of work disability.

  9. Leadership styles of nurse managers and registered sickness absence among their nursing staff.

    PubMed

    Schreuder, Jolanda A H; Roelen, Corné A M; van Zweeden, Nely F; Jongsma, Dianne; van der Klink, Jac J L; Groothoff, Johan W

    2011-01-01

    Sickness absence leads to understaffing and interferes with nursing efficiency and quality. It has been reported in literature that managerial leadership is associated with self-reported sickness absence in the working population. This study investigated the relationship between managerial leadership and sickness absence in health care by associating nurse managers' leadership styles with registered sickness absence among their nursing staff. The cross-sectional study included 699 nurses working in six wards (staff range = 91-140 employees) of a Dutch somatic hospital employing a total of 1,153 persons. The nurse managers heading the wards were asked to complete the Leadership Effectiveness and Adaptability Description questionnaire for situational leadership. The Leadership Effectiveness and Adaptability Description scores were linked to employer-registered nursing staff sickness absence. High relationship-high task behavior (odds ratio [OR] = 0.76, 95% confidence interval [CI] = 0.65-0.85) and high relationship-low task behavior (OR = 0.37, 95% CI = 0.14 -0.98) were inversely related to the number of short (one to seven consecutive days) episodes of sickness absence among the staff. Low relationship-high task styles (OR = 2.44, 95% CI = 1.14-5.22) as well as low relationship-low task styles (OR = 2.44, 95% CI = 1.26-4.71) were positively associated with the number of short episodes of sickness absence. However, the leadership styles only explained 10% of the variance in short episodes of sickness absence. Leadership styles are associated with registered sickness absence. The nursing staff of relationship-oriented nurse managers has fewer short episodes of sickness absence than the staff of task-oriented managers. Training nurse managers in relational leadership styles may reduce understaffing and improve nursing efficiency and quality.

  10. Celotex (Registered) Replacement Study

    SciTech Connect

    Couture, S; Hafner, R

    2002-10-01

    The AL-R8 is the pit storage container in most widespread use at Pantex. The AL-R8 container family consists of standard 20-in.-diameter steel drums, 30 to 60 in. in height, with insulation inserts made of Celotex{reg_sign}--a fiberboard product made from processed sugar cane. Celotex is an acceptable material for inserts in many radioactive material shipping and storage containers. It is a good shock mitigator/insulator, does a fair job in fire protection (when oxygen is excluded), shielding, and criticality, and is inexpensive and easily available. However, the fiberboard absorbs water in humid environments which, when combined with chemical residues in the fiberboard, forms corrosive compounds that can shorten the life of the container and affect container contents. To protect the contents from this potentially damaging environment, the AL-R8 SI was developed to isolate the contents within a sealed stainless steel vessel inside the AL-R8. Although the SI protected the contents, corrosion studies indicated the SI lid bolts might corrode over time and surveillance showed that areas of the outer drum were still subject to corrosion. To address this potential problem, DOE/Albuquerque sponsored bolt and Celotex replacement studies. The bolt replacement study was assigned to Mason and Hanger's Pantex Facility and this Celotex Replacement Study to Lawrence Livermore National Laboratory. The Celotex Replacement Study evaluated options for replacing Celotex with a material that is chemically compatible with the AL-R8 SI container. The evaluation was limited to materials either used previously in nuclear materials shipping and storage containers or materials with known properties in a low-radiation environment. This limitation was set to ensure that the long-term aging effect on the new material is known a priori. Initial material evaluations narrowed the material choices to foam and cork. Although cork performed better than foam in some tests, cork was considered a less

  11. Distribution of subjective health complaints, and their association with register based sickness absence in the Danish working population.

    PubMed

    Poulsen, Otto Melchior; Persson, Roger; Kristiansen, Jesper; Andersen, Lars Louis; Villadsen, Ebbe; Ørbæk, Palle

    2013-03-01

    To describe the distribution of subjective health complaints (SHCs) in a Danish working population and the associations between SHC and register based sickness absence. The study entailed 2876 men and 3574 women aged 18-59 years that constituted the 2005 panel in the Danish Work Environment Cohort Study (DWECS). All had completed a subjective health complaints inventory and the Nordic Musculoskeletal Questionnaire (NMQ). Seven SHC/NMQ indices were constructed and merged with subsequently collected data on prolonged sickness absence periods (each period > 14 days) that was registered in the national Danish register on social transfer payments: the DREAM register. Ordinal logistic regression was used to model the cumulative odds for sickness absence as a function of strata. The majority of participants reported at least one SHC during a 30-day period (circa 89% of the men and 95% of the women). The reports of severe SHC, defined as recurring SHC within the 30-day period, were less common. About 55% of the men and 68% of the women reported at least one severe SHC during a 30-day period. The odds ratios of sickness absence increased with the number of SHC a participant acknowledged. The odds ratios were slightly reduced after adjusting for age, disease history and social class. The majority of the working population in Denmark report at least one SHC during a 30-day period. Roughly half of the population report having at least one recurrent (often to very often) SHC during the last 30-days (severe SHC). Reporting the presence of several SHCs increases the likelihood of having more prospectively registered periods of sickness absence above two weeks.

  12. Return to Work among Employees with Long-Term Sickness Absence in Eldercare: A Prospective Analysis of Register-Based Outcomes

    ERIC Educational Resources Information Center

    Clausen, Thomas; Friis Andersen, Malenea; Bang Christensen, Karl; Lund, Thomas

    2011-01-01

    This study investigates whether psychosocial work characteristics and work-related psychological states predict return to work (RTW) after long-term sickness absence among eldercare staff. We followed 9947 employees in a national register on payment of sickness-absence compensation for 1 year and found that 598 employees had absence periods of 8…

  13. Return to Work among Employees with Long-Term Sickness Absence in Eldercare: A Prospective Analysis of Register-Based Outcomes

    ERIC Educational Resources Information Center

    Clausen, Thomas; Friis Andersen, Malenea; Bang Christensen, Karl; Lund, Thomas

    2011-01-01

    This study investigates whether psychosocial work characteristics and work-related psychological states predict return to work (RTW) after long-term sickness absence among eldercare staff. We followed 9947 employees in a national register on payment of sickness-absence compensation for 1 year and found that 598 employees had absence periods of 8…

  14. Workplace levels of psychosocial factors as prospective predictors of registered sickness absence.

    PubMed

    Christensen, Karl Bang; Nielsen, Martin L; Rugulies, Reiner; Smith-Hansen, Lars; Kristensen, Tage S

    2005-09-01

    We sought to investigate whether workplace levels of psychosocial work environment factors predict individual sickness absence. Data were collected in a prospective study in 52 Danish workplaces in three organizations: municipal care, technical services, and a pharmaceutical company. Psychosocial factors were aggregated as workplace means. We used multilevel Poisson regression models with psychosocial factors as predictors and individual level sickness absence from absence registries as outcome. High workplace levels of decision authority predicted low sickness absence in the technical services (rate ratio = 0.66, 95% confidence interval = 0.51-0.86) and high workplace levels of skill discretion predicted low sickness absence in the pharmaceutical company (rate ratio = 0.74, 95% confidence interval = 0.62-0.88) after control for relevant confounders. Workplaces in municipal care did not differ with respect to the psychosocial factors. Psychosocial factors at the workplace level may be important predictors of sickness absence.

  15. Estimating vaccination coverage in the absence of immunisation registers--the German experience.

    PubMed

    Siedler, A; Rieck, T; Reuss, A; Walter, D; Poggensee, G; Poethko-Muller, C; Reiter, S

    2012-04-26

    Immunisation registers are regarded as an appropriate solution to measure vaccination coverage on a population level. In Germany, a decentralised healthcare system and data protection regulations constrain such an approach. Moreover, shared responsibilities in the process of immunisation and multiple providers form the framework for public health interventions on vaccination issues. On the national level, those interventions consist mainly of conceptualising immunisation strategies, establishing vaccination programmes, and issuing recommendations. This paper provides an overview on sources and methods for collecting appropriate coverage data at national level and their public health relevance in Germany. Methods of data collection and available information on immunisations are described for three approaches: school entrance health examination, population surveys and insurance refund claim data. School entrance health examinations allow regional comparisons and estimation of trends for a specific cohort of children and for all recommended childhood vaccinations. Surveys deliver population based data on completeness and timeliness of selected vaccinations in populations defined by age or socio-demographic parameters and on knowledge and attitudes towards vaccination. Insurance refund claim data inform continuously on immunisation status (e.g. of children aged two years) or on vaccination incidence promptly after new or modified recommendations. In a complex healthcare system, the German National Public Health Institute (Robert Koch Institute, RKI) successfully compiles coverage data from different sources, which complement and validate one another. With the German approach of combining different data sources in the absence of immunisation registers, it is possible to gain solid and reliable data on the acceptance of vaccination programmes and target groups for immunisation. This approach might be of value for other countries with decentralised healthcare systems.

  16. Job demands, job resources and long-term sickness absence in the Danish eldercare services: a prospective analysis of register-based outcomes.

    PubMed

    Clausen, Thomas; Nielsen, Karina; Carneiro, Isabella Gomes; Borg, Vilhelm

    2012-01-01

    To investigate associations between psychosocial job demands, job resources and cases of registered long-term sickness absence among nursing staff in the eldercare services. Research has shown that psychosocial work environment exposures predict sickness absence in healthcare settings. However, only few studies have longitudinally investigated associations between specific job demands and job resources and risk of long-term sickness absence. Questionnaire data were collected in 2004 and 2005 among all employees in the eldercare services in 35 Danish municipalities and were followed in a National register on payment of sickness absence compensation for a 1-year follow-up period (N = 7921). Three psychosocial job demands - emotional demands, quantitative demands and role conflicts - and three job resources - influence, quality of leadership and team climate - were investigated to predict risk of sickness absence for eight or more consecutive weeks in the follow-up period. Data were analysed using Cox proportional hazards model. A percentage of 6·5 of the respondents were absent for eight or more consecutive weeks during follow-up. The analyses showed that emotional demands, role conflicts, influence, quality of leadership and team climate were significantly associated with risk of long-term sickness absence. In an analysis with mutual adjustment for all job demands and job resources, influence constituted the strongest predictor of long-term sickness absence (negative association). Job demands and job resources are significantly associated with risk of long-term sickness absence. Interventions aimed at improving the psychosocial work environment may, therefore, contribute towards preventing long-term sickness absence in the eldercare services. © 2011 Blackwell Publishing Ltd.

  17. Return to work among employees with long-term sickness absence in eldercare: a prospective analysis of register-based outcomes.

    PubMed

    Clausen, Thomas; Friis Andersen, Malene; Christensen, Karl Bang; Lund, Thomas

    2011-09-01

    This study investigates whether psychosocial work characteristics and work-related psychological states predict return to work (RTW) after long-term sickness absence among eldercare staff. We followed 9947 employees in a national register on payment of sickness-absence compensation for 1 year and found that 598 employees had absence periods of 8 or more consecutive weeks. Using Cox regression analysis, these 598 employees were followed for a year after onset of sickness absence to investigate associations between baseline questionnaire data on psychosocial work characteristics and work-related psychological states on the one side and 'risk' of RTW on the other. The results showed that none of the psychosocial work characteristics, emotional demands, role conflicts, quality of leadership and influence, were significantly associated with RTW. Of the two work-related psychological states, affective organizational commitment and experience of meaning at work, the results showed that sickness-absent employees who experienced low meaning at work at baseline had a significantly reduced 'risk' of RTW when compared with employees who experienced high meaning at work. No significant associations were found for affective organizational commitment. The results imply that experience of meaning at work must be considered an important work-life resource, as it enhances the capacity of sickness-absent employees to RTW after extended sickness-absence periods.

  18. Visual impairment and falls: a register study.

    PubMed

    Källstrand-Ericson, Jeanette; Hildingh, Cathrine

    2009-02-01

    The aim of this register study was to investigate falls and fall injuries of inpatients 65 years and over to determine whether a causal factor of visual impairment was documented. All Organisation for Economic Cooperation and Development (OECD) countries have an increasing older population with falls and fall injuries becoming a major problem. A visual impairment can be an independent risk factor for falls but can also occur in combination with other intrinsic and extrinsic risk factors. A retrospective non-randomised register study. In 2004, all documented falls of inpatients aged 65 years and over were examined. Medical records and eye clinic records were scrutinised to identify whether any visual impairment have been documented. The majority of falls occurred between the hours of 24:00-06:00 and the inpatients most often affected were those with a visual impairment. The falls occurred in connection with movement when the inpatient was unaccompanied. Documentation in records at the medical clinic was defective and subjectively perceived visual impairment was not documented at all. Both subjective and objective visual impairment occurred in all eye clinic records. Visual impairment along with the ageing process are features affecting falls and the hospital environment needs to be adapted by improving the use of strong, contrasting colours and providing good lighting for older inpatients with visual impairment during the night time period. Hospital safety for older people with visual impairment is a concern if falls are to be reduced. Healthcare professionals need to undertake individual risk assessments to establish the degree of visual impairment of the older person so that appropriate interventions can be implemented to reduce the incidence of falls and fall injuries.

  19. The gender gap in sickness absence from work and the influence of parental absence on offspring absence 15 years later: register-based cohort of Norwegians born in 1974-1976.

    PubMed

    Kristensen, Petter; Corbett, Karina; Mehlum, Ingrid Sivesind

    2015-07-21

    Women have shown consistently higher levels of sickness absence from work in comparison to men, but explanations for this gender gap have not been completely understood. Life-course studies suggest that health and health-related social benefits in adult age are influenced by early life experiences. We aimed to estimate intergenerational associations with a 15-year time gap between parents' and offspring sickness absences, pursuing the hypothesis that this parental influence would have a stronger impact for women than for men. All persons born alive between 1974 and 1976 in Norway were followed up in several national registries. Employed persons considered to be at risk of sickness absence and also with parents at risk of sickness absence (n = 78,878) were followed in the calendar year of their 33(rd) birthday with respect to spells lasting >16 days. The probability of one or more spells during this year constituted the one-year risk under study. Additive risk differences in association with an exposure (parental sickness absence 15 years earlier) were estimated in a binomial regression analysis. The estimates were adjusted for parental socioeconomic factors. The 1-year sickness absence risk was higher for women (30.4%) than for men (12.3%). The crude risk differences between those exposed and those unexposed to parental sickness absence were similar in percentage points (PP) for women (3.8; 95% confidence interval (CI) 2.6 to 4.9) and men (3.8; 95% CI 2.9 to 4.6). The risk differences were moderately attenuated after adjustment for parental education and father's income to 3.4 PP (2.2 to 4.5) for women and 2.8 PP (2.0 to 3.7) for men. Male absence was more strongly associated with the father's than with the mother's sickness absence, while associations for women were stronger for the same diagnostic groups as their parents. Parental sickness absence was moderately associated with sickness absence in the next generation. Bias from unmeasured confounders cannot

  20. A descriptive case-register study of delusional disorder.

    PubMed

    de Portugal, Enrique; González, Nieves; Haro, Josep M; Autonell, Jaume; Cervilla, Jorge A

    2008-03-01

    A few empirically based studies' data on delusional disorder (DD) exist. We aim to describe sociodemographic and clinical correlates of DD and to identify clinical profiles associated to DD and its subtypes. This is a case-register study based on all those subjects attending community mental health services within a geographically well-defined area. Four hundred and sixty-seven patients had been diagnosed as DD cases at psychiatric services serving a catchment area of some 607,494 inhabitants living in South Barcelona (Spain) during a three-year period (2001-2003). A thorough systematic review of computerised medical records was used to establish DSM-IV diagnosis, rendering a valid sample of 370 patients who fulfilled DSM-IV criteria for DD. Independent variables gathered include sociodemographic data, family and personal psychiatric history, and comorbid diagnoses on all DSM-IV axes (including GAF). We used descriptive and univariate statistical methods to explore sample frequencies and correlates across DD types. The mean age of the patients was 55 years and the sample had a mean GAF score of 51 suggesting a poor functionality; 56.5% of the patients were female. The most frequent DD types were persecutory (48%), jealous (11%), mixed (11%) and somatic (5%), whilst 23% qualified for the NOS type. Most frequent symptoms identified were self-reference (40%), irritability (30%), depressive mood (20%) and aggressiveness (15%). Hallucinations were present in 16% of the patients (6% tactile; 4% olfactory). Nearly 9% had a family history of schizophrenia (higher among those with the jealous subtype) and 42% had a comorbid axis II diagnosis (mostly paranoid personality disorder). Depression was significantly more frequent among the persecutory and jealous types. Finally, global functioning was significantly better among jealous and mixed types and worse amongst erotomanic and grandiose cases (p=0.008). In the absence of other similar empirical data, this modest study

  1. An overview of characteristics of registered studies on dental implants.

    PubMed

    Gajendrareddy, Praveenkumar; Elangovan, Satheesh; Rampa, Sankeerth; Allareddy, Veeratrishul; Lee, Min Kyeong; Nalliah, Romesh P; Allareddy, Veerasathpurush

    2014-09-01

    Clinical trials serve as the empirical basis for clinical decision making. The objective of the current study is to provide an overview of clinical trials examining dental implant outcomes. All registered studies on Dental Implants were selected for analysis. The clinicaltrials.gov website was used to query the characteristics of registered studies. The search term used was dental implants. As of the study conduct date (01/01/2014), a total of 205 studies on dental implants were registered. These included 168 interventional and 37 observational studies. Results were available for only 14 studies. All observational studies and 98.8% of interventional studies included both male and female subjects. Close to 60% of studies had sample sizes between 1 and 50. NIH was listed as funding source in only 5 interventional studies and 3 observational studies. 80% of interventional studies were randomized. However, double masking was reported in only 15% of interventional studies with majority being open labeled. ClinicalTrials.gov registry was created with the intention of increasing the transparency of conducted or ongoing clinical studies and to minimize publication bias commonly seen with industry-sponsored studies. Results of the current study showed that a predominating number of registered studies are funded by industry and other sources, very few registered studies have made their results public, and the ClinicalTrials.gov registry does not provide sufficient information on the quality of study design and thus precluding the public and researchers to judge on the quality of registered studies and publication bias. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Study of hemoglobinopathies in Oman through a national register.

    PubMed

    Rajab, A G; Patton, M A; Modell, B

    2000-12-01

    A national register of symptomatic hemoglobinopathies has been developed in Oman to facilitate the development of the National Program for the control of genetic blood disorders. The information was initially collected retrospectively through hospital records and was refined prospectively with data collected through a survey of pediatricians. The percentages of heterozygotes in different population groups and geographical locations, birth prevalence, age distribution of cases and factors determining frequencies of Hemoglobinopathies in different regions of the country were studied from the register. The register has identified 1757 cases of homozygous Sickle Cell Anemia and 243 cases of beta-thalassemia major in a population of 1.5 million in 1995. Register based national figures of heterozygote carriers approximate 10% for Sickle Cell Anemia and 4% for beta-thalassemia major. Defining regional and tribal variations can assist efficient targeting of health resources. This approach provides a simple model for other countries or regions to follow providing there is a health care system that facilitates registration.

  3. Context Switching with Multiple Register Windows: A RISC Performance Study

    NASA Technical Reports Server (NTRS)

    Konsek, Marion B.; Reed, Daniel A.; Watcharawittayakul, Wittaya

    1987-01-01

    Although previous studies have shown that a large file of overlapping register windows can greatly reduce procedure call/return overhead, the effects of register windows in a multiprogramming environment are poorly understood. This paper investigates the performance of multiprogrammed, reduced instruction set computers (RISCs) as a function of window management strategy. Using an analytic model that reflects context switch and procedure call overheads, we analyze the performance of simple, linearly self-recursive programs. For more complex programs, we present the results of a simulation study. These studies show that a simple strategy that saves all windows prior to a context switch, but restores only a single window following a context switch, performs near optimally.

  4. Childbirth, hospitalisation and sickness absence: a study of female twins.

    PubMed

    Björkenstam, Emma; Alexanderson, Kristina; Narusyte, Jurgita; Kjeldgård, Linnea; Ropponen, Annina; Svedberg, Pia

    2015-01-08

    To investigate associations of giving birth with morbidity in terms of hospitalisation and social consequences of morbidity in terms of sickness absence (SA), while taking familial (genetics and shared environmental) factors into account. Prospective register-based cohort study. Estimates of risk of hospitalisation and SA were calculated as HRs with 95% CIs. All female twins, that is, women with a twin sister, born in Sweden. 5118 Swedish female twins (women with a twin sister), born during 1959-1990, where at least one in the twin pair had their first childbirth (T0) during 1994-2009 and none gave birth before 1994. Hospitalisation and SA during year 3-5 after first delivery or equivalent. Preceding the first childbirth, the mean annual number of SA days increased for mothers, and then decreased again. Hospitalisation after T0 was associated with higher HRs of short-term and long-term SA (HR for short-term SA 3.0; 95% CI 2.5 to 3.6 and for long-term SA 2.3; 95% CI 1.6 to 3.2). Hospitalisation both before and after first childbirth was associated with a higher risk of future SA (HR for long-term SA 4.2; 95% CI 2.7 to 6.4). Familial factors influenced the association between hospitalisation and long-term SA, regardless of childbirth status. Women giving birth did not have a higher risk for SA than those not giving birth and results indicate a positive health selection into giving birth. Mothers hospitalised before and/or after giving birth had higher risks for future SA, that is, there was a strong association between morbidity and future SA. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. Childbirth, hospitalisation and sickness absence: a study of female twins

    PubMed Central

    Björkenstam, Emma; Alexanderson, Kristina; Narusyte, Jurgita; Kjeldgård, Linnea; Ropponen, Annina; Svedberg, Pia

    2015-01-01

    Objective To investigate associations of giving birth with morbidity in terms of hospitalisation and social consequences of morbidity in terms of sickness absence (SA), while taking familial (genetics and shared environmental) factors into account. Design Prospective register-based cohort study. Estimates of risk of hospitalisation and SA were calculated as HRs with 95% CIs. Setting All female twins, that is, women with a twin sister, born in Sweden. Participants 5118 Swedish female twins (women with a twin sister), born during 1959–1990, where at least one in the twin pair had their first childbirth (T0) during 1994–2009 and none gave birth before 1994. Main outcome measures Hospitalisation and SA during year 3–5 after first delivery or equivalent. Results Preceding the first childbirth, the mean annual number of SA days increased for mothers, and then decreased again. Hospitalisation after T0 was associated with higher HRs of short-term and long-term SA (HR for short-term SA 3.0; 95% CI 2.5 to 3.6 and for long-term SA 2.3; 95% CI 1.6 to 3.2). Hospitalisation both before and after first childbirth was associated with a higher risk of future SA (HR for long-term SA 4.2; 95% CI 2.7 to 6.4). Familial factors influenced the association between hospitalisation and long-term SA, regardless of childbirth status. Conclusions Women giving birth did not have a higher risk for SA than those not giving birth and results indicate a positive health selection into giving birth. Mothers hospitalised before and/or after giving birth had higher risks for future SA, that is, there was a strong association between morbidity and future SA. PMID:25573523

  6. Prenatal Maternal Smoking and Tourette Syndrome: A Nationwide Register Study.

    PubMed

    Leivonen, Susanna; Chudal, Roshan; Joelsson, Petteri; Ekblad, Mikael; Suominen, Auli; Brown, Alan S; Gissler, Mika; Voutilainen, Arja; Sourander, Andre

    2016-02-01

    This is the first nationwide register-based study to examine the relationship between prenatal maternal smoking and Tourette syndrome. A total of 767 children diagnosed with Tourette syndrome were identified from the Finnish Hospital Discharge Register. Each case was matched to four controls. Information on maternal smoking during pregnancy was obtained from the Finnish Medical Birth Register. Conditional logistic regression models were used for statistical analyses. Prenatal maternal smoking was associated with Tourette syndrome when comorbid with ADHD (OR 4.0, 95 % CI 1.2-13.5, p = 0.027 for exposure during first trimester, OR 1.7, 95 % CI, 1.05-2.7, p = 0.031 for exposure for the whole pregnancy). There was no association between maternal smoking during pregnancy and Tourette syndrome without comorbid ADHD (OR 0.5, 95 % CI 0.2-1.3, p = 0.166, OR 0.9, 95 % CI 0.7-1.3, p = 0.567). Further research is needed to elucidate the mechanisms behind the association between prenatal maternal smoking and Tourette syndrome with comorbid ADHD.

  7. Obesity and sickness absence: results from the CHAP study.

    PubMed

    Harvey, S B; Glozier, N; Carlton, O; Mykletun, A; Henderson, M; Hotopf, M; Holland-Elliott, K

    2010-08-01

    Obesity is an increasing public health problem. A small number of studies have examined the relationship between obesity and sickness absence, with mixed results, particularly regarding short-term sickness absence. To determine if obesity is associated with short- and long-term sickness absence and to investigate the mechanisms that may underlie any association. Cross-sectional (n = 1489) and prospective (n = 625) analyses were conducted on staff from London Underground Ltd. All participants underwent regular clinical examinations that involved their height and weight being measured, obesity-related medical problems being diagnosed and psychiatric disorders being identified. The number of days taken for short- (<10 days in an episode) and long-term sickness absence were recorded by managers on an electronic database. There was a positive linear association between employees' body mass index (BMI) and the number of days' work missed due to sickness absence on both cross-sectional and prospective analyses (P < 0.001). Obesity was a risk factor for both short- and long-term sickness absence. Obese individuals typically took an extra 4 days sick leave every year. The majority of the increased risk for long-term sickness absence appeared to be mediated via co-morbid chronic medical conditions. The excess short-term sickness absence was not explained by obesity-related medical problems, psychiatric disorders or workplace factors. Obese employees take significantly more short- and long-term sickness absence than workers of a healthy weight. There is growing evidence to support employers becoming more involved in tackling obesity.

  8. The associations between workplace bullying, salivary cortisol, and long-term sickness absence: a longitudinal study.

    PubMed

    Grynderup, Matias Brødsgaard; Nabe-Nielsen, Kirsten; Lange, Theis; Conway, Paul Maurice; Bonde, Jens Peter; Garde, Anne Helene; Gullander, Maria; Kaerlev, Linda; Persson, Roger; Rugulies, Reiner; Vammen, Marianne Agergaard; Høgh, Annie; Hansen, Åse Marie

    2017-09-16

    Workplace stressors, such as bullying, are strongly related to subsequent long-term sickness absence, but little is known of the possible physiological mechanisms linking workplace stressors and sickness absence. The primary aim of this study was to investigate to what extent cortisol levels were associated with subsequent sickness absence and if cortisol mediated the association between workplace bullying and sickness absence. We additionally investigated possible bidirectional associations between bullying, cortisol, and long-term sickness absence. Participants came from two Danish cohort studies, the "Psychosocial RIsk factors for Stress and MEntal disease" (PRISME) cohort and the "Workplace Bullying and Harassment" (WBH) cohort (n = 5418). Information about exposure to workplace bullying and morning and evening salivary cortisol was collected at three time points with approximately two years in between. After each data collection, all participants were followed for two years in registers, and cases with long-term sickness absence lasting 30 or more consecutive days were identified. The association between cortisol levels and subsequent sickness absence was assessed by logistic regression, while the extent to which the association between bullying and sickness absence was mediated by cortisol was quantified through natural direct and indirect effects. High evening cortisol was associated with a decreased risk of sickness absence (OR = 0.82, 95% CI = 0.68-0.99), but we did not find that high morning cortisol levels (OR = 0.98, 95% CI = 0.81-1.18) or high morning-to-evening slope (OR = 0.99, 95% CI = 0.82-1.18) were associated with subsequent sickness absence. We also tested for reverse causation and found that long-term sickness absence, but not salivary cortisol, was a strong risk factor for subsequent workplace bullying. There was no indication that cortisol mediated the association between workplace bullying and sickness absence. We found no

  9. Databases and registers: useful tools for research, no studies.

    PubMed

    Curbelo, Rafael J; Loza, Estíbaliz; de Yébenes, Maria Jesús García; Carmona, Loreto

    2014-04-01

    There are many misunderstandings about databases. Database is a commonly misused term in reference to any set of data entered into a computer. However, true databases serve a main purpose, organising data. They do so by establishing several layers of relationships; databases are hierarchical. Databases commonly organise data over different levels and over time, where time can be measured as the time between visits, or between treatments, or adverse events, etc. In this sense, medical databases are closely related to longitudinal observational studies, as databases allow the introduction of data on the same patient over time. Basically, we could establish four types of databases in medicine, depending on their purpose: (1) administrative databases, (2) clinical databases, (3) registers, and (4) study-oriented databases. But a database is a useful tool for a large variety of studies, not a type of study itself. Different types of databases serve very different purposes, and a clear understanding of the different research designs mentioned in this paper would prevent many of the databases we launch from being just a lot of work and very little science.

  10. Retaining early career registered nurses: a case study.

    PubMed

    Mills, Jane; Chamberlain-Salaun, Jennifer; Harrison, Helena; Yates, Karen; O'Shea, Andrea

    2016-01-01

    A core objective of the Australian health system is to provide high quality, safe health care that meets the needs of all Australians. To achieve this, an adequate and effective workforce must support the delivery of care. With rapidly changing health care systems and consumer demographics, demand for care is increasing and retention of sufficient numbers of skilled staff is now a critical priority to meet current and future health care demands. Nurses are the largest cohort of professionals within the health workforce. Reducing the rates at which nurses leave the profession and supporting nurses to practice in their profession longer will have beneficial implications for the sustainability of a nursing workforce and, ultimately, to patient outcomes. The aim of the study was to describe and explain early career registered nurses' (ECRNs) experiences and support requirements during the first five years of practice for the purposes of identifying strategies that would support greater retention of ECRNs. A single case study design focused on early career registered nurses (ECRNs) working in a hospital and health service in northern Australia. The research team adopted Djukic et al's definition of ECRNs as "RNs who have practiced for less than 5 years". Data was collected via three individual interviews and two focus groups. Thirty-five ECRNs participated in the study. Qualitative analysis of data generated during interviews and focus groups, identified the key themes of receiving career advice and choice or no choice. Analysis of study data in the context of the broader literature resulted in the researchers identifying six areas of focus for ECRN retention: 1) well-planned, supported and structured transition periods; 2) consideration of rotation through different areas with a six month minimum for skills development; 3) empowering decision making; 4) placement opportunities and choice in decisions of where to work; 5) career advice and support that considers ECRNs

  11. Explaining educational differences in sickness absence: a population-based follow-up study.

    PubMed

    Kaikkonen, Risto; Härkänen, Tommi; Rahkonen, Ossi; Gould, Raija; Koskinen, Seppo

    2015-07-01

    There is a marked socioeconomic gradient in sickness absences, but the causes of this gradient are poorly understood. This study examined the role of health and work-related factors as determinants of educational differences in long-term sickness absence in an 8-year follow-up. The study comprised a population-based sample of 5835 Finns aged 30-64 years (participation 89%, N=3946) in a register-based 8-year follow-up. This is a novel method to predict the population average of sickness absence days per working year (DWY) based on the expected outcome values using Poisson and gamma regression models. The difference in the DWY between the lowest and highest educational level was clear among both men (3.2 days/year versus 8.0 days/year) and women (women 4.4 days/year versus 10.1 days/year). Adjusting for physical working conditions, health status and health behavior, and obesity attenuated the differences. Psychosocial working conditions had only a minor effect on the association. After adjusting for health and work-related factors, the difference attenuated by 1.8 days and 2.6 days among men and women, respectively. Our results suggest that improvements in physical working conditions and reducing smoking, particularly among employees with a low level of education, may markedly reduce educational differences in sickness absence.

  12. Job satisfaction of Malaysian registered nurses: a qualitative study.

    PubMed

    Atefi, Narges; Abdullah, Khatijah L; Wong, Li P

    2016-01-01

    Job satisfaction is an important factor in health care settings. Strong empirical evidence supports a causal relationship between job satisfaction, patient safety and quality of care. However, there have not been any studies exploring the job satisfaction of Malaysian nurses. The main purpose of this qualitative descriptive study was to explore the factors related to feelings of job satisfaction as well as job dissatisfaction experienced by registered nurses in Malaysia. A convenient sample of 46 Malaysian nurses recruited from a large hospital (number of beds = 895) participated in the study. A total of seven focus group discussions were conducted with nurses from surgical, medical and critical care wards. A semi-structured interview guide was used to facilitate the interviews, which were audio-recorded, transcribed verbatim and checked. The transcripts were used as data and were analysed using a thematic approach. The study identified three main themes that influenced job satisfaction: (1) nurses' personal values and beliefs; (2) work environment factors and (3) motivation factors. Concerning the nurses' personal values and beliefs, the ability to help people made the nurses felt honoured and happy, which indirectly contributed to job satisfaction. For work environment factors, team cohesion, benefit and reward, working conditions play an important role in the nurses' job satisfaction. Motivation factors, namely, professional development and clinical autonomy contributed to job satisfaction. It is important for nurse leaders to provide more rewards, comfortable work environments and to understand issues that affect nurses' job satisfaction. Our findings highlight the importance of factors that can improve nurses' job satisfaction. The study provides basic information for hospital administrators in planning effective and efficient policies to improve nursing job satisfaction in order to increase the quality of patient care and decrease nursing turnover. © 2014

  13. The Female Register: An Empirical Study of Lakoff's Hypotheses

    ERIC Educational Resources Information Center

    Crosby, Faye; Nyquist, Linda

    1977-01-01

    The data support Lakoff's hypotheses that the female register is used more by women than by men, although they do not necessarily justify her further assertion that women's speech reflects, or is caused by, the low status of women in our society. (Author/HP)

  14. Anorexia nervosa: a psychiatric case register study from Aberdeen.

    PubMed

    Szmukler, G; McCance, C; McCrone, L; Hunter, D

    1986-02-01

    The results of an examination of the 238 cases of anorexia nervosa on the Aberdeen Psychiatric Case Register for the period 1965-82 are reported. A highly significant increase in the number of cases over time was found. The average annual incidence rate for the period 1978-82 was 4.06 per 100 000 population. The case notes of every second patient on the register were inspected to assess diagnostic reliability, to define patient characteristics further and to look for changes in these over time. The diagnosis was highly suspect in 5% of cases. A social class bias was found, with an over-representation of classes I and II but an under-representation of social class III. Few significant changes were noted in the patients over time. The utilization of services was also examined, and it was found that 24% of the patients remained in contact for 4 years or more.

  15. Inadequate Diagnostic Evaluation in Young Patients Registered with a Diagnosis of Dementia: A Nationwide Register-Based Study

    PubMed Central

    Salem, Lise Cronberg; Andersen, Birgitte Bo; Nielsen, T. Rune; Stokholm, Jette; Jørgensen, Martin Balslev; Waldemar, Gunhild

    2014-01-01

    Background Establishing a diagnosis of dementia in young patients may be complex and have significant implications for the patient. The aim of this study was to evaluate the quality of the diagnostic work-up in young patients diagnosed with dementia in the clinical routine. Methods Two hundred patients were randomly selected from 891 patients aged ≤65 years registered with a diagnosis of dementia for the first time in 2008 in Danish hospitals, and 159 medical records were available for review. Three raters evaluated their medical records for the completeness of the diagnostic work-up on which the diagnosis of dementia had been based, using evidence-based guidelines for the diagnostic evaluation of dementia as reference standards. Results According to the rater review, only 111 (70%) patients met the clinical criteria for dementia. An acceptable diagnostic work-up including all items of recommended basic diagnostic evaluation was performed in only 24%, although more often (28%) in the subgroup of patients where dementia was confirmed by raters. Conclusion This first nationwide study of unselected young patients registered with a diagnosis of dementia indicated that the concept of dementia may be misinterpreted by clinicians and that a diagnosis of dementia in the young is only rarely based on a complete basic diagnostic work-up, calling for increased competency. PMID:24711812

  16. Studies on Freezing RAM Semen in Absence of Glycerol.

    NASA Astrophysics Data System (ADS)

    Abdelnaby, Abdelhady Abdelhakeam

    1988-12-01

    Glycerol is widely used as a major cryoprotective agent for freezing spermatozoa of almost all species. However, it reduces fertility of sheep inseminated cervically compared with intrauterine insemination. Studies were conducted to develop a method and procedure for freezing ram semen in the absence of glycerol. Post -thaw survival of ram spermatozoa frozen in the absence of glycerol was affected by time and temperature after collection and before dilution and time after dilution and before freezing. Increase in time at 5^ circC before or after dilution and before freezing increased both post-thaw motility and number of cells passing through Sephadex filter. A cold dilution method was developed. Slow cooling of fresh ram semen and diluting at 5^circ C 2-3 hr. after collection, then freezing 1 hr. after dilution improved both post-thaw motility and number of cells passing through Sephadex filter compared with immediate dilution at 30-37^circC after collection and freezing 3-4 hr. later (P < 0.05). An extender was developed to freeze ram semen in the absence of glycerol. An increase in post-thaw motility was obtained when semen was extended in TES titrated with Tris to pH 7.0 (TEST) and osmotic pressure of 375-400 mOsm/kg, containing 25-30% (v/v) egg yolk and 10% (v/v) maltose. A special device (boat) for freezing was constructed to insure the same height of the sample above LN _2 and thus the same freezing rate from freeze to freeze. Freezing of semen in 0.25cc straws at 5-10 cm above LN_2 (73.8 to 49.5 ^circC/min) yielded higher post-thaw motility than the rates resulted from freezing at 15 cm above LN_2 or 1 cm above LN _2. Faster Thawing in 37^ circC water for 30 sec. (7.8^ circC/sec.) increased post-thaw motility compared with slower thawing in 5 or 20^circ C water (P < 0.05). A lambing rate of 52.2% was obtained in one fertility trial conducted with ram semen frozen without glycerol and 17.1% in a second trial. One injection (IM) of 15 mg PGF_{2alpha}/ewe for

  17. The EULAR Study Group for Registers and Observational Drug Studies: comparability of the patient case mix in the European biologic disease modifying anti-rheumatic drug registers.

    PubMed

    Kearsley-Fleet, Lianne; Závada, Jakub; Hetland, Merete Lund; Nordström, Dan C; Aaltonen, Kalle J; Listing, Joachim; Zink, Angela; Gati, Tamas; Rojkovich, Bernadette; Iannone, Florenzo; Gremese, Elisa; van Riel, Piet L C M; van de Laar, Martinus A F J; Lie, Elisabeth; Kvien, Tore K; Canhão, Helena; Fonseca, João E; Rotar, Žiga; Loza, Estibaliz; Carmona, Loreto; Askling, Johan; Johansson, Kari; Finckh, Axel; Dixon, William G; Hyrich, Kimme L

    2015-06-01

    Under the auspices of the European League Against Rheumatism (EULAR), a study group of investigators representing European biologic DMARD (bDMARD) registers was convened. The purpose of this initial assessment was to collect and compare a cross section of patient characteristics and collate information on the availability of potential confounders within these registers. Baseline characteristics of patients starting their first bDMARD in an arbitrary year (2008) for the treatment of RA, including demographic and disease characteristics, bDMARD drug details and co-morbidities, were collected and compared across 14 European bDMARD registers. A total of 5320 patients were included. Half the registers had restricted recruitment to certain bDMARDs during the study year. All registers` collected data on age, gender, disease duration, seropositivity for IgM-RF and 28-joint DAS (DAS28). The mean DAS28 ranged from 4.2 to 6.6 and the mean HAQ from 0.8 to 1.9. Current smoking ranged from 9% to 34%. Nine registers reported co-morbidities with varying prevalence. In addition to demonstrating European-wide collaboration across rheumatology bDMARD registers, this assessment identified differences in prescribing patterns, recruitment strategies and data items collected. These differences need to be considered when applying strategies for combined analysis. The lack of a common data model across Europe calls for further work to harmonize data collection across registers. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. Registered nurses' clinical reasoning skills and reasoning process: A think-aloud study.

    PubMed

    Lee, JuHee; Lee, Young Joo; Bae, JuYeon; Seo, Minjeong

    2016-11-01

    As complex chronic diseases are increasing, nurses' prompt and accurate clinical reasoning skills are essential. However, little is known about the reasoning skills of registered nurses. This study aimed to determine how registered nurses use their clinical reasoning skills and to identify how the reasoning process proceeds in the complex clinical situation of hospital setting. A qualitative exploratory design was used with a think-aloud method. A total of 13 registered nurses (mean years of experience=11.4) participated in the study, solving an ill-structured clinical problem based on complex chronic patients cases in a hospital setting. Data were analyzed using deductive content analysis. Findings showed that the registered nurses used a variety of clinical reasoning skills. The most commonly used skill was 'checking accuracy and reliability.' The reasoning process of registered nurses covered assessment, analysis, diagnosis, planning/implementation, and evaluation phase. It is critical that registered nurses apply appropriate clinical reasoning skills in complex clinical practice. The main focus of registered nurses' reasoning in this study was assessing a patient's health problem, and their reasoning process was cyclic, rather than linear. There is a need for educational strategy development to enhance registered nurses' competency in determining appropriate interventions in a timely and accurate fashion. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Sickness absence and return to work among Japanese stroke survivors: a 365-day cohort study

    PubMed Central

    Endo, Motoki; Sairenchi, Toshimi; Kojimahara, Noriko; Haruyama, Yasuo; Sato, Yasuto; Kato, Rika; Yamaguchi, Naohito

    2016-01-01

    Objectives The objective of this study was to investigate the cumulative return to work (RTW) rate and to clarify the predictors of the time to full-time RTW (full RTW) and resignation among Japanese stroke survivors, within the 365-day period following their initial day of sickness absence due to stroke. Setting This study was based on tertiary prevention of occupational health in large-scaled Japanese companies of various industries. Participants The participants in this study were 382 Japanese workers who experienced an episode of sickness leave due to clinically certified stroke diagnosed between 1 January 2000 and 31 December 2011. Data were obtained from an occupational health register. Participants were followed up for 365 days after the start day of the first sickness absence. The cumulative RTW rates by Kaplan-Meier estimates and predictors for time to full RTW and resignation by Cox regression were calculated. Results A total of 382 employees had their first sickness absence due to stroke during the 12-year follow-up period. The cumulative full RTW rates at 60, 120, 180 and 365 days were 15.1%, 33.6%, 43.5% and 62.4%, respectively. Employees who took sick leave due to cerebral haemorrhage had a longer time to full RTW (HR, 0.50; 95% CI 0.36 to 0.69) than those with cerebral infarction. Older employees (over 50 years of age) demonstrated a shorter time to resignation than younger employees (HR, 3.30; 95% CI 1.17 to 9.33). Manual workers had a longer time to resignation than non-manual workers (HR, 0.24; 95% CI 0.07 to 0.78). Conclusions Cumulative RTW rates depended on the subtype of stroke, and older age was a predictor of resignation. PMID:26729388

  20. Impact of improved recording of work-relatedness in primary care visits at occupational health services on sickness absences: study protocol for a randomised controlled trial.

    PubMed

    Atkins, Salla; Ojajärvi, Ulla; Talola, Nina; Viljamaa, Mervi; Nevalainen, Jaakko; Uitti, Jukka

    2017-07-26

    Employment protects and fosters health. Occupational health services, particularly in Finland, have a central role in protecting employee health and preventing work ability problems. However, primary care within occupational health services is currently underused in informing preventive activities. This study was designed to assess whether the recording of work ability problems and improvement of follow-up of work-related primary care visits can reduce sickness absences and work disability pensions after 1 year. A pragmatic trial will be conducted using patient electronic registers and registers of the central pensions agency in Finland. Twenty-two occupational health centres will be randomised to intervention and control groups. Intervention units will receive training to improve recording of work ability illnesses in the primary care setting and improved follow-up procedures. The intervention impact will be assessed through examining rates of sickness absence across intervention and control clinics as well as before and after the intervention. The trial will develop knowledge of the intervention potential of primary care for preventing work disability pensions and sickness absence. The use of routine patient registers and pensions registers to assess the outcomes of a randomised controlled trial will bring forward trial methodology, particularly when using register-based data. If successful, the intervention will improve the quality of occupational health care primary care and contribute to reducing work disability. ISRCTN Registry reference number ISRCTN45728263 . Registered on 18 April 2016.

  1. Widespread pain - do pain intensity and care-seeking influence sickness absence? - A population-based cohort study.

    PubMed

    Mose, Søren; Christiansen, David Høyrup; Jensen, Jens Christian; Andersen, Johan Hviid

    2016-05-04

    Both musculoskeletal pain-intensity in relation to a specific location (e.g. lower back or shoulder) and pain in multiple body regions have been shown to be associated with impaired function and sickness absence, but the impact of pain intensity on the association between widespread pain and sickness absence has not been studied. Additionally it is unknown whether care-seeking in general practice due to musculoskeletal disorders has a positive or negative impact on future absenteeism. The purpose of this study was to examine the influence of pain intensity on the association between number of musculoskeletal pain sites and sickness absence, and to analyze the impact on absenteeism from care-seeking in general practice due to musculoskeletal disorders. 3745 Danish adults registered with eight General Practitioners (GPs) in one primary medical center reported location and intensity of experienced musculoskeletal pain in seven different body regions in February 2008. Outcome was duration of sickness absence based on register data divided into long-term (>52 weeks during follow-up) and sickness absence of shorter duration (12-52 weeks during follow-up) over a period of 4 years. Data on pain-intensity were analyzed at three different cut-off levels for each body region: i) > 1 (any pain), ii) > 2 (bothersome pain), iii) > 3 (very bothersome pain). Analyses were stratified and compared between participants without GP contact and participants with GP contact due to musculoskeletal disorders. Musculoskeletal pain in more than two body regions was strongly associated with long-term sickness absence in an exposure-response pattern. Different cut-off levels of pain intensity and adjustment for age, sex, educational level and work environmental factors did not alter the results. Similar findings were observed for sickness absence of shorter duration, although the association was weaker. Care-seeking in general practice due to musculoskeletal disorders did not overall

  2. Job strain and informal caregiving as predictors of long-term sickness absence: A longitudinal multi-cohort study.

    PubMed

    Mortensen, Jesper; Dich, Nadya; Lange, Theis; Alexanderson, Kristina; Goldberg, Marcel; Head, Jenny; Kivimäki, Mika; Madsen, Ida Eh; Rugulies, Reiner; Vahtera, Jussi; Zins, Marie; Rod, Naja Hulvej

    2017-01-01

    Objectives The aim of this study was to investigate the individual, joint and interactive effects of job strain and informal caregiving on long-term sickness absence with special attention to gender differences. Methods The study comprised a prospective cohort study of 6798 working adults from France, 14 727 from Finland, and 5275 from the UK. A total of 26 800 participants, age 52 (interquartile range 47-56) years participated in the study. Job strain was assessed using the demand-control model. Informal caregiving was defined as care for a sick, disabled, or elderly person. Long-term sickness absence spells defined as absence >14 consecutive days were registered during two years follow-up. We used recurrent-events Cox regression in random-effects meta-analyses. Results A total of 12% men and 21% women had ≥1 long-term sickness absence spell. Among women, both high job strain [hazard ratio (HR) 1.08, 95% confidence interval (95% CI) 1.00-1.17] and informal caregiving (HR 1.13, 95% CI 1.04-1.23) were associated with a modestly higher risk of sickness absence. Women doubly exposed to high job strain and informal caregiving also showed a moderately higher risk of sickness absence (HR 1.20, 95% CI 1.03-1.41), but the excess risk was not more than expected from joint exposure to caregiving and job strain. Neither job strain nor informal caregiving predicted sickness absence for men. Conclusions High job strain and informal caregiving predicted long-term sickness absence among women. However there was no noticeable interaction in the presence of both exposures.

  3. Exploring the experience of Canadian registered psychiatric nurses: a phenomenological study.

    PubMed

    Jackson, J; Morrissette, P J

    2014-03-01

    This paper describes a phenomenological study that was conducted in 2012 and investigated the experiences of registered psychiatric nurses working in the province of Manitoba. Ten registered psychiatric nurses participated in semistructured, audio-recorded interviews, during which they described their experiences, yielding written protocols that were thematically analysed. Results from this study revealed six predominant themes that included (1) perception of psychiatric nursing; (2) patient aggression; (3) patient family involvement; (4) nurse-doctor relationship; (5) responsibility and worry; and (6) shift in practice and educational standards. The results of this study can assist in better understanding registered psychiatric nursing practice, inform educational programmes, and spawn future research.

  4. Who is at risk for long-term sickness absence? A prospective cohort study of Danish employees.

    PubMed

    Lund, Thomas; Labriola, Merete; Villadsen, Ebbe

    2007-01-01

    The aim of this study was to identify who is at risk for long-term sickness absence according to occupation, gender, education, age, business sector, agency size and ownership. The study is based on a sample of 5357 employees aged 18-69, interviewed in 2000. The cohort was followed up in a national register from January 1st 2001 to June 30th 2003, to identify cases with sickness absences that exceeded 8 weeks. During follow-up 486 persons (9.1%) experienced one or more periods of absence that exceeded 8 weeks. Higher risk of long-term sickness absence was associated with gender, age, educational level, and the municipal employment sector. Kindergarten teachers and people employed in day care, health care, janitorial work, food preparation, and unskilled workers were at greatest risk. Managers, computer professionals, technicians and designers, and professionals had lower risks. The health care and social service sectors were also in the high risk category, whereas the private administration sector had a lower risk. The study identifies specific occupational target populations and documents the need to perform job-specific research and tailor interventions if the intended policy of decreasing long-term sickness absence within the Danish labour market is to be realized.

  5. [Prospective study of the differences between the syndromes of infantile absence epilepsy and syndromes of juvenile absence epilepsy].

    PubMed

    Oller, L

    1996-08-01

    In this prospective study of the differences between the epileptic syndrome of absence attacks in the child (EAN) and the syndrome of juvenile absence attacks (EAJ), the author considers the characteristics of these syndromes in order to differentiate their various aspects, namely clinical features, complementary tests, course and prognosis. These cases are from a series of 6,299 epileptic patients. One of the objectives of a prospective study begun in 1970 was to evaluate the clinical course of all cases in which valproic acid was used. Valproic acid is known to be most effective in the basic crises of these two syndromes, namely the typical absence attacks. It is therefore an analysis of the clinical features and their subsequent course and prognosis when thus treated, since a retrospective study including a much larger number of patients would not be considered to be satisfactory in view of the 'bias' due to only some patients having access to treatment with this drug. The author analyzes 138 cases of EAN and 42 cases of EAJ seen between 1970 and the end of 1995. These syndromes, particularly EAN, have always been considered to have an excellent prognosis. The author tries to show from the point of view of long term follow-up, that absence attacks may not only persist into adult life but also be associated with other types of crises which worsen the prognosis. Thus, for instance, in EAN 50% of the cases show generalized tonic-clonic seizures on long-term follow-up. In EAJ the corresponding figure is 76.1%. This data modifies previous ideas as to the benign course of these syndromes when they are followed-up for a long period. The basic criteria were: a first visit after 1970 and an age of onset between 3 and 10 years for EAN and over 10 years for EAJ. In all cases there was the following conditions, onset by absence attacks, lack of permanent neurological or psychological disorders, and a video-EEG recording of a typical generalized EEG during an attack.

  6. Sickness absence as a prognostic marker for common chronic conditions: analysis of mortality in the GAZEL study

    PubMed Central

    Kivimaki, Mika; Head, Jenny; Ferrie, Jane E.; Singh-Manoux, Archana; Westerlund, Hugo; Vahtera, Jussi; Leclerc, Annette; Melchior, Maria; Chevalier, Anne; Alexanderson, Kristina; Zins, Marie; Goldberg, Marcel

    2008-01-01

    Objectives To determine whether sickness absence is a prognostic marker in terms of mortality among people with common chronic conditions. Methods Prospective occupational cohort study of 13 077 men and 4871 women aged 37 to 51 from the National Gas and Electricity Company, France. Records of physician-certified sickness absences over a 3-year period were obtained from employers’ registers. Chronic conditions were assessed in annual surveys over the same period. The main outcome measure was all-cause mortality (803 deaths, mean follow-up after assessment of sickness absence, 13.9 years) Results In Cox proportional-hazard models adjusted for age, sex, socioeconomic position and co-morbidity, >28 annual sickness absence days vs no absence days was associated with an excess mortality risk among those with cancer (hazard ratio 5.4, 95% CI 2.2 to 13.1), depression (1.7, 1.1 to 2.8), chronic bronchitis/asthma (2.7, 1.6 to 4.6), and hypertension (1.6, 1.0 to 2.6). The corresponding hazard ratios for more than 5 long (>14 days) sickness absence episodes per 10 person-years vs no such episodes were 5.4 (2.2 to 13.1), 1.8 (1.3 to 2.7), 2.0 (1.3 to 3.2) and 1.8 (1.2 to 2.7), respectively. Areas under receiver-operating-characteristics curves for these absence measures varied between 0.56 and 0.73 indicating the potential of these measures to distinguish groups at high risk of mortality. The findings were consistent across sex, age and socioeconomic groups and in those with and without co-morbid conditions. Conclusion Data on sickness absence may provide useful prognostic information for common chronic conditions at the population level. PMID:18611969

  7. Incidence of sickness absence by type of employment contract: one year follow-up study in Spanish salaried workers.

    PubMed

    Zaballa, Elena; Martínez, José Miguel; Duran, Xavier; Albertí, Constança; Gimeno Ruiz de Porras, David; Benavides, Fernando G

    2016-01-01

    To examine the differences in the incidence of registered sickness absence by type of employment contract in a large representative sample of salaried workers in Spain in 2009. A study of 653,264 salaried workers covered by the Social Security system who had 133,724 sickness absence episodes in 2009. Crude and adjusted rate ratios and their corresponding 95 % confidence intervals (CIs) were calculated with Poisson regression models. The incidence rate per 100 workers-year of sickness absence for temporary workers (IR = 32.2) was slightly higher than that of permanent workers (IR = 28.9). This pattern was observed in both men (RR = 1.12; 95 % CI 1.10-1.14) and women (RR 1.11; 95 % CI 1.09-1.12). However, after adjusting for age, company size, and occupational category, the differences disappeared in men (aRR = 1.01; 95 % CI 0.99-1.02) and decreased in women (aRR = 1.06; 95 % CI 1.04-1.07). Our findings provide evidence on the independence of sickness absence benefits from the type of employment contract as well as on the nonexistence of incentives for taking sickness absence in workers with a permanent employment contract. In the context of increasing market flexibility, these results show a positive functioning of the Social Security system.

  8. Potential drug interactions with statins: Estonian register-based study

    PubMed Central

    Volmer, Daisy; Hartikainen, Sirpa; Zharkovsky, Alexander

    2015-01-01

    In Estonia, HMG-CoA reductase inhibitors are widely used to modify lipid levels but there are no current data on additional medicines prescribed alongside the statins. The aim of this study was to identify the frequency of potential clinically relevant interactions at a national level among an outpatient population treated with statins between January and June 2008, based on the prescription database of the Estonian Health Insurance Fund. This retrospective prevalence study included 203,646 outpatients aged 50 years or older, of whom 29,367 received statin therapy. The study analysed individuals who had used at least one prescription medicine for a minimum of 7 days concomitantly with statins. Potential drug interactions were analysed using Epocrates online, Stockley’s Drug Interactions, and the drug interaction database developed in Estonia. Statins metabolised by the CYP3A4 isoenzyme were prescribed to 64% of all statin users. Medicines known to have potentially clinically significant interactions with statins were prescribed to 4.6% of patients. The drugs prescribed concomitantly most often with simvastatin were warfarin (5.7%) and amiodarone (3.9%), whereas digoxin (1.2%) and ethinylestradiol (2%) were prescribed with atorvastatin. Potential interactions were not detected in the treatment regimens of rosuvastatin, pravastatin, and fluvastatin users. PMID:28352703

  9. Submission of clinical studies to ethics committees or clinical trials registers: the authors' point of view.

    PubMed

    Pehboeck, Daniel; Hohlrieder, Matthias; Wenzel, Volker; Benzer, Arnulf

    2009-04-01

    To evaluate the satisfaction of clinical scientists when submitting study drafts to an ethics committee/clinical trials register (CLINICALTRIALS, EUDRACT, ISRCTN) we conducted an online survey of 240 authors publishing in anesthesia/critical care medicine (A) or in major general medical (M) journals from January to December 2007. No statistical difference between groups A and M was seen with regard to the number of studies submitted to ethics committees or registered in various clinical trials registers. On a visual analogue scale (VAS -10 to +10), the subjective evaluation of the effort required to submit a study draft to an ethics committee or enter it in a clinical trials register produced almost only negative grades in both groups. The mean different perceptions ranged from -3.5 to -0.1 in group A and from -4.4 to -0.2 (except for +0.1 and 1.9 in 2 subgroups) in group M. The authors in both groups gave a positive score to the better transparency in scientific research resulting from introduction of the clinical trials registers (+2.4 in group A, +4.8 in group M). The results of our study indicate widespread author dissatisfaction when submitting a clinical trial to ethics committees or clinical trials registers.

  10. From challenges to advanced practice registered nursing role development: Qualitative interview study.

    PubMed

    Jokiniemi, Krista; Haatainen, Kaisa; Pietilä, Anna-Maija

    2015-12-01

    The aim of this study is to describe the factors hindering and facilitating the implementation of the advanced practice registered nurses role at Finnish university hospitals, and to examine the implications for its future development. A descriptive qualitative approach, using thematic individual interviews, was conducted in 2011 with a sample of 11 advanced practice registered nurses. The data were analysed using qualitative content analysis. The advanced practice registered nurses role barriers had an impact on the role development needs. In turn, the facilitating factors helped encounter the challenges of the role, therefore having an impact on both the current role achievement, as well as contributing to the future role development. The factors hindering and facilitating the advanced practice registered nurses role need to be acknowledged to support the role implementation and planning of the future of the role. © 2014 Wiley Publishing Asia Pty Ltd.

  11. Communication ability in cerebral palsy: a study from the CP register of western Sweden.

    PubMed

    Himmelmann, Kate; Lindh, Karin; Hidecker, Mary Jo Cooley

    2013-11-01

    Communication is often impaired in cerebral palsy (CP). Tools are needed to describe this complex function, in order to provide effective support. To study communication ability and the relationship between the Communication Function Classification System (CFCS) and CP subtype, gross motor function, manual ability, cognitive function and neuroimaging findings in the CP register of western Sweden. Sixty-eight children (29 girls), 14 with unilateral spastic CP, 35 with bilateral spastic CP and 19 with dyskinetic CP, participated. The CFCS, Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels, cognitive impairment and neuroimaging findings were recorded. Half the children used speech, 32% used communication boards/books and 16% relied on body movements, eye gaze and sounds. Twenty-eight per cent were at the most functional CFCS level I, 13% at level II, 21% at level III, 10% at level IV and 28% at level V. CFCS levels I-II were found in 71% of children with unilateral spastic CP, 46% in bilateral spastic CP and 11% in dyskinetic CP (p = 0.03). CFCS correlated with the GMFCS, MACS and cognitive function (p < 0.01). Periventricular lesions were associated with speech and more functional CFCS levels, while cortical/subcortical and basal ganglia lesions were associated with the absence of speech and less functional CFCS levels (p < 0.01). Communication function profiles in CP can be derived from the CFCS, which correlates to gross and fine motor and cognitive function. Good communication ability is associated with lesions acquired early, rather than late, in the third trimester. Copyright © 2013 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  12. Chronic lower respiratory diseases among demolition and cement workers: a population-based register study.

    PubMed

    Mølgaard, Ellen Fischer; Hannerz, Harald; Tüchsen, Finn; Brauer, Charlotte; Kirkeskov, Lilli

    2013-01-11

    To estimate standardised hospitalisation ratios (SHR) for chronic lower respiratory diseases among demolition and cement workers in Denmark, 1995-2009. This is a population-based register study on data from 'the Occupational Hospitalisation Register'. SHR of chronic obstructive pulmonary disease (COPD) was calculated for both demolition and cement workers. Register study with data from all hospitals in Denmark. 895 demolition workers and 5633 cement and concrete workers were included in the study and all economical active men were used as reference group. We found a statistically significant high SHR for the cement workers, SHR=134 (95% CI 117 to 153). The SHR for demolition workers was 131 (95% CI 87 to 188). We find a higher risk of being hospitalised due to COPD in cement and concrete workers (significant) and demolition workers (insignificant) compared to gainfully employed men.

  13. Epilepsy in Individuals with a History of Asperger's Syndrome: A Danish Nationwide Register-Based Cohort Study

    ERIC Educational Resources Information Center

    Mouridsen, Svend Erik; Rich, Bente; Isager, Torben

    2013-01-01

    We performed a nationwide, register-based retrospective follow-up study of epilepsy in all people who were born between January 1, 1980 and June 29, 2006 and registered in the Danish Psychiatric Central Register with Asperger's syndrome on February 7, 2011. All 4,180 identified cases with AS (3,431 males and 749 females) were screened through the…

  14. Epilepsy in Individuals with a History of Asperger's Syndrome: A Danish Nationwide Register-Based Cohort Study

    ERIC Educational Resources Information Center

    Mouridsen, Svend Erik; Rich, Bente; Isager, Torben

    2013-01-01

    We performed a nationwide, register-based retrospective follow-up study of epilepsy in all people who were born between January 1, 1980 and June 29, 2006 and registered in the Danish Psychiatric Central Register with Asperger's syndrome on February 7, 2011. All 4,180 identified cases with AS (3,431 males and 749 females) were screened through the…

  15. Sickness Absence and Disability Pension After Breast Cancer Diagnosis: A 5-Year Nationwide Cohort Study.

    PubMed

    Kvillemo, Pia; Mittendorfer-Rutz, Ellenor; Bränström, Richard; Nilsson, Kerstin; Alexanderson, Kristina

    2017-06-20

    Purpose To explore future diagnosis-specific sickness absence and disability pension among women with breast cancer compared with women without breast cancer. Also, to examine associations with disease-related and sociodemographic factors among those with breast cancer. Methods Longitudinal register data on 3,547 women living in Sweden (age 20 to 65 years) who were first diagnosed with breast cancer in 2005, and a matched comparison cohort (n = 14,188), were analyzed for the annual prevalence of diagnosis-specific sickness absence and disability pension over 5 years. Logistic regressions were used to explore associations of disease-related and sociodemographic factors with future sickness absence and disability pension among women with breast cancer. Results Immediately after being diagnosed with breast cancer, the proportion of women with sickness absence was high but decreased continuously from the 1st through 5th year after diagnosis (71%, 40%, 30%, 22%, and 19%, respectively). In comparison, the range for women without breast cancer was 17% to 11%, respectively. The higher prevalence of sickness absence after breast cancer was mainly a result of breast cancer diagnosis, not a mental diagnosis, or other somatic diagnoses. Advanced cancer at diagnosis, > 90 days sickness absence before diagnosis, low education, and being born outside Sweden were associated with higher odds ratios for sickness absence and disability pension (odds ratio range, 1.40 to 6.45). Conclusion The level of sickness absence increased substantially in women with breast cancer during the first year after diagnosis and approached the level of breast cancer-free women in the following years; however, even in the first year, most women were not on sickness absence for a substantial time, and even in high-risk groups, many were not on sickness absence or disability pension in the following years. Information about relatively low future sickness absence and disability pension levels can be used by

  16. A Study in Difference: Structures and Cultures in Australian Registered Training Organisations. Full Report

    ERIC Educational Resources Information Center

    Clayton, Berwyn; Fisher, Thea; Harris, Roger; Bateman, Andrea; Brown, Mike

    2008-01-01

    This report presents the findings of a study examining organisational culture and structure in ten Australian registered training organisations (RTOs) and is part of a program of research examining the factors which affect and help build the capability of vocational education and training (VET) providers. The study sought to determine: (1) how…

  17. An Exploration of Registered Nurses' Intentions to Leave the Profession: A Qualitative Study

    ERIC Educational Resources Information Center

    Lutter, Stacy Lynn

    2011-01-01

    The purpose of this qualitative study was to explore the perceptions of female registered nurses who have intentions to leave the profession with particular attention to the influence of gender. The theoretical framework of feminist poststructuralism informed this study, which emphasizes the role of discourse and power relations in the…

  18. An Exploration of Registered Nurses' Intentions to Leave the Profession: A Qualitative Study

    ERIC Educational Resources Information Center

    Lutter, Stacy Lynn

    2011-01-01

    The purpose of this qualitative study was to explore the perceptions of female registered nurses who have intentions to leave the profession with particular attention to the influence of gender. The theoretical framework of feminist poststructuralism informed this study, which emphasizes the role of discourse and power relations in the…

  19. The Present Absence: Assessment in Social Studies Classrooms

    ERIC Educational Resources Information Center

    Torrez, Cheryl A.; Claunch-Lebsack, Elizabeth Ann

    2014-01-01

    In this article, first the authors describe the aims of and a definition of social studies education and classroom assessment. Second, the authors provide an overview of issues related to classroom assessment followed by trends in social studies classrooms and assessment. Then the authors address essential systems and best practices related to…

  20. Leadership effectiveness and recorded sickness absence among nursing staff: a cross-sectional pilot study.

    PubMed

    Schreuder, Jolanda A H; Roelen, Corné A M; Van Zweeden, Nely F; Jongsma, Dianne; Van der Klink, Jac J L; Groothoff, Johan W

    2011-07-01

    To investigate nurse managers' leadership behaviour in relation to the sickness absence records of nursing staff. Sickness absence is high in healthcare and interferes with nursing efficiency and quality. Nurse managers' leadership behaviour may be associated with nursing staff sickness absence. Six nurse managers completed the Leadership Effectiveness and Adaptability Description (LEAD) questionnaire, which assesses leadership behaviour in terms of leadership flexibility (i.e. the range of leadership styles) and effectiveness (i.e. using the leadership style that is appropriate for a given situation). LEAD scores were linked to the number of recorded days of sickness absence and both short (1-7 days) and long (>7 days) episodes of sickness absence in the nursing teams. Leadership flexibility of nurse managers was not associated with sickness absence among nurses. High leadership effectiveness was associated with fewer days and fewer short episodes of sickness absence. Leadership effectiveness was unrelated to the number of long episodes of sickness absence. Effective nurse managers had less short-term sickness absence in their nursing teams. If these tentative cross-sectional associations are confirmed in longitudinal studies including more departments, then training effective leadership may improve the management of short-term sickness absence. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

  1. Overview of registered studies in orthodontics: Evaluation of the ClinicalTrials.gov registry.

    PubMed

    Allareddy, Veerasathpurush; Rampa, Sankeerth; Masoud, Mohamed I; Lee, Min Kyeong; Nalliah, Romesh; Allareddy, Veerajalandhar

    2014-11-01

    The Food and Drug Administration Modernization Act of 1997 made it mandatory for all phase II through IV trials regulated by this Act to be registered. After this, the National Institutes of Health created ClinicalTrials.gov, which is a registry of publicly and privately supported clinical studies of human participants. The objective of this study was to examine the characteristics of registered studies in orthodontics. The ClinicalTrials.gov Web site was used to query all registered orthodontic studies. The search term used was "orthodontics." No limitations were placed for the time period. All registered studies regardless of their recruitment status, study results, and study type were selected for analysis. A total of 64 orthodontic studies were registered as of January 1, 2014. Of these, 52 were interventional, and 12 were observational. Close to 60% of the interventional studies and 66.7% of the observational studies had sample sizes of 50 or fewer subjects. About 21.2% of the interventional studies and 16.7% of the observational studies had sample sizes greater than 100. Only 1 study was funded by the National Institutes of Health, and the rest were funded by "other" or "industry" sources. Close to 87.7% of the interventional studies were randomized. Interventional model assignments included factorial assignment (3.9%), parallel assignments (74.5%), crossover assignment (7.8%), and single-group assignment (13.7%). Most studies were treatment oriented (80.4%). The types of masking used by the interventional studies included open label (28.9%), single blind (44.2%), and double blind (26.9%). Outcome assessors were blinded in only 6 studies. Orthodontic studies registered in ClinicalTrials.gov are dominated by small single-center studies. There are wide variations with regard to treatment allocation approaches and randomization methods in the studies. These results also indicate the need for multicenter clinical studies in orthodontics. Copyright © 2014

  2. A Study in Difference: Structures and Cultures in Registered Training Organisations. Support Document 3

    ERIC Educational Resources Information Center

    Clayton, Berwyn; Fisher, Thea; Harris, Roger; Bateman, Andrea; Brown, Mike

    2008-01-01

    This document supports the report "A Study in Difference: Structures and Cultures in Registered Training Organisations." The first section outlines the methodology used to undertake the research and covers the design of the research, sample details, the data collection process and the strategy for data analysis and reporting. The…

  3. Utility of local health registers in measuring perinatal mortality: a case study in rural Indonesia.

    PubMed

    Burke, Leona; Suswardany, Dwi Linna; Michener, Keryl; Mazurki, Setiawaty; Adair, Timothy; Elmiyati, Catur; Rao, Chalapati

    2011-03-17

    Perinatal mortality is an important indicator of obstetric and newborn care services. Although the vast majority of global perinatal mortality is estimated to occur in developing countries, there is a critical paucity of reliable data at the local level to inform health policy, plan health care services, and monitor their impact. This paper explores the utility of information from village health registers to measure perinatal mortality at the sub district level in a rural area of Indonesia. A retrospective pregnancy cohort for 2007 was constructed by triangulating data from antenatal care, birth, and newborn care registers in a sample of villages in three rural sub districts in Central Java, Indonesia. For each pregnancy, birth outcome and first week survival were traced and recorded from the different registers, as available. Additional local death records were consulted to verify perinatal mortality, or identify deaths not recorded in the health registers. Analyses were performed to assess data quality from registers, and measure perinatal mortality rates. Qualitative research was conducted to explore knowledge and practices of village midwives in register maintenance and reporting of perinatal mortality. Field activities were conducted in 23 villages, covering a total of 1759 deliveries that occurred in 2007. Perinatal mortality outcomes were 23 stillbirths and 15 early neonatal deaths, resulting in a perinatal mortality rate of 21.6 per 1000 live births in 2007. Stillbirth rates for the study population were about four times the rates reported in the routine Maternal and Child Health program information system. Inadequate awareness and supervision, and alternate workload were cited by local midwives as factors resulting in inconsistent data reporting. Local maternal and child health registers are a useful source of information on perinatal mortality in rural Indonesia. Suitable training, supervision, and quality control, in conjunction with computerisation to

  4. Utility of local health registers in measuring perinatal mortality: A case study in rural Indonesia

    PubMed Central

    2011-01-01

    Background Perinatal mortality is an important indicator of obstetric and newborn care services. Although the vast majority of global perinatal mortality is estimated to occur in developing countries, there is a critical paucity of reliable data at the local level to inform health policy, plan health care services, and monitor their impact. This paper explores the utility of information from village health registers to measure perinatal mortality at the sub district level in a rural area of Indonesia. Methods A retrospective pregnancy cohort for 2007 was constructed by triangulating data from antenatal care, birth, and newborn care registers in a sample of villages in three rural sub districts in Central Java, Indonesia. For each pregnancy, birth outcome and first week survival were traced and recorded from the different registers, as available. Additional local death records were consulted to verify perinatal mortality, or identify deaths not recorded in the health registers. Analyses were performed to assess data quality from registers, and measure perinatal mortality rates. Qualitative research was conducted to explore knowledge and practices of village midwives in register maintenance and reporting of perinatal mortality. Results Field activities were conducted in 23 villages, covering a total of 1759 deliveries that occurred in 2007. Perinatal mortality outcomes were 23 stillbirths and 15 early neonatal deaths, resulting in a perinatal mortality rate of 21.6 per 1000 live births in 2007. Stillbirth rates for the study population were about four times the rates reported in the routine Maternal and Child Health program information system. Inadequate awareness and supervision, and alternate workload were cited by local midwives as factors resulting in inconsistent data reporting. Conclusions Local maternal and child health registers are a useful source of information on perinatal mortality in rural Indonesia. Suitable training, supervision, and quality control

  5. Management of sickness absence: a quality improvement study from Slovenia

    PubMed Central

    Kersnik, J.

    1999-01-01

    Problem - A need to improve the communication system between general practitioners (GPs) and the national health insurance institute's (NHII) committee of experts for the referral and approval of sickness leave for patients. Design - A structured low cost quality improvement method for motivating GPs to change their current practice was developed. Background and setting - The study was done in Kranj health district in Slovenia. GPs and members of the committee of experts identified potential problems using a cause and effect diagram. The study period for baseline data collection was from November 1996 to December 1996, and the re-evaluation took place in May 1997. All GPs in Kranj health district (n=78) took part. Data were collected on 443 patients referred by GPs to the NHII committee during the first phase of the study and 590 patients during the re-evaluation phase. Key measures for improvement - Reducing the number of cases reported by members of the committee of experts as causing problems after the intervention. Feedback to GPs about the success of the process. Strategies for change - A combination of methods was used: posted feedback, a guideline on record keeping, and a guideline, called AID (analysis of incidental deviations from expected service - in Slovene: analiza izjemnih dogodkov), on processing medical documentation. Effects of change - An overall drop was observed in the number of cases that caused problems (from 44% to 26%, p<0.001). The most common problem at baseline (19.4% of the problems) was the seventh most common at the re-evaluation, then contributing only 9.2% of total problems (p=0.02). Lessons learnt - The results support a quality improvement philosophy that empowers "owners" of the process to be the key resource in managing change, and they show the importance of the inner motivation of those involved. Despite working in a country undergoing transition, medical professionals were still willing to improve their performance

  6. Bangladesh Cerebral Palsy Register (BCPR): a pilot study to develop a national cerebral palsy (CP) register with surveillance of children for CP.

    PubMed

    Khandaker, Gulam; Smithers-Sheedy, Hayley; Islam, Johurul; Alam, Monzurul; Jung, Jenny; Novak, Iona; Booy, Robert; Jones, Cheryl; Badawi, Nadia; Muhit, Mohammad

    2015-09-25

    The causes and pathogenesis of cerebral palsy (CP) are all poorly understood, particularly in low- and middle-income countries (LMIC). There are gaps in knowledge about CP in Bangladesh, especially in the spheres of epidemiological research, intervention and service utilization. In high-income countries CP registers have made substantial contributions to our understanding of CP. In this paper, we describe a pilot study protocol to develop, implement, and evaluate a CP population register in Bangladesh (i.e., Bangladesh Cerebral Palsy Register - BCPR) to facilitate studies on prevalence, severity, aetiology, associated impairments and risk factors for CP. The BCPR will utilise a modified version of the Australian Cerebral Palsy Register (ACPR) on a secured web-based platform hosted by the Cerebral Palsy Alliance Research Institute, Australia. A standard BCPR record form (i.e., data collection form) has been developed in consultation with local and international experts. Using this form, the BPCR will capture information about maternal health, birth history and the nature of disability in all children with CP aged <18 years. The pilot will be conducted in the Shahjadpur sub-district of Sirajgonj district in the northern part of Bangladesh. There are 296 villages in Shahjadpur, a total population of 561,076 (child population ~ 226,114), an estimated 70,998 households and 12,117 live births per annum. Children with CP will be identified by using the community based Key Informants Method (KIM). Data from the completed BPCR record together with details of assessment by a research physician will be entered into an online data repository. Once implemented, BCPR will be, to the best of our knowledge, the first formalised CP register from a LMIC. Establishment of the BCPR will enable estimates of prevalence; facilitate clinical surveillance and promote research to improve the care of individuals with CP in Bangladesh.

  7. Vocal tract in female registers--a dynamic real-time MRI study.

    PubMed

    Echternach, Matthias; Sundberg, Johan; Arndt, Susan; Markl, Michael; Schumacher, Martin; Richter, Bernhard

    2010-03-01

    The area of vocal registers is still unclarified. In a previous investigation, dynamic real-time magnetic resonance imaging (MRI), which is able to produce up to 10 frames per second, was successfully applied for examinations of vocal tract modifications in register transitions in male singers. In the present study, the same MRI technique was used to study vocal tract shapes during four professional young sopranos' lower and upper register transitions. The subjects were asked to sing a scale on the vowel /a/ across their transitions. The transitions were acoustically identified by four raters. In neither of these transitions, clear vocal tract changes could be ascertained. However, substantial changes, that is, widening of the lips, opening of the jaw, elevation of the tongue dorsum, and continuous widening of the pharynx, were observed when the singers reached fundamental frequencies that were close to the frequency of the first formant of the vowel sung. These findings suggest that in these subjects register transition was not primarily the result of modifications of the vocal tract.

  8. Referring to multimodal rehabilitation for patients with musculoskeletal disorders - a register study in primary health care.

    PubMed

    Sennehed, Charlotte Post; Holmberg, Sara; Stigmar, Kjerstin; Forsbrand, Malin; Petersson, Ingemar F; Nyberg, Anja; Grahn, Birgitta

    2017-01-07

    In 2008, the Swedish government introduced a National Rehabilitation Program, in which the government financially reimburses the county councils for evidence-based multimodal rehabilitation (MMR) interventions. The target group is patients of working age with musculoskeletal disorders (MSD), expected to return to work or remain at work after rehabilitation. Much attention in the evaluations has been on patient outcomes and on processes. We lack knowledge about how factors related to health care providers and community can have an impact on how patients have access to MMR. The aim of this study was therefore to study the impact of health care provider and community related factors on referrals to MMR in patients with MSD applying for health care in primary health care. This was a primary health care-based cohort study based on prospectively ascertained register data. All primary health care centres (PHCC) contracted in Region Skåne in 2010-2012, referring to MMR were included (n = 153). The health care provider factors studied were: community size, PHCC size, public or private PHCC, whether or not the PHCCs provided their own MMR, burden of illness and the community socioeconomic status among the registered population at the PHCCs. The results are presented with descriptive statistics and for the analysis, non-parametric and multiple linear regression analyses were applied. PHCCs located in larger communities sent more referrals/1000 registered population (p = 0.020). Private PHCCs sent more referrals/1000 registered population compared to public units (p = 0.035). Factors related to more MMR referrals/1000 registered population in the multiple regression analyses were PHCCs located in medium and large communities and with above average socioeconomic status among the registered population at the PHCCs, private PHCC and PHCCs providing their own MMR. The explanation degree for the final model was 24.5%. We found that referral rates to MMR were positively

  9. [Greenhouse gardeners and sickness absence. A questionnaire study among greenhouse gardeners in Aarhus region].

    PubMed

    Pallesen, Ellen; Nielsen, Claus Vinther; Drews, Birgit Mammen

    2007-02-26

    The aim of the study was to examine sickness absence and risk factors for sickness absence in a population of greenhouse gardeners in the county of Arhus. The study was cross sectional and based on data from questionnaires sent to all employees and greenhouse gardens in the county. Greenhouse gardeners had an average of four days of sickness absence a year. Self-rated health was poorer than average of the Danish population in general. Female gender, age below 40 years, troublesome relationships to family and friends, "poor" physical working environment and job insecurity were all predictors for increased risk of sickness absence lasting more than two weeks a year. Sickness absence was low compared to the average of the Danish labour market. Considering poorer self-rated health and frequent occurrence of some of the above-mentioned predictors for increased risk of sickness absence--female gender, age below 40 years and for women, high exposure to "poor" physical working environment--an average sickness absence of only four days was a puzzle. The data from the study were not sufficient to explain this paradox. It might be due to compensating factors at work or at a personal level. It might be due to information bias, as sickness absence could be underestimated, but agreement between reported sickness absence from employees and greenhouse gardens diminished that probability. It might have been a consequence of selection bias, the "healthy workers'" effect. Employees with considerable sickness absence might have been dismissed for long-term absence or might have quit the job because they were not able to cope with it.

  10. Characteristics and publication patterns of obstetric studies registered in ClinicalTrials.gov.

    PubMed

    Stockmann, Chris; Sherwin, Catherine M T; Koren, Gideon; Campbell, Sarah C; Constance, Jonathan E; Linakis, Matthew; Balch, Alfred; Varner, Michael W; Spigarelli, Michael G

    2014-04-01

    Physiologic changes during pregnancy alter the pharmacokinetics, safety, and efficacy of many drugs. For clinicians, there is often uncertainty regarding the safety of these drugs due to a scarcity of published data. This study aimed to comprehensively evaluate the characteristics and publication patterns of obstetric studies registered in ClinicalTrials.gov from 2007 to 2012. Primary outcome measures, funding sources, inclusion criteria, and the reporting of study results were evaluated. A manual review of Medline/PubMed was performed to identify publications associated with studies registered in ClinicalTrials.gov. Of 93,709 total studies, there were 5,203 (6%) obstetric studies registered in ClinicalTrials.gov. Interventional studies accounted for 70% and 30% were observational. Clinical trials of drugs (49%), procedures (13%), and behavioral interventions (12%) were most common. Among interventional drug trials, 84% featured randomized allocation to study arms and 93% included measures of safety and/or efficacy as primary endpoints. Of 946 (18%) studies completed more than 2 years ago, only 11% had reported results and <7% had been published. In an area with a great need for evidence of safe and effective therapies, the low publication rate of completed studies incorporating elements of high-quality trial design is concerning. The sources of this trend should be closely investigated. © 2013, The American College of Clinical Pharmacology.

  11. Psychosocial correlates of police-registered youth crime. A Finnish population-based study.

    PubMed

    Elonheimo, Henrik; Sourander, Andre; Niemelä, Solja; Nuutila, Ari-Matti; Helenius, Hans; Sillanmäki, Lauri; Ristkari, Terja; Parkkola, Kai

    2009-01-01

    This study is focused on psychosocial correlates of youth crime in a sample of 2330 Finnish boys born in 1981. Two kinds of data were combined: questionnaires completed by the boys at call-up in 1999 and crime registered in the Finnish National Police Register between 1998 and 2001. One-fifth of the boys were registered to offending during the 4-year period in late adolescence; 14% were registered for one or two offences, 4% for three to five offences, and 3% for more than five offences. Crime accumulated heavily in those with more than five offences, as they accounted for 68% of all crime. Independent correlates of crime were living in a small community, parents' low educational level and divorce, having a regular relationship, self-reported delinquency, daily smoking, and weekly drunkenness, whereas anxious-depressiveness was reversely associated with crime. Most psychosocial problems covaried linearly with offending frequency, being particularly manifested by multiple recidivists. However, recidivists had very rarely used mental health services. The results indicate that offending and various psychosocial problems accumulate in a small minority of boys not reached by mental health services.

  12. Factors Associated with Musculoskeletal Disorders among Registered Nurses: Evidence from the Thai Nurse Cohort Study.

    PubMed

    Thinkhamrop, W; Laohasiriwong, W

    2015-01-01

    Background Health, safety, and well being have been known to be influenced by occupational characteristics. Nurses constantly encounter musculoskeletal disorders (MSDs) from work demands worldwide. Nevertheless, there is insufficient of knowledge regarding causes of musculoskeletal disorders among nurses in Thailand. Objective To investigate factors associated with musculoskeletal disorder among registered nurses in Thailand. Method This study is part of the 2009 Thai Nurse Cohort Study which consisted of 18,756 nationally representative sample of registered nurses. Data collection was performed via postal self-administered questionnaires. Manifesting musculoskeletal disorders was self-reported by registered nurses, 1,070 nurses were excluded since they were unemployed during previous 12 months. Multiple logistic regression was used for data analysis. Result Of 17,686 registered nurses, the overall 12 months prevalence of musculoskeletal disorders was 47.8%. It was found that workplace violence was the strongest factor which statistically significant associated with musculoskeletal disorders (adjusted odds ratio, OR, 2.01; 95% confidence interval, 95% CI, 1.42 to 2.83; P < 0.001), anxiety/depression (OR = 1.96: 95% CI: 1.78 to 2.15; P < 0.001), perceiving job required a lot of physical effort (OR = 1.69; 95% CI: 1.52 to 1.87; P < 0.001), every 10 years increased of age (OR = 1.40; 95% CI: 1.22 to 1.62; P < 0.001), overweight (OR = 1.39; 95% CI: 1.01 to 1.52; P = 0.015). Conclusion Registered nurses were most vulnerable of musculoskeletal disorders especially those who experienced workplace violence, anxiety/depression, strenuous work, older age, and overweight. Consequently, recommending safety practices to nurses should be considered for musculoskeletal disorders (MSDs) prevention by ergonomics and workplace design.

  13. The prevalence of clinically diagnosed ankylosing spondylitis and its clinical manifestations: a nationwide register study.

    PubMed

    Exarchou, Sofia; Lindström, Ulf; Askling, Johan; Eriksson, Jonas K; Forsblad-d'Elia, Helena; Neovius, Martin; Turesson, Carl; Kristensen, Lars Erik; Jacobsson, Lennart T H

    2015-05-09

    Prevalence estimates of ankylosing spondylitis vary considerably, and there are few nationwide estimates. The present study aimed to describe the national prevalence of clinically diagnosed ankylosing spondylitis in Sweden, stratified according to age, sex, geographical, and socio-economic factors, and according to subgroups with ankylosing spondylitis-related clinical manifestations and pharmacological treatment. All individuals diagnosed with ankylosing spondylitis according to the World Health Organization International Classification of Disease codes, between 1967 and 2009, were identified from the National Patient Register. Data regarding disease manifestations, patient demographics, level of education, pharmacological treatment, and geographical region were retrieved from the National Patient Register and other national registers. A total of 11,030 cases with an ankylosing spondylitis diagnosis (alive, living in Sweden, and 16 to 64 years old in December 2009) were identified in the National Patient Register, giving a point prevalence of 0.18% in 2009. The prevalence was higher in northern Sweden, and lower in those with a higher level of education. Men had a higher prevalence of ankylosing spondylitis (0.23% versus 0.14%, P < 0.001), a higher frequency of anterior uveitis (25.5% versus 20.0%, P < 0.001) and were more likely to receive tumor necrosis factor inhibitors than women (15.6% versus 11.8% in 2009, P < 0.001). Women were more likely than men to have peripheral arthritis (21.7% versus 15.3%, P < 0.001), psoriasis (8.0% versus 6.9%, P = 0.03), and treatment with oral corticosteroids (14.0% versus 10.4% in 2009, P < 0.001). This nationwide, register-based study demonstrated a prevalence of clinically diagnosed ankylosing spondylitis of 0.18%. It revealed phenotypical and treatment differences between the sexes, as well as geographical and socio-economic differences in disease prevalence.

  14. Registered nurses' reflections on bioscience courses during the undergraduate nursing programme: an exploratory study.

    PubMed

    Craft, Judy A; Hudson, Peter B; Plenderleith, Mark B; Gordon, Christopher J

    2017-06-01

    To explore new graduate registered nurses' reflections of bioscience courses during their nursing programme and the relationship between bioscience content and their clinical practice. Undergraduate nursing students internationally find bioscience courses challenging, which may be due to the volume of content and level of difficulty of these courses. Such challenges may be exacerbated by insufficient integration between bioscience theory and nursing clinical practice. A descriptive, cross-sectional mixed methods study was conducted. A 30-item questionnaire with five written response questions which explored recently registered nurses' reflections on bioscience courses during their nursing degree was employed. Descriptive analyses were reported for individual items. Thematic analysis of qualitative responses was grouped to reveal emerging themes. Registered nurses' (n = 22) reflections revealed that bioscience courses were a significant challenge during their undergraduate programme, and they lacked confidence explaining the biological basis of nursing. Participants would like improved knowledge of the relevant bioscience for nursing and agreed that bioscience courses should be extended into the undergraduate final year. The importance of relating bioscience content to nursing practice was elaborated extensively throughout written responses. Although registered nurses reflected that bioscience courses were difficult with large volumes of content, having more bioscience with greater relevance to nursing applications was considered important in their current clinical practice. It is suggested that bioscience academics develop greater contextual links between bioscience content and clinical practice relevant to nursing. After working as a registered nurse, there was appreciation of bioscience relevance for clinical practice, and the nurses believed they would have benefitted from more nursing-related bioscience during their undergraduate programme. Focussed

  15. Prevalence and comorbidities of chronic hepatitis C: a nationwide population-based register study in Sweden.

    PubMed

    Büsch, Katharina; Waldenström, Jesper; Lagging, Martin; Aleman, Soo; Weiland, Ola; Kövamees, Jan; Duberg, Ann-Sofi; Söderholm, Jonas

    2017-01-01

    The aim of this study was to estimate the prevalence of physician-diagnosed and registered chronic hepatitis C (CHC), and to estimate the reported frequencies of Charlson comorbidities compared with matched comparators from the general population. Patients were identified according to ICD codes for CHC in the Swedish National Patient Register (1997-2013). Prevalence was estimated according to different patient identification algorithms and for different subgroups. Charlson comorbidities were ascertained from the same register and compared with age/sex/county of residence matched general population comparators. A total of 34,633 individuals with physician-diagnosed CHC were alive in Sweden in 2013 (mean age, 49 years; 64% men), corresponding to a physician-diagnosed prevalence of 0.36%. The prevalence varied by case definition (0.22%-0.36%). The estimate dropped to 0.14% for monitored CHC disease (defined as ≥1 CHC-related visit in 2013). Overall, 41.3% of the CHC patients had ≥1 physician-registered Charlson comorbidity; the most common was liver diseases (22.1%). Compared with matched comparators from the general population (n = 171,338), patients with CHC had more physician-diagnosed and registered diseases such as chronic pulmonary disease (10.2% vs. 4.0%), diabetes (10.6% vs. 5.5%) and liver-related cancer (1.3% vs. 0.2%; all p < .01). No information on behavioural factors, such as smoking, alcohol consumption or on-going illicit drug use, was available. The physician-diagnosed prevalence of CHC was slightly lower than previously reported estimates, and varied by case definition. The additional comorbidities observed in the CHC group should be taken into consideration, as these comorbidities add to the disease burden.

  16. Is the incidence of recurrent pregnancy loss increasing?: a retrospective register-based study in Sweden.

    PubMed

    Rasmark Roepke, Emma; Matthiesen, Leif; Rylance, Rebecca; Christiansen, Ole Bjarne

    2017-08-18

    The aim of this study was to estimate the incidence of recurrent pregnancy loss (RPL). The prevalence of RPL defined as ≥3 consecutive miscarriages before gestation week 22, is often stated to be 1%. To our knowledge no study has estimated the incidence of RPL, which might be more informative and clinically relevant than the prevalence. This retrospective register-based study was conducted from 2003 until 2012 in Sweden with data provided by the Swedish National Board of Health and Welfare. 6852 women were registered with the diagnoses of RPL in the National Patient Register. The incidence of RPL is the number of new women receiving the RPL diagnosis per year in the numerator and population at risk in the denominator. For each year, from 2003 to 2012, the incidence was calculated in two different risk populations, 1) all women aged 18-42 years, and 2) all women registered as being pregnant (deliveries or miscarriages). The average incidence in the study period was 53 per 100 000 (0.05%) in women aged 18-42 years and 650 per 100 000 (0.65%) in women who had achieved pregnancy in the period. The incidence of RPL in the two risk populations increased by 74% and 58%, respectively, during the study period. This study suggests that the incidence of RPL increased during the ten-year period studied. Causes can only be speculated upon in this study design, but might be associated with environmental changes, as the increase was fairly rapid. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  17. Chronic lower respiratory diseases among demolition and cement workers: a population-based register study

    PubMed Central

    Mølgaard, Ellen Fischer; Hannerz, Harald; Tüchsen, Finn; Brauer, Charlotte; Kirkeskov, Lilli

    2013-01-01

    Objective To estimate standardised hospitalisation ratios (SHR) for chronic lower respiratory diseases among demolition and cement workers in Denmark, 1995–2009. Design This is a population-based register study on data from ‘the Occupational Hospitalisation Register’. SHR of chronic obstructive pulmonary disease (COPD) was calculated for both demolition and cement workers. Settings Register study with data from all hospitals in Denmark. Participants 895 demolition workers and 5633 cement and concrete workers were included in the study and all economical active men were used as reference group. Results We found a statistically significant high SHR for the cement workers, SHR=134 (95% CI 117 to 153). The SHR for demolition workers was 131 (95% CI 87 to 188). Conclusions We find a higher risk of being hospitalised due to COPD in cement and concrete workers (significant) and demolition workers (insignificant) compared to gainfully employed men. PMID:23315517

  18. A phenomenographic study of registered nurses' understanding of their role in student learning--an Australian perspective.

    PubMed

    Brammer, Jillian

    2006-11-01

    Students may be 'buddied' with registered nurses during their clinical experience since the designated clinical facilitator cannot be available for each student at all times. Little is known about the way registered nurses understand this informal role. The rationale for this study was to gain an insight of the variation of understanding registered nurses have of their role with students, and explored the qualitatively different ways registered nurses perceive their role with students on clinical experience and the implications of this understanding for student learning. A phenomenographic approach was used to identify the variation of understanding and meaning of the role of the registered nurse with students on clinical practice from the perspective of the registered nurse. Phenomenography is a field of descriptive research concerned with the variation in ways people experience and understand similar phenomena. A purposive sample of 30 registered nurses from 15 public and private hospitals in central and south eastern Queensland, Australia. Individual semi-structured interviews from a final sample of 28 interviews were analysed to identify Categories of Description. Eight variations of understanding registered nurses have of their informal role with students were identified. The registered nurses' understanding varies from a focus that is 'student-centred', to 'completion of workload-centred', to 'registered nurse control', to a preference for no contact with students. As a consequence some students may have positive learning experiences while others will have limited learning opportunities. The research highlights the varied ways registered nurses understand their role with students that may promote or impede the quality of student learning and development to meet professional competency standards. Formal recognition of the complexity of the registered nurse role by health care agencies and tertiary education providers is essential to ensure registered nurses

  19. Cross-Cultural Register Differences in Infant-Directed Speech: An Initial Study.

    PubMed

    Farran, Lama K; Lee, Chia-Cheng; Yoo, Hyunjoo; Oller, D Kimbrough

    2016-01-01

    Infant-directed speech (IDS) provides an environment that appears to play a significant role in the origins of language in the human infant. Differences have been reported in the use of IDS across cultures, suggesting different styles of infant language-learning. Importantly, both cross-cultural and intra-cultural research suggest there may be a positive relationship between the use of IDS and rates of language development, underscoring the need to investigate cultural differences more deeply. The majority of studies, however, have conceptualized IDS monolithically, granting little attention to a potentially key distinction in how IDS manifests across cultures during the first two years. This study examines and quantifies for the first time differences within IDS in the use of baby register (IDS/BR), an acoustically identifiable type of IDS that includes features such as high pitch, long duration, and smooth intonation (the register that is usually assumed to occur in IDS), and adult register (IDS/AR), the type of IDS that does not include such features and thus sounds as if it could have been addressed to an adult. We studied IDS across 19 American and 19 Lebanese mother-infant dyads, with particular focus on the differential use of registers within IDS as mothers interacted with their infants ages 0-24 months. Our results showed considerable usage of IDS/AR (>30% of utterances) and a tendency for Lebanese mothers to use more IDS than American mothers. Implications for future research on IDS and its role in elucidating how language evolves across cultures are explored.

  20. Cross-Cultural Register Differences in Infant-Directed Speech: An Initial Study

    PubMed Central

    Farran, Lama K.; Lee, Chia-Cheng; Yoo, Hyunjoo; Oller, D. Kimbrough

    2016-01-01

    Infant-directed speech (IDS) provides an environment that appears to play a significant role in the origins of language in the human infant. Differences have been reported in the use of IDS across cultures, suggesting different styles of infant language-learning. Importantly, both cross-cultural and intra-cultural research suggest there may be a positive relationship between the use of IDS and rates of language development, underscoring the need to investigate cultural differences more deeply. The majority of studies, however, have conceptualized IDS monolithically, granting little attention to a potentially key distinction in how IDS manifests across cultures during the first two years. This study examines and quantifies for the first time differences within IDS in the use of baby register (IDS/BR), an acoustically identifiable type of IDS that includes features such as high pitch, long duration, and smooth intonation (the register that is usually assumed to occur in IDS), and adult register (IDS/AR), the type of IDS that does not include such features and thus sounds as if it could have been addressed to an adult. We studied IDS across 19 American and 19 Lebanese mother-infant dyads, with particular focus on the differential use of registers within IDS as mothers interacted with their infants ages 0–24 months. Our results showed considerable usage of IDS/AR (>30% of utterances) and a tendency for Lebanese mothers to use more IDS than American mothers. Implications for future research on IDS and its role in elucidating how language evolves across cultures are explored. PMID:26981626

  1. Characteristics of antimicrobial studies registered in the USA through ClinicalTrials.Gov.

    PubMed

    Stockmann, Chris; Sherwin, Catherine M T; Ampofo, Krow; Hersh, Adam L; Pavia, Andrew T; Byington, Carrie L; Ward, Robert M; Spigarelli, Michael G

    2013-08-01

    Increasing rates of antimicrobial-resistant infections and the dwindling pipeline of new agents necessitate judicious, evidence-based antimicrobial prescribing. Clinical trials represent a vital resource for establishing evidence of safety and efficacy, which are crucial to guiding antimicrobial treatment decisions. The objective of this study was to comprehensively evaluate the characteristics of antimicrobial research studies registered in ClinicalTrials.gov. Primary outcome measures, funding sources, inclusion criteria and the reporting of study results were evaluated for 16055 antimicrobial studies registered in ClinicalTrials.gov as of mid 2012. Interventional studies accounted for 93% of registered antimicrobial studies. Clinical trials of drugs (82%) and biologics (9%) were most common. Antibacterial, antiviral and antifungal studies accounted for 43%, 41% and 16% of drug trials, respectively. Among interventional drug trials, 73% featured randomised allocation to study arms and 71% included measures of safety and/or efficacy as primary endpoints. Children were eligible for enrolment in 26% of studies. Among the studies, 60% were sponsored primarily by non-profit organisations, 30% by industry and 10% by the federal government. Only 7% of studies reported results; however, 71% of these were sponsored primarily by industry. Antimicrobial studies commonly incorporated elements of high-quality trial design, including randomisation and safety/efficacy endpoints. Publication of study results and updating of ClinicalTrials.gov should be encouraged for all studies, with particular attention paid to research sponsored by non-profit organisations and governmental agencies. Leveraging the application of these data to guide the careful selection of antimicrobial agents will be essential to preserve their utility for years to come. Copyright © 2013 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.

  2. Occupational exposure to isothiazolinones. A study based on a product register.

    PubMed

    Nielsen, H

    1994-07-01

    A national data base on chemical products (the Danish Product Register (PROBAS)) was searched in order to survey occupational exposure to isothiazolinones. 5-chloro-2-methyl-4-isothiazolin-3-one/2-methyl-4-isothiazolin+ ++-3-one(MCI/MI) was registered in 550 products, 1,2-benzisothiazolin-3-one(BIT) in 156 products and 2-n-octyl-4-isothiazolin-3-one in 16 products. For the MCI/MI-containing products, of which 343 had information on concentration, 64% of the products contained above or equal to 0.001% (10 ppm) MCI/MI. Main product categories were paints, hair shampoos, skin care products, and cleaning agents. For BIT-containing products, of which 139 had information on concentration, 54% of the products contained above or equal to 0.01% (100 ppm) BIT. Main product categories were cleaning agents, polishes, and paints. Only a few products were registered with content of 2-n-octyl-4-isothiazolin-3-one and these were not studied further. The dermatological literature has often focused on isothiazolinones in cosmetics as the source of allergy. The present study showed that attention should also be paid to occupational exposure, as isothiazolinones occur in many industrial product categories.

  3. Psychosocial outcomes in adult men born with hypospadias: A register-based study

    PubMed Central

    Skarin Nordenvall, Anna; Norrby, Christina; Butwicka, Agnieszka; Frisén, Louise; Nordenström, Anna; Almqvist, Catarina; Nordenskjöld, Agneta

    2017-01-01

    In this nationwide matched cohort study, we have investigated whether being born with hypospadias affect subsequent psychosocial outcomes in adulthood. We analyzed prospectively collected data from national Swedish registers. Data on the diagnoses were collected from the National Patient Register and the Medical Birth Register. Data on psychosocial outcomes such as educational and income level, marital status and disability pension were collected from Statistics Sweden. The effects of covariates, such as age, county of birth, presence of other malformations and psychiatric illness, were taken into account. The associations between hypospadias and psychosocial outcomes were calculated using conditional logistic regression and expressed as odds ratios (OR) and 95% confidence intervals (CI). We included 4378 men diagnosed with hypospadias, born between 1969 and 1993 in Sweden. Patients with hypospadias were matched with unaffected men by year of birth and birth county. We did not detect any differences in educational or income level. The probability of entering marriage (OR 1.02, 95% CI 0.90–1.14) did not differ, regardless of phenotype. We did, however, detect a 40% increased probability of receiving a disability pension, (OR 1.39, 95% CI 1.20–1.61). In conclusion, men born with hypospadias in Sweden do not differ from unaffected men with respect to the majority of psychosocial outcomes studied. They are, however, at increased risk of receiving a disability pension, which motivates further investigations. PMID:28384289

  4. Developing register-based measures for assessment of working time patterns for epidemiologic studies.

    PubMed

    Härmä, Mikko; Ropponen, Annina; Hakola, Tarja; Koskinen, Aki; Vanttola, Päivi; Puttonen, Sampsa; Sallinen, Mikael; Salo, Paula; Oksanen, Tuula; Pentti, Jaana; Vahtera, Jussi; Kivimäki, Mika

    2015-05-01

    Epidemiological studies suggest that long working hours and shift work may increase the risk of chronic diseases, but the "toxic" elements remain unclear due to crude assessment of working time patterns based on self-reports. In this methodological paper, we present and evaluate objective register-based algorithms for assessment of working time patterns and validate a method to retrieve standard payroll data on working hours from the employer electronic records. Detailed working hour records from employers' registers were obtained for 12 391 nurses and physicians, a total 14.5 million separate work shifts from 2008-2013. We examined the quality and validity of the obtained register data and designed 29 algorithms characterizing four potentially health-relevant working time patterns: (i) length of the working hours; (ii) time of the day; (iii) shift intensity; and (iv) social aspects of the working hours. The collection of the company-based register data was feasible and the retrieved data matched with the originally published shift plans. The transferred working time records included <0.01% missing data. Two percent were duplicates that could be easily removed. The 29 variables of working time patterns, generated for each year, were stable across the follow-up (year-to-year correlation coefficients from r=0.7-0.9 for 23 variables), their distributions were as expected, and correlations of the variables within the four main dimensions of working hours were plausible. The developed method and algorithms allow a detailed characterization of four main dimensions of working time patterns potentially relevant for health. We recommend this method for future large-scale epidemiological studies.

  5. Preventing Sickness Absence With Career Management Intervention

    PubMed Central

    Toppinen-Tanner, Salla; Böckerman, Petri; Mutanen, Pertti; Martimo, Kari-Pekka; Vuori, Jukka

    2016-01-01

    This study examined whether a group intervention focusing on building up preparedness for career management can prevent future sickness absence. Register-based data on the number of sickness absence days and sickness absence episodes were examined as outcomes of the intervention among 684 employees in 17 organizations in a randomized controlled trial. Sickness absence data were collected covering a period from 1 year before (baseline) to approximately 2 years after the intervention (follow-up). The data were analyzed using zero-inflated negative binomial models. After controlling for baseline absence, age, gender, and organization, the intervention was effective in decreasing the number of longer sickness absences (lasting longer than > 2 weeks), but no other significant effects were found. These findings point out that it is feasible to use a career management intervention to prevent future sickness absence in work organizations. PMID:27930479

  6. A prospective cohort study examining the preferred learning styles of acute care registered nurses.

    PubMed

    McCrow, Judy; Yevchak, Andrea; Lewis, Peter

    2014-03-01

    This paper reports on the preferred learning styles of Registered Nurses practicing in acute care environments and relationships between gender, age, post-graduate experience and the identified preferred learning styles. A prospective cohort study design was used. Participants completed a demographic questionnaire and the Felder-Silverman Index of Learning Styles (ILS) questionnaire to determine preferred learning styles. Most of the Registered Nurse participants were balanced across the Active-Reflective (n = 77, 54%), and Sequential-Global (n = 96, 68%) scales. Across the other scales, sensing (n = 97, 68%) and visual (n = 76, 53%) were the most common preferred learning style. There were only a small proportion who had a preferred learning style of reflective (n = 21, 15%), intuitive (n = 5, 4%), verbal (n = 11, 8%) or global learning (n = 15, 11%). Results indicated that gender, age and years since undergraduate education were not related to the identified preferred learning styles. The identification of Registered Nurses' learning style provides information that nurse educators and others can use to make informed choices about modification, development and strengthening of professional hospital-based educational programs. The use of the Index of Learning Styles questionnaire and its ability to identify 'balanced' learning style preferences may potentially yield additional preferred learning style information for other health-related disciplines. Copyright © 2013 Elsevier Ltd. All rights reserved.

  7. Dementia and Traffic Accidents: A Danish Register-Based Cohort Study

    PubMed Central

    Siersma, Volkert; Nielsen, Connie Thurøe; Vass, Mikkel; Waldorff, Frans Boch

    2016-01-01

    Background As a consequence of a rapid growth of an ageing population, more people with dementia are expected on the roads. Little is known about whether these people are at increased risk of road traffic-related accidents. Objective Our study aims to investigate the risk of road traffic-related accidents for people aged 65 years or older with a diagnosis of dementia in Denmark. Methods We will conduct a nationwide population-based cohort study consisting of Danish people aged 65 or older living in Denmark as of January 1, 2008. The cohort is followed for 7 years (2008-2014). Individual’s personal data are available in Danish registers and can be linked using a unique personal identification number. A person is identified with dementia if the person meets at least one of the following criteria: (1) a diagnosis of the disease in the Danish National Patient Register or in the Danish Psychiatric Central Research Register, and/or (2) at least one dementia diagnosis-related drug prescription registration in the Danish National Prescription Registry. Police-, hospital-, and emergency room-reported road traffic-related accidents occurred within the study follow-up are defined as the study outcome. Cox proportional hazard regression models are used for the main analysis. Results Our study protocol has 3 phases including data collection, data analysis, and reporting. The first phase of register-based data collection of 853,228 individual’s personal information was completed in August, 2016. The next phase is data analysis, which is expected to be finished before December 2016, and thereafter writing publications based on the findings. The study started in January 2016 and will end in December 2018. Discussion This study covers the entire elderly population of Denmark, and thereby will avoid selection bias due to nonparticipation and loss to follow-up. Furthermore, this ensures that the study results are reliable and generalizable. However, underreporting of traffic

  8. The accuracy of the Jamaican national physician register: a study of the status of physicians registered and their countries of training

    PubMed Central

    Knight-Madden, Jennifer; Gray, Robert

    2008-01-01

    Background The number of physicians per 10,000 population is a basic health indicator used to determine access to health care. Studies from the United States of America and Europe indicate that their physician registration databases may be flawed. Clinical research activities have suggested that the current records of physicians registered to practice in Jamaica may not be accurate. Our objective was to determine whether the Medical Council of Jamaica (MCJ) accurately records and reports the identities, number and specialty designation of physicians in Jamaica. An additional aim was to determine the countries in which these physicians were trained. Methods Data regarding physicians practicing in Jamaica in 2005 were obtained from multiple sources including the MCJ and the telephone directory. Intense efforts at tracing were undertaken in a sub-sample of physicians, internists and paediatricians to further improve the accuracy of the data. Data were analysed using SPSS, version 11.5. Results The MCJ listed 2667 registered physicians of which 118 (4.4%) were no longer practicing in Jamaica. Of the subset of 150 physicians who were more actively traced, an additional 11 were found to be no longer in practice. Thus at least 129 (4.8%) of the physicians on the MCJ list were not actively practising in Jamaica. Twenty-nine qualified physicians who were in practice, but not currently on the Jamaican register, were identified from other data sources. This yielded an estimate of 2567 physicians or 9.68 physicians per 10,000 persons. Seven hundred and twenty six specialists were identified, 118 from the MCJ list only, 452 from other sources, in particular medical associations, and 156 from both the MCJ list and other sources. Sixty-six percent of registered doctors completed medical school at the University of the West Indies (UWI). Conclusion These data suggest that the MCJ list includes some physicians no longer practicing in Jamaica while underestimating the number of

  9. Migration and health: exploring the role of migrant status through register-based studies.

    PubMed

    Nørredam, Marie

    2015-04-01

    This thesis aims to explore migrant status as a determinant in register-based studies on migrant health. It is based on eight studies that investigate the following three main issues: 1) What is the importance of migrant status for morbidity patterns among migrants compared with Native Danes? 2) Do migrant status and ethnicity affect clinical indicators of access among migrants compared with native Danes? 3) What is the importance of migrant status for mortality patterns among migrants compared with Native Danes? The thesis builds on a register-based historical prospective cohort design. Through Statistics Denmark, all refugees (n = 29,174) and family reunification immigrants (n = 33,287) who received residence permits in Denmark from 1 January 1993 to 31 December 1999 were included and matched 4:1 on age and sex with Native Danes. Register linkage was obtained twice during follow-ups in 2004 and 2008 respectively. Personal identification numbers were cross-linked to the Danish Psychiatric Central Register, the National Patient Registry, the Registry of Coercive Measures in Psychiatric Treatment, the Register of Causes of Death, and the Danish Cancer Registry. Migrant status defined by legal grounds for obtaining a residence permit was dichotomised into refugees and family reunification immigrants and used as the determinant in most studies. Analyses involved both Poisson and Cox regression analysis. Most analyses were stratified by ethnicity and adjusted for age and sex. Some were also stratified for individual income. Three sub-themes were investigated: morbidity, clinical indicators of access, and mortality. The first sub-theme (Papers I-III) showed that refugees had a consistently higher morbidity from several mental health disorders in contrast to family reunification immigrants, whose morbidity from mental disorders was lower than or similar to native Danes. The cancer incidence study did not find an effect of migrant status but found, rather, that migrants

  10. Socio-economic differences in the association between sickness absence and mortality: the prospective DREAM study of Danish private sector employees.

    PubMed

    Lund, T; Kivimäki, M; Christensen, K B; Labriola, M

    2009-03-01

    To examine duration of sickness absence as a risk marker for future mortality by socio-economic position among all private sector employees in Denmark in 1998-2004. All residents in Denmark employed in the private sector receiving sickness absence compensation in 1998 were investigated in a prospective cohort study. 236 207 persons (38.2% women, 61.8% men, age range 18-65, mean age 37.8 years) alive on 1 January 2001 were included in the study. Mortality from 1 January 2001 to 31 December 2004 was assessed using national register data. Deaths in 1999 and 2000 were excluded to determine the status of sickness absence duration as an early risk marker. For analyses within occupational grades, data were available for a sub-population of 137 607 study participants. 3040 persons died during follow-up. The age-adjusted risk of future mortality increased by duration of sickness absence in a graded fashion among men and non-blue collar workers. Among women and blue collar workers, there was no association of mortality with duration of sickness absences below 6 weeks. However, employees with > or =6 weeks of absence compared to those with 1-week absence had a substantial excess risk of death in all groups: adjusted hazard ratio 2.2 (95% CI 1.8 to 2.7) for women, 2.1 (95% CI 1.8 to 2.4) for men, 3.7 (95% CI 1.9 to 7.2) in white collar occupations, 3.3 (95% CI 2.2 to 5.0) in intermediate grade occupations and 2.0 (95% CI 1.7 to 2.3) in blue collar occupations. Administratively collected data on sickness absence compensation for periods > or =6 weeks identified "at risk" groups for future excess mortality in male and female private sector employees across occupational grade levels.

  11. Public availability of results of observational studies evaluating an intervention registered at ClinicalTrials.gov.

    PubMed

    Baudart, Marie; Ravaud, Philippe; Baron, Gabriel; Dechartres, Agnes; Haneef, Romana; Boutron, Isabelle

    2016-01-28

    Observational studies are essential for assessing safety. The aims of this study were to evaluate whether results of observational studies evaluating an intervention with safety outcome(s) registered at ClinicalTrials.gov were published and, if not, whether they were available through posting on ClinicalTrials.gov or the sponsor website. We identified a cohort of observational studies with safety outcome(s) registered on ClinicalTrials.gov after October 1, 2007, and completed between October 1, 2007, and December 31, 2011. We systematically searched PubMed for a publication, as well as ClinicalTrials.gov and the sponsor website for results. The main outcomes were the time to the first publication in journals and to the first public availability of the study results (i.e. published or posted on ClinicalTrials.gov or the sponsor website). For all studies with results publicly available, we evaluated the completeness of reporting (i.e. reported with the number of events per arm) of safety outcomes. We identified 489 studies; 334 (68%) were partially or completely funded by industry. Results for only 189 (39%, i.e. 65% of the total target number of participants) were published at least 30 months after the study completion. When searching other data sources, we obtained the results for 53% (n = 158; i.e. 93% of the total target number of participants) of unpublished studies; 31% (n = 94) were posted on ClinicalTrials.gov and 21% (n = 64) on the sponsor website. As compared with non-industry-funded studies, industry-funded study results were less likely to be published but not less likely to be publicly available. Of the 242 studies with a primary outcome recorded as a safety issue, all these outcomes were adequately reported in 86% (114/133) when available in a publication, 91% (62/68) when available on ClinicalTrials.gov, and 80% (33/41) when available on the sponsor website. Only 39% of observational studies evaluating an intervention with safety outcome

  12. The educational gradient of obesity increases among Swedish pregnant women: a register-based study.

    PubMed

    Bjermo, Helena; Lind, Simon; Rasmussen, Finn

    2015-04-01

    Overweight or obesity is detrimental during pregnancy. We studied time trends in the educational gradient of overweight and obesity among pregnant women. Differences in overweight and obesity by area of residence and country of birth were also examined. The study was based on the Swedish Medical Birth Register between 1992 and 2010 and included 1,569,173 singleton pregnancies. Weight and height were registered during the first visit at the antenatal-care clinic. Data on education, country of birth, and area of residence were derived from registers with national coverage. In 2008-2010, 32% of Swedish nulliparous pregnant women were overweight or obese. The relative risk of obesity among lower educated women compared to women with higher education increased from 1.91 (95% confidence interval: 1.85-1.97) in 1992-1995 to 2.09 (95% confidence interval: 2.05-2.14) in 2008-2010. There was an inverse linear relationship between risks of overweight or obesity, and population density and type of residence municipality. An excessive gestational weight gain according to the American Institute of Medicine was observed among 57-63% of the overweight or obese women, but there were small differences by education. Pregnant women born in Africa, Middle East or Latin America had higher risks of being overweight or obese compared to women born in Sweden. The prevalence of obesity as well as the social inequalities in obesity during pregnancy increased in Sweden between 1992 and 2010. Further understanding of social inequalities and geographical differentials in health behaviours of pregnant women is needed when planning public health interventions.

  13. Prior depression and incident back pain among military registered nurses: A retrospective cohort study.

    PubMed

    Nelson, D Alan; Menzel, Nancy; Horoho, Patricia

    2017-06-28

    Occupational back pain rates are substantial among registered nurses, and nurses also report high rates of depression. The role of depression as a potential predictor of back pain among nurses appears understudied. The objective of the study was to determine whether a history of depression predicted incident back pain in a population of military registered nurses when controlling for relevant risk factors. We employed a retrospective cohort approach using longitudinal data in which gender-specific subject groups were followed from the beginning of duty as a registered nurse to the occurrence of an outcome, or to censoring due to completion of service or the end of available data. This study included all United States Army registered nurses who began work during 2011-2014 without evidence of prior back pain in clinical records. Data from automatically-collected medical and administrative sources were combined and used to provide 2134 person-years of observation on 1248 individuals. These data were organized at the person-month level in a panel data structure to support discrete-time multivariable logistic regression models. The models examined the relationships between prior depression, Body Mass Index, the presence of prior combat duty and selected control variables and the outcome, the incident occurrence of back pain. The incidence rate of back pain was 18.6 per 100 person-years and the period prevalence was 31.7%. Prior depression was a statistically-significant predictor of incident back pain among female subjects (odds ratio [OR]: 1.75, 95% confidence interval [CI]: 1.08-2.83, P-value<0.05). Body Mass Index of 30kg/m(2) or greater, prior combat deployments, and age 36 years or older was each associated with back pain for male and female nurses. The study's findings provide the first evidence of a temporal link between antecedent depression and later back pain among female military nurses. High Body Mass Index was found to be a further, modifiable risk factor

  14. Registered nurses' thinking strategies on malnutrition and pressure ulcers in nursing homes: a scenario-based think-aloud study.

    PubMed

    Fossum, Mariann; Alexander, Gregory L; Göransson, Katarina E; Ehnfors, Margareta; Ehrenberg, Anna

    2011-09-01

    The aim of this study was to explore the thinking strategies and clinical reasoning processes registered nurses use during simulated care planning for malnutrition and pressure ulcers in nursing home care. Clinical reasoning is an essential component of nursing practice. Registered nurses' thinking strategies and clinical reasoning have received limited attention in nursing science. Further research is needed to understand registered nurses' clinical reasoning, especially for prevention of malnutrition and pressure ulcers as they are important quality indicators of resident care in nursing homes. A qualitative explorative design was used with a think-aloud interview technique. The transcribed verbalisations were analysed with qualitative deductive content analysis. Data were collected during six months in 2007-2008 from 30 registered nurses at nine nursing homes in Norway. The registered nurses used a variety of thinking strategies, but there were differences in the frequency of use of the different strategies. The three most commonly used thinking strategies were 'making choices', 'forming relationships' and 'drawing conclusions'. None of the nurses performed a structured risk assessment of malnutrition or pressure ulcers. Registered nurses started with assessing data from the scenarios, but after a short and elementary assessment they moved directly to planning. Many different thinking strategies were used in registered nurses' clinical reasoning for prevention of malnutrition and pressure ulcers. The thinking strategy 'making choices' was most commonly used and registered nurses' main focus in their reasoning was on planning nursing interventions. This study showed that most of the registered nurses go directly to planning when reasoning clinically about residents in nursing homes. A lack of systematic risk assessments was identified. The insight gained from this study can be used to recommend improvements in tools designed for nursing homes to support the

  15. Epilepsy in individuals with a history of Asperger's syndrome: a Danish nationwide register-based cohort study.

    PubMed

    Mouridsen, Svend Erik; Rich, Bente; Isager, Torben

    2013-06-01

    We performed a nationwide, register-based retrospective follow-up study of epilepsy in all people who were born between January 1, 1980 and June 29, 2006 and registered in the Danish Psychiatric Central Register with Asperger's syndrome on February 7, 2011. All 4,180 identified cases with AS (3,431 males and 749 females) were screened through the nationwide Danish National Hospital Register (DNHR) with respect to epilepsy. Mean age at follow-up was 18.1 years (range 4-31 years). Of the 4,180 individuals with AS, 164 (3.9%) were registered with at least one epilepsy diagnosis in the DNHR, which is significantly increased (p < 0.0001) relative to the same age group in the general population, where an estimate is about 2.0%.

  16. Diagnosis-specific sickness absence and all-cause mortality in the GAZEL study

    PubMed Central

    Ferrie, Jane E.; Vahtera, Jussi; Kivimäki, Mika; Westerlund, Hugo; Melchior, Maria; Alexanderson, Kristina; Head, Jenny; Chevalier, Anne; Leclerc, Annette; Zins, Marie; Goldberg, Marcel; Singh-Manoux, Archana

    2009-01-01

    Objective To examine diagnosis-specific sickness absence as a risk marker for all-cause mortality. Design Prospective occupational cohort (the GAZEL study). Medically-certified sickness absence spells greater than 7 days for 15 diagnostic categories, 1990–1992, were examined in relation to all-cause mortality, January 1993-February 2007. The reference group for each diagnostic category was participants with no spell >7 days for that diagnosis. Participants French public utility workers (5,271 women and 13,964 men) aged 37–51 in 1990, the GAZEL study. Over the follow-up period there were 144 deaths in women and 758 in men. Main results 7,875 employees (41.0%) had at least one spell of sickness absence >7 days over the three-year period. The commonest diagnoses were mental disorders, musculoskeletal diseases, respiratory diseases and external causes in both sexes; genitourinary diseases in women, and digestive and circulatory diseases in men. Of these common diagnoses mental disorders in women, hazard ratio (95% confidence intervals) 1.24 (1.1–1.4); and mental disorders 1.35 (1.3–1.5), digestive diseases 1.29 (1.1–1.6) and circulatory diseases 1.35 (1.2–1.6) in men were associated with mortality after adjustment for age, employment grade and sickness absence in all other diagnostic categories. Conclusions Employees with medically-certified absence spells of one week or more over a three-year period had a 60% excess risk of early death. In women and men, this excess risk was associated with some of the commonest diagnoses of sickness absence, in particular mental disorders. Sickness absence for mental disorders may be a useful early indicator of groups at increased risk of fatal disease. PMID:19039005

  17. Trends in the psychopharmacological treatment of bipolar disorder: a nationwide register-based study.

    PubMed

    Bjørklund, Louise; Horsdal, Henriette Thisted; Mors, Ole; Østergaard, Søren Dinesen; Gasse, Christiane

    2016-04-01

    In bipolar disorder, treatment with antidepressants without concomitant use of mood stabilisers (antidepressant monotherapy) is associated with development of mania and rapid cycling and is therefore not recommended. The present study aimed to investigate the psychopharmacological treatment patterns in bipolar disorder over time, with a focus on antidepressant monotherapy. Cohort study with annual cross-sectional assessment of the use of psychotropic medications between 1995 and 2012 for all Danish residents aged 10 years or older with a diagnosis of bipolar disorder registered in the Danish Psychiatric Central Research Register. Users of a given psychotropic medication were defined as individuals having filled at least one prescription for that particular medication in the year of interest. We identified 20 618 individuals with bipolar disorder. The proportion of patients with bipolar disorder using antidepressants, atypical antipsychotics and anticonvulsants increased over the study period, while the proportion of patients using lithium, typical antipsychotics and benzodiazepines/sedatives decreased. The proportion of patients treated with antidepressant monotherapy decreased from 20.5% in 1997 to 12.1% in 2012, and among antidepressant users, the proportion in monotherapy decreased from 47.7% to 23.9%, primarily driven by a decrease in the use of tricyclic antidepressants. The results show an increase in the proportion of patients with bipolar disorder being treated with antidepressants in the period from 1997 to 2012. However, in accordance with international treatment guidelines, the extent of antidepressant monotherapy decreased during the same period.

  18. Facilitating access to health research through a participatory research register: a feasibility study in outpatient clinics.

    PubMed

    Leach, Verity A; McGeagh, John D; Margelyte, Ruta; Redmond, Niamh M; Walther, Axel; Redwood, Sabi; Martin, Richard M; Donovan, Jenny L

    2018-01-01

    A research register (Reach West) has been established to facilitate recruitment of people and patients to health-related research. We conducted a prospective feasibility study to investigate the practicality of recruiting through outpatient clinics. Patients over 18 years of age attending dental, eye or oncology outpatient clinics in an acute hospital in the West of England were provided with the opportunity to participate in Reach West. In Phase I, recruitment packs were handed to clinic attendees who could place completed consent forms in secure drop-box or return them later on-line or by post. In Phase II, recruitment packs were posted directly to patients with consent forms to be returned by post or on-line. Response rates by age, sex, postcode (for level of deprivation), and clinic type were recorded for those agreeing to participate on paper or on-line. In Phase I, 2,314 of 4,500 (51.4%) of recruitment packs were handed out to clinic attendees, and 114 (5%) consented to join Reach West. In Phase II, 7,173 of 9000 packs were posted (79.7%), and 387 (5.4%) consented to participate. The overall consent rate was 6% (580), with the majority doing so on paper (87%) rather than on-line. The sample was balanced by sex, but mostly comprised people over 50 years located in less deprived postcodes. Non-staff costs for postal recruitment were lower than hand-outs in clinic (£6.84 compared with £8.05 per participant). Recruiting participants to the Reach West register was feasible among those with oncology, dental or eye outpatient appointments by post or with packs given out in the clinic. Response rates were similar to those achieved for other registers. Recruitment of participants can be achieved through outpatient clinics but other strategies will also be required to attract large numbers of participants and more diverse populations.

  19. Pregnancy outcomes in patients with ankylosing spondylitis: a nationwide register study.

    PubMed

    Jakobsson, Gustav L; Stephansson, Olof; Askling, Johan; Jacobsson, Lennart T H

    2016-10-01

    Unlike other chronic inflammatory diseases, little is known about how ankylosing spondylitis (AS) affects outcomes of pregnancy and birth characteristics. In a nationwide population-based case-control study, 388 deliveries among women with AS (identified in the Swedish National Patient Register and Medical Birth Register) and deliveries among matched controls (n=1082) from the general population were included. Information regarding pregnancies after AS diagnosis, birth outcomes and possible confounders were retrieved from the national Swedish registers. ORs with 95% CIs were calculated with generalised estimating equations. Emergency and elective Caesarean section (CS) were performed in 16.5% and 9.8% of deliveries among women with AS compared with 6.5% and 6.9%, respectively, in population controls, resulting in OR of 3.00 (95% CI 2.01 to 4.46) and 1.66 (95% CI 1.09 to 2.54), respectively. Offspring of women with AS were more often preterm (9.0% vs 4.9%) and small-for-gestational-age (SGA) (3.1% vs 1.5%), resulting in an OR of 1.92 (95% CI 1.17 to 3.15) and 2.12 (95% CI 1.00 to 4.50), respectively. Adjustment for smoking habits, age, educational level, parity and exclusion of women with comorbidities resulted in similar or only slightly lower point estimates of risk. Cases with a more extensive antirheumatic therapy exposures tended to have a higher risk for elective CS and being SGA. Women with AS had a higher prevalence for several adverse birth outcomes, with results suggesting an influence by both disease severity and comorbidities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  20. A nationwide register study of the characteristics, incidence and validity of diagnosed Tourette syndrome and other tic disorders.

    PubMed

    Leivonen, Susanna; Voutilainen, Arja; Hinkka-Yli-Salomäki, Susanna; Timonen-Soivio, Laura; Chudal, Roshan; Gissler, Mika; Huttunen, Jukka; Sourander, Andre

    2014-09-01

    The aim of this study was to describe the characteristics and incidence rates of diagnosed tic disorders in the Finnish Hospital Discharge Register, including changing incidence rates between 1991 and 2010. We also aimed to validate the diagnoses of Tourette's syndrome recorded in the register. Children born between January 1, 1991 and December 31, 2010, who were diagnosed with tic disorders, were identified from the Finnish Hospital Discharge Register (n = 3003). We studied the validity of the Tourette's syndrome diagnoses by reviewing the medical charts of 88 children born since 1997 and carrying out telephone interviews with 55 of their guardians. The incidence rates of all diagnosed tic disorders increased during the study period. A comorbid diagnosis of hyperkinetic disorder diagnosis was recorded in 28.2% of the children with Tourette's syndrome, and the validity of the register-based Tourette's syndrome diagnosis was approximately 95%. This is the first nationwide study to demonstrate the increasing incidence of all register-based tic disorder diagnoses. The validity of the Tourette's syndrome diagnoses in the Finnish Hospital Discharge Register was good, and the data provided are suitable for use in further register-based studies of tic disorders. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  1. The incidence of eating disorders in a Danish register study: Associations with suicide risk and mortality.

    PubMed

    Zerwas, Stephanie; Larsen, Janne Tidselbak; Petersen, Liselotte; Thornton, Laura M; Mortensen, Preben Bo; Bulik, Cynthia M

    2015-06-01

    Our aim was to characterize the incidence rates and cumulative incidence of anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS), and examine associations among eating disorder diagnoses, suicide attempts, and mortality. Individuals born in Denmark between 1989 and 2006 were included (N = 966,141, 51.3% male). Eating disorders diagnoses (AN, broad AN, BN, EDNOS) were drawn from the Danish Psychiatric Central Research Register (PCRR) and Danish National Patient Register (NPR). Suicide attempts and deaths were captured in the NPR, the PCRR, and the Danish Civil Registration System (CRS). In females, AN had a peak hazard at approximately age 15 years, BN at 22 years, and EDNOS had an extended peak that spanned 18 years-22 years. Eating disorder diagnoses predicted a significantly higher hazard for death and suicide attempt compared with the referent of individuals with no eating disorders. In males, peak hazard for diagnosis was earlier than in females. The present study represents one of the largest and longest studies of eating disorder incidence and suicide attempts and death in both females and males. Eating disorders are accompanied by increased hazard of suicide attempts and death even in young adults. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Studies based on the Danish Adoption Register: schizophrenia, BMI, smoking, and mortality in perspective.

    PubMed

    Petersen, Liselotte; Sørensen, Thorkild I A

    2011-07-01

    The genetic and familial environmental influences making up familial correlations in traits and familial aggregation of diseases may be disentangled by adoption studies. Thus, resemblance between the adoptee and the biological relatives indicates a contribution of the segregating gene they have in common, and resemblance between the adoptee and the rearing adoptive family members indicates influences of the shared family environment. The Danish Adoption Register includes information on all 14,425 non-familial adoptions of Danish children legally granted in Denmark from 1924 to 1947. To illustrate the adoption study approach in research, we present results achieved in schizophrenia, body fatness, smoking, and mortality. Significantly higher prevalence of schizophrenia and related conditions were found in biological relatives to adoptees with schizophrenia than among biological relatives to adoptees without schizophrenia. Clear trends in body mass index of biological relatives and the weight of adoptees were found in several settings. A genetic influence on smoking habits were found within a generation. A moderate genetic influence on the mortality rate has been found. The Danish Adoption Register has contributed to the knowledge about environmental and genetic influence in various fields. Genetic influence on the risk of schizophrenia, body fatness, smoking habits, and on the mortality rate has been found.

  3. Electronic mail, a new written-language register: a study with French-speaking adolescents.

    PubMed

    Volckaert-Legrier, Olga; Bernicot, Josie; Bert-Erboul, Alain

    2009-03-01

    The aim of this study was to determine the extent to which the linguistic forms used by adolescents in electronic mail (e-mail) differ from those used in standard written language. The study was conducted in French, a language with a deep orthography that has strict, addressee-dependent rules for using second person personal pronouns (unfamiliar and familiar forms). Data were collected from 80 adolescents ages 12 to 15 in a natural situation where they had to introduce themselves by e-mail to two addressees (peer/teacher). Participants were divided into two groups (skilled/unskilled in computer-mediated communication). Their emails contained a large number of orthographic deviations (the most frequent being neographic forms). Participants skilled in computer-mediated communication (CMC) deviated more than unskilled ones did. The number of orthographic deviations was not linked to the participants' standard writing ability. The personal-pronoun data clearly showed that adolescents used the familiar form of 'you' (tu) to address the peer and the unfamiliar form (vous) to address the teacher. We conclude that, for adolescents, e-mail constitutes a distinct written-language register. Nevertheless, the e-mail register seems to follow the pragmatic rules of standard spoken and written interaction.

  4. An Exploratory Descriptive Study of Registered Nurse Innovation: Implications for Levels of Adoption.

    PubMed

    Polster, Debra; Villines, Dana

    The aims of this study were to describe registered nurses' levels of personal innovativeness and registered nurses' perceived organizational innovativeness and determine the relationship between these 2 variables. There is limited research to describe the levels of innovation of nurses within a hospital. The levels of innovation can determine the likelihood of adoption of evidence-based practices at the bedside. As change agents, clinical nurse specialists can determine successful implementation strategies tailored to nurse levels of innovation. This was a descriptive study at a midwest, urban, teaching, 408-bed Magnet hospital. Surveys were completed by 217 nurses. The participants reported high personal innovativeness ((Equation is included in full-text article.)= 32.1; SD, 6.4), and the institution was perceived as innovative, with 90.3% of scores categorized as positive innovativeness. The statistically significant correlation was in the medical-surgical unit (r = -0.52, P < .01). There is no correlation between personal innovativeness and organizational innovativeness except for medical-surgical nurses (P = .03). They are likely to perceive the organization more innovative than themselves. Determining adopter characteristics can be valuable to the clinical nurse specialist by adapting strategic interventions to advance nursing practice. Exploring levels of adoption can be an innovative strategy to transform nursing at the bedside and throughout the organization.

  5. Laryngeal cancer in Denmark: a nationwide longitudinal study based on register linkage data.

    PubMed Central

    Guenel, P; Engholm, G; Lynge, E

    1990-01-01

    To identify high and low risk groups for laryngeal cancer in Denmark, all individuals aged 30-74 in the 1970 census were followed up over 10 years. Census data were linked with the Central Population Register to identify persons who died or emigrated during the follow up, and with the Danish Cancer Register to identify cases of laryngeal cancer. Individuals were categorised according to sex, age, and sociodemographic characteristics as declared on the census forms. A multivariate analysis was carried out by means of multiplicative Poisson models. The study showed that the risk of laryngeal cancer was strongly related to sociodemographic factors. The risk for skilled workers living in Copenhagen (relative risk (RR) 4.76, 95% confidence interval (CI) 3.61-6.28) was estimated to be almost five times higher than the risk for men self employed in agriculture and living in rural areas. The variation in the risk of laryngeal cancer is not fully explained by known variations in tobacco and alcohol consumption, and this study highlights additional risk factors particularly related to occupation and marital state. PMID:2383517

  6. International variation in absence from work attributed to musculoskeletal illness: findings from the CUPID study

    PubMed Central

    Coggon, David; Ntani, Georgia; Vargas-Prada, Sergio; Martinez, José Miguel; Serra, Consol; Benavides, Fernando G; Palmer, Keith T

    2013-01-01

    Objectives To quantify the variation in rates of absence due to musculoskeletal pain across 47 occupational groups (mostly nurses and office workers) from 18 countries, and to explore personal and group-level risk factors that might explain observed differences. Methods A standardised questionnaire was used to obtain information about musculoskeletal pain, sickness absence and possible risk factors in a cross-sectional survey of 12 416 workers (92–1017 per occupational group). Additionally, group-level data on socioeconomic variables, such as sick pay and unemployment rates, were assembled by members of the study team in each country. Associations of sickness absence with risk factors were examined by Poisson regression. Results Overall, there were more than 30-fold differences between occupational groups in the 12-month prevalence of prolonged musculoskeletal sickness absence, and even among office workers carrying out similar occupational tasks, the variation was more than tenfold. Personal risk factors included older age, lower educational level, tendency to somatise, physical loading at work and prolonged absence for non-musculoskeletal illness. However, these explained little of the variation between occupational groups. After adjustment for individual characteristics, prolonged musculoskeletal sickness absence was more frequent in groups with greater time pressure at work, lower job control and more adverse beliefs about the work-relatedness of musculoskeletal disorders. Conclusions Musculoskeletal sickness absence might be reduced by eliminating excessive time pressures in work, maximising employees’ responsibility and control and providing flexibility of duties for those with disabling symptoms. Care should be taken not to overstate work as a cause of musculoskeletal injury. PMID:23695413

  7. Risk of mental disorders in refugees and native Danes: a register-based retrospective cohort study.

    PubMed

    Norredam, Marie; Garcia-Lopez, A; Keiding, N; Krasnik, A

    2009-12-01

    Refugees are vulnerable to mental health disorders because of migration trauma. However, register-based prevalence studies are missing. To investigate the risk of mental disorders among refugees compared with that among native Danes. Refugees (n = 29,139), who received residence permission in Denmark from 1.1.1993 to 31.12.1999 were matched 1:4 on age and sex with native Danes (n = 116,556). Civil registration numbers were linked to the Danish Psychiatric Central Register to obtain data on ICD-10 diagnosis upon discharge for all first-time psychiatric hospital contacts for refugees (n = 2,120) and native Danes (n = 5,044) between 1.1.1994 and 31.12.2003. Treated prevalence was then calculated using a Poisson regression model. Refugee men (RR = 2.02; 95%CI = 1.75-2.34) and refugee women (RR = 1.49; 95%CI = 1.29-1.72) had higher overall risks of having a first-time psychiatric contact for mental disorders than did native Danes; specific risks of psychotic, affective and neurotic disorders were even higher. The results were most striking for refugee men, and for refugees from the former Yugoslavia, Iraq and the Middle East. Refugees have high rates of various mental disorders. Healthcare services should target refugees' mental health from arrival in the receiving country.

  8. EDUCATIONAL INEQUALITIES IN REPEAT ABORTION: A LONGITUDINAL REGISTER STUDY IN FINLAND 1975-2010.

    PubMed

    Väisänen, Heini

    2016-11-01

    The proportion of repeat abortions among all abortions has increased over the last decades in Finland. This study examined the association of education with the likelihood of repeat abortion, and the change in this association over time using reliable longitudinal data. A unique set of register data from three birth cohorts were followed from age 20 to 45, including about 22,000 cases of repeat abortion, and analysed using discrete-time event-history models. Low education was found to be associated with a higher likelihood of repeat abortion. Women with low education had abortions sooner after the preceding abortion, and were more often single, younger and had larger families at the time of abortion than more highly educated women. The educational differences were more significant for later than earlier cohorts. The results show a lack of appropriate contraceptive use, possibly due to lack of knowledge of, or access to, services. There is a need to improve access to family planning services, and contraceptives should be provided free of charge. Register data overcome the common problems of under-reporting of abortion and attrition ensuring the results are reliable, unique and of interest internationally.

  9. Factors impacting participation in sports for children with limb absence: a qualitative study.

    PubMed

    Sayed Ahmed, Batoul; Lamy, Marena; Cameron, Debra; Artero, Lisa; Ramdial, Sandra; Leineweber, Matthew; Andrysek, Jan

    2017-03-12

    Individuals with limb absence benefit from participating in sports. While barriers and facilitators affecting sport participation are well documented for adults, they have not been explored for children with limb absence. To identify the perceived factors impacting participation in sports according to children with limb absence and their parents. This study uses a descriptive qualitative study design. Nineteen participants, consisting of children and their parents, were recruited from an outpatient hospital clinic for semi-structured interviews. The 11 interviews were audio recorded and transcribed. Transcripts were then coded and analyzed using the DEPICT model. The thematic analysis was guided by the International Classification of Functioning, Disability, and Health framework. Analysis of our participant interviews identified six themes as having an influence on sport participation: "functionality of prosthesis", "plan in advance", "know what I can do" (understanding capabilities), "it's like every stroke, 2 million questions" (stigma and the social environment), "love for the game" (love for sport), and "these things are an investment" (the investment involved). The findings have the potential to inform the development and implementation of strategies to increase levels of participation in sports among children with limb absence. Information from this study may help to deepen the rehabilitation team's understanding of factors that impact engagement in sports among children with limb absence. Implications for Rehabilitation Children with limb absence present with unique barriers and facilitators to participating in sports, thus, what may be a facilitator or barrier for one child may not for another. Strategies to increase a child's participation in sports should consider both person and environmental factors. Rehabilitation professionals can play a crucial role in educating both families and the community on living and coping with a limb difference, services and

  10. The fate of prospective spine studies registered on www.ClinicalTrials.gov.

    PubMed

    Ohnmeiss, Donna D

    2015-03-01

    There has been concern expressed about research ethics with respect to not fully reporting data collected during clinical studies. One site available for all clinical trials is ClinicalTrials.gov. The original purpose of this site was to facilitate patients seeking a trial for the treatment of their particular condition. The internationally available site offers general information about the study, sponsor name, principal investigator, patient selection criteria, enrollment goal, study design, outcome measures, participating centers, initiation date, date posted, date completed, and other pertinent data. The site can be used to identify studies conducted for a particular condition or intervention. The purpose of this study was to investigate the fate of spine-related studies registered on www.ClinicalTrials.gov, with particular focus on the publication rate of completed trials. Analysis and classification of clinical studies posted on an international research registry Web page and literature search for related publications. Not applicable. The primary outcome measure was publication of the study registered on ClinicalTrials.gov. Multiple searches were conducted on ClinicalTrials.gov Web site to identify studies related to commonly treated spinal conditions, including herniated disc, degenerative disc disease, stenosis, and spondylolisthesis. Studies related to tumors, fractures, or that included nonspine conditions were not included. For studies classified as completed more than 18 months before this review, literature searches were conducted to determine if the results of the study had been published and factors related to publication. The author has no financial conflict related to this work. There were 263 spine-related studies identified from searches on the ClinicalTrials.gov site. Data on the site had the studies classified as follows: 72 completed, 70 active, not recruiting (generally indicates collecting follow-up data), 74 recruiting, 11 recruiting by

  11. Meta-Analysis of Studies Investigating the Effects of Father Absence on Children's Cognitive Performance.

    ERIC Educational Resources Information Center

    Salzman, Stephanie A.

    A meta-analysis was conducted of 137 studies investigating the effects of father absence due to employment, military service, death, divorce, separation, or desertion on children's cognitive performance as assessed by scores on standardized intelligence, scholastic aptitude, and academic achievement tests and school grades. Aggregation of the…

  12. Birth outcomes after induced abortion: a nationwide register-based study of first births in Finland.

    PubMed

    Klemetti, R; Gissler, M; Niinimäki, M; Hemminki, E

    2012-11-01

    Is the perinatal health of first-born children affected by the mother's previous induced abortion(s) (IAs)? Prior IAs, particularly repeat IAs, are correlated with an increased risk of some health problems at first birth; even in a country with good health care quality. A positive association between IA and risk of preterm birth or a dose-response effect has been found in some previous studies. Limited information and conflicting results on other infant outcomes are available. Nationwide register-based study including 300 858 first-time mothers during 1996-2008 in Finland. All the first-time mothers with a singleton birth (obtained from the Medical Birth Register) in the period 1996-2008 (n = 300 858) were linked to the Abortion Register for the period 1983-2008. Of the first-time mothers, 10.3% (n = 31 083) had one, 1.5% had two and 0.3% had three or more IAs. Most IAs were surgical (88%) performed before 12 weeks (91%) and carried out for social reasons (97%). After adjustment, perinatal deaths and very preterm birth (<28 gestational week) suggested worse outcomes after IA. Increased odds for very preterm birth were seen in all the subgroups and exhibited a dose-response relationship: 1.19 [95% confidence interval (CI) 0.98-1.44] after one IA, 1.69 (1.14-2.51) after two and 2.78 (1.48-5.24) after three IAs. Increased odds for preterm birth (<37 weeks) and low birthweight (<2500 g and <1500 g) were seen only among mothers with three or more IAs: 1.35 (1.07-1.71), 1.43 (1.12-1.84) and 2.25 (1.43-3.52), respectively. Observational studies like ours, however large and well-controlled, will not prove causality. In terms of public health and practical implications, health education should contain information of the potential health hazards of repeat IAs, including very preterm birth and low birthweight in subsequent pregnancies. Health care professionals should be informed about the potential risks of repeat IAs on infant outcomes in subsequent pregnancy. National

  13. Maternal endometriosis and genital malformations in boys: a Danish register-based study.

    PubMed

    Arendt, Linn Håkonsen; Lindhard, Morten Søndergaard; Henriksen, Tine Brink; Forman, Axel; Olsen, Jørn; Ramlau-Hansen, Cecilia Høst

    2017-10-01

    To investigate the association between maternal endometriosis and occurrence of the genital anomalies cryptorchidism and hypospadias in sons. Population-based cohort study. Not applicable. All live-born singleton boys born from 1978 to 2012. None. Cryptorchidism and hypospadias in boys based on information from the Danish National Patient Register. The study included 1,073,026 live-born singleton boys. A total of 6,443 boys were sons of women diagnosed with endometriosis before pregnancy. Altogether, 27,342 boys were diagnosed with cryptorchidism, of whom 16,446 had corrective surgery. Hypospadias was diagnosed in 4,853 boys. As compared with unexposed boys, a tendency towards a slightly higher occurrence of cryptorchidism was observed among boys of women with endometriosis (adjusted hazard ratio [aHR] 1.18; 95% confidence interval [CI], 0.97, 1.44). When stratified by medically assisted reproduction (MAR) technologies, the association was slightly stronger among boys born to women with endometriosis who had conceived via MAR, yet it remained moderate and statistically insignificant (aHR 1.27; 95% CI, 0.97, 1.70). When women who conceived with MAR were excluded, the association between endometriosis and cryptorchidism disappeared. For hypospadias, we observed no association, either in the main analysis or the stratified analysis. The findings from this register-based study do not provide strong evidence for a higher occurrence of the studied genital anomalies among boys of women with endometriosis. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  14. Reproductive patterns among twins--Swedish register study of men and women born 1973-1983.

    PubMed

    Bladh, Marie; Josefsson, Ann; Carstensen, John; Finnström, Orvar; Sydsjö, Gunilla

    2013-01-16

    During the last decades there has been a steady increase of twin births. A combination of improved medical treatment of preterm and small-for-gestational age children has contributed to a higher number of surviving twins. Prematurity is known to affect reproduction in a negative way. Few studies have focused on the potential effect twinning may have on future reproduction. Thus, the aim of this study was to investigate the effect of being born a twin compared to being born a singleton have on future reproduction. In a national population-based register study, all individuals born between 1973-1983 who were alive and living in Sweden at 13 years of age (n = 1 016 908) constituted the sample. Data on each study subject's own birth as well as the birth of their first offspring, and parental socio-demographic factors were collected from Swedish population based registers. Hazard ratios and corresponding 95% CI was calculated using Cox proportional hazards model. Twins, both men and women, had a reduced likelihood of reproducing compared to singletons (women: HR = 0.89, 95% CI = 0.86-0.93; men: HR = 0.92, 95% CI = 0.87-0.97). This difference in birth rates can only partly be explained by diverging birth characteristics. Amongst men and women born very preterm, twins had an increased likelihood of reproducing compared to singletons (women: HR = 1.25, 95% CI = 1.02-1.62; men: HR = 1.34, 95% CI = 1.01-1.78). Twins have lower reproduction rates compared to singletons, which only to a certain degree can be explained by diverging birth characteristics.

  15. Drug treatment for attention-deficit/hyperactivity disorder and suicidal behaviour: register based study.

    PubMed

    Chen, Qi; Sjölander, Arvid; Runeson, Bo; D'Onofrio, Brian M; Lichtenstein, Paul; Larsson, Henrik

    2014-06-18

    To investigate the association between drug treatment for attention-deficit/hyperactivity disorder (ADHD) and risk of concomitant suicidal behaviour among patients with ADHD. Register based longitudinal study using within patient design. Linkage of multiple national registers in Sweden. 37,936 patients with ADHD born between 1960 and 1996 and followed from 2006 to 2009 for treatment status by ADHD drug treatment and suicide related events (suicide attempt and completed suicide). Incidence rate of suicide related events during ADHD drug treatment periods compared with that during non-treatment periods. Among 37,936 patients with ADHD, 7019 suicide related events occurred during 150,721 person years of follow-up. At the population level, drug treatment of ADHD was associated with an increased rate of suicide related events (hazard ratio 1.31, 95% confidence interval 1.19 to 1.44). However, the within patient comparison showed a reverse association between ADHD drug treatment and rate of suicide related events (0.89, 0.79 to 1.00). Among stimulant users, a reduced within patient rate of suicide related events was seen during treatment periods (0.81, 0.70 to 0.94). Among non-stimulant/mixed users, no significantly increased within patient rate of suicide related events during non-stimulant treatment periods was seen (0.96, 0.72 to 1.30). This study found no evidence for a positive association between the use of drug treatments for ADHD and the risk of concomitant suicidal behaviour among patients with ADHD. If anything, the results pointed to a potential protective effect of drugs for ADHD on suicidal behaviour, particularly for stimulant drugs. The study highlights the importance of using within patient designs to control for confounding in future pharmacoepidemiological studies. © Chen et al 2014.

  16. Reproductive patterns among twins - a Swedish register study of men and women born 1973-1983

    PubMed Central

    2013-01-01

    Background During the last decades there has been a steady increase of twin births. A combination of improved medical treatment of preterm and small-for-gestational age children has contributed to a higher number of surviving twins. Prematurity is known to affect reproduction in a negative way. Few studies have focused on the potential effect twinning may have on future reproduction. Thus, the aim of this study was to investigate the effect of being born a twin compared to being born a singleton have on future reproduction. Methods In a national population-based register study, all individuals born between 1973–1983 who were alive and living in Sweden at 13 years of age (n = 1 016 908) constituted the sample. Data on each study subject’s own birth as well as the birth of their first offspring, and parental socio-demographic factors were collected from Swedish population based registers. Hazard ratios and corresponding 95% CI was calculated using Cox proportional hazards model. Results Twins, both men and women, had a reduced likelihood of reproducing compared to singletons (women: HR = 0.89, 95% CI = 0.86-0.93; men: HR = 0.92, 95% CI = 0.87-0.97). This difference in birth rates can only partly be explained by diverging birth characteristics. Amongst men and women born very preterm, twins had an increased likelihood of reproducing compared to singletons (women: HR = 1.25, 95% CI = 1.02-1.62; men: HR = 1.34, 95% CI = 1.01-1.78). Conclusions Twins have lower reproduction rates compared to singletons, which only to a certain degree can be explained by diverging birth characteristics. PMID:23324566

  17. A register study of life events in young adults born to mothers with mild intellectual disability.

    PubMed

    Lindblad, Ida; Billstedt, Eva; Gillberg, Christopher; Fernell, Elisabeth

    2014-12-01

    Young adults, born to population-representative mothers with intellectual disability (ID), were targeted for psychosocial/life event follow-up. The whole group originally comprised 42 individuals but 3 had died and 1 had moved abroad. The remaining 38 were approached and 10 consented to participate in an interview study. However, of the remaining 28, it was not possible to establish contact with 21 who were instead searched for in various official registers. Most (n = 18) individuals in the study group had been in contact with different authorities and clinics. Of the 21 individuals, 10 had contact with social services since childhood and 4 of these had been taken into care (foster family) and 6 had had contact families during childhood. One individual had been taken into a treatment centre and one grew up mainly with the father. Altogether 12 (57%) of 21 individuals did not grow up full-time with their biological mother. Twelve (57%) had major neurodevelopmental/neuropsychiatric conditions, including five with ID and seven with attention-deficit hyperactivity disorder (ADHD). Four individuals were registered within the Prison and Probation Service due to various types of crimes. Individuals born to mothers with ID in our study group were at high risk of adverse experiences and negative outcomes, such as increased childhood mortality, a relatively large proportion of children taken into care, high rates of ID and ADHD in the children and of criminality in young adulthood. Taken together with the results obtained in an in-depth interview study of those in the originally targeted sample with whom it was possible to obtain contact, the present findings suggest that it will be important to provide early support and longitudinal developmental follow-up in groups of children growing up with a mother with ID. Children in this situation appear to be at a number of risks, probably related both to hereditary factors and to social disadvantage. © The Author(s) 2014.

  18. Opioid rotation in patients initiated on oxycodone or morphine: a register study

    PubMed Central

    Ericson, Lisa; Ambring, Anneli; Björholt, Ingela; Dahm, Peter

    2013-01-01

    Purpose Strong opioids are recommended for the treatment of moderate to severe pain. However, some patients do not achieve a successful treatment outcome due to intolerable adverse events and/or inadequate analgesia, thus may benefit from switching to another opioid, a procedure known as “opioid rotation.” The type of opioid at treatment initiation may influence the risk of opioid rotation and the objective of this study was to assess such rotation after treatment initiation with two alternative treatments, controlled-release (CR) oxycodone versus CR morphine in patients suffering from non-cancer pain. Method The study reported here was a real-life study based on Swedish register data: the Prescribed Drug, National Patient, and Cause of Death registers. The captured data cover the entire Swedish population treated in specialist care. A statistical analysis plan was agreed and signed before data were accessed. Results Data from 50,223 cases were included in the analyses. The risk of rotation was 19% higher in patients initiating treatment with morphine compared with oxycodone (hazard ratio 1.19; 95% confidence interval 1.11–1.27; P < 0.001), after adjusting for such baseline variables that were both significantly correlated with the outcome variable (time to rotation) and significantly different between the groups; age at index date, osteoarthritis and number of pain-related drugs. Conclusion Patients with non-cancer pain who initiated treatment with CR morphine had a higher risk of opioid rotation than patients initiated with CR oxycodone. PMID:23717049

  19. Management of COPD, equal treatment across age, gender, and social situation? A register study.

    PubMed

    Henoch, Ingela; Strang, Susann; Löfdahl, Claes-Göran; Ekberg-Jansson, Ann

    2016-01-01

    Chronic obstructive pulmonary disease (COPD) is a progressive chronic disease where treatment decisions should be based on disease severity and also should be equally distributed across age, gender, and social situation. The aim of this study was to determine to what extent patients with COPD are offered evidence-based interventions and how the interventions are distributed across demographic and clinical factors in the sample. Baseline registrations of demographic, disease-related, and management-related variables of 7,810 patients in the Swedish National Airway Register are presented. One-third of the patients were current smokers. Patient-reported dyspnea and health-related quality of life were more deteriorated in elderly patients and patients living alone. Only 34% of currently smoking patients participated in the smoking cessation programs, and 22% of all patients were enrolled in any patient education program, with women taking part in them more than men. Less than 20% of the patients had any contact with physiotherapists or dieticians, with women having more contact than men. Men had more comorbidities than women, except for depression and osteoporosis. Women were more often given pharmacological treatments. With increasing severity of dyspnea, participation in patient education programs was more common. Dietician contact was more common in those with lower body mass index and more severe COPD stage. Both dietician contact and physiotherapist contact increased with deteriorated health-related quality of life, dyspnea, and increased exacerbation frequency. The present study showed that COPD management is mostly equally distributed across demographic characteristics. Only a minority of the patients in the present study had interdisciplinary team contacts. Thus, this data shows that the practical implementation of structured guidelines for treatment of COPD varies, to some extent, with regard to age and gender. Also, disease characteristics influence guideline

  20. Comparative burden of arthropathy in mild haemophilia: a register-based study in Sweden.

    PubMed

    Osooli, M; Lövdahl, S; Steen Carlsson, K; Knobe, K; Baghaei, F; Holmström, M; Astermark, J; Berntorp, E

    2017-03-01

    Mild haemophilia is a congenital bleeding disorder affecting males. The burden of arthropathy in mild haemophilia has not been comprehensively described. The aim of this study was to compare the incidence, age at diagnosis and surgery for arthropathy and related hospitalizations between people with mild haemophilia and the general population in Sweden. This was a register-based cohort study. Eligible participants were those with mild haemophilia born between 1941 and 2008 and a randomly selected, birthdate and sex-matched comparison group from the general population. Follow-up was from birth (or earliest 1984) until death, emigration or end of the study in 2008. Data on arthropathy were obtained from a national patient register. Negative binomial and competing risk regression and Kaplan-Meier estimate curves were used in the analysis. Overall, 315 people with haemophilia and 1529 people in the comparison group were included. Participants with haemophilia born between 1984 and 2008 had a ninefold (95% CI: 3.3-27.2) and 16-fold (95% CI: 6.7-36.5) increased incidence of arthropathy-related hospital admission and arthropathy diagnosis respectively. None in this cohort underwent surgery. Among participants with haemophilia born prior to 1984, the rates of arthropathy diagnosis and surgery of the index joints (knee, elbow, ankle) were increased twofold (95% CI: 1.0-3.2) and fivefold (95% CI: 1.7-17.8) respectively. Our data suggested a higher burden of arthropathy among individuals with mild haemophilia compared to the general population. Further research should investigate the need for targeted joint screening programmes among individuals with mild haemophilia. © 2017 John Wiley & Sons Ltd.

  1. Are the cochrane group registers comprehensive? A case study of Japanese psychiatry trials.

    PubMed

    Furukawa, Toshi A; Inada, Toshiya; Adams, Clive E; McGuire, Hugh; Inagaki, Ataru; Nozaki, Shoko

    2002-04-12

    Language bias is a form of publication bias and constitutes a serious threat to meta-analyses. The Cochrane Controlled Trials Register is one attempt to remedy this and now contains more than 300,000 citations. However we are still unsure if it provides comprehensive coverage, particularly for non-English trials. We have recently established a comprehensive register of Japanese trials of psychotropic drugs through extensive personal contacts, electronic searches and handsearches. We examined two Cochrane psychiatry group registers against this Japanese database. The Japanese register contained 56 reports of randomized controlled trials (RCTs) of antidepressants for depression but the Cochrane Depression, Anxiety and Neurosis group register contained 18, with an overlap of only nine. The Japanese register contained 61 reports of RCTs of neuroleptics for schizophrenia and the Cochrane Schizophrenia group register contained 36, with an overlap of only six. Taking account of some duplicate publications, only a quarter to a third of all relevant Japanese RCTs were retrievable from the Cochrane group registers. Similar, or worse, yields may be expected with RCTs conducted in other East Asian countries, and in other fields of medicine. What evidence there is suggests that this situation may lead to a systematic over estimate of treatment effect.

  2. Prevalence of Intellectual Disability: A Comprehensive Study Based on National Registers

    ERIC Educational Resources Information Center

    Westerinen, Hannu; Kaski, M.; Virta, L.; Almqvist, F.; Iivanainen, M.

    2007-01-01

    Background: Based on standard social benefit registers, the prevalence of intellectual disability (ID) in Finland is estimated to be 0.6%, while epidemiological surveys yield 1.1%. Combining several registers, our aim was to find a more reliable estimate of the prevalence of ID, especially among children and adolescents. This is important when…

  3. Twin-singleton differences in intelligence: a register-based birth cohort study of Norwegian males.

    PubMed

    Eriksen, Willy; Sundet, Jon M; Tambs, Kristian

    2012-10-01

    The aim was to determine the difference in intelligence between singletons and twins in young adulthood. Data from the Medical Birth Register of Norway were linked with register data from the Norwegian National Conscript Service. The study base consisted of data on the 445,463 males who were born alive in either single or twin births in Norway during 1967-1984 and who were examined at the time of the mandatory military conscription (age 18-20). Within this study base, there were data on 1,653 sibships of full brothers that included at least one man born in single birth and at least one man born in twin birth (4,307 persons, including 2,378 twins and 1,929 singletons). The intelligence scores of the singletons were 11% (95% confidence interval [CI]: 9-14%) of a standard deviation higher than those of the twins, after adjustment for birth year, birth order, parental ages at delivery, parental education levels, and other factors. The adjusted within-family difference was also 11% (95 % CI: 6-16%) of a standard deviation, indicating that unmeasured factors shared by siblings (e.g., maternal body height) have not influenced the estimate in important ways. When gestational age at birth was added to the model, the estimate for the difference in intelligence score was approximately the same. Including birth weight in the model strongly reduced the estimate. In conclusion, twins born in Norway during 1967-1984 had slightly lower intelligence in early adulthood compared with the singletons.

  4. Amputations and socioeconomic position among persons with diabetes mellitus, a population-based register study

    PubMed Central

    Venermo, Maarit; Manderbacka, Kristiina; Ikonen, Tuija; Keskimäki, Ilmo; Winell, Klas; Sund, Reijo

    2013-01-01

    Objective Low socioeconomic position is a known health risk. Our study aims to evaluate the association between socioeconomic position (SEP) and lower limb amputations among persons with diabetes mellitus. Design Population-based register study. Setting Finland, nationwide individual-level data. Participants All persons in Finland with any record of diabetes in the national health and population registers from 1991 to 2007 (FinDM II database). Methods Three outcome indicators were measured: the incidence of first major amputation, the ratio of first minor/major amputations and the 2-year survival with preserved leg after the first minor amputation. SEP was measured using income fifths. The data were analysed using Poisson and Cox regression as well as age-standardised ratios. Results The risk ratio of the first major amputation in the lowest SEP group was 2.16 (95% CI 1.95 to 2.38) times higher than the risk in the highest SEP group (p<0.001). The incidence of first major amputation decreased by more than 50% in all SEP groups from 1993 to 2007, but there was a stronger relative decrease in the highest compared with the lowest SEP group (p=0.0053). Likewise, a clear gradient was detected in the ratio of first minor/major amputations: the higher the SEP group, the higher the ratio. After the first minor amputation, the 2-year and 10-year amputation-free survival rates were 55.8% and 9.3% in the lowest and 78.9% and 32.3% in the highest SEP group, respectively. Conclusions According to all indicators used, lower SEP was associated with worse outcomes in the population with diabetes. Greater attention should be paid to prevention of diabetes complications, adherence to treatment guidelines and access to the established pathways for early expert assessment when diabetic complications arise, with a special attention to patients from lower SEP groups. PMID:23572197

  5. Transfemoral Amputation After Failure of Knee Arthroplasty: A Nationwide Register-Based Study.

    PubMed

    Gottfriedsen, Tinne B; Schrøder, Henrik M; Odgaard, Anders

    2016-12-07

    Transfemoral amputation is considered the last treatment option for failed knee arthroplasty. The extent to which this procedure is performed is not well known. The purpose of this study was to identify the incidence and causes of amputation following failure of knee arthroplasty in a nationwide population. Data were extracted from the Danish Civil Registration System, the Danish National Patient Register, and the Danish Knee Arthroplasty Register. With use of individual data linkage, 92,785 primary knee arthroplasties performed from 1997 to 2013 were identified. Of these, 258 were followed by amputation. Hospital records of all identified cases were reviewed. A competing-risk model was used to estimate the cumulative incidence of amputation. Differences in cumulative incidences were analyzed with use of the Gray test. A total of 115 amputations were performed for causes related to failed knee arthroplasty. The 15-year cumulative incidence of amputation was 0.32% (95% confidence interval [CI], 0.23% to 0.48%). The annual incidence of amputation following arthroplasties performed from 1997 to 2002 was 0.025% compared with 0.018% following arthroplasties performed from 2008 to 2013 (p = 0.06). The causes of the amputation were periprosthetic infection in 95 cases (83%), soft-tissue deficiency in 26 (23%), severe bone loss in 21 (18%), extensor mechanism disruption in 11 (10%), intractable pain in 11 (10%), periprosthetic fracture in 10 (9%), and vascular complications in 9 (8%). In 92 (80%) of the cases, there were ≥2 indications for amputation. The cumulative incidence of amputation within 15 years after primary knee arthroplasty was 0.32%, with a tendency toward a decreasing incidence in the last part of the study period. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  6. Emergent programme theories of a national quality register - a longitudinal study in Swedish elderly care.

    PubMed

    Nordin, Annika; Andersson Gäre, Boel; Andersson, Ann-Christine

    2017-07-27

    This study aimed to explore programme theories of a national quality register. A programme theory is a bundle of assumptions underpinning how and why an improvement initiative functions. The purpose was to examine and establish programme theories of a national quality register widely used in Sweden: Senior alert. The paper reports on how programme theories among change recipients emerge in relation to the established programme theory of the initiator. A qualitative approach and a longitudinal research design were used. To develop programme theories among change recipients, individual semistructured interviews were conducted. Three sets of interviews were conducted in the period of 2011 to 2013, totalling 22 interviews. In addition, 4 participant observations were made. To develop the initiator's programme theory, an iterative multistage collaboration process between the researchers and the initiator was used. A directed content analysis was used to analyse data. The initiator and change recipients described similar programme logics, but differing programme theories. With time, change recipients' programme theories emerged. Their programme theories converged and became more like the programme theory of the initiator. This study has demonstrated the importance of making both the initiator's and change recipients' programme theories explicit. To learn about conditions for improvement initiatives, comparisons between their programme theories are valuable. Differences in programme theories provide information on how initiators can customize support for their improvement initiatives. Similar programme logics can be underpinned by different programme theories, which can be deceptive. Programme theories emerge over time and need to be understood as dynamic phenomena. © 2017 The Authors Journal of Evaluation in Clinical Practice Published by John Wiley & Sons Ltd.

  7. Injuries before and after diagnosis of cancer: nationwide register based study.

    PubMed

    Shen, Qing; Lu, Donghao; Schelin, Maria E C; Jöud, Anna; Cao, Yang; Adami, Hans-Olov; Cnattingius, Sven; Fall, Katja; Valdimarsdóttir, Unnur; Fang, Fang

    2016-08-31

     To examine the relative risks of iatrogenic and non-iatrogenic injuries during the period shortly before and after a diagnosis of cancer.  Nationwide register based study.  Swedish national population and health registers.  720 901 patients with diagnosis of cancer, 1991-2009, in Sweden.  All hospital admissions in patients with cancer with a main discharge diagnosis of iatrogenic (from medical complications) or non-iatrogenic injuries in 1990-2010 identified from the Swedish patient register. Conditional Poisson regression was used to compare the incidence rate of injuries during the "diagnostic period" (16 weeks before to 16 weeks after diagnosis) with the incidence rate during a "pre-diagnostic period" (the same 32 weeks one year before diagnosis) among the same patients.  During the diagnostic period, there were 7306 iatrogenic (incidence rate 0.60 per 1000 person months) and 8331 non-iatrogenic injuries (incidence rate 0.69 per 1000 person months). For iatrogenic injuries, the incidence rate ratio was 7.0 (95% confidence interval 6.6 to 7.4) during the diagnostic period compared with the pre-diagnostic period. The increase in risk started two weeks before cancer diagnosis and peaked during the two weeks after diagnosis (48.6, 37.3 to 63.5). For non-iatrogenic injuries, the incidence rate ratio was 1.9 (1.8 to 2.0) during the diagnostic period compared with the pre-diagnostic period. The increase in risk began four weeks before diagnosis and peaked during the two weeks before diagnosis (5.3, 4.6 to 6.1). There were increased risks of both types of injury during the diagnostic period for all common cancers, with the smallest risk increase noted for non-melanoma skin cancer.  Patients with cancer have highly increased risks of both iatrogenic and non-iatrogenic injuries requiring inpatient care : shortly before and after their diagnosis. These findings shed further light on the total burden of medical complications and call for prevention of intentional

  8. Gender and use of hypnotics or sedatives in old age: a nationwide register-based study.

    PubMed

    Johnell, Kristina; Fastbom, Johan

    2011-10-01

    To investigate whether gender is associated with use of hypnotics or sedatives and with different types of hypnotics or sedatives in older people after adjustment for age, socioeconomic status (i.e., education) and co-morbidity (i.e., number of other drugs). Sweden Method We conducted a register-based analysis of data on gender, age, dispensed drugs, and education from people aged 75-89 years registered in the Swedish Prescribed Drug Register between July and October 2005 (n = 645,429). The hypnotic or sedative drug classes were benzodiazepines, benzodiazepine related drugs (i.e., Z-drugs) and other types of hypnotics or sedatives. The individual hypnotics or sedatives were nitrazepam, flunitrazepam, triazolam, zopiclone, zolpidem, clomethiazole and propiomazine. In the total study population, 27.1% of the women and 18.1% of the men were dispensed at least one hypnotic or sedative drug. The logistic regression analyses of those who used hypnotics or sedatives (n = 151,700) revealed that women were more likely than men to use benzodiazepines (adjusted OR = 1.11; 95% CI 1.07-1.14) and benzodiazepine related drugs (adjusted OR = 1.14; 95% CI 1.12-1.17), whereas men were more likely to use other types of hypnotics or sedatives (adjusted OR = 0.69; 95% CI 0.67-0.71). Among the individual hypnotics or sedatives, the strongest associations with gender was found for nitrazepam (adjusted OR = 1.19; 95% CI 1.14-1.25 for women compared with men), zolpidem (adjusted OR = 1.18; 95% CI 1.16-1.21), clomethiazole (adjusted OR = 0.48; 95% CI 0.46-0.51) and propiomazine (adjusted OR = 0.77; 95% CI 0.75-0.79). Use of hypnotics or sedatives in old age seems to be related to female gender. Also, among elderly users of hypnotics or sedatives, women appear to be more likely to use benzodiazepines and benzodiazepine related drugs than men. The explanation to these gender differences merits further investigation.

  9. Psychosocial work environment and sickness absence among British civil servants: the Whitehall II study.

    PubMed Central

    North, F M; Syme, S L; Feeney, A; Shipley, M; Marmot, M

    1996-01-01

    OBJECTIVES. This study sought to examine the association between the psychosocial work environment and subsequent rates of sickness absence. METHODS. The analyses were based on a cohort of male and female British civil servants (n=9072). Rates of short spells (7 days) of sickness absence were calculated for different aspects of the psychosocial work environment, as measured by self-reports and personnel managers' ratings (external assessments). RESULTS. Low levels of work demands, control, and support were associated with higher rates of short and long spells of absence in men and, to a lesser extent, in women. The differences were similar for the self-reports and external assessments. After adjustment for grade of employment, the differences were diminished but generally remained significant for short spells. The combination of high demands and low control was only associated with higher rates of short spells in the lower grades. CONCLUSIONS. The psychosocial work environment predicts rates of sickness absence. Increased levels of control and support at work could have beneficial effects in terms of both improving the health and well-being of employees and increasing productivity. PMID:8604757

  10. Kinetic study for copper adsorption onto soil minerals in the absence and presence of humic acid.

    PubMed

    Komy, Zanaty R; Shaker, Ali M; Heggy, Said E M; El-Sayed, Mohamed E A

    2014-03-01

    Equilibrium and kinetics of Cu(2+) adsorption onto soil minerals (kaolinite and hematite) in the absence and presence of humic acid have been investigated under various conditions. The influences of ionic strength, pH and solution cations on the rate of the adsorption have been studied. The rate and the amount of adsorbed Cu(2+) onto soil minerals in the absence or the presence of humic acid increased with decreasing ionic strength, increasing pH and in the presence of the background electrolyte K(+) rather than Ca(2+). Humic acid enhanced the rate and the amount of adsorbed Cu(2+) onto soil minerals. The adsorption equilibrium data showed that adsorption behavior of Cu(2+) could be described more reasonably by Langmiur adsorption isotherm than Freundlich isotherm in the absence or presence of humic acid. Pseudo first and pseudo second order models were used to evaluate the kinetic data and the rate constants. The results indicated that the adsorption of Cu(2+) onto hematite and kaolinite in the absence and presence of humic acid is more conforming to pseudo second order kinetics.

  11. Extracellular GABA in the ventrolateral thalamus of rats exhibiting spontaneous absence epilepsy: a microdialysis study.

    PubMed

    Richards, D A; Lemos, T; Whitton, P S; Bowery, N G

    1995-10-01

    There is compelling evidence that excessive GABA-mediated inhibition may underlie the abnormal electrical activity, initiated in the thalamus, associated with epileptic absence seizures. In particular, the GABAB receptor subtype seems to play a critical role, because its antagonists are potent inhibitors of absence seizures, whereas its agonists exacerbate seizure activity. Using a validated rat model of absence epilepsy, we have previously found no evidence of abnormal GABAB receptor density or affinity in thalamic tissue. In the present study, we have used in vivo microdialysis to monitor changes in levels of extracellular GABA and other amino acids in this brain region. We have shown that basal extracellular levels of GABA and, to a lesser extent, taurine are increased when compared with values in nonepileptic controls. However, modifying GABAergic transmission with the GABAB agonist (-)-baclofen (2 mg/kg i.p.), the GABAB antagonist CGP-35348 (200 mg/kg i.p.), or the GABA uptake inhibitor tiagabine (100 microM) did not produce any further alteration in extracellular GABA levels, despite the ability of these compounds to increase (baclofen and tiagabine) or decrease (CGP-35348) seizure activity. These findings suggest that the increased basal GABA levels observed in this animal model are not simply a consequence of seizure activity but may contribute to the initiation of absence seizures.

  12. Workplace bullying and subsequent psychotropic medication: a cohort study with register linkages

    PubMed Central

    Lallukka, Tea; Haukka, Jari; Partonen, Timo; Rahkonen, Ossi; Lahelma, Eero

    2012-01-01

    Objectives We aimed to examine longitudinally whether workplace bullying was associated with subsequent psychotropic medication among women and men. Design A cohort study. Setting Helsinki, Finland. Participants Employees of the City of Helsinki, Finland (n=6606, 80% women), 40–60 years at baseline in 2000–2002, and a register-based follow-up on medication. Primary and secondary outcome measures Workplace bullying comprised questions about current and earlier bullying as well as observing bullying. The Finnish Social Insurance Institution's register data on purchases of prescribed reimbursed psychotropic medication were linked with the survey data. All psychotropic medication 3 years prior to and 5 years after the baseline survey was included. Covariates included age, prior psychotropic medication, childhood bullying, occupational class, and body mass index. Cox proportional hazard models (HR, 95% CI) were fitted and days until the first purchase of prescribed psychotropic medication after baseline were used as the time axis. Results Workplace bullying was associated with subsequent psychotropic medication after adjusting for age and prior medication among both women (HR 1.51, 95% CI 1.18 to 1.93) and men (HR 2.15, 95% CI 1.36 to 3.41). Also observing bullying was associated with subsequent psychotropic medication among women (HR 1.53, 95% CI 1.25 to 1.88) and men (HR 1.92, 95% CI 1.23 to 2.99). The associations only modestly attenuated after full adjustment. Conclusions Our findings highlight the significance of workplace bullying to subsequent psychotropic medication reflecting medically confirmed mental problems. Tackling workplace bullying likely helps prevent mental problems among employees. PMID:23242240

  13. Unconscious Race and Class Biases among Registered Nurses: Vignette-Based Study Using Implicit Association Testing.

    PubMed

    Haider, Adil H; Schneider, Eric B; Sriram, N; Scott, Valerie K; Swoboda, Sandra M; Zogg, Cheryl K; Dhiman, Nitasha; Haut, Elliott R; Efron, David T; Pronovost, Peter J; Freischlag, Julie A; Lipsett, Pamela A; Cornwell, Edward E; MacKenzie, Ellen J; Cooper, Lisa A

    2015-06-01

    Implicit bias is an unconscious preference for a specific social group that can have adverse consequences for patient care. Acute care clinical vignettes were used to examine whether implicit race or class biases among registered nurses (RNs) impacted patient-management decisions. In a prospective study conducted among surgical RNs at the Johns Hopkins Hospital, participants were presented 8 multi-stage clinical vignettes in which patients' race or social class were randomly altered. Registered nurses were administered implicit association tests (IATs) for social class and race. Ordered logistic regression was then used to examine associations among treatment differences, race, or social class, and RN's IAT scores. Spearman's rank coefficients comparing RN's implicit (IAT) and explicit (stated) preferences were also investigated. Two hundred and forty-five RNs participated. The majority were female (n=217 [88.5%]) and white (n=203 [82.9%]). Most reported that they had no explicit race or class preferences (n=174 [71.0%] and n=108 [44.1%], respectively). However, only 36 nurses (14.7%) demonstrated no implicit race preference as measured by race IAT, and only 16 nurses (6.53%) displayed no implicit class preference on the class IAT. Implicit association tests scores did not statistically correlate with vignette-based clinical decision making. Spearman's rank coefficients comparing implicit (IAT) and explicit preferences also demonstrated no statistically significant correlation (r=-0.06; p=0.340 and r=-0.06; p=0.342, respectively). The majority of RNs displayed implicit preferences toward white race and upper social class patients on IAT assessment. However, unlike published data on physicians, implicit biases among RNs did not correlate with clinical decision making. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Joint associations of smoking and physical activity with disability retirement: a register-linked cohort study

    PubMed Central

    Lallukka, Tea; Rahkonen, Ossi; Lahelma, Eero; Lahti, Jouni

    2015-01-01

    Objectives We examined the risk of disability retirement by smoking and physical activity, and particularly whether the risk due to smoking is affected by the level of physical activity. Additionally, the contribution of baseline health, sociodemographic and work-related factors to the joint associations of smoking and physical activity with disability retirement was considered. Design Cohort study. Setting Helsinki, Finland. Participants Employees of the City of Helsinki, aged 40–60 years at baseline in 2000–2002, were followed up using complete register data from the Finnish Centre of Pensions until the end of 2010 (n=6390, with a consent to register linkage from 74%). Primary outcome measure All-cause disability retirement (ICD-10). Results Altogether, 608 employees (9.5%) retired due to disability during the follow-up. Cox regression models were fitted to examine the joint associations of smoking and physical activity with subsequent disability retirement. Never-smokers, ex-smokers and moderate smokers who were inactive or moderately active had an increased risk of disability retirement, but if they were vigorously active, they had no excess risk. Instead, all heavy smokers (15 or more cigarettes per day among women, and 20 or more among men), irrespective of physical activity, had an increased risk of disability retirement. The examined associations attenuated but remained for ex-smokers and heavy smokers after adjustments for gender, age, socioeconomic position, mental and physical workload, problem drinking, body mass index and self-rated health. No gender interactions were found. Conclusions Vigorous physical activity might help prevent disability retirement not only among never-smokers, but even among ex-smokers and moderate smokers. However, among heavy smokers, physical activity is not sufficient to eliminate the adverse effects of smoking on health and work ability. PMID:26224014

  15. Hypertensive disorders in pregnancy and later dementia: a Swedish National Register Study.

    PubMed

    Andolf, Ellika G; Sydsjö, Gunilla C M; Bladh, Marie K; Berg, Goran; Sharma, Surendra

    2017-04-01

    Our aim was to investigate the rate of vascular dementia and dementia in women with previous hypertensive disorders in pregnancy, since white matter lesions of the brain and cardiovascular disease are linked both to dementia and hypertensive disorders in pregnancy. Prospective population-based registry study on all women giving birth in Sweden between 1973 and 1975 (284 598). Women with and without hypertensive disorders in pregnancy were identified by means of the Swedish Medical Birth Register and linked to the National Patient Register, where data on somatic disease later in life were obtained. International classification of disease was used. The Cox proportional hazard model was used to calculate hazard ratios for both groups and adjusted for possible confounders. Main outcome measures were in-hospital diagnosis of cardiovascular disease, vascular dementia and dementia. No increased risks were seen for vascular dementia or dementia after any hypertensive disorders in pregnancy. If broken down in specific diagnoses for hypertensive disease in pregnancy, adjusted risks for vascular dementia after hypertension and proteinuria during pregnancy the hazard ratio was 6.27 (95% CI 1.65-27.44). Higher risks for cardiovascular disease were confirmed. Because of the very low absolute risk, the wide confidence interval and risk of misclassification, our results on vascular dementia could be questioned. Considering the pathophysiology of preeclampsia, the findings of brain lesions and the increased risk for cardiovascular disease, the possibly increased risk for all kinds of dementia must be investigated in larger and more well-defined cohorts. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  16. Nationwide prevalence of inflammatory bowel disease in Sweden: a population-based register study.

    PubMed

    Büsch, K; Ludvigsson, J F; Ekström-Smedby, K; Ekbom, A; Askling, J; Neovius, M

    2014-01-01

    Regional studies on inflammatory bowel disease (IBD) suggest an increasing prevalence over time, but no nationwide estimate has been published so far. To estimate the IBD prevalence in 2010 in Sweden overall, by disease, and in specific patient segments. Patients were identified according to international classification codes for ulcerative colitis and Crohn's disease in in-patient care (1987-2010), day surgery and nonprimary out-patient care (1997-2010) in the nationwide Swedish Patient Register. Requiring two or more diagnoses of IBD in nonprimary care, a total of 61 344 individuals with physician-diagnosed IBD were alive in Sweden in 2010 (mean age 50 years; 51% men), corresponding to a prevalence of 0.65% (95% CI, 0.65-0.66). The prevalence increased with age, and peaked in women at ages 50-59 years and in men at ages 60-69 years. Adding the requirement of IBD as main (vs. main or contributory) diagnosis code, or diagnosis from an internal medicine/gastroenterology/surgery department did not change the prevalence estimate. Prevalence of actively treated disease (defined as two or more IBD-related visits, of which one occurred in 2010, plus at least one dispensed prescription of IBD-related drugs in 2010) was 0.27% (95% CI, 0.27-0.28). The Swedish nationwide register-based IBD prevalence was higher compared with previous Swedish and international estimates. While prevalence estimates were robust across different case definitions, once two or more visits were required, only about one-third of prevalent patients were drawing resources from specialised care in 2010. © 2013 John Wiley & Sons Ltd.

  17. Resource allocation of in vitro fertilization: a nationwide register-based cohort study

    PubMed Central

    Klemetti, Reija; Gissler, Mika; Sevón, Tiina; Hemminki, Elina

    2007-01-01

    Background Infertility is common and in vitro fertilization (IVF) is a widely used treatment. In IVF the need increases and the effectiveness and appropriateness decrease by age. The purpose of this study was to describe allocation of resources for IVF by women's age, socioeconomic position, area of residence and treatment sector (public vs. private) and to discuss how fairly the IVF resources are allocated in Finland. Methods Women who received IVF between 1996 and 1998 (N = 9175) were identified from the reimbursement records of the Social Insurance Institution (SII). Information on IVF women's background characteristics came from the Central Population Register and the SII, on treatment costs from IVF clinics and the SII, and on births from the Medical Birth Register. The main outcome measures were success of IVF by number of cycles and treated women, expenditures per IVF cycles, per women, per live-birth, and per treatment sector, and private and public expenditures. Expenditures were estimated from health care visits and costs. Results During a mean period of 1.5 years, older women (women aged 40 or older) received 1.4 times more IVF treatment cycles than younger women (women aged below 30). The success rate decreased by age: from 22 live births per 100 cycles among younger women to 6 per 100 among older women. The mean cost of a live birth increased by age: compared to younger women, costs per born live birth of older women were 3-fold. Calculated by population, public expenditure was allocated most to young women and women from the highest socioeconomic position. Regional differences were not remarkable. Conclusion Children of older infertile women involve more expense due to the lower success rates of IVF. Socioeconomic differences suggest unfair resource allocation in Finland. PMID:18154645

  18. Employer-based support for registered nurses undertaking postgraduate study via distance education.

    PubMed

    Black, Kirsten E; Bonner, Ann

    2011-02-01

    Previous literature has focused on the need for support of undergraduate nursing students during clinical placements. Little is known about the support provided by employers for registered nurses (RNs) who pursue further education. This study sought to identify and describe the types, levels and perceived need for support in the workplace for RNs as they undertake further postgraduate nursing study by distance education (DE). Using an exploratory descriptive design a self-report questionnaire was distributed to a convenient sample of 270 RNs working in one acute care public hospital in Tasmania, Australia. 92 questionnaires (response rate 34%) were returned with 26 (28%) reporting being currently enrolled in further study by DE and a further 50 (54)% of RNs planning future study. Results revealed that 100% of participants with a Masters degree completed this by DE. There were differences between the support sought by RNs to that offered by employers, and 16 (34%) who had done or were currently doing DE study, received no support to undertake DE. There was an overwhelming desire by RNs for support; 87 (94%), with a majority believing some support should be mandatory 76 (83%). This study may encourage employers to introduce structured support systems that will actively assist nurses to pursue further study.

  19. Absence seizure

    MedlinePlus

    Seizure - petit mal; Seizure - absence; Petit mal seizure; Epilepsy - absence seizure ... Abou-Khalil BW, Gallagher MJ, Macdonald RL. Epilepsies. In: Daroff ... Practice . 7th ed. Philadelphia, PA: Elsevier; 2016:chap 101. ...

  20. Results from a randomized controlled study between total disc replacement and fusion compared with results from a spine register

    PubMed Central

    Berg, Svante; Tropp, Hans

    2010-01-01

    Background Difficulties in performing randomized controlled trials (RCTs) to evaluate new treatment options are increasing. Higher costs and patient unwillingness are the main obstacles. A spinal surgery register has been in use in Sweden for 11 years. Our aim was to determine whether this register can provide the same information as an RCT and whether register data compare favorably with RCT data, making RCTs unnecessary. If not the case, was patient selection or follow-up frequency the cause of any differences? Materials and methods We compared baseline data and outcome, retrieved from our register, between 2 surgical groups, total disc replacement (TDR) and fusion at 1 or 2 levels, performed for degenerative disc disease. One hundred fifty-two patients were part of an RCT, whereas four hundred fifty-five patients had been treated according to an active decision. These 2 subgroups were the subjects for comparison. Results The 2 subgroups were not similar at baseline. Patients who were fused in the non-RCT subgroup were older, had a higher Oswestry Disability Index, and were more frequently smokers than the other patients. The outcome for the non-RCT group showed larger differences in favor of TDR than the RCT did. The nonresponders in the non-RCT group showed worse life quality and disability at baseline, and patients who answered the 1-year follow-up questionnaire but not the 2-year follow-up questionnaire had an inferior clinical result compared with the other patients at 1 year. Conclusion Data from our register showed results similar to the RCT, but a register cannot fully replace an RCT study when evaluating a new treatment option if the RCT has narrower selection than just the diagnosis. In this RCT comparing TDR with posterior fusion, the normal exclusion criteria for TDR were used. These were not registered, so the register could not prevent a possible selection bias, which might also be caused by the nonresponders. PMID:25802653

  1. A Prospective Study of Ventilation Rates and Illness Absence in California Office Buildings

    SciTech Connect

    Eliseeva, Ekaterina A.; Spears, Michael; Chan, Wanyu R.; Cohn, Sebastian; Sullivan, Douglas P.; Fisk, William J.

    2014-10-07

    Background – This study investigated the associations of ventilation rates (VRs), estimated from indoor CO2 concentrations, in offices with the amount of respiratory infections, illness absences, and building-related health symptoms in occupants. Methods – Office buildings were recruited from three California climate zones. In one or more study spaces within each building, real-time logging sensors measured carbon dioxide, temperature, and relative humidity for one year. Ventilation rates were estimated using daily peak CO2 levels, and also using an alternative metric. Data on occupants and health outcomes were collected through web-based surveys every three months. Multivariate models were used to assess relationships between metrics of ventilation rate or CO2 and occupant outcomes. For all outcomes, negative associations were hypothesized with VR metrics, and positive associations with CO2 metrics. Results – Difficulty recruiting buildings and low survey response limited sample size and study power. In 16 studied spaces within 9 office buildings, VRs were uniformly high over the year, from twice to over nine times the California office VR standard (7 L/s or 15 cfm per person). VR and CO2 metrics had no statistically significant relationships with occupant outcomes, except for a small significantly positive association of the alternative VR metric with respiratory illness-related absence, contrary to hypotheses. Conclusions– The very high time-averaged VRs in the California office buildings studied presumably resulted from “economizer cycles” bringing in large volumes of outdoor air; however, in almost all buildings even the estimated minimum VRs supplied (without the economizer) substantially exceeded the minimum required VR. These high VRs may explain the absence of hypothesized relationships with occupant outcomes. Among uniformly high VRs, little variation in contaminant concentration and occupant effects would be expected. These findings may

  2. Preceptoring nursing students: registered nurses' perceptions of nursing students' preparation and study approaches in clinical education.

    PubMed

    Hallin, Karin; Danielson, Ella

    2010-05-01

    Preceptorship influences Registered Nurses' (RNs) daily work to different degrees depending on nursing students' knowledge, and willingness to learn. Consequently, it is of the utmost importance to investigate how RNs assess nursing students in clinical education. The aim of this study was to describe RNs' perceptions of nursing students' preparation and study approaches at hospital workplaces, and to explore relationships between RNs' perceptions and their personal/clinical characteristics. A cross-sectional design was used. In 2006, 142 of 196 RNs at a Swedish hospital answered a questionnaire (response rate 72.5%). The majority of RNs (63-84%) rated students' study approaches highly and thought students comprehended the outcomes of learning. Fewer (45-49%), rated students as having adequate theoretical knowledge highly and were of the opinion that they had acquired knowledge about the unit. Statistically, non specialist nurses rated significantly higher compared with specialist nurses. Significant positive correlations were found between the RNs' perceptions of nursing students and their interest in preceptoring. The extent to which preparation programmes, established in collaboration between a university and a hospital, had improved preceptors and nursing students was not graded. Further descriptive and intervention studies are therefore needed. Copyright 2009 Elsevier Ltd. All rights reserved.

  3. Personal Factors Associated with Sickness Absence: A Study of 194 Men with Contrasting Sickness Absence Experience in a Refinery Population1

    PubMed Central

    Taylor, P. J.

    1968-01-01

    Men with different patterns of sickness absence behaviour have been identified from a refinery population by simple epidemiological techniques. A detailed clinical study is described of four groups: 56 men with five or more sickness spells in 1964 and a matched control of 56 men; 35 men who had 60 or more days of sickness absence in 1964; and finally 47 men who had not had one day off sick for at least eight years. Whereas the men who were frequently sick tended to be younger and mostly on day work, those with long periods of sickness were reasonably representative of the whole population, and the men without any sickness absence were older and mostly on shift work. An analysis of records both before and since 1964 showed that the groups had maintained a consistent pattern of sickness absence, but when individuals were considered their behaviour was less consistent. Nevertheless there appeared to be states of sickness absence `liability' and also `resistance' which persisted for a variable length of time from a year or two up to many years. The pre-employment medical examination proved in retrospect to have been of little predictive value. Absenteeism, lateness, and also occupational injuries were all strongly associated with sickness spells, although the level of overtime was not. Previous episodes of neurotic illness, peptic ulceration, and loss of work due to back pain were also associated with frequent sickness spells, so also were frequent colds and troublesome constipation. An unexpected finding from the physical examination was that over one quarter of those who were never sick had some organic disease. Although neither the social nor economic circumstances differed between the groups, the attitude of the men towards themselves and their work proved to be of major importance. A memory of an unhappy childhood was more common in both groups with a lot of sickness absence, whilst dislike of the job or frustrated ambition was common in men with frequent spells

  4. Convergence in the Bilingual Lexicon: A Pre-registered Replication of Previous Studies.

    PubMed

    White, Anne; Malt, Barbara C; Storms, Gert

    2016-01-01

    Naming patterns of bilinguals have been found to converge and form a new intermediate language system from elements of both the bilinguals' languages. This converged naming pattern differs from the monolingual naming patterns of both a bilingual's languages. We conducted a pre-registered replication study of experiments addressing the question whether there is a convergence between a bilingual's both lexicons. The replication used an enlarged set of stimuli of common household containers, providing generalizability, and more reliable representations of the semantic domain. Both an analysis at the group-level and at the individual level of the correlations between naming patterns reject the two-pattern hypothesis that poses that bilinguals use two monolingual-like naming patterns, one for each of their two languages. However, the results of the original study and the replication comply with the one-pattern hypothesis, which poses that bilinguals converge the naming patterns of their two languages and form a compromise. Since this convergence is only partial the naming pattern in bilinguals corresponds to a moderate version of the one-pattern hypothesis. These findings are further confirmed by a representation of the semantic domain in a multidimensional space and the finding of shorter distances between bilingual category centers than monolingual category centers in this multidimensional space both in the original and in the replication study.

  5. Convergence in the Bilingual Lexicon: A Pre-registered Replication of Previous Studies

    PubMed Central

    White, Anne; Malt, Barbara C.; Storms, Gert

    2017-01-01

    Naming patterns of bilinguals have been found to converge and form a new intermediate language system from elements of both the bilinguals’ languages. This converged naming pattern differs from the monolingual naming patterns of both a bilingual’s languages. We conducted a pre-registered replication study of experiments addressing the question whether there is a convergence between a bilingual’s both lexicons. The replication used an enlarged set of stimuli of common household containers, providing generalizability, and more reliable representations of the semantic domain. Both an analysis at the group-level and at the individual level of the correlations between naming patterns reject the two-pattern hypothesis that poses that bilinguals use two monolingual-like naming patterns, one for each of their two languages. However, the results of the original study and the replication comply with the one-pattern hypothesis, which poses that bilinguals converge the naming patterns of their two languages and form a compromise. Since this convergence is only partial the naming pattern in bilinguals corresponds to a moderate version of the one-pattern hypothesis. These findings are further confirmed by a representation of the semantic domain in a multidimensional space and the finding of shorter distances between bilingual category centers than monolingual category centers in this multidimensional space both in the original and in the replication study. PMID:28167921

  6. Kidney Disease Among Registered Métis Citizens of Ontario: A Population-Based Cohort Study

    PubMed Central

    Hayward, Jade S.; McArthur, Eric; Nash, Danielle M.; Sontrop, Jessica M.; Russell, Storm J.; Khan, Saba; Walker, Jennifer D.; Nesrallah, Gihad E.; Sood, Manish M.; Garg, Amit X.

    2017-01-01

    Background: Indigenous peoples in Canada have higher rates of kidney disease than non-Indigenous Canadians. However, little is known about the risk of kidney disease specifically in the Métis population in Canada. Objective: To compare the prevalence of chronic kidney disease and incidence of acute kidney injury and end-stage kidney disease among registered Métis citizens in Ontario and a matched sample from the general Ontario population. Design: Population-based, retrospective cohort study using data from the Métis Nation of Ontario’s Citizenship Registry and administrative databases. Setting: Ontario, Canada; 2003-2013. Patients: Ontario residents ≥18 years. Measurements: Prevalence of chronic kidney disease and incidence of acute kidney injury and end-stage kidney disease. Secondary outcomes among patients hospitalized with acute kidney injury included non-recovery of kidney function and mortality within 1 year of discharge. Methods: Database codes and laboratory values were used to determine study outcomes. Métis citizens were matched (1:4) to Ontario residents on age, sex, and area of residence. The analysis included 12 229 registered Métis citizens and 48 916 adults from the general population. Results: We found the prevalence of chronic kidney disease was slightly higher among Métis citizens compared with the general population (3.1% vs 2.6%, P = 0.002). The incidence of acute kidney injury was 1.2 per 1000 person-years in both Métis citizens and the general population (P = 0.54). Of those hospitalized with acute kidney injury, outcomes were similar among Métis citizens and the general population except 1-year mortality, which was higher for Métis citizens (24.5% vs 15.3%, P = 0.03). The incidence of end-stage kidney disease did not differ between groups (<3.0 per 10 000 person-years, P = 0.73). Limitations: The Métis Nation of Ontario Citizenship Registry only captures about 20% of Métis people in Ontario. Administrative health care

  7. Perceived organizational justice as a predictor of long-term sickness absence due to diagnosed mental disorders: results from the prospective longitudinal Finnish Public Sector Study.

    PubMed

    Elovainio, Marko; Linna, Anne; Virtanen, Marianna; Oksanen, Tuula; Kivimäki, Mika; Pentti, Jaana; Vahtera, Jussi

    2013-08-01

    Organizational justice perceptions have been suggested to be associated with symptoms of mental health but the nature of the association is unknown due to reporting bias (measurement error related to response style and reversed causality). In this study, we used prospective design and long-term (>9 days) sickness absence with psychiatric diagnosis as the outcome measure. Participants were 21,221 Finnish public sector employees (the participation rate at baseline in 2000-2002 68%), who responded to repeated surveys of procedural and interactional justice in 2000-2004 along with register data on sickness absence with a diagnosis of depression or anxiety disorders (822 cases). Results from logistic regression analyses showed that a one-unit increase in self-reported and work-unit level co-worker assessed interactional justice was associated with a 25-32% lower odds of sickness absence due to anxiety disorders. These associations were robust to adjustments for a variety of potential individual-level confounders including chronic disease (adjusted OR for self-reported interactional justice 0.77, 95% CI 0.65-0.91) and were replicated using co-worker assessed justice. Only weak evidence of reversed causality was found. The results suggest that low organizational justice is a risk factor for sickness absence due to anxiety disorders.

  8. Absence of response: a study of nurses' experience of stress in the workplace.

    PubMed

    Olofsson, Brita; Bengtsson, Claire; Brink, Eva

    2003-09-01

    It has become clear that nursing is a high-risk occupation with regards to stress-related diseases. In this study, we were interested in nurses' experiences of stress and the emotions arising from stress at work. Results showed that nurses experienced negative stress which was apparently related to the social environment in which they worked. Four nurses were interviewed. The method used was grounded theory. Analysis of the interviews singled out absence of response as the core category. Recurring stressful situations obviously caused problems for the nurses in their daily work. Not only did they lack responses from their supervisors, they also experienced emotions of frustration, powerlessness, hopelessness and inadequacy, which increased the general stress experienced at work. Our conclusion is that the experience of absence of response leads to negative stress in nurses.

  9. Head or brain injuries and Alzheimer's disease: A nested case-control register study.

    PubMed

    Tolppanen, Anna-Maija; Taipale, Heidi; Hartikainen, Sirpa

    2017-06-07

    Many previous studies have been limited by self- or proxy-reported injury or short follow-up. We investigated whether head or brain injuries are associated with Alzheimer's disease (AD), possible modifying factors and dose-response relationship. Nested register-based case-control study of all community dwellers who received clinically verified AD diagnosis in Finland in 2005 to 2011 (n = 70,719) and one to four matched controls for each case (n of controls = 282,862). The magnitude of association between hospital-treated head and/or brain injuries was strongly dependent on the lag time between exposure and outcome. With a 5-year lag time, head injury (adjusted odds ratio; 95% confidence interval 1.19; 1.15-1.23) or brain injury (1.23; 1.18-1.29) was associated with higher risk of AD. Dose-response relationship with number and severity of injuries was observed. Associations were stronger in those with earlier onset of AD. Stronger associations with shorter lag times indicate that head and/or brain injuries may also reflect the ongoing AD disease process. Copyright © 2017 the Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

  10. Psychiatric and neurological disorders are associated with bullous pemphigoid – a nationwide Finnish Care Register study

    PubMed Central

    Försti, Anna-Kaisa; Jokelainen, Jari; Ansakorpi, Hanna; Seppänen, Allan; Majamaa, Kari; Timonen, Markku; Tasanen, Kaisa

    2016-01-01

    Bullous pemphigoid (BP) is an autoimmune blistering skin disease with increasing incidence. BP is associated with neurological disorders, but it has not been established, what subtypes of dementia and stroke are associated with BP, and what is the temporal relation between these diseases. Also, the association between BP and psychiatric disorders is controversial. We conducted a retrospective nationwide study, using the Finnish Care Register for Health Care diagnoses between 1987 and 2013. The study population of 4524 BP patients were compared with 66138 patients with basocellular carcinoma (BCC), neurological and psychiatric comorbid disorders were evaluated for both groups, and associations were estimated by Cox regression and logistic regression analyses. The strongest risk of developing BP was found after diagnosis of multiple sclerosis (MS) (OR=5.9, 95% CI 3.9–8.5). Among psychiatric diseases, the corresponding risk was strongest in schizophrenia (OR=2.7, 95% CI 2.0–3.5), and as a novel finding, also personality disorders (OR=2.2, 95% CI 1.3–3.3) preceded BP. In conclusion, many psychiatric disorders, especially schizophrenia, carry heightened risk for BP. Furthermore, several neurological diseases which cause central nervous system inflammation or degeneration were related to BP, and the association was strongest between MS and BP. PMID:27845416

  11. Factors that influence research involvement among registered dietitians working as university faculty: a qualitative interview study.

    PubMed

    Whelan, Kevin; Markless, Sharon

    2012-07-01

    Research involvement is fundamental to the practice of dietetics and dietetics faculty should be ideally placed to contribute to this. Studies have identified a range of factors that influence faculty research involvement, many of which are relevant to registered dietitians. The aim of this study was to explore the factors that influence research involvement among dietetics faculty using qualitative semi-structured interviews. Thirteen dietetics faculty members were purposively sampled and participated in semi-structured interviews. Interviews were recorded, transcribed, and analyzed thematically by the same researcher. Eight themes emerged that influenced research involvement among dietetics faculty and these related to the following distinct factors: institution and department (ie, size and structure, research philosophy, being established in research); activities (ie, faculty roles, time and teaching, research and grants); and individuals (ie, significant others, self). There was complex interaction between each of the eight themes. Many of the themes were very specific to the dietetics context, including being a small discipline, being in newer universities without established research portfolios, having greater teaching responsibilities, and the availability of grants in areas related to nutrition. The factors influencing research involvement among dietetics faculty members are complex and interact; therefore, solutions to overcome these barriers will need to account for this. These findings provide understanding that can contribute to this endeavor.

  12. The Rise of Cell Therapy Trials for Stroke: Review of Published and Registered Studies

    PubMed Central

    Pimentel-Coelho, Pedro Moreno; Barbosa da Fonseca, Lea Mirian; de Freitas, Gabriel Rodriguez; Mendez-Otero, Rosalia

    2013-01-01

    Stroke is the second leading cause of death and the third leading cause of disability worldwide. Approximately 16 million first-ever strokes occur each year, leading to nearly 6 million deaths. Nevertheless, currently, very few therapeutic options are available. Cell therapies have been applied successfully in different hematological diseases, and are currently being investigated for treating ischemic heart disease, with promising results. Recent preclinical studies have indicated that cell therapies may provide structural and functional benefits after stroke. However, the effects of these treatments are not yet fully understood and are the subject of continuing investigation. Meanwhile, different clinical trials for stroke, the majority of them small, nonrandomized, and uncontrolled, have been reported, and their results indicate that cell therapy seems safe and feasible in these conditions. In the last 2 years, the number of published and registered trials has dramatically increased. Here, we review the main findings available in the field, with emphasis on the clinical results. Moreover, we address some of the questions that have been raised to date, to improve future studies. PMID:23509917

  13. Morbidity before and after the Diagnosis of Hyperthyroidism: A Nationwide Register-Based Study

    PubMed Central

    Brandt, Frans; Thvilum, Marianne; Almind, Dorthe; Christensen, Kaare; Green, Anders; Hegedüs, Laszlo; Brix, Thomas Heiberg

    2013-01-01

    Background Hyperthyroidism has been linked with different morbidities, like atrial fibrillation, stroke and diabetes mellitus. However, our knowledge regarding the extent and temporal relation between hyperthyroidism and other diseases is fragmented. Here, we aimed at evaluating various morbidities before and after the diagnosis of hyperthyroidism. Methods Observational cohort study. From nationwide Danish health registers 2631 hyperthyroid singletons and 375 twin pairs discordant for hyperthyroidism were identified and followed for an average of 6 years (range 0–13). Data on the occurrence of cardiovascular diseases, lung diseases, diabetes mellitus, rheumatic diseases and malignant diseases was obtained by person-to-person record linkage with the National Danish Patient Register and/or the Danish National Prescription Registry (lung diseases and diabetes mellitus). Logistic and Cox regression models were used to assess the risk of morbidity before and after the diagnosis of hyperthyroidism, respectively. All Cox regression analyses were adjusted for the degree of co-morbidity preceding the diagnosis of hyperthyroidism, using the Charlson score. Results Hyperthyroid individuals had a significantly higher risk of being diagnosed with cardiovascular diseases (odds ratio (OR) 1.65; 95% confidence interval (CI): 1.45–1.87), lung diseases (OR 1.53; 95% CI: 1.29–1.60), and diabetes mellitus (OR 1.43, 95% CI: 1.20–1.72), but not with malignant diseases (OR 1.16, 95% CI: 0.99–1.36) prior to the diagnosis of hyperthyroidism. After the diagnosis of hyperthyroidism, subjects had a significantly higher risk of being diagnosed with cardiovascular diseases (hazard ratio (HR) 1.34; 95% CI: 1.15–1.56), lung diseases (HR 1.28; 95% CI: 1.10–1.49), and diabetes mellitus (HR 1.46; 95% CI: 1.16–1.84), but not with rheumatic diseases (HR 1.39, 95% CI: 0.92–2.09) or malignant diseases (HR 1.18, 95% CI 0.97–1.42). Conclusions We demonstrate a significantly increased

  14. Morbidity, injuries and sick absence in fishermen and seafarers--a prospective study.

    PubMed

    Tomaszunas, S; Wecławik, Z; Lewiński, M

    1988-01-01

    In the period 1986-1988 a prospective study comprising 30 crew members of deep-sea factory-trawlers (altogether 2468 fishermen) and 85 of the merchant navy vessels (total 2906 seafarers). At least one chronic ailment or a deviation from the norm was found in 32.5% of fishermen and in 45.4% of seafarers. On the average the seafarers were older than their counterparts fishermen by 2 years and 2 month. Traumas, fractures, wounds and injuries were the most often, the prevailing reason for the sick absence (619 days sick absence per 1000 fishermen and 1075 days sick absence per 1000 seamen annually). The most frequent in fishermen were: acute infections of the respiratory tract, skin diseases, diseases of the oral cavity and teeth, diseases of the articulations. The diseases of a highest prevalence in seafarers were: acute infections of the respiratory tract, diseases of the oral cavity and teeth, skin diseases, gastritis and duodenitis. There were noted 27 serious ailments and 9 accidents requiring repatriations on shore and home in fishermen and 18 such diseases and 21 accidents in seafarers.

  15. [Nursing registers on sleep and patient perception in a psychiatric unit. A comparative study].

    PubMed

    Osés, J Antomás; Del Barrio, S Huarte; Murillo, C Gárriz

    2011-01-01

    Insomnia is a frequent problem in people who suffer from mental illnesses. The nursing staff control and register whether or not patients sleep. The aim of this article is to analyze the concordance between the perceptions of the patients of a psychiatric unit on the quality of sleep, and the notes in this respect contained in the nursing records. A comparative study between the answers given by the patients of our unit to 126 questions on insomnia on specific nights, and what was reflected in their nursing records. A reduced version of the Athens Insomnia Scale (AIS-5) was used. The average value obtained according to the patients' answers was higher (worse sleep) than that given by the nurses, both globally and by item. The nursing records showed much lower values than those given by the patient; Pearson's correlation analysis gave a coefficient of 0.26. Analysis of the degree of agreement provided an index of 0.13 that does not differ significantly from nil agreement. There is a difference between the nursing observations and the subjective sensations of the patients about how they sleep. They indicate that they sleep worse than the nursing records reflect. External observation and self-perception are not antagonistic aspects, but two complementary aspects of patients' sleep.

  16. Priorities for the professional development of registered nurses in nursing homes: a Delphi study.

    PubMed

    Cooper, Emily; Spilsbury, Karen; McCaughan, Dorothy; Thompson, Carl; Butterworth, Tony; Hanratty, Barbara

    2017-01-08

    To establish a consensus on the care and professional development needs of registered nurses (RNs) employed by UK care homes. Two-stage, online modified Delphi study. A panel (n = 352) of individuals with experience, expertise or interest in care home nursing: (i) care home nurses and managers; (ii) community healthcare professionals (including general practitioners, geriatricians, specialist and district nurses); and (iii) nurse educators in higher education. RNs employed by nursing homes require particular skills, knowledge, competence and experience to provide high-quality care for older residents. The most important responsibilities for the nursing home nurse were: promoting dignity, personhood and wellbeing, ensuring resident safety and enhancing quality of life. Continuing professional development priorities included personal care, dementia care and managing long-term conditions. The main barrier to professional development was staff shortages. Nursing degree programmes were perceived as inadequately preparing nurses for a nursing home role. Nursing homes could improve by providing supportive learning opportunities for students and fostering challenging and rewarding careers for newly RNs. If nurses employed by nursing homes are not fit for purpose, the consequences for the wider health and social-care system are significant. Nursing homes, the NHS, educational and local authorities need to work together to provide challenging and rewarding career paths for RNs and evaluate them. Without well-trained, motivated staff, a high-quality care sector will remain merely an aspiration.

  17. The competencies of Registered Nurses working in care homes: a modified Delphi study.

    PubMed

    Stanyon, Miriam Ruth; Goldberg, Sarah Elizabeth; Astle, Anita; Griffiths, Amanda; Gordon, Adam Lee

    2017-07-01

    registered Nurses (RNs) working in UK care homes receive most of their training in acute hospitals. At present the role of care home nursing is underdeveloped and it is seen as a low status career. We describe here research to define core competencies for RNs working in UK care homes. a two-stage process was adopted. A systematic literature review and focus groups with stakeholders provided an initial list of competencies. The competency list was modified over three rounds of a Delphi process with a multi-disciplinary expert panel of 28 members. twenty-two competencies entered the consensus process, all competencies were amended and six split. Thirty-one competencies were scored in round two, eight were agreed as essential, one competency was split into two. Twenty-four competencies were submitted for scoring in round three. In total, 22 competencies were agreed as essential for RNs working in care homes. A further 10 competencies did not reach consensus. the output of this study is an expert-consensus list of competencies for RNs working in care homes. This would be a firm basis on which to build a curriculum for this staff group.

  18. A pilot study evaluating the perceptions of Certified Registered Nurse Anesthetists toward human patient simulation.

    PubMed

    Hawkins, Robert; Bendickson, Lee; Benson, Pretoria; Osborne, Lisa; McPherson, Jennifer; Todd, Larry; Snelson, Jennifer; Bruner, Sandra; Bohan, Kevin

    2014-10-01

    An evaluation was conducted of perceptions of practicing Certified Registered Nurse Anesthetists (CRNAs) toward use of simulation for initial certification, continuing education, and recertification. The hypothesis was that a 1-day simulation experience would improve their perceptions toward simulation use. The first phase developed content-valid questions to examine CRNAs' perceptions toward simulation. The second phase used these questions to survey practicing CRNAs in the District of Columbia, Maryland, and Virginia. During the third phase, 9 CRNAs were selected to complete a 1-day simulation experience and complete the perception questionnaire before and after the experience. Through content validity index calculations, 25 of 27 questions were retained for use in this study. A total of 378 CRNAs responded to the questionnaire. There was consensus that human patient simulation (HPS) is an important part of anesthesia provider training, and 85.7% strongly agreed, agreed, or somewhat agreed that HPS should be a required component for initial certification. Additionally, 52.9% of respondents agreed (somewhat agreed or strongly agreed) that continuing education units from HPS should be required for recertification. After the simulation, a significant (P < .05) positive change in level of agreement was noted for 13 of 25 questions, including questions related to initial training and recertification.

  19. Asthma and respiratory symptoms among hairdressers in Denmark: results from a register based questionnaire study.

    PubMed

    Lysdal, Susan Hovmand; Mosbech, Holger; Johansen, Jeanne Duus; Søsted, Heidi

    2014-12-01

    Hairdressers are at risk of developing occupational respiratory disorders due to persulfates and other hairdressing chemicals. A register based questionnaire study comprising 7,840 graduates from hairdressing vocational schools was conducted. The postal questionnaire concerned self-reported asthma, airway symptoms, occupation, smoking, and atopic dermatitis. A response rate of 67.9% was obtained. The hairdressers reported asthma (11.2%), cough (25.3%), nasal congestion (24.0%), and rhinitis (18.2%). Less than 1/3 of all hairdressers with suspected occupational asthma reported their asthma as an occupational disease to the authorities. In total, 27.3% were daily smokers; the smoking pattern was similar between hairdressers with and without asthma. Local exhaust ventilation was only used consistently by 63.8% for permanent waving and hair coloring procedures. Asthma and especially respiratory symptoms were commonly reported by hairdressers, but rarely reported as an occupational disease. Local exhaust ventilation was inconsistently used. Our results underline the need for improved measures to ascertain and prevent occupational asthma in hairdressers. © 2014 Wiley Periodicals, Inc.

  20. Work disability before and after diabetes diagnosis: a nationwide population-based register study in Sweden.

    PubMed

    Ervasti, Jenni; Virtanen, Marianna; Pentti, Jaana; Lallukka, Tea; Tinghög, Petter; Kjeldgard, Linnea; Mittendorfer-Rutz, Ellenor; Alexanderson, Kristina

    2015-06-01

    We evaluated the risk of work disability (sick leave and disability pension) before and after diabetes diagnosis relative to individuals without diabetes during the same time period, as well as the trajectory of work disability around the diagnosis. This Swedish population-based cohort study with register data included 14 428 individuals with incident diabetes in 2006 and 39 702 individuals without diabetes during 2003 to 2009. Work disability was substantially higher among people with diabetes (overall mean = 95 days per year over the 7 years, SD = 143) than among those without diabetes (mean = 35 days, SD = 95). The risk of work disability was slightly higher after diabetes diagnosis than before and compared with the risk of those without diabetes. The trajectory of work disability was already increasing before diagnosis, increased even more at the time of diagnosis, and leveled off after diagnosis. Individual sociodemographic characteristics and comorbid conditions contributed both to the risk and to the trajectory of work disability. Although diabetes has an independent effect on work disability, sex, age, education, and comorbid conditions play a significant role.

  1. Longitudinal register study of attendance frequencies in public and private dental services in Finland.

    PubMed

    Widström, E; Komu, M; Mikkola, H

    2013-09-01

    The Public Dental Service (PDS) in Finland was recently opened to all adults. According to annual statistics, 75% of children and 51% of adults made dental attendances in 2008. This study aimed to survey the frequency of dental attendance across three years and compared attendance frequencies between age groups and treatment sectors. Data from municipal databases and the reimbursement register of the Social Insurance Institution were collected on all who had attended the PDS (733,000) or the private sector (473,000) in 2008 and they were retrospectively followed from 2008 to 2006. Most children had attended the PDS in each year (57.4%) or in two of the three years (32.2%). Most working aged (57.3%) and elderly (69.1%) were annual attenders in the private sector. In addition, 27.1% of the former and 19.8% of the latter had attended in two of the three years. Attending in one year only was unusual. In the PDS, adult annual attendance was uncommon (31.9%), and adult attenders were fairly evenly distributed over the three categories, attending in one, two or all three years. Annual or biannual attendances seemed to be the norm among children in the PDS and adults in the private sector. Adults in the PDS showed irregular attendance patterns probably partly due to scarcity of resources for recall patients in the PDS.

  2. Exploring leadership roles, goals, and barriers among Kansas registered nurses: a descriptive cross-sectional study.

    PubMed

    Peltzer, Jill N; Ford, Debra J; Shen, Qiuhua; Fischgrund, Avery; Teel, Cynthia S; Pierce, Janet; Jamison, Marian; Waldon, Trynn

    2015-01-01

    The Institute of Medicine's Future of Nursing report advocates for full nurse leader representation across multiple settings to address current challenges in our health care system. The purpose of this study was to examine nursing leadership development needs among Kansas registered nurses (RNs). Data were collected through an online survey and analyzed using quantitative and qualitative methods. Nearly 1,000 Kansas RNs participated. Most reported holding one or more leadership positions. Prevalent leadership goals were health care organization volunteer administrative roles. The most frequently identified barrier to developing leadership roles was time constraints. Many wanted to develop skills to serve on a board, 20% were interested in personal leadership development, and 19% in policy development. Based on the findings, the Kansas Action Coalition leadership team is developing programs to address the leadership needs of Kansas RNs. By building capacity in advanced leadership roles, RNs will be better prepared serve as full partners and lead efforts to promote the health of Kansans. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. A metadata-based patient register for cooperative clinical research: a case study in acute myeloid leukemia.

    PubMed

    Fischer, Anja S; Mansmann, Ulrich

    2011-01-01

    In many medical indications clinical research is organized within study groups which provide and maintain the clinical infrastructure for their randomized clinical trials. Each group also manages a data center where high quality databases store the study specific individual patient data. Sharing this data between study groups is not straightforward. Therefore, a concept is needed which allows to represent a detailed overview on the information available across the cooperating groups. We propose a metadata based patient register and describe a first prototype. It provides information about available patient data sets to interested research partners while the typical register approach only collects a predefined limited core data set. This register implementation enables cooperative groups to allocate clinical data for future research projects in distributed data sources beyond the restrictions of core data sets. Additionally, it supports the research network in communication and data standardization and complies with a governance structure which is compatible with ethical aspects, privacy protection, and patient rights.

  4. Explaining the social gradient in sickness absence: a study of a general working population in Sweden.

    PubMed

    Löve, Jesper; Hensing, Gunnel; Holmgren, Kristina; Torén, Kjell

    2013-06-05

    Some previous studies have proposed potential explanatory factors for the social gradient in sickness absence. Yet, this research area is still in its infancy and in order to comprise the full range of socioeconomic positions there is a need for studies conducted on random population samples. The main aim of the present study was to investigate if somatic and mental symptoms, mental wellbeing, job strain, and physical work environment could explain the association between low socioeconomic position and belonging to a sample of new cases of sick-listed employees. This study was conducted on one random working population sample (n = 2763) and one sample of newly sick-listed cases of employees (n = 3044), drawn from the same random general population in western Sweden. Explanatory factors were self-rated 'Somatic and mental symptoms', 'Mental well-being', 'job strain', and 'physical work conditions' (i.e. heavy lifting and awkward work postures). Multiple logistic regression analyses were used. Somatic and mental symptoms, mental well-being, and job strain, could not explain the association between socioeconomic position and sickness absence in both women and men. However, physical work conditions explained the total association in women and much of this association in men. In men the gradient between Non-skilled manual OR 1.76 (1.24;2.48) and Skilled manual OR 1.59 (1.10;2.20), both in relation to Higher non-manual, remained unexplained. The present study strengthens the scientific evidence that social differences in physical work conditions seem to comprise a key element of the social gradient in sickness absence, particularly in women. Future studies should try to identify further predictors for this gradient in men.

  5. Inequity of access to ACE inhibitors in Swedish heart failure patients: a register-based study

    PubMed Central

    Lindahl, Bertil; Hanning, Marianne; Westerling, Ragnar

    2016-01-01

    Background Several international studies suggest inequity in access to evidence-based heart failure (HF) care. Specifically, studies of ACE inhibitors (ACEIs) point to reduced ACEI access related to female sex, old age and socioeconomic position. Thus far, most studies have either been rather small, lacking diagnostic data, or lacking the possibility to account for several individual-based sociodemographic factors. Our aim was to investigate differences, which could reflect inequity in access to ACEIs based on sex, age, socioeconomic status or immigration status in Swedish patients with HF. Methods Individually linked register data for all Swedish adults hospitalised for HF in 2005–2010 (n=93 258) were analysed by multivariate regression models to assess the independent risk of female sex, high age, low employment status, low income level, low educational level or foreign country of birth, associated with lack of an ACEI dispensation within 1 year of hospitalisation. Adjustment for possible confounding was made for age, comorbidity, Angiotensin receptor blocker therapy, period and follow-up time. Results Analysis revealed an adjusted OR for no ACEI dispensation for women of 1.31 (95% CI 1.27 to 1.35); for the oldest patients of 2.71 (95% CI 2.53 to 2.91); and for unemployed patients of 1.59 (95% CI 1.46 to 1.73). Conclusions Access to ACEI treatment was reduced in women, older patients and unemployed patients. We conclude that access to ACEIs is inequitable among Swedish patients with HF. Future studies should include clinical data, as well as mortality outcomes in different groups. PMID:26261264

  6. Changes in mortality inequalities over two decades: register based study of European countries

    PubMed Central

    Kulhánová, Ivana; Artnik, Barbara; Bopp, Matthias; Borrell, Carme; Clemens, Tom; Costa, Giuseppe; Dibben, Chris; Kalediene, Ramune; Lundberg, Olle; Martikainen, Pekka; Menvielle, Gwenn; Östergren, Olof; Prochorskas, Remigijus; Rodríguez-Sanz, Maica; Strand, Bjørn Heine; Looman, Caspar W N; de Gelder, Rianne

    2016-01-01

    Objective To determine whether government efforts in reducing inequalities in health in European countries have actually made a difference to mortality inequalities by socioeconomic group. Design Register based study. Data source Mortality data by level of education and occupational class in the period 1990-2010, usually collected in a census linked longitudinal study design. We compared changes in mortality between the lowest and highest socioeconomic groups, and calculated their effect on absolute and relative inequalities in mortality (measured as rate differences and rate ratios, respectively). Setting All European countries for which data on socioeconomic inequalities in mortality were available for the approximate period between years 1990 and 2010. These included Finland, Norway, Sweden, Scotland, England and Wales (data applied to both together), France, Switzerland, Spain (Barcelona), Italy (Turin), Slovenia, and Lithuania. Results Substantial mortality declines occurred in lower socioeconomic groups in most European countries covered by this study. Relative inequalities in mortality widened almost universally, because percentage declines were usually smaller in lower socioeconomic groups. However, as absolute declines were often smaller in higher socioeconomic groups, absolute inequalities narrowed by up to 35%, particularly among men. Narrowing was partly driven by ischaemic heart disease, smoking related causes, and causes amenable to medical intervention. Progress in reducing absolute inequalities was greatest in Spain (Barcelona), Scotland, England and Wales, and Italy (Turin), and absent in Finland and Norway. More detailed studies preferably using individual level data are necessary to identify the causes of these variations. Conclusions Over the past two decades, trends in inequalities in mortality have been more favourable in most European countries than is commonly assumed. Absolute inequalities have decreased in several countries, probably

  7. Use of technical skills and medical devices among new registered nurses: A questionnaire study.

    PubMed

    Ewertsson, Mona; Gustafsson, Margareta; Blomberg, Karin; Holmström, Inger K; Allvin, Renée

    2015-12-01

    One comprehensive part of nursing practice is performing technical skills and handling of medical equipment. This might be challenging for new registered nurses (RNs) to do in patient-safe way. The aim of this study was to describe and compare the extent to which new RNs perform various technical skills and handle medical devices in different settings, and to investigate their possibility for continued learning in this respect. A further aim was to describe their perceptions of incident reporting related to technical skills and medical devices. A cross-sectional study with descriptive and comparative design. RNs who recently graduated from a nursing programme at three Swedish universities and had worked as a RN for up to 1 year were included in the study (n=113, response rate 57%). Data were collected by means of a postal questionnaire. Half of the RNs reported that they performed several of the listed tasks every day or every week, regardless of workplace. These tasks were most frequently performed in surgical departments. The majority of the participants (76%) stated a need of continued practical training. However, less than half of them (48%) had access to a training environment. Several participants (43%) had been involved in incidents related to technical skills or medical devices, which were not always reported. Nearly a third of the participants (31%) did not use the existing guidelines when performing technical skills, and reflection on performance was uncommon. This study highlights the importance of shared responsibilities between nurse educators and health care employers to provide learning opportunities for new RNs in technical skills, to maintain patient safety. To increase the safety culture where nursing students and new RNs understand the importance of using evidence-based guidelines and taking a reflective approach in the performance of technical tasks is needed. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. GP consultations for common mental disorders and subsequent sickness certification: register-based study of the employed population in Norway.

    PubMed

    Gjesdal, Sturla; Holmaas, Tor Helge; Monstad, Karin; Hetlevik, Øystein

    2016-12-01

    Challenges related to work are in focus when employed people with common mental disorders (CMDs) consult their GPs. Many become sickness certified and remain on sick leave over time. To investigate the frequency of new CMD episodes among employed patients in Norwegian general practice and subsequent sickness certification. Using a national claims register, employed persons with a new episode of CMD were included. Sickness certification, sick leave over 16 days and length of absences were identified. Patient- and GP-related predictors for the different outcomes were assessed by means of logistic regression. During 1 year 2.6% of employed men and 4.2% of employed women consulted their GP with a new episode of CMD. Forty-five percent were sickness certified, and 24 percent were absent over 16 days. Thirty-eight percent had depression and 19% acute stress reaction, which carried the highest risk for initial sickness certification, 75%, though not for prolonged absence. Men and older patients had lower risk for sickness certification, but higher risk for long-term absence. Better knowledge of factors at the workplace detrimental to mental health, and better treatment for depression and stress reactions might contribute to timely return of sickness absentees. © The Author 2016. Published by Oxford University Press.

  9. GP consultations for common mental disorders and subsequent sickness certification: register-based study of the employed population in Norway

    PubMed Central

    Gjesdal, Sturla; Holmaas, Tor Helge; Monstad, Karin; Hetlevik, Øystein

    2016-01-01

    Background. Challenges related to work are in focus when employed people with common mental disorders (CMDs) consult their GPs. Many become sickness certified and remain on sick leave over time. Objectives. To investigate the frequency of new CMD episodes among employed patients in Norwegian general practice and subsequent sickness certification. Methods. Using a national claims register, employed persons with a new episode of CMD were included. Sickness certification, sick leave over 16 days and length of absences were identified. Patient- and GP-related predictors for the different outcomes were assessed by means of logistic regression. Results. During 1 year 2.6% of employed men and 4.2% of employed women consulted their GP with a new episode of CMD. Forty-five percent were sickness certified, and 24 percent were absent over 16 days. Thirty-eight percent had depression and 19% acute stress reaction, which carried the highest risk for initial sickness certification, 75%, though not for prolonged absence. Men and older patients had lower risk for sickness certification, but higher risk for long-term absence. Conclusion. Better knowledge of factors at the workplace detrimental to mental health, and better treatment for depression and stress reactions might contribute to timely return of sickness absentees. PMID:27535329

  10. Can the coverage of screening for cancer of the cervix be improved using the Electoral Register? A pilot study.

    PubMed

    Cook, G A; Wald, N J

    1985-09-30

    We conducted a pilot study to assess the feasibility using the Electoral Register to carry out a cervical cancer screening programme on a Health District basis. A random sample of 500 names and addresses were drawn from a computerised list of the Electoral Register from three Electoral Wards in Oxford. A pilot study showed that the Electoral Register could be used successfully in this way and that the proportion of women aged 35-64 years who had a cervical smear examination as a result of the screening initiative was increased by a quarter, from 64% to 79%. The numbers of women involved at each step of the screening process were determined, and these may provide a useful guide to others considering implementing similar schemes.

  11. Intraoperative cervical treatment does not affect the prevalence of vaginal bleeding 1 year postoperatively after subtotal hysterectomy. A register study from the Swedish National Register for Gynecological Surgery.

    PubMed

    Borendal Wodlin, Ninnie

    2017-09-02

    The objectives were to establish the prevalence of persistent vaginal bleeding following subtotal hysterectomy, to analyze the effect of intraoperative cervical treatment on the occurrence of persistent vaginal bleeding, and to evaluate the impact of persistent vaginal bleeding on the patient-reported opinion concerning result of surgery and medical condition. Retrospective study with data from the Swedish National Register for Gynecological Surgery including 5240 women undergoing subtotal hysterectomy for benign conditions between January 2004 and June 2016. Demographic and clinical data were obtained from the pre- and perioperative forms. Data concerning occurrence of persistent vaginal bleeding, rating of medical condition and contentment with result of surgery were collected from the 1-year inquiry form. Statistical analyses were performed with multivariable logistic regression models. The results are presented as adjusted odd ratios and 95% confidence intervals. Persistent vaginal bleeding occurred in 18.6%. Intraoperative cervical treatment did not affect the frequency of persistent vaginal bleeding (adjusted odds ratio 1.48; 95% confidence interval 0.93-2.37). More than 90% were satisfied with the result of the hysterectomy, but women with persistent vaginal bleeding were less content compared with those without persistent vaginal bleeding (adjusted odds ratio 0.42; 95% confidence interval 0.26-0.67). The self-perception of the medical condition did not differ between the women with and without persistent vaginal bleeding (adjusted odds ratio 1.16; 95% confidence interval 0.33-4.12). Nearly two in ten women may expect persistent vaginal bleeding following subtotal hysterectomy, and cervical treatment intraoperatively did not affect this. More than 90% were satisfied with the result but women with persistent vaginal bleeding were less content. Preoperative information on this risk of persistent vaginal bleeding may be important when choosing hysterectomy

  12. Educational achievements of children of parents with multiple sclerosis: A nationwide register-based cohort study.

    PubMed

    Moberg, J Y; Magyari, M; Koch-Henriksen, N; Thygesen, L C; Laursen, B; Soelberg Sørensen, P

    2016-11-01

    Little is known about the impact of parental multiple sclerosis (MS) on offspring's educational attainment. The objective of the study was to examine educational achievements in offspring of parents with MS compared with matched children of parents without MS in a nationwide register-based cohort study. Children of all Danish-born residents with onset between 1950 and 1986 were identified by linking the Danish Multiple Sclerosis Registry with the Civil Registration System. Twins, children with MS, and emigrated persons were excluded. The reference cohort consisted of randomly drawn individuals from the Civil Registration System without parental MS matched 8:1 to the MS offspring by sex and year of birth. Information about education was linked to the cohorts from nationwide educational registries. We included 4177 children of MS parents and 33,416 reference persons. Children of MS parents achieved statistically significant higher average grades than the reference cohort in their final exam of basic school with a mean grade difference of 0.46 (95 % CI 0.22-0.69; p = 0.0002). We found no difference in achievement of educational level above basic school (OR 1.04; 95 % CI 0.98-1.10; p = 0.20). There was a trend toward more MS offspring attaining health-related educations (OR 1.10; 95 % CI 1.00-1.21; p = 0.06). In conclusion, children of MS parents showed a small advantage in grade point average in final examinations in basic school, and they more often tended toward health-related educations. This study revealed no negative consequences of parental MS on grades and highest educational level achieved.

  13. Increasing illness among people out of labor market - A Danish register-based study.

    PubMed

    Andersen, Ingelise; Brønnum-Hansen, Henrik; Kriegbaum, Margit; Hougaard, Charlotte Ørsted; Hansen, Finn Kenneth; Diderichsen, Finn

    2016-05-01

    In spite of decades of very active labor market policies, 25% of Denmark's population in the working ages are still out-of-work. The aim of this study was to investigate whether that is due to consistent or even increasing prevalence of ill health. For the period of 2002-2011, we investigated if i) the prevalence of four chronic diseases (cardiovascular disease, diabetes, cancer and mental disorders) among those out-of-work had changed, ii) the occurrence of new cases of those diseases were higher among those who were already out-of-work, or iii) if non-health-related benefits were disproportionately given to individuals recently diagnosed with a disease compared to those without disease. The study was register-based and comprised all Danish residents aged 20-60. During the study period, the prevalence of cardiovascular diseases and mental disorders increased among both employed and non-employed people. The increased prevalence for mental disorder was particularly high among people receiving means-tested benefits. Disease incidence was higher among people outside rather than inside the labor market, especially for mental disorders. Employed people with incident diseases had an unsurprisingly increased risk of leaving the labor market. However, a high proportion of people with incident mental disorders received low level means-tested benefits in the three years following this diagnosis, which is concerning. Men treated for mental disorders in 2006 had high excess probability of receiving a cash-benefit, OR = 4.83 (4.53-5.14) for the period 2007-2010. The estimates were similar for women. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. How voter turnout varies between different chronic conditions? A population-based register study.

    PubMed

    Sund, Reijo; Lahtinen, Hannu; Wass, Hanna; Mattila, Mikko; Martikainen, Pekka

    2017-05-01

    While poor self-rated health is known to decrease an individual's propensity to vote, disaggregation of the components of health on turnout has thus far received only little attention. This study deepens on the understanding of such relationships by examining the association between chronic diseases and voting. The study uses an individual-level register-based data set that contains an 11% random sample of the entire electorate in the 1999 Finnish parliamentary elections. With information on hospital discharge diagnoses and reimbursements for drugs prescribed, we identify persons with chronic hospital-treated diseases (coronary heart disease, chronic obstructive pulmonary disease (COPD) and asthma, depression, cancer, psychotic mental disease, diabetes, cerebrovascular disease, rheumatic disease, epilepsy, arthrosis, alcoholism, dementia, atherosclerosis, Parkinson's disease, other degenerative brain diseases, multiple sclerosis and kidney disease). After adjusting for gender, age, education, occupational class, income, partnership status, cohabitation with underaged children and hospitalisation during Election Day, neurodegenerative brain diseases had the strongest negative relationship with voting (dementia OR=0.20, 95% CI 0.18 to 0.22; others up to OR=0.70). Alcoholism (OR=0.66) and mental disorders also had a negative association (depression OR=0.91; psychotic mental disease OR=0.79), whereas cancer and COPD/asthma had a positive association (both OR=1.05). Having more than one condition at a time further decreased voting probability. By showing how different health conditions are related to voter turnout, this study provides essential information for identifying gaps in the potential for political participation and for further inquiries aiming to develop models that explain the link between health and voting probability. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  15. Increasing incidence of anal sphincter tears among primiparas in Sweden: a population-based register study.

    PubMed

    Ekéus, Cecilia; Nilsson, Emma; Gottvall, Karin

    2008-01-01

    The aim of this study was to examine the incidence and risk factors for anal sphincter tears (ASTs) at delivery. A national population-based study was conducted with data from the Medical Birth Register including all primiparas with singleton pregnancy, who gave birth vaginally in Sweden from 1994 to 2004 (n=365,886). Women with a third and fourth degree AST were compared with those who gave birth during the same period without incurring such tears. The incidence of third degree AST increased by >60%, from 3.4% in 1994 to 5.2% in 2004 in spontaneous births, and from 8.7 to 14.8% in instrumental deliveries during the study period. The proportion of fourth degree AST increased from 0.3 to 0.55% in spontaneous births and from 0.8 to 1.4% in instrumental-assisted deliveries during the same period. Compared with non-instrumental delivery, vacuum extraction (VE) deliveries were related to an increased risk of AST. An infant birth weight of >4,000 g was also associated with an increased risk for both third and fourth degree AST. In addition, women born in Africa and Asia had significantly higher risk for both third and fourth degree AST compared to women born in Sweden. The incidence of third and fourth degree AST increased in both spontaneous births and instrumental deliveries. Instrumental delivery and an infant birth weight >4,000 g are the main risk factors for AST. Women from Africa and Asia have pronounced risks.

  16. Registered nurses' experiences of daily work, a balance between strain and stimulation: a qualitative study.

    PubMed

    Hallin, Karin; Danielson, Ella

    2007-09-01

    The challenges in the health care have given rise to a highly stressful work situation and a more complicated role for registered nurses (RNs). Qualitative studies about daily work as a whole is limited. It is therefore vital for future development of nursing knowledge and nursing education to recurrently investigate RNs' experiences of their ability to grasp and manage their daily work situation and to promote a high quality of care. The aim of this study was to describe RNs' experiences of their daily work. This follow up study was carried out involving 15 Swedish RNs 6 years after their graduation. Interviews, conducted with conversational strategy, were chosen for the data collection and content analysis was used to handle the interview texts. The analysis resulted in a main theme 'to balance strain and stimulation', two themes and seven sub-themes. The first theme 'a stressful work situation' consisted of the sub-themes: 'to meet all demands', 'to be insufficient', 'to be unsure of oneself', and 'too little contact with patient'. The second theme 'a stimulating work situation' consisted of the sub-themes: 'to encounter patients and health care staff is enriching', 'to have the situation under control', and 'to have the skills necessary to be independent'. A pattern emerged throughout the themes, which showed that due to the increasing number of patients RNs' capacity for management, prioritising and planning out of team work, and performing exacting documentation diminished. The RNs' daily work has been illustrated as a scale of balance that oscillated between strain and stimulation; an oscillation towards strain could lead to a vicious circle. The RNs need support from the start through nursing education and continuously in profession. This is a crucial issue for nursing education and health care sector.

  17. Patterns of Contact with Hospital for Children with an Autism Spectrum Disorder: A Danish Register-Based Study

    ERIC Educational Resources Information Center

    Atladottir, Hjordis Osk; Schendel, Diana E.; Lauritsen, Marlene B.; Henriksen, Tine Brink; Parner, Erik T.

    2012-01-01

    The aim of this study was to study patterns of contact with hospital for children with autism spectrum disorder (ASD) using Danish population based register data. We included all children born in Denmark from 1994 through 2002. We found that children diagnosed with ASD had an increased rate of contact with hospital, almost regardless of the cause…

  18. Gender Differences in Filicide Offense Characteristics--A Comprehensive Register-Based Study of Child Murder in Two European Countries

    ERIC Educational Resources Information Center

    Putkonen, Hanna; Amon, Sabine; Eronen, Markku; Klier, Claudia M.; Almiron, Maria P.; Cederwall, Jenny Yourstone; Weizmann-Henelius, Ghitta

    2011-01-01

    Objective: This study searched for gender differences in filicidal offense characteristics and associated variables. Methods: In this binational register-based study all filicide perpetrators (75 mothers and 45 fathers) and their crimes in Austria and Finland 1995-2005 were examined for putative gender differences. The assessed variables were…

  19. Gender Differences in Filicide Offense Characteristics--A Comprehensive Register-Based Study of Child Murder in Two European Countries

    ERIC Educational Resources Information Center

    Putkonen, Hanna; Amon, Sabine; Eronen, Markku; Klier, Claudia M.; Almiron, Maria P.; Cederwall, Jenny Yourstone; Weizmann-Henelius, Ghitta

    2011-01-01

    Objective: This study searched for gender differences in filicidal offense characteristics and associated variables. Methods: In this binational register-based study all filicide perpetrators (75 mothers and 45 fathers) and their crimes in Austria and Finland 1995-2005 were examined for putative gender differences. The assessed variables were…

  20. Patterns of Contact with Hospital for Children with an Autism Spectrum Disorder: A Danish Register-Based Study

    ERIC Educational Resources Information Center

    Atladottir, Hjordis Osk; Schendel, Diana E.; Lauritsen, Marlene B.; Henriksen, Tine Brink; Parner, Erik T.

    2012-01-01

    The aim of this study was to study patterns of contact with hospital for children with autism spectrum disorder (ASD) using Danish population based register data. We included all children born in Denmark from 1994 through 2002. We found that children diagnosed with ASD had an increased rate of contact with hospital, almost regardless of the cause…

  1. Cumulative occupational mechanical exposures during working life and risk of sickness absence and disability pension: prospective cohort study.

    PubMed

    Sundstrup, Emil; Hansen, Åse Marie; Mortensen, Erik Lykke; Poulsen, Otto Melchior; Clausen, Thomas; Rugulies, Reiner; Møller, Anne; Andersen, Lars L

    2017-09-01

    Objectives The aim of this study was to determine the prospective association of cumulative mechanical exposure during working life with health-related labor market outcomes. Methods This prospective cohort study combines data from 5076 older workers (age 49-63 years) from the Copenhagen Aging and Midlife Biobank with a job exposure matrix and a national register containing information on social transfer payment. By coding individual job histories from the Danish version of ISCO-codes (International Standard Classification of Occupations), we calculated cumulative occupational mechanical exposures from a JEM for ton-years (lifting 1000 kg each day in one year), lifting-years (lifting loads weighing ≥20 kg >10 times each day in one year), kneeling-years (kneeling for one hour each day in one year) and vibration-years (whole-body vibration for one hour each day in one year). Cox-regression analyses estimated the relative risk of register-based long-term sickness absence (LTSA) and disability pension with cumulative occupational mechanical exposures throughout working life. Analyses were censored for competing events and adjusted for multiple confounders. Results During the follow-up period, 970 persons (19.3%) had ≥1 episode of LTSA and 85 persons (1.7%) were granted a disability pension. Number of ton-, lifting- and kneeling-years showed an exposure-response association with increased risk of LTSA (P<0.0001). In addition, both long term [≥20 years; hazard ratio (HR) 1.76 95% CI 1.39-2.22] and short term (<10 years; HR 1.20 95% CI 1.02-1.41) exposure to kneeling work increased the risk of LTSA. Lifting-years, but not the other mechanical exposures, were associated with risk of disability pension (HR 1.75 95% CI 1.01-3.04). Conclusions Cumulative occupational mechanical exposures during working life - such as lifting and kneeling work - increased the risk of LTSA. Importantly, being exposed to lifting increased the risk of disability pension.

  2. Non-cancer morbidity among Estonian Chernobyl cleanup workers: a register-based cohort study.

    PubMed

    Rahu, Kaja; Bromet, Evelyn J; Hakulinen, Timo; Auvinen, Anssi; Uusküla, Anneli; Rahu, Mati

    2014-05-14

    To examine non-cancer morbidity in the Estonian Chernobyl cleanup workers cohort compared with the population sample with special attention to radiation-related diseases and mental health disorders. Register-based cohort study. Estonia. An exposed cohort of 3680 men (cleanup workers) and an unexposed cohort of 7631 men (population sample) were followed from 2004 to 2012 through the Population Registry and Health Insurance Fund database. Morbidity in the exposed cohort compared with the unexposed controls was estimated in terms of rate ratio (RR) with 95% CIs using Poisson regression models. Elevated morbidity in the exposed cohort was found for diseases of the nervous system, digestive system, musculoskeletal system, ischaemic heart disease and for external causes. The most salient excess risk was observed for thyroid diseases (RR=1.69; 95% CI 1.38 to 2.07), intentional self-harm (RR=1.47; 95% CI 1.04 to 2.09) and selected alcohol-related diagnoses (RR=1.25; 95% CI 1.12 to 1.39). No increase in morbidity for stress reactions, depression, headaches or sleep disorders was detected. No obvious excess morbidity consistent with biological effects of radiation was seen in the exposed cohort, with the possible exception of benign thyroid diseases. Increased alcohol-induced morbidity may reflect alcohol abuse, and could underlie some of the higher morbidity rates. Mental disorders in the exposed cohort were probably under-reported. The future challenge will be to study mental and physical comorbidities in the Chernobyl cleanup workers cohort. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  3. Non-cancer morbidity among Estonian Chernobyl cleanup workers: a register-based cohort study

    PubMed Central

    Rahu, Kaja; Bromet, Evelyn J; Hakulinen, Timo; Auvinen, Anssi; Uusküla, Anneli; Rahu, Mati

    2014-01-01

    Objective To examine non-cancer morbidity in the Estonian Chernobyl cleanup workers cohort compared with the population sample with special attention to radiation-related diseases and mental health disorders. Design Register-based cohort study. Setting Estonia. Participants An exposed cohort of 3680 men (cleanup workers) and an unexposed cohort of 7631 men (population sample) were followed from 2004 to 2012 through the Population Registry and Health Insurance Fund database. Methods Morbidity in the exposed cohort compared with the unexposed controls was estimated in terms of rate ratio (RR) with 95% CIs using Poisson regression models. Results Elevated morbidity in the exposed cohort was found for diseases of the nervous system, digestive system, musculoskeletal system, ischaemic heart disease and for external causes. The most salient excess risk was observed for thyroid diseases (RR=1.69; 95% CI 1.38 to 2.07), intentional self-harm (RR=1.47; 95% CI 1.04 to 2.09) and selected alcohol-related diagnoses (RR=1.25; 95% CI 1.12 to 1.39). No increase in morbidity for stress reactions, depression, headaches or sleep disorders was detected. Conclusions No obvious excess morbidity consistent with biological effects of radiation was seen in the exposed cohort, with the possible exception of benign thyroid diseases. Increased alcohol-induced morbidity may reflect alcohol abuse, and could underlie some of the higher morbidity rates. Mental disorders in the exposed cohort were probably under-reported. The future challenge will be to study mental and physical comorbidities in the Chernobyl cleanup workers cohort. PMID:24833681

  4. Crime in Huntington's disease: a study of registered offences among patients, relatives, and controls.

    PubMed

    Jensen, P; Fenger, K; Bolwig, T G; Sørensen, S A

    1998-10-01

    Criminal behaviour has been described as a problem in Huntington's disease, but systematic studies including control groups have been missing. Based on information from Danish registries, rates and types of crime committed by patients with Huntington's disease, non-affected relatives, and controls were studied. 99 males and 151 females with Huntington's disease were compared with 334 non-affected first degree relatives (134 men and 200 women) and to matched control groups as to frequencies and types of registered criminal convictions. Due to specific age criteria, the group of relatives comprised only about 9% carriers of the gene coding for Huntington's disease. In male patients, crime rates were significantly increased compared with first degree relatives (RR=2.8) and controls (RR=2.3). All types of crime occurred more often in male patients; more severe crimes (murder, rape, arson) were not reported. Rates of drunken driving were significantly increased compared with relatives (RR=3.8) and controls (RR=7.1). Crime rates were neither increased in female patients nor in male and female first degree relatives. The results indicate increased prevalence of criminal behaviour in males carrying the gene for Huntington's disease. The crimes committed seem to be of relatively minor severity and are probably closely linked to the personality changes often seen as a result of the disease process, although depressive reactions to the disease, with secondary alcohol misuse, may also play a part. Environmental and familial factors shared by patients and non-affected at risk persons seem to be of less aetiological importance.

  5. Registered nurses' experiences of patient violence on acute care psychiatric inpatient units: an interpretive descriptive study.

    PubMed

    Stevenson, Kelly N; Jack, Susan M; O'Mara, Linda; LeGris, Jeannette

    2015-01-01

    Nurses working in acute care psychiatry settings experience high rates of patient violence which influences outcomes for nurses and the organization. This qualitative study explored psychiatric nurses' experiences of patient violence in acute care inpatient psychiatric settings. An interpretive descriptive design guided this study that included 17 semi-structured interviews with a purposeful sample of 12 Canadian registered nurses who self-reported experiencing patient violence within acute care inpatient psychiatry. Thematic analysis and constant comparison techniques were used for analysis. A problem, needs and practice analysis was also used to structure overall data interpretation. Thirty three unique exposures to patient violence among the sample of nurses were analysed. Nurses reported experiencing physical, emotional and verbal violence. For many, patient violence was considered "part of the job." Nurses often struggled with role conflict between one's duty to care and one's duty to self when providing care following a critical incident involving violence. Issues of power, control and stigma also influenced nurse participant perceptions and their responses to patient violence. Nurses used a variety of strategies to maintain their personal safety and to prevent, and manage patient violence. Nurses endorsed the need for improved education, debriefing following an incident, and a supportive work environment to further prevent patient violence. Present findings have implications for reducing the barriers to reporting violent experiences and the creation of best practice guidelines to reduce patient violence in the workplace. Understanding the perspectives and experiences of nurses in acute inpatient psychiatry leads to greater understanding of the phenomenon of patient violence and may inform the development of interventions to prevent and to respond to patient violence, as well as support nurses working within the acute care setting.

  6. The influence of crisis resolution treatment on employment: a retrospective register-based comparative study.

    PubMed

    Blæhr, Emely Ek; Madsen, Jacob Vagner; Christiansen, Nanna Limskov Stærk; Ankersen, Pia Vedel

    2017-08-24

    Crisis resolution treatment (CRT) is a short-term acute psychiatric home-based treatment offered as an alternative to hospitalization. The purpose of CRT is to support patient recovery by maintaining and improving competencies in relation to everyday life. Individuals with mental disorders are at increased risk of leaving the labor market, which is a central aspect of everyday life. Thus, a primary outcome of interest is whether CRT enables higher employment compared with traditional hospitalization. The aim of this study was to assess the effectiveness of CRT compared with hospitalization in relation to attempted or committed suicides, admissions, readmissions and employment. This study utilized register-based psychiatric data. The CRT intervention, which was carried out in a psychiatric center (N = 374), was matched to traditional hospitalization treatment in a corresponding area (N = 9460). The outcomes (suicide attempts, suicides, admissions and readmissions) were replicated by applying propensity score matching (PSM) to evaluate the general treatment effect of CRT. The effectiveness of CRT on employment was estimated by applying PSM combined with a difference-in-difference estimator to account for any time trends. Receiving CRT was associated with significantly more employment after 1 year compared with hospitalization. Furthermore, after 1 year, receiving CRT was associated with fewer suicide attempts, admissions and readmissions. The associations were not significant after two years. The results suggest that CRT patients retain a higher employment rate, which could indicate better recovery. Using CRT could lead to savings in the social security system owing to higher employment rates.

  7. Prenatal diagnosis in Sweden 2011 to 2013-a register-based study.

    PubMed

    Petersson, Kerstin; Lindkvist, Marie; Persson, Margareta; Conner, Peter; Åhman, Annika; Mogren, Ingrid

    2016-11-22

    Prenatal diagnosis involves methods used in early pregnancy as either screening tests or diagnostic methods. The aims of the study were to i) investigate guidelines on prenatal diagnosis in the counties of Sweden, ii) investigate uptake of prenatal diagnosis, and iii) background characteristics and pregnancy outcomes in relation to different prenatal diagnostic methods. A retrospective cross-sectional study using data from the Swedish Pregnancy Register 2011 to 2013 (284,789 pregnancies) was performed. Additionally, guidelines on prenatal diagnosis were collected. Biostatistical and epidemiological analyses were performed including calculation of odds ratios (OR) and their 95% confidence intervals in univariate and multivariate logistic regression analyses. The national uptake of routine ultrasound examination, Combined Ultrasound and Biochemical test (CUB), Amniocentesis (AC) and Chorionic Villus Sampling (CVS) were 97.6, 33.0, 2.6 and 1.1%, respectively. From 2012, 6/21 counties offered CUB test to all pregnant women, nine counties at specific indications, and five counties did not offer CUB at all. Advanced maternal age demonstrated the highest impact on uptake of prenatal diagnosis. Further, university educational level in relation to lower educational level was associated with an increased likelihood of undergoing CUB (OR 2.30, 95% CI 2.26-2.35), AC (OR 1.54, 95% CI 1.46-1.63) and CVS (OR 2.68, 95% CI 2.44-2.93). Offers of prenatal diagnosis varied considerably between counties resulting in unequal access to prenatal diagnosis for pregnant women. The intentions of the Swedish Health and Medical Services Act stating equal care for all, was thus not fulfilled.

  8. Background radiation and childhood leukemia: A nationwide register-based case-control study.

    PubMed

    Nikkilä, Atte; Erme, Sini; Arvela, Hannu; Holmgren, Olli; Raitanen, Jani; Lohi, Olli; Auvinen, Anssi

    2016-11-01

    High doses of ionizing radiation are an established cause of childhood leukemia. However, substantial uncertainty remains about the effect of low doses of radiation, including background radiation and potential differences between genetic subgroups of leukemia have rarely been explored. We investigated the effect of the background gamma radiation on childhood leukemia using a nationwide register-based case-control study. For each of the 1,093 cases, three age- and gender matched controls were selected (N = 3,279). Conditional logistic regression analyses were adjusted for confounding by Down syndrome, birth weight (large for gestational age), and maternal smoking. Complete residential histories and previously collected survey data of the background gamma radiation in Finland were used to assess the exposure of the study subjects to indoor and outdoor gamma radiation. Overall, background gamma radiation showed a non-significant association with the OR of childhood leukemia (OR 1.01, 95% CI 0.97, 1.05 for 10 nSv/h increase in average equivalent dose rate to red bone marrow). In subgroup analyses, age group 2-<7 years displayed a larger effect (OR 1.27, 95% CI 1.01, 1.60 for 1 mSv increase in equivalent cumulative dose to red bone marrow). Suggestive difference in OR by genetic subtype was found. Our results provide further support to the notion that low doses of ionizing radiation increase the risk for childhood leukemia, particularly at age 2-<7 years. Our findings suggest a larger effect of radiation on leukemia with high hyperpdiploidy than other subgroups, but this result requires further confirmation.

  9. Sickness Absence and Precarious Employment: A Comparative Cross-National Study of Denmark, Finland, Sweden, and Norway.

    PubMed

    Oke, A; Braithwaite, P; Antai, D

    2016-07-01

    Precarious employment is a major social determinant of health and health inequalities with effects beyond the health of workers. To investigate the association between precarious employment and sickness absence in 4 Nordic countries, Denmark, Finland, Norway, and Sweden. Logistic regression analyses were conducted separately for each country on data from 4186 respondents aged 15-65 years in Denmark, Finland, Norway, and Sweden derived from the 2010 European Working Conditions Survey. Sickness absence was based on self-reports and defined as absence of seven or more day per year. Precarious employment was operationalized as a multidimensional construct of indicators. Analyses were also conducted separately for men and women. The prevalence of sickness absence was lowest in Sweden (18%), and highest in Finland (28%). 3 precarious employment indicators were positively associated with sickness absence; the pattern being largely similar in the total sample. In the sex-disaggregated sample, 5 precarious employment indicators increased the likelihood of sickness absence; the pattern was heterogeneous, with women generally having significantly higher odds of sickness absence than men. "Low household income" and "sickness presenteeism" were strong predictors of sickness absence among both sexes in most of the 4 studied countries. Sickness absence varied between the Nordic countries in the sex-disaggregated analyses. Precarious employment indicators predicted sickness absence in the Nordic countries. Findings emphasize the need to prioritize informed and monitored collective bargaining for all workers, increase working time flexibility, and improving work conditions.

  10. Registered Nurses’ Perceptions about the Situation of Family Caregivers to Patients with Heart Failure - A Focus Group Interview Study

    PubMed Central

    2016-01-01

    Introduction Heart failure is a growing public health problem associated with poor quality of life and significant morbidity and mortality. The majority of heart failure care is provided by family caregivers, and is associated with caregiver burden and reduced quality of life. Research emphasizes that future nursing interventions should recognize the importance of involving family caregivers to achieve optimal outcomes. Aims The aims of this study are to explore registered nurses’ perceptions about the situation of family caregivers to patients with heart failure, and registered nurses’ interventions, in order to improve family caregivers’ situation. Methods The study has a qualitative design with an inductive approach. Six focus group interviews were held with 23 registered nurses in three hospitals and three primary health care centres. Data were analysed using qualitative content analysis. Results Two content areas were identified by the a priori study aims. Four categories and nine sub-categories emerged in the analysis process. The content area “Family caregivers' situation” includes two categories: “To be unburdened” and “To comprehend the heart failure condition and its consequences”. The content area “Interventions to improve family caregivers' situation” includes two categories: “Individualized support and information” and “Bridging contact”. Conclusions Registered nurses perceive family caregivers' situation as burdensome, characterized by worry and uncertainty. In the PHCCs, the continuity and security of an RN as a permanent health care contact was considered an important and sustainable intervention to better care for family caregivers' worry and uncertainty. In the nurse-led heart failure clinics in hospitals, registered nurses can provide family caregivers with the opportunity of involvement in their relative's health care and address congruence and relationship quality within the family through the use of "Shared care

  11. Perceptions of Registered Nurses after Completing a Bachelor of Science Degree in Nursing: A Phenomenological Study

    ERIC Educational Resources Information Center

    John, Diane Yvette

    2010-01-01

    Background. The demands of the current health-care system support the need for more nurses to be prepared at the bachelor's level (American Association of the Colleges of Nursing [AACN], 2007). However, only 28% of the registered nurse (RN) population in Florida holds a bachelor's degree in nursing (BSN), which may be the result of increased…

  12. Perceptions of Registered Nurses after Completing a Bachelor of Science Degree in Nursing: A Phenomenological Study

    ERIC Educational Resources Information Center

    John, Diane Yvette

    2010-01-01

    Background. The demands of the current health-care system support the need for more nurses to be prepared at the bachelor's level (American Association of the Colleges of Nursing [AACN], 2007). However, only 28% of the registered nurse (RN) population in Florida holds a bachelor's degree in nursing (BSN), which may be the result of increased…

  13. The Dental Hygienist: A Study of the Employment Patterns of Registered Dental Hygienists in Southern Maryland.

    ERIC Educational Resources Information Center

    Armstrong, David F.

    This document reports the results of a survey of all registered dental hygienists reported by the State of Maryland as residents of southern Maryland (n=397), 82% of whom responded. The purpose of the survey was to examine the employment patterns of dental hygienists in the Montgomery College service area in order to determine if hygienists who…

  14. Pre-pregnancy mental distress and musculoskeletal pain and sickness absence during pregnancy - a twin cohort study.

    PubMed

    Seglem, Karoline B; Ørstavik, Ragnhild; Torvik, Fartein A; Gjerde, Line C; Røysamb, Espen; Reichborn-Kjennerud, Ted; Knudsen, Gun Peggy; Tambs, Kristian

    2017-06-01

    Sickness absence (SA) among pregnant women is high. The aim of this study was to examine whether factors known to predict SA in general also predict SA during pregnancy by estimating the association between prior mental distress and musculoskeletal pain and SA during pregnancy, and to assess the influence of familial (genetic and shared environmental) factors. In this prospective cohort study, data from 2076 female twins born 1967-79 who participated in a questionnaire study in 1998 were linked to register data on SA and childbirth during the years 1998-2008. Baseline measures included mental distress (symptoms of anxiety and depression; SCL-5) and musculoskeletal pain (lumbar spine, neck/shoulder and/or persisting muscular pain). SA was measured as a ratio of days on SA divided by potential working days. Negative binomial regression was performed for individual and within-pair effects. Musculoskeletal pain, but not mental distress, was prospectively associated with overall SA during pregnancy in the adjusted individual-level analyses. With each standard deviation increase in musculoskeletal pain, SA granted for any disorder increased with 12% (IRR 1.12, 95% CI = 1.07-1.17) and SA granted for pregnancy related disorders increased with 9% (IRR 1.09, 95% CI = 1.02-1.17). Within-pair estimates were similar, suggesting little or no familial confounding. Women with previous musculoskeletal pain are at increased risk of SA during pregnancy, whereas no increased risk in women with previous symptoms of mental distress could be demonstrated. SA during pregnancy seems partly to be associated with different factors than SA in general.

  15. How does collegial support increase retention of registered nurses in homecare nursing agencies? a qualitative study.

    PubMed

    Noguchi-Watanabe, Maiko; Yamamoto-Mitani, Noriko; Takai, Yukari

    2016-01-01

    Collegial workplace support has been linked to higher registered nurse (RN) retention in various clinical settings. In Japan, homecare agencies experience high RN turnover. The purpose of this study was to develop a conceptual framework to describe how perceived support from colleagues affects RNs' decision to remain in an agency. A qualitative research method based on grounded theory was used. Participants were RNs with at least 4 years of experience at the same homecare agency. Participants were theoretically sampled via managers of 12 homecare nursing agencies. Semi-structured interviews and supplementary participant observations were conducted. Data were analyzed using a constant comparative technique, and the process of how workplace support affected participants' decision to remain at their agency was clarified. In total, 26 RNs were interviewed, 23 of whom were observed in their practice setting. Participants' perception of support from colleagues was framed as being "encouraged to grow in one's own way", which comprised practicing with protected autonomy in an insight-producing environment. Participants reported that they were able to practice with protected autonomy, receiving 1) mindful monitoring, 2) semi-independent responsibility, 3) help as needed, and 4) collegial empathy and validation. RNs also felt supported in an insight-producing environment by 1) enlightening dialogue, 2) being set for one's next challenges, and 3) being able to grow at one's own pace. Reportedly, these were defining characteristics in their decision to continue working in their agencies. For RNs to willingly stay at a homecare nursing agency, it is essential that they are able to practice with protected autonomy in an insight-producing environment that encourages them to grow in their own way. Further research is needed to explore ways to create and enhance such environments to lower RN turnover.

  16. Diagnostic accuracy of sleep bruxism scoring in absence of audio-video recording: a pilot study.

    PubMed

    Carra, Maria Clotilde; Huynh, Nelly; Lavigne, Gilles J

    2015-03-01

    Based on the most recent polysomnographic (PSG) research diagnostic criteria, sleep bruxism is diagnosed when >2 rhythmic masticatory muscle activity (RMMA)/h of sleep are scored on the masseter and/or temporalis muscles. These criteria have not yet been validated for portable PSG systems. This pilot study aimed to assess the diagnostic accuracy of scoring sleep bruxism in absence of audio-video recordings. Ten subjects (mean age 24.7 ± 2.2) with a clinical diagnosis of sleep bruxism spent one night in the sleep laboratory. PSG were performed with a portable system (type 2) while audio-video was recorded. Sleep studies were scored by the same examiner three times: (1) without, (2) with, and (3) without audio-video in order to test the intra-scoring and intra-examiner reliability for RMMA scoring. The RMMA event-by-event concordance rate between scoring without audio-video and with audio-video was 68.3 %. Overall, the RMMA index was overestimated by 23.8 % without audio-video. However, the intra-class correlation coefficient (ICC) between scorings with and without audio-video was good (ICC = 0.91; p < 0.001); the intra-examiner reliability was high (ICC = 0.97; p < 0.001). The clinical diagnosis of sleep bruxism was confirmed in 8/10 subjects based on scoring without audio-video and in 6/10 subjects with audio-video. Although the absence of audio-video recording, the diagnostic accuracy of assessing RMMA with portable PSG systems appeared to remain good, supporting their use for both research and clinical purposes. However, the risk of moderate overestimation in absence of audio-video must be taken into account.

  17. Attention to nurses' rewarding - an interview study of registered nurses working in primary and private healthcare in Finland.

    PubMed

    Seitovirta, Jaana; Vehviläinen-Julkunen, Katri; Mitronen, Lasse; De Gieter, Sara; Kvist, Tarja

    2017-04-01

    To identify meaningful types of rewards and the consequences of rewards as expressed by Finnish registered nurses working in primary and private healthcare. Previous studies have found significant associations between nurses' rewards and both their commitment and job satisfaction. Furthermore, appropriate rewards can have beneficial effects on factors including workforce stability and occupational satisfaction that are highly important in times of nurse shortages. A cross-sectional, qualitative interview study. Data were collected via individual semi-structured interviews (n = 20) with registered nurses working in Finland's primary and private healthcare, and subjected to qualitative content analysis. Six meaningful types of rewards were identified by the registered nurses: Financial compensation and benefits, Work-Life balance, Work content, Professional development, Recognition, and Supportive leadership. Rewards encouraged respondents to perform their work correctly and reinforced occupational satisfaction, but also caused feelings of envy and stress. It is essential to pay attention to nurses' preferences for particular rewards and to reward management. When designing effective reward systems for registered nurses, it is not sufficient to provide financial rewards alone, as various kinds of non-financial rewards are both meaningful and necessary. When trying to improve registered nurses' commitment and job satisfaction through reward management, it is important to listen to nurses' opinions to create a reward system that integrates financial and non-financial rewards and is fair from their perspective. Healthcare organisations that offer registered nurses a holistic reward system are more likely to retain satisfied and committed nurses at a time of increasing nursing shortages. © 2016 John Wiley & Sons Ltd.

  18. Implementing the supportive supervision intervention for registered nurses in a long-term care home: a feasibility study.

    PubMed

    McGilton, Katherine S; Profetto-McGrath, Joanne; Robinson, Angela

    2013-11-01

    This pilot study was conducted in response to the call in 2009 by the International Association of Gerontology and Geriatrics to focus on effective leadership structures in nursing homes and to develop leadership capacity. Few researchers have evaluated interventions aimed at enhancing the leadership ability of registered nurses in long-term care. The aim of the pilot study was to test the feasibility of a three-part supportive supervisory intervention to improve supervisory skills of registered nurses in long-term care. A repeated measures group design was used. Quantitative data were collected from healthcare aides, licensed practical nurses (i.e., supervised staff), and registered nurses (i.e., supervisors). Focus groups with care managers and supervisors examined perceptions of the intervention. There were nonsignificant changes in both the registered nurse supervisors' job satisfaction and the supervised staff's perception of their supervisors' support. Supervised staff scores indicated an increase in the use of research utilization but did not reflect an increase in job satisfaction. Focus group discussions revealed that the supervisors and care managers perceived the workshop to be valuable; however, the weekly self-reflection, coaching, and mentoring components of the intervention were rare and inconsistent. While the primary outcomes were not influenced by the Supportive Supervision Intervention, further effort is required to understand how best to enhance the supportive supervisory skills of RNs. Examples of how to improve the possibility of a successful intervention are advanced. Effective supervisory skills among registered nurses are crucial for improving the quality of care in long-term care homes. Registered nurses are receptive to interventions that will enhance their roles as supervisors. © 2013 Sigma Theta Tau International.

  19. Gastro esophageal reflux disease is associated with absence from work: results from a prospective cohort study.

    PubMed

    Leodolter, Andreas; Nocon, Marc; Kulig, Michael; Willich, Stefan N; Malfertheiner, Peter; Labenz, Joachim

    2005-12-07

    To study the association of gastro-esophageal reflux disease (GERD) with the absence from work and to estimate the extent of loss in gross domestic product due to inability to work. Analysis was based on the prospectively gathered data of a large European cohort study involving 6 215 symptomatic GERD patients (ProGERD). Among these patients, 2 871 were initially employed. The calculation of the loss of gross domestic product was based on the assumption that the prevalence of GERD was about 15% in Germany. According to the German Federal Statistical Office, the mean gross wage of employees was 150 EUR/d in 2002. The data of 2 078 employed patients who were prospectively followed up for over 2 years were analyzed. At study entry, the patients reported a mean of 1.8 d per year of inability to work. During the prospective follow-up under routine clinical care, the proportion of patients reporting days with inability to work decreased from 14% to 6% and the mean number of days per year with inability to work decreased to 0.9 d. Assuming a prevalence of troublesome GERD of 15% in the employed German population, the loss of gross domestic product amounted to 668 million EUR/year in Germany. GERD causes a relevant impairment on the national economics by absence from work. The presented data demonstrate the importance of GERD, not only for patients and health insurance companies, but also for the community at large.

  20. Prevalence of primary outcome changes in clinical trials registered on ClinicalTrials.gov: a cross-sectional study.

    PubMed

    Ramagopalan, Sreeram; Skingsley, Andrew P; Handunnetthi, Lahiru; Klingel, Michelle; Magnus, Daniel; Pakpoor, Julia; Goldacre, Ben

    2014-01-01

    An important principle in the good conduct of clinical trials is that a summary of the trial protocol, with a pre-defined primary outcome, should be freely available before the study commences. The clinical trials registry ClinicalTrials.gov provides one method of doing this, and once the trial is registered, any changes made to the primary outcome are documented. The objectives of this study were: to assess the proportion of registered trials on ClinicalTrials.gov that had the primary outcome changed; to assess when the primary outcome was changed in relation to the listed study start and end dates and to assess whether the primary outcome change had any relation to the study sponsor. A cross-sectional analysis of all interventional clinical trials registered on ClinicalTrials.gov as of 25 October 2012 was performed. The main outcome was any change made to the initially listed primary outcome and the time of the change in relation to the trial start and end date. Our analysis showed that 28229 of 89204 (31.7%) registered studies had their primary outcome changed.  Industry funding was associated with all primary outcome changes, odds ratio (OR)= 1.36, 95% confidence interval (CI)=1.31-1.41, p<0.001; with primary outcome changes after study start date OR=1.37, 95% CI=1.32-1.42, p<0.001; with primary outcome changes after primary completion date OR=1.84, 95% CI=1.75-1.94, p<0.001 and with primary outcome changes after study completion date OR=1.82, 95% CI=1.73-1.91, p<0.001.  Conclusions A significant proportion of interventional trials registered on ClinicalTrials.gov have their primary outcomes altered after the listed study start and completion dates. These changes are associated with funding source.

  1. Multimorbidity and Its Patterns according to Immigrant Origin. A Nationwide Register-Based Study in Norway

    PubMed Central

    Diaz, Esperanza; Poblador-Pou, Beatriz; Gimeno-Feliu, Luis-Andrés; Calderón-Larrañaga, Amaia; Kumar, Bernadette N.; Prados-Torres, Alexandra

    2015-01-01

    Introduction As the flows of immigrant populations increase worldwide, their heterogeneity becomes apparent with respect to the differences in the prevalence of chronic physical and mental disease. Multimorbidity provides a new framework in understanding chronic diseases holistically as the consequence of environmental, social, and personal risks that contribute to increased vulnerability to a wide variety of illnesses. There is a lack of studies on multimorbidity among immigrants compared to native-born populations. Methodology This nationwide multi-register study in Norway enabled us i) to study the associations between multimorbidity and immigrant origin, accounting for other known risk factors for multimorbidity such as gender, age and socioeconomic levels using logistic regression analyses, and ii) to identify patterns of multimorbidity in Norway for immigrants and Norwegian-born by means of exploratory factor analysis technique. Results Multimorbidity rates were lower for immigrants compared to Norwegian-born individuals, with unadjusted odds ratios (OR) and 95% confidence intervals 0.38 (0.37–0.39) for Eastern Europe, 0.58 (0.57–0.59) for Asia, Africa and Latin America, and 0.67 (0.66–0.68) for Western Europe and North America. Results remained significant after adjusting for socioeconomic factors. Similar multimorbidity disease patterns were observed among Norwegian-born and immigrants, in particular between Norwegian-born and those from Western European and North American countries. However, the complexity of patterns that emerged for the other immigrant groups was greater. Despite differences observed in the development of patterns with age, such as ischemic heart disease among immigrant women, we were unable to detect the systematic development of the multimorbidity patterns among immigrants at younger ages. Conclusions Our study confirms that migrants have lower multimorbidity levels compared to Norwegian-born. The greater complexity of

  2. Job Strain, Health and Sickness Absence: Results from the Hordaland Health Study

    PubMed Central

    Wang, Min-Jung; Mykletun, Arnstein; Møyner, Ellen Ihlen; Øverland, Simon; Henderson, Max; Stansfeld, Stephen; Hotopf, Matthew; Harvey, Samuel B.

    2014-01-01

    Objectives While it is generally accepted that high job strain is associated with adverse occupational outcomes, the nature of this relationship and the causal pathways involved are not well elucidated. We aimed to assess the association between job strain and long-term sickness absence (LTSA), and investigate whether any associations could be explained by validated health measures. Methods Data from participants (n = 7346) of the Hordaland Health Study (HUSK), aged 40–47 at baseline, were analyzed using multivariate Cox regression to evaluate the association between job strain and LTSA over one year. Further analyses examined whether mental and physical health mediated any association between job strain and sickness absence. Results A positive association was found between job strain and risk of a LTSA episode, even controlling for confounding factors (HR = 1.64 (1.36–1.98); high job strain exposure accounted for a small proportion of LTSA episodes (population attributable risk 0.068). Further adjustments for physical health and mental health individually attenuated, but could not fully explain the association. In the fully adjusted model, the association between high job strain and LTSA remained significant (HR = 1.30 (1.07–1.59)). Conclusion High job strain increases the risk of LTSA. While our results suggest that one in 15 cases of LTSA could be avoided if high job strain were eliminated, we also provide evidence against simplistic causal models. The impact of job strain on future LTSA could not be fully explained by impaired health at baseline, which suggests that factors besides ill health are important in explaining the link between job strain and sickness absence. PMID:24755878

  3. Registered nurses' clinical reasoning in home healthcare clinical practice: A think-aloud study with protocol analysis.

    PubMed

    Johnsen, Hege Mari; Slettebø, Åshild; Fossum, Mariann

    2016-05-01

    The home healthcare context can be unpredictable and complex, and requires registered nurses with a high level of clinical reasoning skills and professional autonomy. Thus, additional knowledge about registered nurses' clinical reasoning performance during patient home care is required. The aim of this study is to describe the cognitive processes and thinking strategies used by recently graduated registered nurses while caring for patients in home healthcare clinical practice. An exploratory qualitative think-aloud design with protocol analysis was used. Home healthcare visits to patients with stroke, diabetes, and chronic obstructive pulmonary disease in seven healthcare districts in southern Norway. A purposeful sample of eight registered nurses with one year of experience. Each nurse was interviewed using the concurrent think-aloud technique in three different patient home healthcare clinical practice visits. A total of 24 home healthcare visits occurred. Follow-up interviews were conducted with each participant. The think-aloud sessions were transcribed and analysed using three-step protocol analysis. Recently graduated registered nurses focused on both general nursing concepts and concepts specific to the domains required and tasks provided in home healthcare services as well as for different patient groups. Additionally, participants used several assertion types, cognitive processes, and thinking strategies. Our results showed that recently graduated registered nurses used both simple and complex cognitive processes involving both inductive and deductive reasoning. However, their reasoning was more reactive than proactive. The results may contribute to nursing practice in terms of developing effective nursing education programmes. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Effects of Familial Risk Factors and Place of Birth on the Risk of Autism: A Nationwide Register-Based Study

    ERIC Educational Resources Information Center

    Lauritsen, Marlene Briciet; Pedersen, Carsten Bocker; Mortensen, Preben Bo

    2005-01-01

    Background: The etiology of autism is unknown. A strong genetic component has been detected but non-genetic factors may also be involved in the etiology. Methods: We used data from the Danish Psychiatric Central Register and the Danish Civil Registration System to study some risk factors of autism, including place of birth, parental place of…

  5. Using Plant Clinic Registers to Assess the Quality of Diagnoses and Advice Given to Farmers: A Case Study from Uganda

    ERIC Educational Resources Information Center

    Danielsen, Solveig; Boa, Eric; Mafabi, Moses; Mutebi, Emmanuel; Reeder, Robert; Kabeere, Flavia; Karyeija, Robert

    2013-01-01

    Purpose: This study developed a framework for quality assessment of diagnoses and advice given at plant clinics. Design/methodology/approach: Clinic registers from five plant clinics in Uganda (2006-2010) were used to develop quality assessment protocols for diagnoses and advice given by plant doctors. Assessment of quality of diagnoses was based…

  6. Using Plant Clinic Registers to Assess the Quality of Diagnoses and Advice Given to Farmers: A Case Study from Uganda

    ERIC Educational Resources Information Center

    Danielsen, Solveig; Boa, Eric; Mafabi, Moses; Mutebi, Emmanuel; Reeder, Robert; Kabeere, Flavia; Karyeija, Robert

    2013-01-01

    Purpose: This study developed a framework for quality assessment of diagnoses and advice given at plant clinics. Design/methodology/approach: Clinic registers from five plant clinics in Uganda (2006-2010) were used to develop quality assessment protocols for diagnoses and advice given by plant doctors. Assessment of quality of diagnoses was based…

  7. A Study of Semiotic Registers in the Development of the Definite Integral of Functions of Two and Three Variables

    ERIC Educational Resources Information Center

    McGee, Daniel Lee; Martinez-Planell, Rafael

    2014-01-01

    Tracing the path from a numerical Riemann sum approximating the area under a curve to a definite integral representing the precise area in various texts and online presentations, we found 3 semiotic registers that are used: the geometric register, the numerical register, and the symbolic register. The symbolic register had 3 representations: an…

  8. A Study of Semiotic Registers in the Development of the Definite Integral of Functions of Two and Three Variables

    ERIC Educational Resources Information Center

    McGee, Daniel Lee; Martinez-Planell, Rafael

    2014-01-01

    Tracing the path from a numerical Riemann sum approximating the area under a curve to a definite integral representing the precise area in various texts and online presentations, we found 3 semiotic registers that are used: the geometric register, the numerical register, and the symbolic register. The symbolic register had 3 representations: an…

  9. Mortality following unemployment during an economic downturn: Swedish register-based cohort study

    PubMed Central

    Montgomery, Scott; Udumyan, Ruzan; Magnuson, Anders; Osika, Walter; Sundin, Per-Ola; Blane, David

    2013-01-01

    Objective To investigate if unemployment during an economic downturn is associated with mortality, even among men with markers of better health (higher cognitive function scores and qualifications), and to assess whether the associations vary by age at unemployment. Design Longitudinal register-based cohort study. Setting Study entry was in 1990 and 2001 when Sweden was entering periods of significant economic contraction. Participants A representative sample of men from the general population (n=234 782) born between 1952 and 1956 who participated in military conscription examinations. Men in receipt of disability or sickness benefit at study entry were excluded. Main outcome measure All-cause mortality. Results Unemployment compared with employment in 1991 (ages 34–38 years) produced adjusted HRs (with 95% CIs) for all-cause mortality (3651 deaths) during follow-up to 2001 and after stratification by education of 2.35 (1.99 to 2.76) for compulsory education, 2.25 (1.97 to 2.58) for up to 3 years postcompulsory education and 1.90 (1.40 to 2.57) for more than 3 years postcompulsory education. When unemployment was compared with employment in 2001 (ages 45–49 years) with follow-up to 2010, the pattern of mortality risk (4271 deaths) stratified by education was reversed, producing adjusted HRs of 2.81 (2.47 to 3.21) for compulsory education, 2.87 (2.58 to 3.19) for up to 3 years postcompulsory education and 3.44 (2.78 to 4.25) for more than 3 years postcompulsory education. Interaction testing confirmed effect modification by age/period (p=0.003). The degree of gradient reversal was slightly less pronounced after stratification by cognitive function but produced a similar pattern of results (p=0.004). Conclusions Unemployment at older ages is associated with greater mortality risk than at younger ages, with the greatest relative increase in risk among men with markers of better health, suggesting the greater vulnerability of all older workers to

  10. Absence of the fourth tendon of the flexor digitorum brevis muscle: a cadaveric study.

    PubMed

    Bernhard, Andrew; Miller, Josh; Keeler, Jason; Siesel, Kathy; Bridges, Evan

    2013-08-01

    This study was undertaken to help confirm the percentages concerning the presence or absence of the flexor digitorum brevis muscle tendon to the fifth toe. We also hope to be able to determine the presence based on gender and nationality. It is known to be absent occasionally; however, there is no definitive study dedicated to its prevalence. Using a pool of 60 cadavers, 97 total feet were included in our analysis. Of these feet, 47 (48%) lacked a flexor digitorum brevis tendon to the fifth toe at all. Furthermore, 25 (26%) had notably small tendons to the fifth toe. The final 25 (26%) had what the researchers deemed present tendons. This information could be helpful in surgical planning, including tendon transfer techniques, and biomechanical evaluations. Further research would need to be conducted as this was a cadaveric study. Cadaver/anatomy research, Level V.

  11. Perceived Unmet Rehabilitation Needs 1 Year After Stroke: An Observational Study From the Swedish Stroke Register.

    PubMed

    Ullberg, Teresa; Zia, Elisabet; Petersson, Jesper; Norrving, Bo

    2016-02-01

    Met care demands are key aspects in poststroke quality of care. This study aimed to identify baseline predictors and 12-month factors that were associated with perceived unmet rehabilitation needs 1 year poststroke. Data on patients who were independent in activities of daily living, hospitalized for acute stroke during 2008 to 2010, and followed up 1 year poststroke through a postal questionnaire were obtained from the Swedish stroke register. Patients reporting fulfilled rehabilitation needs were compared with those with unmet needs (Chi square test). The study included 37 383 patients, 46% female. At 12 months, 8019 (21.5%) patients reported unmet rehabilitation needs. Compared with those with met rehabilitation needs, patients reporting unmet rehabilitation needs were older (75.4 versus 72.4 years; P<0.0001); a higher proportion was activities of daily living-dependent (59% versus 31.9%; P<0.0001) and institutionalized (24.3% versus 11.5%; P<0.0001) at 12 months. Poststroke depression (32.3% versus 24.9%; P<0.0001) and insufficient pain medication were more common in patients with unmet needs (54.5% versus 32.3%; P<0.0001). Baseline predictors of unmet rehabilitation needs at 12 months in an age-adjusted model were severe stroke (odds ratio [OR]=3.04; confidence interval [CI]: 2.39-3.87), prior stroke (OR=1.63; CI: 1.53-1.75), female sex (OR=1.14; CI: 1.07-1.20), diabetes mellitus (OR=1.24; CI: 1.15-1.32), stroke other than ischemic (OR=1.26; CI: 1.20-1.32), and atrial fibrillation (OR=1.19; CI: 1.12-1.27). Unfulfilled rehabilitation needs 1 year poststroke are common and associated with high age, dependency, pain, and depression. Long-term follow-up systems should, therefore, be comprehensive and address multiple domains of poststroke problems, rather than having a single-domain focus. © 2016 American Heart Association, Inc.

  12. Norwegian GPs' participation in multidisciplinary meetings: a register-based study from 2007.

    PubMed

    Hetlevik, Øystein; Gjesdal, Sturla

    2010-11-15

    An increasing number of patients with chronic disorders and a more complex health service demand greater interdisciplinary collaboration in Primary Health Care. The aim of this study was therefore to identify factors related to general practitioners (GPs), their list populations and practice municipalities associated with a high rate of GP participation in multidisciplinary meetings (MDMs). A national cross-sectional register-based study of Norwegian general practice was conducted, including data on all GPs in the Regular GP Scheme in 2007 (N = 3179). GPs were grouped into quartiles based on the annual number of MDMs per patient on their list, and the groups were compared using one-way analysis of variance. Binary logistic regression was used to analyse associations between high rates of participation and characteristics of the GP, their list population and practice municipality. On average, GPs attended 30 MDMs per year. The majority of the meetings concerned patients in the age groups 20-59 years. Psychological disorders were the motivation for 53% of the meetings. In a multivariate logistic regression model, the following characteristics predicted a high rate of MDM attendance: younger age of the GP, with an OR of 1.6 (95% CI 1.2-2.1) for GPs < 45 years, a short patient list, with an OR of 4.9 (3.2-7.5) for list sizes below 800 compared to lists ≥ 1600, higher proportion of psychological diagnosis in consultations (OR3.4 (2.6-4.4)) and a high MDM proportion with elderly patients (OR 4.1 (3.3-5.4)). Practising in municipalities with less than 10,000 inhabitants (OR 3.7 (2.8-4.9)) and a high proportion of disability pensioners (OR 1.6 (1.2-2.2)) or patients receiving social assistance (OR 2.2 (1.7-2.8)) also predicted high rates of meetings. Psychological problems including substance addiction gave grounds for the majority of MDMs. GPs with a high proportion of consultations with such problems also participated more frequently in MDMs. List size was negatively

  13. Diagnosed Anxiety Disorders and the Risk of Subsequent Anorexia Nervosa: A Danish Population Register Study.

    PubMed

    Meier, Sandra M; Bulik, Cynthia M; Thornton, Laura M; Mattheisen, Manuel; Mortensen, Preben B; Petersen, Liselotte

    2015-11-01

    Anxiety disorders and anorexia nervosa are frequently acknowledged to be highly comorbid conditions, but still, little is known about the clinical and aetiological cohesion of specific anxiety diagnoses and anorexia nervosa. Using the comprehensive Danish population registers, we aimed to determine the risk of anorexia nervosa in patients with register-detected severe anxiety disorders. We also explored whether parental psychopathology was associated with offspring's anorexia nervosa. Anxiety disorders increased the risk of subsequent anorexia nervosa, with the highest risk observed in obsessive-compulsive disorder. Especially, male anxiety patients were at an increased risk for anorexia nervosa. Furthermore, an increased risk was observed in offspring of fathers with panic disorder. A diagnosis of an anxiety disorder, specifically obsessive-compulsive disorder, constitutes a risk factor for subsequent diagnosis of anorexia nervosa. These observations support the notion that anxiety disorders and anorexia nervosa share etiological mechanisms and/or that anxiety represents one developmental pathway to anorexia nervosa.

  14. Disease burden of herpes zoster in Sweden - predominance in the elderly and in women - a register based study

    PubMed Central

    2013-01-01

    Background The herpes zoster burden of disease in Sweden is not well investigated. There is no Swedish immunization program to prevent varicella zoster virus infections. A vaccine against herpes zoster and its complications is now available. The aim of this study was to estimate the herpes zoster burden of disease and to establish a pre-vaccination baseline of the minimum incidence of herpes zoster. Methods Data were collected from the Swedish National Health Data Registers including the Patient Register, the Pharmacy Register, and the Cause of Death Register. The herpes zoster burden of disease in Sweden was estimated by analyzing the overall, and age and gender differences in the antiviral prescriptions, hospitalizations and complications during 2006-2010 and mortality during 2006-2009. Results Annually, 270 per 100,000 persons received antiviral treatment for herpes zoster, and the prescription rate increased with age. It was approximately 50% higher in females than in males in the age 50+ population (rate ratio 1.39; 95% CI, 1.22 to 1.58). The overall hospitalization rate for herpes zoster was 6.9/100,000 with an approximately three-fold increase for patients over 80 years of age compared to the age 70-79 group. A gender difference in hospitalization rates was observed: 8.1/100,000 in females and 5.6/100,000 in males. Herpes zoster, with a registered complication, was found in about one third of the hospitalized patients and the most common complications involved the peripheral and central nervous systems. Death due to herpes zoster was a rare event. Conclusions The results of this study demonstrate the significant burden of herpes zoster disease in the pre-zoster vaccination era. A strong correlation with age in the herpes zoster- related incidence, hospitalization, complications, and mortality rates was found. In addition, the study provides further evidence of the female predominance in herpes zoster disease. PMID:24330510

  15. Assessing vaccination coverage in infants, survey studies versus the Flemish immunisation register: achieving the best of both worlds.

    PubMed

    Braeckman, Tessa; Lernout, Tinne; Top, Geert; Paeps, Annick; Roelants, Mathieu; Hoppenbrouwers, Karel; Van Damme, Pierre; Theeten, Heidi

    2014-01-09

    Infant immunisation coverage in Flanders, Belgium, is monitored through repeated coverage surveys. With the increased use of Vaccinnet, the web-based ordering system for vaccines in Flanders set up in 2004 and linked to an immunisation register, this database could become an alternative to quickly estimate vaccination coverage. To evaluate its current accuracy, coverage estimates generated from Vaccinnet alone were compared with estimates from the most recent survey (2012) that combined interview data with data from Vaccinnet and medical files. Coverage rates from registrations in Vaccinnet were systematically lower than the corresponding estimates obtained through the survey (mean difference 7.7%). This difference increased by dose number for vaccines that require multiple doses. Differences in administration date between the two sources were observed for 3.8-8.2% of registered doses. Underparticipation in Vaccinnet thus significantly impacts on the register-based immunisation coverage estimates, amplified by underregistration of administered doses among vaccinators using Vaccinnet. Therefore, survey studies, despite being labour-intensive and expensive, currently provide more complete and reliable results than register-based estimates alone in Flanders. However, further improvement of Vaccinnet's completeness will likely allow more accurate estimates in the nearby future.

  16. Gastro esophageal reflux disease is associated with absence from work: Results from a prospective cohort study

    PubMed Central

    Leodolter, Andreas; Nocon, Marc; Kulig, Michael; Willich, Stefan N; Malfertheiner, Peter; Labenz, Joachim

    2005-01-01

    AIM: To study the association of gastro-esophageal reflux disease (GERD) with the absence from work and to estimate the extent of loss in gross domestic product due to inability to work. METHODS: Analysis was based on the prospectively gathered data of a large European cohort study involving 6 215 symptomatic GERD patients (ProGERD). Among these patients, 2 871 were initially employed. The calculation of the loss of gross domestic product was based on the assumption that the prevalence of GERD was about 15% in Germany. According to the German Federal Statistical Office, the mean gross wage of employees was 150 €/d in 2002. RESULTS: The data of 2 078 employed patients who were prospectively followed up for over 2 years were analyzed. At study entry, the patients reported a mean of 1.8 d per year of inability to work. During the prospective follow-up under routine clinical care, the proportion of patients reporting days with inability to work decreased from 14% to 6% and the mean number of days per year with inability to work decreased to 0.9 d. Assuming a prevalence of troublesome GERD of 15% in the employed German population, the loss of gross domestic product amounted to 668 million €/year in Germany. CONCLUSION: GERD causes a relevant impairment on the national economics by absence from work. The presented data demonstrate the importance of GERD, not only for patients and health insurance companies, but also for the community at large. PMID:16437662

  17. Subliminal semantic priming in near absence of attention: A cursor motion study.

    PubMed

    Xiao, Kunchen; Yamauchi, Takashi

    2015-12-15

    The role of attention in subliminal semantic priming remains controversial: some researchers argue that attention is necessary for subliminal semantic priming, while others suggest that subliminal semantic processing is free from the influence of attention. The present study employs a cursor motion method to measure priming and evaluate the influence of attention. Specifically, by employing a semantic priming task developed by Naccache, Blandin, and Dehaene (2002), we investigate the extent to which top-down attention influences semantic priming. Results indicate that, consistent with the Naccache et al. (2002) results, attention facilitates priming. However, inconsistent with their theory, significant priming is still observed even in near absence of attention. We suggest that top-down attention helps but is not necessary for subliminal semantic processing.

  18. Are risk factors for atherothrombotic disease associated with back pain sickness absence? The Whitehall II Study

    PubMed Central

    Hemingway, H.; Shipley, M.; Stansfeld, S.; Shannon, H.; Frank, J.; Brunner, E.; Marmot, M.

    1999-01-01

    STUDY OBJECTIVE: To explore the previously stated hypothesis that risk factors for atherothrombotic disease are associated with back pain. DESIGN: Prospective (mean of four years of follow up) and retrospective analyses using two main outcome measures: (a) short (< or = 7 days) and long (> 7 days) spells of sickness absence because of back pain reported separately in men and women; (b) consistency of effect across the resulting four duration of spell and sex cells. SETTING: 14 civil service departments in London. PARTICIPANTS: 3506 male and 1380 female white office-based civil servants, aged 35-55 years at baseline. MAIN RESULTS: In age adjusted models, low apo AI was associated with back pain across all four duration-sex cells and smoking was associated across three cells. Six factors were associated with back pain in two cells: low exercise and high BMI, waist-hip ratio, triglycerides, insulin and Lp(a). On full adjustment (for age, BMI, employment grade and back pain at baseline), each of these factors retained a statistically significant effect in at least one duration-sex cell. Triglycerides were associated with short and long spells of sickness absence because of back pain in men in fully adjusted models with rate ratios (95% confidence intervals) of 1.53 (1.1, 2.1) and 1.75 (1.0, 3.2) respectively. There was little or no evidence of association in age adjusted models with: fibrinogen, glucose tolerance, total cholesterol, apoB, hypertension, factor VII, von Willebrand factor, electrocardiographic evidence of coronary heart disease and reported angina. CONCLUSIONS: In this population of office workers, only modest support was found for an atherothrombotic component to back pain sickness absence. However, the young age of participants at baseline and the lack of distinction between different types of back pain are likely to bias the findings toward null. Further research is required to ascertain whether a population sub-group of atherothrombotic back pain can

  19. The First 500 Registrations to the Research Registry(®): Advancing Registration of Under-Registered Study Types.

    PubMed

    Agha, Riaz; Fowler, Alexander J; Limb, Christopher; Al Omran, Yasser; Sagoo, Harkiran; Koshy, Kiron; Jafree, Daniyal J; Anwar, Mohammed Omer; McCullogh, Peter; Orgill, Dennis Paul

    2016-01-01

    The Declaration of Helsinki 2013 encourages the registration of all research studies involving human participants. However, emphasis has been placed on prospective clinical trials, and it is estimated that only 10% of observational studies are registered. In response, Research Registry(®) was launched in February 2015; a retrospectively curated registry that is free and easy to use. Research Registry(®) enables prospective or retrospective registration of studies, including those study types that cannot be registered on existing registries. In this study, we describe the first 500 registrations on Research Registry(®). Since the launch of Research Registry(®) in February 2015, data of registrations have been collected, including type of studies registered, country of origin, and data curation activity. Inappropriate registrations, such as duplicates, were identified by the data curation process. These were removed from the database or modified as required. A quality score was assigned for each registration, based on Sir Austin Bradford Hill's criteria on what research studies should convey. Changes in quality scores over time were assessed. A total of 500 studies were registered on Research Registry(®) from February 2015 to October 2015, with a total of 1.7 million patients enrolled. The most common study types were retrospective cohort studies (37.2%), case series (14.8%), and first-in-man case reports (10.4%). Registrations were received from 57 different countries; the most submissions were received from Turkey, followed by China and the United Kingdom. Retrospective data curation identified 80 studies that were initially registered as the incorrect study type, and were subsequently correct. The Kruskal-Wallis test identified a significant improvement in quality scores for registrations from February 2015 to October 2015 (p < 0.0001). Since its conception in February 2015, Research Registry(®) has established itself as a new registry that is free, easy

  20. Register-based data indicated nonparticipation bias in a health study among aging people.

    PubMed

    Nummela, Olli; Sulander, Tommi; Helakorpi, Satu; Haapola, Ilkka; Uutela, Antti; Heinonen, Heikki; Valve, Raisa; Fogelholm, Mikael

    2011-12-01

    To examine nonparticipation in a survey by linking it with register information and identify potential nonresponse bias of inequalities in health status among aging people. Cross-sectional questionnaire survey with clinical checkups carried out in 2002 among persons born in 1926-1930, 1936-1940, and 1946-1950 in Southern Finland. The sample was linked with register information from Statistics Finland and analyzed in terms of participation and health status as measured by medicine reimbursements. Participation in the survey was more frequent among those who were older, female, married or cohabiting, higher educated and nonurban residents, and those with higher income and moderate health. Among nonrespondents, women were less healthy than men, whereas among respondents, the results were reversed. Among nonrespondents, better income was associated with unfavorable health. Poor health was generally more common among nonrespondents than respondents in several subgroups. Differences in response rates were found in sociodemographic factors, health, and socioeconomic position. Favorable health was generally more frequent among respondents than nonrespondents. In particular, health inequalities by gender and income differed between respondents and nonrespondents. Thus, nonresponse may lead to bias in analyses of health inequalities among aging people. Copyright © 2011 Elsevier Inc. All rights reserved.

  1. Volume of procedures and risk of recurrence after repair of groin hernia: national register study

    PubMed Central

    2008-01-01

    Objective To determine whether the association between volume and outcome found in major surgery also holds true for a minor operation. Design Review of outcomes after hernia surgery in Sweden. Setting Surgical units registered with the Swedish hernia register, which in 2004 covered about 95% of all hernia operations in Sweden. Participants 86 409 patients over 15 years, who underwent 96 601 unilateral or bilateral groin hernia repairs (94 077 inguinal and 2524 femoral) in 1996-2004 at the participating surgical units. Main outcome measure Re-operation for recurrence. Results There was a significantly higher rate of re-operation in surgeons who carried out 1-5 repairs a year than in surgeons who carried out more repairs. There was no association between outcome and further increases in volume. Although about half of surgeons in Sweden who repair hernias are low volume operators, they performed only 8.4% of all repairs. Conclusions Sweden’s numerous low volume hernia surgeons perform such a small proportion of all operations that the impact of their inferior results on the nationwide re-operation rate is minimal. Volume indicates an approximate minimum value for the number of hernia repairs a surgeon should do each year but the outcome in surgeons who carry out more than that number disqualifies volume as an indicator of proficiency. PMID:18426843

  2. Relevance of the 1-year dog study in assessing human health risks for registration of pesticides. An update to include pesticides registered in Japan.

    PubMed

    Kobel, Werner; Fegert, Ivana; Billington, Richard; Lewis, Richard; Bentley, Karin; Langrand-Lerche, Carole; Botham, Phil; Sato, Masako; Debruyne, Eric; Strupp, Christian; van Ravenzwaay, Bennard

    2014-11-01

    Over 400 active pesticides are registered in Japan (FAMIC 2013). The results of dog toxicity studies (usually, the 1-year study) were used by the Japanese regulatory authorities to establish the acceptable daily intake (ADI) for 45 pesticide active ingredients (about 9%). A retrospective review of ADIs established in Japan with dog studies as pivotal data for their derivation was performed: the ADIs were reassessed under the assumption that the 1-year dog study would not be available and an alternate ADI was derived based on the remaining toxicology database. In 35 of the 45 cases (77.8%) the ADI resulting from the absence of the 1-year dog study was no greater than twice the Japanese ADI, a difference considered not to be of biological significance. In 6 cases (13%) the resulting ADI was 2-5 times higher, which is considered of questionable biological relevance. On further evaluation of the database, three of these six cases were assessed as to clarify that there is no clear difference and for the other three additional studies to clarify that uncertain findings would have been required. In 3 of the 45 cases (7%) there may be a real difference within the ADI ratio of 2-5. Only in 1 case (2.2%) ADI was five times higher than that has been set. Accordingly, the absence of a 1-year dog study does not appear to influence the ADI derivation in a relevant manner in more than 98% of cases. For the four compounds with a real difference in ADI, consumer exposure would still be well below the alternative ADI. Therefore, a strong case can be made that the standard mandatory requirement to conduct a 1-year dog study, in addition to the 3-month study, is not justified and of no additional value in protecting human health. In addition, a substantial reduction in test animals could be achieved.

  3. Analysis of risk factors for schizophrenia with two different case definitions: a nationwide register-based external validation study.

    PubMed

    Sørensen, Holger J; Larsen, Janne T; Mors, Ole; Nordentoft, Merete; Mortensen, Preben B; Petersen, Liselotte

    2015-03-01

    Different case definitions of schizophrenia have been used in register based research. However, no previous study has externally validated two different case definitions of schizophrenia against a wide range of risk factors for schizophrenia. We investigated hazard ratios (HRs) for a wide range of risk factors for ICD-10 DCR schizophrenia using a nationwide Danish sample of 2,772,144 residents born in 1955-1997. We compared one contact only (OCO) (the case definition of schizophrenia used in Danish register based studies) with two or more contacts (TMC) (a case definition of at least 2 inpatient contacts with schizophrenia). During the follow-up, the OCO definition included 15,074 and the TMC 7562 cases; i.e. half as many. The TMC case definition appeared to select for a worse illness course. A wide range of risk factors were uniformly associated with both case definitions and only slightly higher risk estimates were found for the TMC definition. Choosing at least 2 inpatient contacts with schizophrenia (TMC) instead of the currently used case definition would result in almost similar risk estimates for many well-established risk factors. However, this would also introduce selection and include considerably fewer cases and reduce power of e.g. genetic studies based on register-diagnosed cases only.

  4. Registered nurses' personal responses to postoperative pain: a descriptive qualitative study.

    PubMed

    Mackintosh-Franklin, Carolyn

    2014-09-01

    This paper explores if nurses' personal responses to postoperative pain contribute to its continuing poor management. A descriptive qualitative design used a purposive sample of 16 registered nurses (RNs), from inpatient surgical areas in the United Kingdom, to participate in one semistructured interview. These were recorded and transcribed verbatim. Analysis used Morse and Field's four stages. A complex picture of collective and individual responses emerged; uncritical adoption of the medical model, with pain as normal and focus on technical aspects of management conforming to a "reference typology." However, individual RNs were also influenced by other personal factors, and findings indicate that scrutinizing individual competency is essential to improve individual and collective practice. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  5. An exploratory study of selected female registered nurses: meaning and expression of nurturance.

    PubMed

    Geissler, E M

    1990-05-01

    The words 'nurse' and 'nursing' originate in the word 'nurture' which dates back to the 14th century. 'Nurturance' appeared for the first time in the 1976 Supplement to the Oxford English Dictionary and in a United States dictionary in 1983. Etymologically and semantically bound to nursing, little is known about the term nurturance. An exploratory design using phenomenological analysis was applied to understand the female registered nurses' experience of nurturing patients throughout the life-span and to uncover behaviours commonly believed nurturant. Interviews with 14 RNs practising in diverse settings revealed 39 nurturant behaviours that were intuited into four themes describing the subjects' perceived structure of nurturance as: (1) enabling maximum potential; (2) providing physical and emotional protection; (3) engaging in a supportive interaction; and (4) conveying shared humanity. Data were formulated into an exhaustive description of the phenomenon nurturance. Additionally, the results support Greenberg-Edelstein's theoretical model of the positive reciprocity of nurturance between nurse and patient.

  6. Non-minor injuries among children sustained in an outdoor environment--a retrospective register study.

    PubMed

    Gyllencreutz, Lina; Rolfsman, Ewa; Saveman, Britt-Inger

    2015-01-01

    The aim was to investigate non-minor injuries sustained during outdoor activities among 0-12 year old children and to explore self-reported circumstances surrounding these incidents. During 2007-2009, the Umeå University Hospital injury database (IDB) registered 795 children with moderate (n = 778) and serious (n = 17) injuries, such as fractures. The IDB includes data from a questionnaire completed in the emergency department by the injured child or a parent. The open-ended questions catch the injured child's description of what circumstances precede the injury incident. The most commonly reported activities contributing to injuries were play, sport, and transport. Surface impacts were also reported as contributing factors along with products such as trampolines, bicycles, and downhill skis. By achieving a deeper knowledge about the activities and circumstances that precede non-minor injury incidents, creating safer outdoor environments may be feasible.

  7. Nurses' work environment and nursing outcomes: a survey study among Finnish university hospital registered nurses.

    PubMed

    Tervo-Heikkinen, Tarja; Partanen, Pirjo; Aalto, Pirjo; Vehviläinen-Julkunen, Katri

    2008-10-01

    The aim was to assess the interrelationships between nurses' work environment and nursing outcomes. A cross-sectional survey of 664 registered nurses (RN) on 34 acute care inpatient hospital wards was used to measure nurses' perceptions. Patient data (n = 4045) consisting of a total patient satisfaction indicator were collected simultaneously with the nurse data during year 2005. RN's assessments of staffing adequacy, respect and relationships were the most important factors of work environment having an influence on job-related stress, job satisfaction, patient satisfaction and adverse events to patients and nurses. Some 77% of the RN reported adverse nurse events and 96% reported adverse patient events during a 3 month retrospective period. Ensuring sufficient and suitably qualified nurses' availability in delivering nursing care is an important management issue. Nurses are concerned about the quality of care, and the concerns perceived by nurses can influence their clinical work.

  8. Understanding eating in the absence of hunger among young children: A systematic review of existing studies

    PubMed Central

    Lansigan, Reina K.; Emond, Jennifer A.; Gilbert-Diamond, Diane

    2014-01-01

    Background Eating in the Absence of Hunger (EAH), or consuming highly palatable foods when satiated, is one behavioral pathway that may lead to childhood obesity. EAH is an objective, laboratory-based measure. A more comprehensive understanding of potential determinants of EAH could inform childhood obesity programs outside of a laboratory setting. Objective Systematic review of EAH experiments to identify individual, familial, and societal-level correlates of EAH among children 12 years of age or younger. Design 1,487 studies were retrieved from five electronic databases (Medline [PubMed], Web of Science, Cochrane Library, CINAHL, PsycINFO). Eligible studies were those that measured EAH as initially operationalized in a laboratory setting enrolling children ≤12 years or reporting age-specific results for children ≤12 years. Only articles written in English were included. Results 12 cross-sectional, six prospective, and one behavioral-intervention studies were included in the review. EAH was observable among boys and girls; absolute levels of EAH increased with age; and maternal feeding styles were associated with EAH among girls. The most consistent evidence supported increased levels of EAH among overweight and obese versus normal weight children, both cross-sectionally and prospectively. Two studies supported a genetic component to EAH. Conclusions Studies enrolling independent samples support a positive association between weight status and EAH among children; studies addressing causality are needed. Other various individual, genetic, and familiar characteristics were associated with EAH, yet studies among more heterogeneous sample populations are needed to confirm findings. Studies addressing societal-level factors related to EAH were absent. PMID:25450900

  9. Socioeconomic inequalities in access to specialized psychotropic prescribing among older Swedes: a register-based study

    PubMed Central

    Fastbom, Johan; Ringbäck Weitoft, Gunilla; Fors, Stefan; Johnell, Kristina

    2014-01-01

    Background: Mental disorders among older adults are mainly treated with psychotropic drugs. Few of these drugs are, however, prescribed by specialized geriatricians or psychiatrists, but rather from general practitioners (GPs). Socioeconomic inequalities in access to specialist prescribing have been found in younger age groups. Hence, we aimed to investigate whether there are socioeconomic differences in access to geriatrician and psychiatrist prescribing of psychotropic drugs among older adults. Methods: By record-linkage of The Swedish Prescribed Drug Register and The Swedish Education Register, we obtained information for persons aged 75–89 years who had filled a prescription for psychotropic drugs (antipsychotics, anxiolytics, hypnotic/sedatives or antidepressants) with information on prescriber specialty from July to October 2005 (n = 221 579). Multinomial regression analysis was used to investigate whether education was associated with geriatrician and psychiatrist prescribing of psychotropic drugs. Results: The vast majority of the psychotropic drugs were prescribed by ‘GPs and other specialists’ (∼95% GPs). Older adults with higher educational level were more likely to be prescribed psychotropic drugs from psychiatrists and geriatricians. However, after adjustment for place of residence, the association between patient’s education and prescription by a geriatrician disappeared, whereas the association with seeing a psychiatrist was only attenuated. Conclusion: Access to specialized prescribing of psychotropics is unequally distributed between socioeconomic groups of older adults in Sweden. This finding was partially confounded by place of residence for geriatrician but not for psychiatrist prescribing. Further research should examine if inequalities in specialized psychotropic prescribing translate into worse outcomes for socioeconomically deprived and non-metropolitan-living older individuals. PMID:24860048

  10. Comparative study of treatment dose plans after the refinement of Leksell Gamma Knife registered single-beam dose profiles

    SciTech Connect

    Cheung, Joel Y. C.; Ng, K. P.; Yu, C. P.; Ho, Robert T. K.

    2007-09-15

    We investigated the amplification of discrepancy when using multiple shots of the same collimator size helmet, by comparing dose plans in the Leksell GammaPlan registered employing the default single-beam dose profiles and the Monte Carlo generated single-beam profiles. Four collimator helmets were studied. The results show that the largest amplification of discrepancy with multiple shots was found with the 8 mm collimator because of the largest discrepancy of its single-beam dose profile. The amplification of discrepancy is significant when tumor volumes increase but insignificant when the tumor volumes are in an elongated shape. Using close shot overlapping strategy (i.e., more shots close packed together) shows no observable increase in the amplification of discrepancy. For the best quality of Leksell Gamma Knife registered radiosurgery, it is suggested that the single-beam dose profiles should be refined, especially the 8 mm collimator, to prevent error amplification when using multiple collimator shots.

  11. Psychiatric status among stepchildren and domestic and international adoptees in Denmark. A comparative nationwide register-based study.

    PubMed

    Laubjerg, Merete; Christensen, Anne Maj; Petersson, Birgit

    2009-08-01

    To investigate adoptees' psychiatric contact compared with non-adoptees and to clarify the related diagnoses. Observational, nationwide, register-based study, where correlations between psychiatric, demographic and socioeconomic variables were analyzed for adoptees compared with non-adoptees. The study period is 1992-2008. The setting is Denmark, encompassing seven different types of adoptees registered from 1988 to 2005 (n = 13,524). The non-adoptees (n = 839,989) are matched on sex, age and residence. Various comparison models are designed: one with delayed entries (17 years) shows a 5.0% psychiatric contact prevalence for non-adoptees and 9.2% for adoptees (adjusted odds ratio: 2.91). Another design without delayed entries (2 years) shows a 2% prevalence for non-adoptees and 3.9% for adoptees (adjusted odds ratio 2.65). p-values <0.0005. Only one type of adoptee: ''registered partner's adoption of the other partner's child'' has a lower risk than non-adoptees (odds ratio: 0.26). Comparison within the same birth region shows a significant increased risk for most adoption types. More adoptees than non-adoptees have more than one contact. Age at adoption is an additional risk factor for4one year only. The most frequent diagnosis is ''Inherent or acquired brain suffering'' (ICD-10: F50 - F99). The results stress that ''adoptee'' is an independent risk factor for psychiatric contact for international as well as for Danish adoptees. Danish stepchildren have a higher risk than non-adopted Danish children, while ''registered partner's child adopted by the other partner'' have a lower risk than non-adopted Danish children.

  12. High-pressure study of lithium amidoborane using Raman spectroscopy and insight into dihydrogen bonding absence

    PubMed Central

    Najiba, Shah; Chen, Jiuhua

    2012-01-01

    One of the major obstacles to the use of hydrogen as an energy carrier is the lack of proper hydrogen storage material. Lithium amidoborane has attracted significant attention as hydrogen storage material. It releases ∼10.9 wt% hydrogen, which is beyond the Department of Energy target, at remarkably low temperature (∼90 °C) without borazine emission. It is essential to study the bonding behavior of this potential material to improve its dehydrogenation behavior further and also to make rehydrogenation possible. We have studied the high-pressure behavior of lithium amidoborane in a diamond anvil cell using in situ Raman spectroscopy. We have discovered that there is no dihydrogen bonding in this material, as the N—H stretching modes do not show redshift with pressure. The absence of the dihydrogen bonding in this material is an interesting phenomenon, as the dihydrogen bonding is the dominant bonding feature in its parent compound ammonia borane. This observation may provide guidance to the improvement of the hydrogen storage properties of this potential material and to design new material for hydrogen storage application. Also two phase transitions were found at high pressure at 3.9 and 12.7 GPa, which are characterized by sequential changes of Raman modes. PMID:23115332

  13. Silent speechreading in the absence of scanner noise: an event-related fMRI study.

    PubMed

    MacSweeney, M; Amaro, E; Calvert, G A; Campbell, R; David, A S; McGuire, P; Williams, S C; Woll, B; Brammer, M J

    2000-06-05

    In a previous study we used functional magnetic resonance imaging (fMRI) to demonstrate activation in auditory cortex during silent speechreading. Since image acquisition during fMRI generates acoustic noise, this pattern of activation could have reflected an interaction between background scanner noise and the visual lip-read stimuli. In this study we employed an event-related fMRI design which allowed us to measure activation during speechreading in the absence of acoustic scanner noise. In the experimental condition, hearing subjects were required to speechread random numbers from a silent speaker. In the control condition subjects watched a static image of the same speaker with mouth closed and were required to subvocally count an intermittent visual cue. A single volume of images was collected to coincide with the estimated peak of the blood oxygen level dependent (BOLD) response to these stimuli across multiple baseline and experimental trials. Silent speechreading led to greater activation in lateral temporal cortex relative to the control condition. This indicates that activation of auditory areas during silent speechreading is not a function of acoustic scanner noise and confirms that silent speechreading engages similar regions of auditory cortex as listening to speech.

  14. Inferring the absence of a species -- a case study of snakes

    USGS Publications Warehouse

    Kery, M.

    2002-01-01

    Though the presence of a species can be unequivocally confirmed, its absence can only be inferred with a degree of probability. I used a model to calculate the minimum number of unsuccessful visits to a site that are necessary to assume that a species is absent. The model requires the probability of detection of the species per visit to be known. This probability, may vary depending on habitat, year, season, the area surveyed, the population size of the species, and the observer. I studied 3 European snake species---asp viper (Vipera aspis), smooth snake (Coronella austriaca), and grass snake (Natrix natrix)--over a 5-yr (1994--1998) interval, and made 645 visits to 87 sites during their activity periods. I used a generalized logistic regression approach with random effects for years and sites to (1) estimate the probability of detection of these species from sites known to be occupied, (2) test factors affecting it, and (3) compute the minimum number of times that a site must be visited to infer the absence of the particular species. Probability of detection for all species was heavily influenced by an index of population size. For V. aspis, probability, of detection increased from 0.23 to 0.50 and 0.70 in small, medium, and large populations, respectively. Similarly, probability of detection increased from 0.09 to 0.45 and 0.56 in small, medium, and large populations of C. austriaca, respectively, and from 0.11 in small to 0.25 in medium and large populations of N. natrix. Probability of detection also varied across months for all 3 species, among habitat types ( C. austriaca only), and from year to year (N. natrix only). Sites with unknown occupancy status conservatively may be assumed to be occupied by small populations. I calculated that such sites need to be surveyed 12, 34, and 26 times for V. aspis, C. austriaca, and N. natrix, respectively, before assuming with 95% probability that the site is unoccupied. These results suggest that some species may be more

  15. How registered nurses, licensed practical nurses and resident aides spend time in nursing homes: An observational study.

    PubMed

    McCloskey, Rose; Donovan, Cindy; Stewart, Connie; Donovan, Alicia

    2015-09-01

    Calls for improved conditions in nursing homes have pointed to the importance of optimizing the levels and skills of care providers. Understanding the work of care providers will help to determine if staff are being used to their full potential and if opportunities exist for improved efficiencies. To explore the activities of care providers in different nursing homes and to identify if variations exist within and across homes and shifts. A multi-centre cross-sectional observational work flow study was conducted in seven different nursing homes sites in one Canadian province. Data were collected by a research assistant who conducted 368 h of observation. The research assistant collected data by following an identical route in each site and recording observations on staff activities. Findings indicate staff activities vary across roles, sites and shifts. Licensed practical nurses (nursing assistants) have the greatest variation in their role while registered nurses have the least amount of variability. In some sites both registered nurses and licensed practical nurses perform activities that may be safely delegated to others. Care providers spend as much as 53.7% of their time engaged in non-value added activities. There may be opportunities for registered nurses and licensed practical nurses to delegate some of their activities to non-regulated workers. The time care providers spend in non-value activities suggest there may be opportunities to improve efficiencies within the nursing home setting. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Altered Effective Connectivity Network in Childhood Absence Epilepsy: A Multi-frequency MEG Study.

    PubMed

    Wu, Caiyun; Xiang, Jing; Jiang, Wenwen; Huang, Shuyang; Gao, Yuan; Tang, Lu; Zhou, Yuchen; Wu, Di; Chen, Qiqi; Hu, Zheng; Wang, Xiaoshan

    2017-03-12

    Using multi-frequency magnetoencephalography (MEG) data, we investigated whether the effective connectivity (EC) network of patients with childhood absence epilepsy (CAE) is altered during the inter-ictal period in comparison with healthy controls. MEG data from 13 untreated CAE patients and 10 healthy controls were recorded. Correlation analysis and Granger causality analysis were used to construct an EC network at the source level in eight frequency bands. Alterations in the spatial pattern and topology of the network in CAE were investigated by comparing the patients with the controls. The network pattern was altered mainly in 1-4 Hz, showing strong connections within the frontal cortex and weak connections in the anterior-posterior pathways. The EC involving the precuneus/posterior cingulate cortex (PC/PCC) significantly decreased in low-frequency bands. In addition, the parameters of graph theory were significantly altered in several low- and high-frequency bands. CAE patients display frequency-specific abnormalities in the network pattern even during the inter-ictal period, and the frontal cortex and PC/PCC might play crucial roles in the pathophysiology of CAE. The EC network of CAE patients was over-connective and random during the inter-ictal period. This study is the first to reveal the frequency-specific alteration in the EC network during the inter-ictal period in CAE patients. Multiple-frequency MEG data are useful in investigating the pathophysiology of CAE, which can serve as new biomarkers of this disorder.

  17. [Descriptive Study of sickness absence in the health care sector of Catalonia (2009-2012)].

    PubMed

    Vilardell, Miquel; Esteve Pardo, Maria; Carreras Valls, Rosa; Olivé Cristany, Victòria; Bretau Viñas, Frederic; Subirats Cid, Pilar; Sánchez Flores, Eugenia; Villegas Rodríguez, Sonia; Guixeras Campos, Assumpció; Torrecillas Mota, Susana; Barroso Reinon, Sonia; Serra Pujadas, Consol; Santiñà Vila, Manel

    2016-01-01

    To describe the incidence and evolution of sickness absence (SA) for non-occupational and occupational illness/injury in the population of workers in Catalonian Health Centers based on the definition of a set of common indicators. The study population consisted of 25,964 workers from 30 health centers in Catalonia, during 2009-2012. Information on SA episodes was obtained from records of the Directorate of Human Resources. SA indicators were defined, and SA incidence rates and temporal evolution were calculated, depending on the length and type of episode, and the size and activity of health centers. SA incidence rates for non-occupational illness and injury showed a decreasing trend during 2009-2012. Smaller centers had lower SA rates for non-occupational conditions than larger centers (p〈0.001). Social health centers had higher SA rates of non-occupational illness and injury, especially those with a very short duration (p〈0.001). Primary care centers had the lowest SA occupational illness and injury rates, with the highest rates occurring in the social health centers, especially long-term centers (p〈0.001). The differences in incidence rates of SA detected by type of activity of the health centers could be due to differences in working conditions. Copyright belongs to the Societat Catalana de Salut Laboral.

  18. An experimental study of a plasma actuator in absence of free airflow: Ionic wind velocity profile

    SciTech Connect

    Mestiri, R.; Hadaji, R.; Ben Nasrallah, S.

    2010-08-15

    In this study, we are interested in the direct current electrical corona discharge created between two wire electrodes. The experimental results are related to some electroaerodynamic actuators based on the direct current corona discharge at the surface of a dielectric material. Several geometrical forms are selected for the dielectric surface, such as a plate, a cylinder, and a NACA 0015 aircraft wing. The current density-electric field characteristics are presented for different cases in order to determine the discharge regimes. The corona discharge produces nonthermal plasma, so it is called plasma discharge. Plasma discharge creates a tangential ionic wind above the surface at the vicinity of the wall. The ionic wind induced by the corona discharge is measured in absence of free external airflow. The ionic wind velocity profiles and the maximum induced tangential force are given for different surface forms, so it is possible to compare the actuators effect based on the span of the ionic wind velocity and thrust values. The higher ionic wind velocity is obtained with the NACA profile, which shows the effectiveness of this actuator for the airflow control.

  19. U(VI)-kaolinite surface complexation in absence and presence of humic acid studied by TRLFS.

    PubMed

    Krepelova, Adela; Brendler, Vinzenz; Sachs, Susanne; Baumann, Nils; Bernhard, Gert

    2007-09-01

    Time-resolved laser-induced fluorescence spectroscopy (TRLFS) was applied to study the U(VI) surface complexes on kaolinite in the presence and absence of humic acid (HA). Two uranyl surface species with fluorescence lifetimes of 5.9 +/- 1.4 and 42.5 +/- 3.4 micros and 4.4 +/- 1.2 and 30.9 +/- 7.2 micros were identified in the binary (U(VI)-kaolinite) and ternary system (U(VI)-HA-kaolinite), respectively. The fluorescence spectra of adsorbed uranyl surface species are described with six and five fluorescence emission bands in the binary and ternary system, respectively. The positions of peak maxima are shifted significantly to higher wavelengths compared to the free uranyl ion in perchlorate medium. HA has no influence on positions of the fluorescence emission bands. In the binary system, both surface species can be attributed to adsorbed bidentate mononuclear surface complexes, which differ in the number of water molecules in their coordination environment. In the ternary system, U(VI) prefers direct binding on kaolinite rather than via HA, but it is sorbed as a uranyl-humate complex. Consequently, the hydration shell of the U(VI) surface complexes is displaced with complexed HA, which is simultaneously distributed between kaolinite particles. Aluminol binding sites are assumed to control the sorption of U(VI) onto kaolinite.

  20. Studies of the lethargic (lh/lh) mouse model of absence seizures: regulatory mechanisms and identification of the lh gene.

    PubMed

    Hosford, D A; Lin, F H; Wang, Y; Caddick, S J; Rees, M; Parkinson, N J; Barclay, J; Cox, R D; Gardiner, R M; Hosford, D A; Denton, P; Wang, Y; Seldin, M F; Chen, B

    1999-01-01

    To understand the cellular and molecular mechanisms that underlie generalized absence seizures sufficiently well to design rational, efficacious new therapies for patients, it is necessary to turn to animal models to gain insights into these mechanisms. The lethargic (lh/lh) mutant mouse expresses spontaneous absence seizures that share behavioral, electrographic, and anticonvulsant profiles with absence seizures in patients. This validates its use to study the mechanisms that underlie absence seizures. This chapter discusses two scientific approaches that involve the use of lh/lh mice. The first part of the chapter discusses neurobiologic approaches used to investigate critical mechanisms that regulate the synchronized burst firing within the thalamocortical network that generates absence seizures. Two of these critical mechanisms have been studied in detail with lh/lh mice. The first critical mechanism involves the required activation of gamma-aminobutyric acid B (GABAB) receptors to generate absence seizures. Because the numbers of GABAB receptors are increased in thalamocortical populations among lh/lh mice compared with littermates without epilepsy, these receptors appear to play a pathophysiologic role in the expression of absence seizures among lh/lh mice. Moreover, there may be a role for GABAB receptors in the generation of absence seizures among humans, because administration of compounds that activate GABAB receptors can produce absence seizures among humans. These findings suggest that GABAB receptor antagonists may represent a new class of antiabsence compounds that will be efficacious against absence seizures among patients. A second critical mechanism that regulates generation of absence seizures involves GABAA receptors in the nucleus reticularis thalami (NRT), a nucleus that sends GABA-ergic afferents to thalamic relay nuclei. Activation of GABAA receptors in the NRT appears to suppress the generation of absence seizures among lh/lh mice and in

  1. Workplace Psychosocial Factors Associated with Work-Related Injury Absence: A Study from a Nationally Representative Sample of Korean Workers

    PubMed Central

    Lu, Ming-Lun; Nakata, Akinori; Swanson, Naomi G.

    2015-01-01

    Background Little is known about the association between psychosocial factors and injury absence in the workplace. Purpose This study aims to assess the association of comprehensive workplace psychosocial factors with work-related injury absence among Korean workers. Methods The data (n=7,856) were derived from the First Korean Working Conditions Survey conducted in 2006 with a representative sample (n=10,043) of the Korean working population. The survey instrument contained questions about hours of work, physical risk factors, work organization, and the effect of work on health/injury. Work-related injury absence was indicated by a dichotomous variable with at least 1 day absence during the preceding 12 months. Logistic regression models were used to calculate odds ratio and confidence interval (CI). Incremental adjustments for sociodemographic, health behavior, and occupational confounding variables were employed in the models. Results The overall 1-year prevalence of work-related injury absence in this study was 1.37 % (95 % CI, 1.11–1.63 %). Those who experienced violence at work (adjusted odds ratio (aOR), 7.05 (95 % CI, 2.69–18.5)), threat of violence at work (aOR, 4.25 (95 % CI, 1.32–13.64)), low job autonomy (aOR, 1.79 (95 % CI, 1.17–2.74)), and high job strain (aOR, 2.38 (95 % CI, 1.29–4.42) had an increased risk of injury absence, compared with their respective counterparts (p<0.05). Among all job types, skilled workers in Korea were at a near fourfold risk of work absence due to occupational injuries, compared with managers in low-risk jobs. Conclusion Workplace violence and increased job strain were two key workplace psychosocial factors associated with work-related injury absence. PMID:23794229

  2. General practitioners' psychosocial resources, distress, and sickness absence: a study comparing the UK and Finland.

    PubMed

    Heponiemi, Tarja; Elovainio, Marko; Presseau, Justin; Eccles, Martin P

    2014-06-01

    Many countries, including the UK and Finland, face difficulties in recruiting GPs and one reason for these difficulties may be due to negative psychosocial work environments. To compare psychosocial resources (job control and participative safety), distress and sickness absences between GPs from the UK and those from Finland. We also examined differences in how psychosocial resources are associated with distress and sickness absence and how distress is associated with sickness absence for both countries. Two independent cross-sectional surveys conducted in general practice in the UK and Finland. Analyses of covariance were used for continuous outcome variables and logistic regression for dichotomized variable (sickness absence) adjusted for gender, qualification year and response format. UK GPs reported more opportunities to control their work and had higher levels of participative safety but were more distressed than Finnish GPs. Finnish GPs were 2.3 (95% confidence interval = 1.8-3.1) times more likely to report sickness absence spells than UK GPs. Among Finnish GPs, job control opportunities and high participative safety were associated with lower levels of distress, but not among UK GPs. Among UK GPs, higher distress was associated with 2.1 (95% confidence interval = 1.3-3.6) times higher likelihood of sickness absence spells, but among Finnish GPs there were no such association. In Finland, primary health care organizations should try to improve participative safety and increase control opportunities of physicians to decrease GP distress, whereas in the UK, other work or private life factors may be more important. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  3. INDUSTRIAL TRAINING RESEARCH REGISTER.

    ERIC Educational Resources Information Center

    Ministry of Labour, London (England).

    IN THIS CLASSIFIED REGISTER OF CURRENT AND RECENTLY COMPLETED STUDIES OF INDUSTRIAL TRAINING IN GREAT BRITAIN, INDIVIDUAL PROJECTS ARE ARRANGED BY THE ITEM NUMBER JUDGED MOST IMPORTANT, AND THE NUMBERS OF OTHER RELEVANT INDUSTRIAL RESEARCH PROJECTS ARE INSERTED AT THE END OF EACH SECTION TO PROVIDE CROSS REFERENCES. DESCRIPTIONS INCLUDE THE TITLE…

  4. Levetiracetam in Absence Epilepsy

    ERIC Educational Resources Information Center

    Verrotti, Alberto; Cerminara, Caterina; Domizio, Sergio; Mohn, Angelika; Franzoni, Emilio; Coppola, Giangennaro; Zamponi, Nelia; Parisi, Pasquale; Iannetti, Paola; Curatolo, Paolo

    2008-01-01

    The aim of the study was to assess the efficacy, tolerability, and safety of levetiracetam therapy in children and adolescents with absence epilepsy. Twenty-one participants (11 male, 10 female) with typical absence seizures were enrolled in this prospective study from seven centres in Italy. The mean age and age range at time of enrolment into…

  5. Levetiracetam in Absence Epilepsy

    ERIC Educational Resources Information Center

    Verrotti, Alberto; Cerminara, Caterina; Domizio, Sergio; Mohn, Angelika; Franzoni, Emilio; Coppola, Giangennaro; Zamponi, Nelia; Parisi, Pasquale; Iannetti, Paola; Curatolo, Paolo

    2008-01-01

    The aim of the study was to assess the efficacy, tolerability, and safety of levetiracetam therapy in children and adolescents with absence epilepsy. Twenty-one participants (11 male, 10 female) with typical absence seizures were enrolled in this prospective study from seven centres in Italy. The mean age and age range at time of enrolment into…

  6. Arsenite binding to sulfhydryl groups in the absence and presence of ferrihydrite: a model study.

    PubMed

    Hoffmann, Martin; Mikutta, Christian; Kretzschmar, Ruben

    2014-04-01

    Binding of arsenite (As(III)) to sulfhydryl groups (Sorg(-II)) plays a key role in As detoxification mechanisms of plants and microorganisms, As remediation techniques, and reduced environmental systems rich in natural organic matter. Here, we studied the formation of Sorg(-II)-As(III) complexes on a sulfhydryl model adsorbent (Ambersep GT74 resin) in the absence and presence of ferrihydrite as a competing mineral adsorbent under reducing conditions and tested their stability against oxidation in air. Adsorption of As(III) onto the resin was studied in the pH range 4.0-9.0. On the basis of As X-ray absorption spectroscopy (XAS) results, a surface complexation model describing the pH dependence of As(III) binding to the organic adsorbent was developed. Stability constants (log K) determined for dithio ((AmbS)2AsO(-)) and trithio ((AmbS)3As) surface complexes were 8.4 and 7.3, respectively. The ability of sulfhydryl ligands to compete with ferrihydrite for As(III) was tested in various anoxic mixtures of both adsorbents at pH 7.0. At a 1:1 ratio of their reactive binding sites, R-SH and ≡FeOH, both adsorbents possessed nearly identical affinities for As(III). The oxidation of Sorg(-II)-As(III) complexes in water vapor saturated air over 80 days, monitored by As and S XAS, revealed that the complexed As(III) is stabilized against oxidation (t1/2 = 318 days). Our results thus document that sulfhydryl ligands are highly competitive As(III) complexing agents that can stabilize As in its reduced oxidation state even under prolonged oxidizing conditions. These findings are particularly relevant for organic S-rich semiterrestrial environments subject to periodic redox potential changes such as peatlands, marshes, and estuaries.

  7. Job stress as a risk factor for absences among manual workers: a 12-month follow-up study.

    PubMed

    Heo, Yong-Seok; Leem, Jong-Han; Park, Shin-Goo; Jung, Dal-Young; Kim, Hwan-Cheol

    2015-01-01

    This study was conducted to evaluate the impact of job stress on absence from work caused by illnesses and accidents through a prospective research design. A total of 2,349 manual workers were included in this analysis. In the first survey, job stress was determined using the Korean Occupational Stress Scale-Short Form. In the second survey, information on absence due to accidents or illnesses during the past one year was obtained through a questionnaire. The relationship was analyzed using a logistic regression model with multiple imputation. After adjusting for confounding variables for males, absence due to accidents was statistically associated with high job demand, insufficient job control, inadequate social support, and organizational injustice. In addition, high job demands and organizational injustice were related to increased absence due to illnesses in both genders. A lack of reward was associated with increased absence due to illnesses among female workers. We found that job stress was associated with a higher risk of absence caused by accidents or illnesses of manual workers.

  8. Job stress as a risk factor for absences among manual workers: a 12-month follow-up study

    PubMed Central

    HEO, Yong-Seok; LEEM, Jong-Han; PARK, Shin-Goo; JUNG, Dal-Young; KIM, Hwan-Cheol

    2015-01-01

    This study was conducted to evaluate the impact of job stress on absence from work caused by illnesses and accidents through a prospective research design. A total of 2,349 manual workers were included in this analysis. In the first survey, job stress was determined using the Korean Occupational Stress Scale-Short Form. In the second survey, information on absence due to accidents or illnesses during the past one year was obtained through a questionnaire. The relationship was analyzed using a logistic regression model with multiple imputation. After adjusting for confounding variables for males, absence due to accidents was statistically associated with high job demand, insufficient job control, inadequate social support, and organizational injustice. In addition, high job demands and organizational injustice were related to increased absence due to illnesses in both genders. A lack of reward was associated with increased absence due to illnesses among female workers. We found that job stress was associated with a higher risk of absence caused by accidents or illnesses of manual workers. PMID:26212413

  9. An epidemiologic study of disease in 32 registered Holstein dairy herds in British Columbia.

    PubMed Central

    van Dorp, R T; Martin, S W; Shoukri, M M; Noordhuizen, J P; Dekkers, J C

    1999-01-01

    Data recorded in a herd health management system were obtained from 32 registered Holstein dairy herds from British Columbia. Frequencies of disease were described, and the effect of herd, age, year, season, and the interrelationships between diseases within a lactation on the occurrence of disease were evaluated. Lactational incidence rates were computed for diseases with a short period of risk (ie, udder edema, milk fever, retained placenta, metritis, displaced abomasum, and ketosis), whereas for diseases with a longer period of risk (ie, cystic ovaries, mastitis and stable footrot), incidence densities were calculated. Overall, the disease incidence was low and showed an increase in frequency by year, which we attributed to more observing and complete recording by the owner, rather than an actual increase in disease incidence. Most diseases occurred early in lactation and their frequency increased with lactation number; the exception was udder edema, which occurred mainly during the first 2 lactations. An informal path model of disease interrelationships was made conditional on herd. Based on the results we inferred 2 independent pathways: one started by udder edema, and the other by milk fever. Udder edema was directly associated with mastitis occurrence from 0 to 30 d in lactation, metritis, and cystic ovaries. Mastitis from 0-30 d in lactation increased the risk of both mastitis from 31-150 d in lactation and cystic ovaries. Both of these increased the risk of late lactation mastitis. Milk fever was directly related with displaced abomasum, which increased the risk of footrot. In general, diseases that occurred in early lactation tended to increase the risk of other diseases later in lactation. PMID:10480460

  10. Validation study of villous atrophy and small intestinal inflammation in Swedish biopsy registers

    PubMed Central

    2009-01-01

    Background Small intestinal biopsy with villous atrophy (VA) is the gold standard for the diagnosis of celiac disease (CD). We validated VA (Marsh 3) and small intestinal inflammation without VA (Marsh 1+2) in Swedish regional biopsy registers. Methods All pathology departments in Sweden (n = 28) were searched to identify individuals with VA or duodenal/jejunal inflammation. The validation consisted of blinded examination of biopsy samples, manual review of biopsy reports, web surveys, and patient chart reviews of 121 individuals with VA and 39 with inflammation. Results We identified 29,148 individuals with VA and 13,446 individuals with inflammation. In a blinded examination, Swedish pathologists correctly classified 90% of biopsies with VA. Manual screening of 1,534 biopsy reports (performed by co-author JFL and a research assistant) found that comorbidity other than CD was rare. IBD was the most common comorbidity and occurred in 0.3% of biopsies with VA (1.6% in inflammation). Among 114 patients with VA and available data, 108 (95%) had a clinical diagnosis of CD. 79% of the validated individuals with VA and 64% of those with inflammation had documented gastrointestinal symptoms prior to biopsy. 88% of the validated individuals with VA had positive CD serology before their first biopsy. 172/180 (96%) of Swedish gastroenterologists and 68/68 (100%) of pediatricians perform a small intestinal biopsy in at least 9 out of 10 individuals prior to diagnosis of CD. Conclusion Regional biopsy data are feasible to identify individuals with CD and small-intestinal inflammation. The specificity of CD is high in villous atrophy. PMID:19284576

  11. Validation study of villous atrophy and small intestinal inflammation in Swedish biopsy registers.

    PubMed

    Ludvigsson, Jonas F; Brandt, Lena; Montgomery, Scott M; Granath, Fredrik; Ekbom, Anders

    2009-03-11

    Small intestinal biopsy with villous atrophy (VA) is the gold standard for the diagnosis of celiac disease (CD). We validated VA (Marsh 3) and small intestinal inflammation without VA (Marsh 1+2) in Swedish regional biopsy registers. All pathology departments in Sweden (n = 28) were searched to identify individuals with VA or duodenal/jejunal inflammation. The validation consisted of blinded examination of biopsy samples, manual review of biopsy reports, web surveys, and patient chart reviews of 121 individuals with VA and 39 with inflammation. We identified 29,148 individuals with VA and 13,446 individuals with inflammation. In a blinded examination, Swedish pathologists correctly classified 90% of biopsies with VA. Manual screening of 1,534 biopsy reports (performed by co-author JFL and a research assistant) found that comorbidity other than CD was rare. IBD was the most common comorbidity and occurred in 0.3% of biopsies with VA (1.6% in inflammation). Among 114 patients with VA and available data, 108 (95%) had a clinical diagnosis of CD. 79% of the validated individuals with VA and 64% of those with inflammation had documented gastrointestinal symptoms prior to biopsy. 88% of the validated individuals with VA had positive CD serology before their first biopsy. 172/180 (96%) of Swedish gastroenterologists and 68/68 (100%) of pediatricians perform a small intestinal biopsy in at least 9 out of 10 individuals prior to diagnosis of CD. Regional biopsy data are feasible to identify individuals with CD and small-intestinal inflammation. The specificity of CD is high in villous atrophy.

  12. Advanced paternal age and childhood cancer in offspring: A nationwide register-based cohort study.

    PubMed

    Urhoj, Stine Kjaer; Raaschou-Nielsen, Ole; Hansen, Anne Vinkel; Mortensen, Laust Hvas; Andersen, Per Kragh; Nybo Andersen, Anne-Marie

    2017-06-01

    Cancer initiation is presumed to occur in utero for many childhood cancers and it has been hypothesized that advanced paternal age may have an impact due to the increasing number of mutations in the sperm DNA with increasing paternal age. We examined the association between paternal age and specific types of childhood cancer in offspring in a large nationwide cohort of 1,904,363 children born in Denmark from 1978 through 2010. The children were identified in the Danish Medical Birth Registry and were linked to information from other national registers, including the Danish Cancer Registry. In total, 3,492 children were diagnosed with cancer before the age of 15 years. The adjusted hazard ratio of childhood cancer according to paternal age was estimated using Cox proportional hazards regressions. We found a 13% (95% confidence interval: 4-23%) higher hazard rate for every 5 years advantage in paternal age for acute lymphoblastic leukemia, while no clear association was found for acute myeloid leukemia (hazard ratio pr. 5 years = 1.02, 95% confidence interval: 0.80-1.30). The estimates for neoplasms in the central nervous system suggested a lower hazard rate with higher paternal age (hazard ratio pr. 5 years = 0.92, 95% confidence interval: 0.84-1.01). No clear associations were found for the remaining childhood cancer types. The findings suggest that paternal age is moderately associated with a higher rate of childhood acute lymphoblastic leukemia, but not acute myeloid leukemia, in offspring, while no firm conclusions could be made for other specific cancer types. © 2017 UICC.

  13. An epidemiologic study of disease in 32 registered Holstein dairy herds in British Columbia.

    PubMed

    van Dorp, R T; Martin, S W; Shoukri, M M; Noordhuizen, J P; Dekkers, J C

    1999-07-01

    Data recorded in a herd health management system were obtained from 32 registered Holstein dairy herds from British Columbia. Frequencies of disease were described, and the effect of herd, age, year, season, and the interrelationships between diseases within a lactation on the occurrence of disease were evaluated. Lactational incidence rates were computed for diseases with a short period of risk (ie, udder edema, milk fever, retained placenta, metritis, displaced abomasum, and ketosis), whereas for diseases with a longer period of risk (ie, cystic ovaries, mastitis and stable footrot), incidence densities were calculated. Overall, the disease incidence was low and showed an increase in frequency by year, which we attributed to more observing and complete recording by the owner, rather than an actual increase in disease incidence. Most diseases occurred early in lactation and their frequency increased with lactation number; the exception was udder edema, which occurred mainly during the first 2 lactations. An informal path model of disease interrelationships was made conditional on herd. Based on the results we inferred 2 independent pathways: one started by udder edema, and the other by milk fever. Udder edema was directly associated with mastitis occurrence from 0 to 30 d in lactation, metritis, and cystic ovaries. Mastitis from 0-30 d in lactation increased the risk of both mastitis from 31-150 d in lactation and cystic ovaries. Both of these increased the risk of late lactation mastitis. Milk fever was directly related with displaced abomasum, which increased the risk of footrot. In general, diseases that occurred in early lactation tended to increase the risk of other diseases later in lactation.

  14. Effect of Rheumatoid Arthritis on Longterm Sickness Absence in 1994-2011: A Danish Cohort Study.

    PubMed

    Hansen, Sofie Mandrup; Hetland, Merete Lund; Pedersen, Jacob; Østergaard, Mikkel; Rubak, Tine Steen; Bjorner, Jakob Bue

    2016-04-01

    By linkage of national registries, we investigated the risk of longterm sickness absence (LTSA) ≥ 3 weeks in a large cohort of Danish patients with rheumatoid arthritis (RA) and non-patients. The study aimed to (1) estimate the risk of LTSA for patients with RA compared with the general population, (2) examine whether the risk of LTSA has changed in recent years, and (3) evaluate the effect of other risk factors for LTSA (e.g., physical work demands, age, sex, education, and psychiatric and somatic comorbidities). A total of 6677 patients with RA aged 18-59 years in the years 1994-2011 were identified in registries and compared with 56,955 controls from the general population matched by age, sex, and city size. The risk of LTSA was analyzed using Cox proportional hazards models with late entry, controlling for other risk factors and assuming separate risks in the first year after diagnosis and the following years. Compared with the general population, patients with RA had increased risk of LTSA in the first year after diagnosis (HR 5.4 during 1994-1999, 95% CI 4.2-6.8) and in following years (HR 2.4, 95% CI 2.1-2.8). For established RA (> 1 yr after diagnosis), the excess was 20% lower in 2006-2011 (HR 1.9, 95% CI 1.7-2.2) compared with 1994-1999 (p < 0.001). For patients with RA and controls, older age, shorter education, a physically demanding job, and somatic and/or psychiatric comorbidities increased the risk of LTSA. While improvements were observed from 1994-1999 to 2006-2011, patients with RA have significant increased risk of LTSA, in particular in the first year after diagnosis.

  15. A Pilot Study of the Cognitive Abilities of Two Year Olds Exposed to Temporary Father Absence

    DTIC Science & Technology

    1996-04-28

    except to illustrate differences between mothers and fathers in parenting styles . Attachment Period One of the earliest measures that researchers...Absence ....... . .... 32 Male-Female Differences in Cognitive Styles ......... 32 Determinants of Cognitive Abilities ...................... 34...single parent families, low levels of father involvement in child rearing activities, and situations in which the father is separated from the family

  16. Heavy Lifting at Work and Risk of Ischemic Heart Disease: Protocol for a Register-Based Prospective Cohort Study

    PubMed Central

    2014-01-01

    Background There are theoretical grounds to suspect that heavy lifting at work is an important risk factor for ischemic heart disease (IHD). However the relationship has not been sufficiently acknowledged by empirical studies. Positive and statistically significant associations have been found in studies that utilize self-reported exposure data. Such studies are, however, prone to reporting bias. All else equal, people with a poor cardiovascular fitness/health may have a higher propensity to perceive their work environment as heavy. Objective The study described in the present protocol aims to investigate the relationship between heavy lifting at work and IHD by use of material and methods that are free from reporting bias. Methods This is a register-based prospective cohort study. Male blue-collar workers in Denmark will be identified and followed through national registers, from 2001-2010, for hospital treatment or death due to IHD. Relative rates of IHD between “workers in occupations likely to involve heavy lifting” and “other blue-collar workers” will be estimated through Poisson regression. Results Results are expected to be ready in mid-2015. Conclusions Since this is not a randomized study, it cannot confirm etiological hypotheses. It may, however, confirm that employment in occupations that involve heavy lifting is a predictor for IHD and thereby lend support to the hypothesis of a causal relationship. PMID:25164612

  17. Breast Cancer, Sickness Absence, Income and Marital Status. A Study on Life Situation 1 Year Prior Diagnosis Compared to 3 and 5 Years after Diagnosis

    PubMed Central

    Eaker, Sonja; Wigertz, Annette; Lambert, Paul C.; Bergkvist, Leif; Ahlgren, Johan; Lambe, Mats

    2011-01-01

    Background Improved cancer survival poses important questions about future life conditions of the survivor. We examined the possible influence of a breast cancer diagnosis on subsequent working and marital status, sickness absence and income. Materials We conducted a matched cohort study including 4,761 women 40–59 years of age and registered with primary breast cancer in a Swedish population-based clinical register during 1993–2003, and 2,3805 women without breast cancer. Information on socioeconomic standing was obtained from a social database 1 year prior and 3 and 5 years following the diagnosis. In Conditional Poisson Regression models, risk ratios (RRs) and 95% confidence intervals (CIs) were estimated to assess the impact of a breast cancer diagnosis. Findings Three years after diagnosis, women who had had breast cancer more often had received sickness benefits (RR = 1.49, 95% CI 1.40–1.58) or disability pension (RR = 1.47, 95% CI 1.37–1.58) than had women without breast cancer. We found no effect on income (RR = 0.99), welfare payments (RR = 0.98), or marital status (RR = 1.02). A higher use of sickness benefits and disability pension was evident in all stages of the disease, although the difference in use of sickness benefits decreased after 5 years, whereas the difference in disability pension increased. For woman with early stage breast cancer, the sickness absence was higher following diagnosis among those with low education, who had undergone mastectomy, and had received chemo- or hormonal therapy. Neither tumour size nor presence of lymph nodes metastasis was associated with sickness absence after adjustment for treatment. Interpretation Even in early stage breast cancer, a diagnosis negatively influences working capacity both 3 and 5 years after diagnosis, and it seems that the type of treatment received had the largest impact. A greater focus needs to be put on rehabilitation of breast cancer patients, work

  18. Infertility among women working in horticulture. A follow-up study in the Danish Occupational Hospitalization Register.

    PubMed

    Hougaard, Karin Sørig; Hannerz, Harald; Feveile, Helene; Bonde, Jens Peter; Burr, Hermann

    2009-04-01

    The possible association between employment in horticulture with potential exposure to pesticides and female infertility was examined by identification of women with hospital contact due to infertility and working in horticulture through the Danish Occupational Hospitalization Register. This follow-up study gave a standardized incidence ratio of 1.06 (95% confidence interval: 0.84-1.32) for treatment of infertility in women working in horticulture compared with the standard population and did not confirm that women working in the horticultural industry are at increased risk for infertility.

  19. Sickness absence poses a threat to the Swedish Welfare State: a cross-sectional study of sickness absence and self-reported illness

    PubMed Central

    Sundquist, Jan; Al-Windi, Ahmad; Johansson, Sven-Erik; Sundquist, Kristina

    2007-01-01

    Background The increasing cost of public social sickness insurance poses a serious economic threat to the Swedish welfare state. In recent years, expenditures for social insurance in general, as well as social sickness insurance in particular, have risen steeply in Sweden. This cross-sectional study analyzed the association between sickness absence (SA) and self-reported reduced working capacity due to a longstanding illness (>3 months), as well between SA and a number of other health problems. Methods Self-reported data on longstanding illness and resultant reduced working capacity, socioeconomic factors, working environment, psychosomatic complaints, anxiety, and general health were obtained for 22,281 employed (paid) persons aged 25 to 64 years. These data were retrieved from the Swedish Living Conditions Survey for 1995 to 2002. National civic registration numbers, replaced with serial numbers to ensure anonymity, were used to link these data to individual-level SA records from the National Social Insurance Board. A logistic regression model was used to estimate the odds ratio of the main outcome variable for the three levels of the SA variable (0–28, 29–90, >90 days/year). Results There was an obvious increasing gradient in length of SA and increasing odds of reporting reduced working capacity. Odds ratios ranged from 3.5 to 19.0; i.e., those with more than ninety days of SA had 19.0 times higher odds of reporting reduced working capacity than those with 0–28 days of SA a year. This very strong association changed less than 10% after adjusting for demographic, socioeconomic, and working environment characteristics. A total of 48.7% of persons on sick leave ≥ 29 days reported no longstanding illness and reduced working capacity. Of these persons, about 43% reported one or more other health problem. Conclusion We confirmed that longstanding illness that results in self-reported reduced working capacity is an important variable related to length of SA

  20. Hard Physical Work Intensifies the Occupational Consequence of Physician-Diagnosed Back Disorder: Prospective Cohort Study with Register Follow-Up among 10,000 Workers

    PubMed Central

    2017-01-01

    While musculoskeletal pain is common in the population, less is known about its labor market consequences in relation to physical activity at work. This study investigates whether hard physical work aggravates the consequences of back disorder. Using Cox regression analyses, we estimated the joint association of physical activity at work and physician-diagnosed back disorder in 2010 with the risk of register-based long-term sickness absence (LTSA) of at least 6 consecutive weeks during 2011-2012 among 9,544 employees from the general working population (Danish Work Environment Cohort Study). Control variables were age, gender, psychosocial work environment, smoking, leisure physical activity, BMI, depression, and mental health. At baseline, 19.4% experienced high low-back pain intensity (≥5, 0–9 scale) and 15.2% had diagnosed back disorder. While high pain intensity was a general predictor for LTSA, physician-diagnosed back disorder was a stronger predictor among those with hard physical work (HR 2.23; 95% CI 1.68–2.96) compared with light work (HR 1.40; 95% CI 1.09–1.80). Similarly, physician-diagnosed back disorder with simultaneous high pain intensity predicted LTSA to a greater extent among those with hard physical work. In conclusion, the occupational consequence of physician-diagnosed back disorder on LTSA is greater among employees with hard physical work. PMID:28255304

  1. Differences in primary health care use among sub-Saharan African immigrants in Norway: a register-based study.

    PubMed

    Diaz, Esperanza; Mbanya, Vivian N; Gele, Abdi A; Kumar, Bernadette

    2017-07-28

    Immigrants' utilization of primary health care (PHC) services differs from that of the host populations. However, immigrants are often classified in broad groups by continent of origin, and the heterogeneity within the same continent may hide variation in use among immigrant groups at a national level. Differences in utilization of PHC between sub-Saharan African immigrants have not received much attention. Registry-based study using merged data from the National Population Register and the Norwegian Health Economics Administration. African immigrants and their descendants registered in Norway in 2008 (36,366 persons) where included in this study. Using χ(2) test and logistic regression models, we assessed the differences in the use of PHC, including general practitioner (GP) and emergency room (ER) services, and the distribution of morbidity burden for immigrants from Somalia, Ethiopia, Eritrea, and Gambia. For the analyses, we used the number of visits and medical diagnoses from each consultation registered by the physician. Among the total studied population, 66.1% visited PHC within 1 year. The diagnoses registered were similar for all four immigrants groups, regardless of country of origin. Compared to immigrants from Somalia, the age and sex adjusted odds ratios (OR) for use of GP were significantly lower for Ethiopians (OR 0.91; 0.86-0.97), Eritreans (OR 0.85; 0.79-0.91), and Gambians (OR 0.88; 0.80-0.97). Similarly, we also observed lower use of ER among Ethiopians (OR 0.88; 0.81-0.95), Eritreans (OR 0.56; 0.51-0.62) and Gambians (OR 0.81; 0.71-0.92). However, immigrants from Somalia reduced their use of PHC with longer duration of stay in Norway. Differences between groups persisted after further adjustment for employment status. Despite the similarities in diagnoses among the sub-Saharan African immigrant groups in Norway, their use of PHC services differs by country of origin and length of stay. It is important to assess the reasons for the differences

  2. Role clarity, fairness, and organizational climate as predictors of sickness absence: a prospective study in the private sector.

    PubMed

    Väänänen, Ari; Kalimo, Raija; Toppinen-Tanner, Salla; Mutanen, Pertti; Peiró, José Maria; Kivimäki, Mika; Vahtera, Jussi

    2004-01-01

    The majority of the research on the effects of the psychosocial work environment on sickness absenteeism has focused on components of job strain and social support among public sector employees without stratification by socioeconomic status. The authors examined less-studied work-related psychosocial predictors of sickness absence in the private sector by socioeconomic status. Questionnaire data on psychosocial factors at work were used to predict the rates of recorded short (1-3 days), long (4-21 days), and very long (over 21 days) sickness absences among 3,850 white- and blue-collar male and female employees in a large-scale enterprise. Multivariate Poisson regression models were adjusted for age, prior absence, and psychosocial factors at work. In white-collar men, low role clarity was associated with a 3.0 (95% CI 1.3-7.1) times greater rate of very long absences than high role clarity. Low fairness in the division of labor predicted a 1.3-fold (95% CI 1.1-1.5) rate of long absences in blue-collar men. In blue-collar women, poor organizational climate was associated with a 1.6 (95% CI 1.0-2.5) times greater rate of short absence spells than favorable organizational climate but among white-collar women all associations between work-related psychosocial factors and sickness absenteeism were weak. These findings indicate that the actions to reduce psychosocial risk factors of sickness absence should match the specific needs of each socioeconomic group.

  3. Methodological challenges in using the Finnish Hospital Discharge Register for studying fire-related injuries leading to inpatient care.

    PubMed

    Haikonen, Kari; Lunetta, Philippe; Lillsunde, Pirjo M; Sund, Reijo

    2013-03-15

    The objective was to examine feasibility of using hospital discharge register data for studying fire-related injuries. The Finnish National Hospital Discharge Register (FHDR) was the database used to select relevant hospital discharge data to study usability and data quality issues. Patterns of E-coding were assessed, as well as prominent challenges in defining the incidence of injuries. Additionally, the issue of defining the relevant amount of hospital days accounted for in injury care was considered. Directly after the introduction of the ICD-10 classification system, in 1996, the completeness of E-coding was found to be poor, but to have improved dramatically around 2000 and thereafter. The scale of the challenges to defining the incidence of injuries was found to be manageable. In counting the relevant hospital days, psychiatric and long-term care were found to be the obvious and possible sources of overestimation. The FHDR was found to be a feasible data source for studying fire-related injuries so long as potential challenges are acknowledged and taken into account. Hospital discharge data can be a unique and powerful means for injury research as issues of representativeness and coverage of traditional probability samples can frequently be completely avoided.

  4. Location of recurrent groin hernias at TEP after Lichtenstein repair: a study based on the Swedish Hernia Register.

    PubMed

    Bringman, S; Holmberg, H; Österberg, J

    2016-06-01

    To investigate which type of hernia that has the highest risk of a recurrence after a primary Lichtenstein repair. Male patients operated on with a Lichtenstein repair for a primary direct or indirect inguinal hernia and with a TEP for a later recurrence, with both operations recorded in the Swedish Hernia Register (SHR), were included in the study. The study period was 1994-2014. Under the study period, 130,037 male patients with a primary indirect or direct inguinal hernia were operated on with a Lichtenstein repair. A second operation in the SHR was registered in 2236 of these patients (reoperation rate 1.7 %). TEP was the chosen operation in 737 in this latter cohort. The most likely location for a recurrence was the same as the primary location. If the recurrences change location from the primary place, we recognized that direct hernias had a RR of 1.51 to having a recurrent indirect hernia compared to having a direct recurrence after an indirect primary hernia repair. Recurrent hernias after Lichtenstein are more common on the same location as the primary one, compared to changing the location.

  5. Young Registered Nurses' Intention to Leave the Profession and Professional Turnover in Early Career: A Qualitative Case Study

    PubMed Central

    Salanterä, Sanna

    2013-01-01

    In a time of global nursing shortages an alarming number of young registered nurses have expressed a willingness to leave the profession. In this qualitative case study we investigate in depth why young nurses leave nursing profession and reeducate themselves for a new career. The study is based on longitudinal interviews of three young registered nurses in Finland. These nurses were first interviewed between December 2006 and May 2007, when they were 29–32 years old and having an intention to leave the profession. The second interview took place four years later, from January 2011 to March 2011 when all of them had made the transition to a new career. Data were analyzed in two stages. In the first stage, comprehensive career story narratives were formed on the basis of the interviews. In the second stage, emerging themes in these stories were compared, contrasted, and interpreted in the context of the overall career histories. Nursing as a second career choice and demanding work content as well as poor practice environment and the inability to identify with the stereotypical images of nurses were main themes that emerged from these career stories. The results of this interpretative qualitative study reflect a shift toward insights into understanding professional turnover as a complex and long-lasting process. PMID:24027640

  6. Experimental study bearing on the absence of carbonate in mantle-derived xenoliths

    SciTech Connect

    Canil, D. )

    1990-10-01

    Experimentation at high pressures in peridotite + CO{sub 2} systems has suggested that some CO{sub 2}-rich, Si-undersaturated magmas originate in mantle source regions consisting of carbonated peridotite. However, a caveat to the petrological application of such experiments has been the virtual absence of carbonate in mantle xenoliths. Decompression experiments were undertaken to resolve this problem and to test the hypothesis that carbonated peridotite exists in the upper mantle, but decomposes during ascent as xenoliths in its host magma. The author demonstrate that carbonate coexisting with silicates in mantle-derived xenoliths could not survive entrainment even in the fastest ascending magmas due to rapid decarbonation upon decompression. The author conclude that carbonate may indeed exist in the upper mantle, and that the paucity of this phase in mantle-derived xenoliths does not require its absence in the mantle source regions of many primary, alkalic magmas.

  7. Lunasin in wheat: a chemical and molecular study on its presence or absence.

    PubMed

    Dinelli, Giovanni; Bregola, Valeria; Bosi, Sara; Fiori, Jessica; Gotti, Roberto; Simonetti, Emanuela; Trozzi, Caterina; Leoncini, Emanuela; Prata, Cecilia; Massaccesi, Luca; Malaguti, Marco; Quinn, Robert; Hrelia, Silvana

    2014-05-15

    Lunasin is a peptide whose anticancer properties are widely reported. Originally isolated from soybean seeds, lunasin was also found in cereal (wheat, rye, barley and Triticale), Solanum and amaranthus seeds. However, it was recently reported that searches of transcript and DNA sequence databases for wheat and other cereals failed to identify sequences with similarity to those encoding the lunasin peptide in soy. In order to clarify the presence or absence of lunasin in wheat varieties, a broad investigation based on chemical (LC-ESI-MS) and molecular (PCR) analyses was conducted. Both approaches pointed out the absence of lunasin in the investigated wheat genotypes; in particular no compounds with a molecular weight similar to that of lunasin standard and no lunasin-related sequences were found in the analysed wheat samples. These findings confirm the hypothesis, reported in recent researches, that lunasin is not a wheat-derived peptide.

  8. Educational level and use of osteoporosis drugs in elderly men and women: a Swedish nationwide register-based study.

    PubMed

    Wastesson, J W; Ringbäck Weitoft, G; Parker, M G; Johnell, K

    2013-02-01

    We examined educational disparities in use of osteoporosis drugs in a nationwide population of Swedes aged 75-89 years old. Individuals with high education were more likely to receive osteoporosis drug treatment than lower educated individuals, particularly among women. This study aims to investigate whether educational level is associated with use of osteoporosis drugs in the general population of older men and women in Sweden, also after adjustment for fractures. By record linkage of The Swedish Prescribed Drug Register, The Swedish Patient Register, and The Swedish Education Register, we obtained information on filling of prescriptions for osteoporosis drugs (bisphosphonates, calcium/vitamin D combinations, and selective estrogen receptor modulators) from July to October 2005, osteoporotic fractures from 1998 to 2004, and educational level for 645,429 people aged 75-89 years. Multivariate logistic regression analysis was used to investigate whether education was associated with use of osteoporosis drug therapy. Higher education was associated with use of osteoporosis drugs for both men [odds ratio (OR)(high education vs low), 1.27; 95% confidence interval (CI), 1.19-1.35] and women (OR(high education vs low), 1.57; 95% CI, 1.52-1.61), after adjustment for age, osteoporotic fractures, and comorbidity (i.e., number of other drugs). Among those who had sustained a fracture (n = 57,613), the educational differences in osteoporosis drug treatment were more pronounced in women than men. Further, women were more likely to receive osteoporosis drug treatment after osteoporotic fracture. Uptake of osteoporosis drug therapy seems to be unequally distributed in the elderly population, even in a country with presumably equal access to health care.

  9. Educating registered nursing and healthcare assistant students in community-based supportive care of older adults: A mixed methods study.

    PubMed

    Pesut, Barbara; McLean, Tammy; Reimer-Kirkham, Sheryl; Hartrick-Doane, Gweneth; Hutchings, Deanna; Russell, Lara B

    2015-09-01

    Collaborative education that prepares nursing and healthcare assistant students in supportive care for older adults living at home with advanced chronic illness is an important innovation to prepare the nursing workforce to meet the needs of this growing population. To explore whether a collaborative educational intervention could develop registered nursing and healthcare assistant students' capabilities in supportive care while enhancing care of clients with advanced chronic illness in the community. Mixed method study design. A rural college in Canada. Twenty-one registered nursing and 21 healthcare assistant students completed the collaborative workshop. Eight registered nursing students and 13 healthcare assistant students completed an innovative clinical experience with fifteen clients living with advanced chronic illness. Pre and post-test measures of self-perceived competence and knowledge in supportive care were collected at three time points. Semi-structured interviews were conducted to evaluate the innovative clinical placement. Application of Friedman's test indicated statistically significant changes on all self-perceived competence scores for RN and HCA students with two exceptions: the ethical and legal as well as personal and professional issues domains for HCA students. Application of Friedman's test to self-perceived knowledge scores showed statistically significant changes in all but one domain (interprofessional collaboration and communication) for RN students and all but three domains for HCA students (spiritual needs, ethical and legal issues, and inter-professional collaboration and communication). Not all gains were sustained until T-3. The innovative community placement was evaluated positively by clients and students. Collaborative education for nursing and healthcare assistant students can enhance self-perceived knowledge and competence in supportive care of adults with advanced chronic illness. An innovative clinical experience can

  10. Advanced paternal age and stillbirth rate: a nationwide register-based cohort study of 944,031 pregnancies in Denmark.

    PubMed

    Urhoj, Stine Kjaer; Andersen, Per Kragh; Mortensen, Laust Hvas; Davey Smith, George; Nybo Andersen, Anne-Marie

    2017-03-01

    Advanced paternal age has been associated with a variety of rare conditions and diseases of great public health impact. An increased number of de novo point mutations in sperm with increasing age have been suggested as a mechanism, which would likely also affect fetal viability. We examined the association between paternal age and stillbirth rate in a large nationwide cohort. We identified all pregnancies in Denmark from 1994 to 2010 carried to a gestational age of at least 22 completed weeks (n = 944,031) as registered in national registers and linked to individual register data about the parents. The hazard ratio of stillbirth according to paternal age was estimated, adjusted for maternal age in 1-year categories, year of outcome, and additionally parental educational levels. The relative rate of stillbirth (n = 4946) according to paternal age was found to be J-shaped with the highest hazard ratio for fathers aged more than 40 years when paternal age was modelled using restricted cubic splines. When modelled categorically, the adjusted hazard ratios of stillbirth were as follows: <25, 1.16 (95% confidence interval, CI 1.01-1.34); 25-29, 1.03 (95% CI 0.95-1.11); 35-39, 1.16 (95% CI 1.07-1.26); 40-44, 1.41 (95% CI 1.26-1.59); 45-49, 1.20 (95% CI 0.97-1.49); 50+, 1.58 (95% CI 1.18-2.11), compared with fathers aged 30-34 years. These estimates attenuated slightly when further adjusted for parental education. Our study showed that paternal age was associated with the relative rate of stillbirth in a J-shaped manner with the highest hazard ratios among fathers aged more than 40 years.

  11. Exposure to maternal smoking during pregnancy and risk of childhood cancer: a study using the Danish national registers.

    PubMed

    Momen, Natalie C; Olsen, Jørn; Gissler, Mika; Li, Jiong

    2016-03-01

    The relation between maternal smoking during pregnancy and childhood cancer in the offspring remains uncertain. This paper uses Danish national registers, which have collected data prospectively on smoking and cancer, to investigate the association. Smoking during pregnancy was ascertained from maternal self-reported data in the Danish National Patient Register. Index children were followed up from birth until the first of the following events: cancer diagnosis, death, emigration, day before 15th birthday, or end of follow-up. Smoking during pregnancy was considered as a binary variable (no smoking in pregnancy and smoking in pregnancy) and by amounts smoked (no smoking, cessation during pregnancy, ≤5, 6-10, or ≥11 cigarettes/day). Of the 801,867 children included in the study, 20 % were exposed to maternal smoking during pregnancy. Overall, the hazard ratio (HR) for childhood cancer for the exposed compared to the non-exposed was 0.91 [95 % confidence interval (CI) 0.78, 1.07]. Stratification by number of cigarettes also gave statistically nonsignificant inverse associations. There was a statistically significant increased risk of childhood cancer among children whose mothers reported smoking cessation in pregnancy (HR 1.46; 95 % CI 1.01, 2.10). Regarding specific cancer sites, maternal smoking in pregnancy was positively associated with the risk of eye cancers in childhood. Our results do not provide evidence for an association between maternal smoking in pregnancy and childhood cancer overall. An increased risk of childhood cancer was seen for children whose mothers reported smoking cessation in pregnancy. Future research could employ biomarkers, such as cotinine, to validate maternal smoking status recorded in registers as, even if collected prospectively, this self-reported variable may be subject to reporting bias.

  12. The Dynamics of Absence Behaviour: Interrelations between Absence from Class and Absence in Class

    ERIC Educational Resources Information Center

    Jonasson, Charlotte

    2011-01-01

    Background: Studies of absence in educational settings have primarily been concerned with the causes for and results of student absence. However, recent research has argued that distinguishing between different forms of absence could be important. In consequence, studying the way in which different forms of absence are interrelated provides…

  13. Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in adult psychiatry. A 20-year register study.

    PubMed

    Nylander, Lena; Holmqvist, Maria; Gustafson, Lars; Gillberg, Christopher

    2013-10-01

    Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are increasingly recognized in adults. This study aimed to assess trends in diagnostic practice, diagnostic delay and comorbidity regarding ADHD and ASD in adult psychiatric patients. Individuals with diagnosed ADHD or ASD were identified in an adult psychiatry register comprising 56,462 patients. ADHD was diagnosed in up to 2.7% and ASD in 1.3% of the patients. Most cases were diagnosed within 2 years of first contact with adult psychiatry, but some patients were treated for 10 years or more before being diagnosed with ADHD or ASD. Seventy per cent of ADHD and 56% of ASD patients were treated as outpatients only. Other psychiatric diagnoses were registered in about 60%. Affective disorders were common in patients with ADHD. Psychoses and intellectual disability were more common in ASD patients. Psychoactive substance use-related disorders were considerably more common in those with ADHD. Concomitant ADHD and ASD were seldom diagnosed in this clinical material. ADHD and ASD were probably much underdiagnosed in the studied group of psychiatric patients. Other psychiatric diagnoses were common, but not ADHD with concomitant ASD.

  14. Myeloid leukaemia in systemic lupus erythematosus--a nested case-control study based on Swedish registers.

    PubMed

    Löfström, Björn; Backlin, Carin; Sundström, Christer; Hellström-Lindberg, Eva; Ekbom, Anders; Lundberg, Ingrid E

    2009-10-01

    To assess the risk factors for leukaemic transformation and myeloid leukaemia in patients with SLE. A national SLE cohort identified through SLE discharge diagnoses in the Swedish hospital discharge register during 1964 to 1995 (n = 6438) was linked to the national cancer register. A nested case-control study in SLE patients who developed acute or chronic myeloid leukaemia was performed with SLE patients without malignancy as controls. Medical records from cases and controls were reviewed and bone marrow specimens were re-evaluated. A Medline search of previously published cases of SLE and myeloid leukaemia was performed. After confirmation of SLE diagnosis according to the ACR criteria, eight patients with SLE and myeloid leukaemia and 18 SLE controls were included in the study. Preceding leucopenia was significantly associated with leukaemia development, whereas other SLE manifestations were not. Two cases had a preceding bone marrow confirming myelodysplastic syndrome (MDS). Only two cases were significantly treated with cyclophosphamide or AZA. A Medline search resulted in only 15 previously published cases of coincident SLE and myeloid leukaemia. Preceding MDS was reported in five of these, whereas only eight had been treated with cytotoxic drugs. Low-dose chemotherapy was not a major cause of myeloid malignancy in our population-based cohort of SLE patients nor in the reported cases from literature. Leucopenia was a risk factor for myeloid leukaemia development and an MDS was frequently seen. Therefore bone marrow investigation should be considered in SLE patients with long-standing leucopenia and anaemia.

  15. Towards a Better Understanding of Sickness Absence in Adolescence: A Qualitative Study among Dutch Intermediate Vocational Education Students

    PubMed Central

    Feron, Frans J. M.; van Mook, Marlieke A. W.; de Rijk, Angelique

    2017-01-01

    An adequate approach to sickness absence can reduce school dropout which is a major problem in Intermediate Vocational Education (IVE). This practice-based study explores the sickness absence reasons and factors influencing reporting the sickness, from a student's perspective. Semistructured interviews were held until saturation. Data were collected and analysed by a multidisciplinary research team including youth health care physicians working with IVE students. The results show that, according to the students, reasons for sickness reporting were health-related or related to problems at home or in school. Students view their sickness absence as necessity, as asking for understanding, or as pardonable. Their views depended on (1) the perception of medical legitimacy, (2) feeling able to take their own responsibility, (3) feeling being taken seriously at school, and (4) the perception that the sickness reporting procedure at school is anonymous and easy. In conclusion, reporting sickness seems more a reaction to a necessity or opportunity than the result of a conscious decision-making process. Personalizing the sickness reporting procedures and demonstrating interest rather than control while discussing the sickness absence with the individual IVE student might very well affect their sickness absence levels. PMID:28573135

  16. Altered functional connectivity in default mode network in absence epilepsy: a resting-state fMRI study.

    PubMed

    Luo, Cheng; Li, Qifu; Lai, Yongxiu; Xia, Yang; Qin, Yun; Liao, Wei; Li, Shasha; Zhou, Dong; Yao, Dezhong; Gong, Qiyong

    2011-03-01

    Dysfunctional default mode network (DMN) has been observed in various mental disorders, including epilepsy (see review Broyd et al. [2009]: Neurosci Biobehav Rev 33:279–296). Because interictal epileptic discharges may affect DMN, resting-state fMRI was used in this study to determine DMN functional connectivity in 14 healthy controls and 12 absence epilepsy patients. To avoid interictal epileptic discharge effects, testing was performed within interictal durations when there were no interictal epileptic discharges. Cross-correlation functional connectivity analysis with seed at posterior cingulate cortex, as well as region-wise calculation in DMN, revealed decreased integration within DMN in the absence epilepsy patients. Region-wise functional connectivity among the frontal, parietal, and temporal lobe was significantly decreased in the patient group. Moreover, functional connectivity between the frontal and parietal lobe revealed a significant negative correlation with epilepsy duration. These findings indicated DMN abnormalities in patients with absence epilepsy, even during resting interictal durations without interictal epileptic discharges. Abnormal functional connectivity in absence epilepsy may reflect abnormal anatomo-functional architectural integration in DMN, as a result of cognitive mental impairment and unconsciousness during absence seizure. Copyright © 2010 Wiley-Liss, Inc.

  17. Sickness absence among Finnish special and general education teachers.

    PubMed

    Ervasti, J; Kivimäki, M; Pentti, J; Suominen, S; Vahtera, J; Virtanen, M

    2011-10-01

    Although teaching is considered a high-stress profession, research on stress-related outcomes among teachers, such as absence from work due to illness (i.e. sickness absence), remains scarce. It is possible that teachers are not a homogeneous group but include subgroups with particularly high risk of sickness absence, such as special education teachers. To examine differences in sickness absence rates between special and general education teachers in a large cohort of 2291 Finnish lower secondary school teachers. Register data on teachers' job titles, sociodemographic characteristics and sickness absence were obtained from 10 municipal employers' registers. Indices of sickness absence included rates of short-term (1-3 days) and long-term (>3 days) absence spells during 2003-05. With multi-level models adjusted for individual- and school-level covariates, we found that although the absolute level of sickness absence was higher among women than among men, male special education teachers were at a 1.36-fold (95% CI: 1.15-1.61) increased risk of short-term and a 1.33-fold (95% CI: 1.01-1.76) increased risk of long-term sickness absence compared with male teachers in general education. Among women, there were no differences in sickness absence between special and general education teachers. Compared to male teachers in general education, male teachers in special education appear to have an excess risk of absence from work due to illness. Future studies should examine the causes for this excess risk and determine the need for preventive interventions.

  18. Differences in sickness absence between self-employed and employed doctors: a cross-sectional study on national sample of Norwegian doctors in 2010.

    PubMed

    Rosta, Judith; Tellnes, Gunnar; Aasland, Olaf G

    2014-05-02

    Doctors have a low prevalence of sickness absence. Employment status is a determinant in the multifactorial background of sickness absence. The effect of doctors' employment status on sickness absence is unexplored. The study compares the number of sickness absence days during the last 12 months and the impact of employment status, psychosocial work stress, self-rated health and demographics on sickness absence between self-employed practitioners and employed hospital doctors in Norway. The study population consisted of a representative sample of 521 employed interns and consultants and 313 self-employed GPs and private practice specialists in Norway, who received postal questionnaires in 2010. The questionnaires contained items on sickness absence days during the last 12 months, employment status, demographics, self-rated health, professional autonomy and psychosocial work stress. 84% (95% CI 80 to 88%) of self-employed and 60% (95% CI 55 to 64%) of employed doctors reported no absence at all last year. In three multivariate logistic regression models with sickness absence as response variable, employment category was a highly significant predictor for absence vs. no absence, 1 to 3 days of absence vs. no absence and 4 to 99 days of absence vs. no absence), while in a model with 100 or more days of absence vs. no absence, there was no difference between employment categories, suggesting that serious chronic disease or injury is less dependent on employment category. Average or poor self-rated health and low professional autonomy, were also significant predictors of sickness absence, while psychosocial work stress, age and gender were not. Self-employed GPs and private practice specialist reported lower sickness absence than employed hospital doctors. Differences in sickness compensation, and organisational and individual factors may to a certain extent explain this finding.

  19. Drug use in centenarians compared with nonagenarians and octogenarians in Sweden: a nationwide register-based study.

    PubMed

    Wastesson, Jonas W; Parker, Marti G; Fastbom, Johan; Thorslund, Mats; Johnell, Kristina

    2012-03-01

    the number of centenarians increases rapidly. Yet, little is known about their health and use of medications. to investigate pharmacological drug use in community-dwelling and institutionalised centenarians compared with nonagenarians and octogenarians. we analysed data on dispensed drugs for centenarians (n = 1,672), nonagenarians (n = 76,584) and octogenarians (n = 383,878) from the Swedish Prescribed Drug Register, record-linked to the Swedish Social Services Register. Multivariate logistic regression analysis was used to analyse whether age was associated with use of drugs, after adjustment for sex, living situation and co-morbidity. in the adjusted analysis, centenarians were more likely to use analgesics, hypnotics/sedatives and anxiolytics, but less likely to use antidepressants than nonagenarians and octogenarians. Moreover, centenarians were more likely to use high-ceiling diuretics, but less likely to use beta-blockers and ACE-inhibitors. centenarians high use of analgesics, hypnotics/sedatives and anxiolytics either reflects a palliative approach to drug treatment in centenarians or that pain and mental health problems increase into extreme old age. Also, centenarians do not seem to be prescribed cardiovascular drug therapy according to guidelines to the same extent as nonagenarians and octogenarians. Whether this reflects an age or cohort effect should be evaluated in longitudinal studies.

  20. Remaining Life Expectancy With and Without Polypharmacy: A Register-Based Study of Swedes Aged 65 Years and Older.

    PubMed

    Wastesson, Jonas W; Canudas-Romo, Vladimir; Lindahl-Jacobsen, Rune; Johnell, Kristina

    2016-01-01

    To investigate the remaining life expectancy with and without polypharmacy for Swedish women and men aged 65 years and older. Age-specific prevalence of polypharmacy from the nationwide Swedish Prescribed Drug Register (SPDR) combined with life tables from Statistics Sweden was used to calculate the survival function and remaining life expectancy with and without polypharmacy according to the Sullivan method. Nationwide register-based study. A total of 1,347,564 individuals aged 65 years and older who had been prescribed and dispensed a drug from July 1 to September 30, 2008. Polypharmacy was defined as the concurrent use of 5 or more drugs. At age 65 years, approximately 8 years of the 20 remaining years of life (41%) can be expected to be lived with polypharmacy. More than half of the remaining life expectancy will be spent with polypharmacy after the age of 75 years. Women had a longer life expectancy, but also lived more years with polypharmacy than men. Older women and men spend a considerable proportion of their lives with polypharmacy. Given the negative health outcomes associated with polypharmacy, efforts should be made to reduce the number of years older adults spend with polypharmacy to minimize the risk of unwanted consequences. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  1. A third of systematic reviews changed or did not specify the primary outcome: a PROSPERO register study.

    PubMed

    Tricco, Andrea C; Cogo, Elise; Page, Matthew J; Polisena, Julie; Booth, Alison; Dwan, Kerry; MacDonald, Heather; Clifford, Tammy J; Stewart, Lesley A; Straus, Sharon E; Moher, David

    2016-11-01

    To examine outcome reporting bias of systematic reviews registered in PROSPERO. Retrospective cohort study. The primary outcomes from systematic review publications were compared with those reported in the corresponding PROSPERO records; discrepancies in the primary outcomes were assessed as upgrades, additions, omissions, or downgrades. Relative risks (RRs) and 95% confidence intervals (CI) were calculated to determine the likelihood of having a change in primary outcome when the meta-analysis result was favorable and statistically significant. Ninety-six systematic reviews were published. A discrepancy in the primary outcome occurred in 32% of the included reviews and 39% of the reviews did not explicitly specify a primary outcome(s); 6% of the primary outcomes were omitted. There was no significant increased risk of adding/upgrading (RR, 2.14; 95% CI: 0.53, 8.63) or decreased risk of downgrading (RR, 0.76; 95% CI: 0.27, 2.17) an outcome when the meta-analysis result was favorable and statistically significant. As well, there was no significant increased risk of adding/upgrading (RR, 0.89; 95% CI: 0.31, 2.53) or decreased risk of downgrading (RR, 0.56; 95% CI: 0.29, 1.08) an outcome when the conclusion was positive. We recommend review authors carefully consider primary outcome selection, and journals are encouraged to focus acceptance on registered systematic reviews. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Exploring the effect of absence selection on landslide susceptibility models: A case study in Sicily, Italy

    NASA Astrophysics Data System (ADS)

    Conoscenti, Christian; Rotigliano, Edoardo; Cama, Mariaelena; Caraballo-Arias, Nathalie Almaru; Lombardo, Luigi; Agnesi, Valerio

    2016-05-01

    A statistical approach was employed to model the spatial distribution of rainfall-triggered landslides in two areas in Sicily (Italy) that occurred during the winter of 2004-2005. The investigated areas are located within the Belice River basin and extend for 38.5 and 10.3 km2, respectively. A landslide inventory was established for both areas using two Google Earth images taken on October 25th 2004 and on March 18th 2005, to map slope failures activated or reactivated during this interval. Geographic Information Systems (GIS) were used to prepare 5 m grids of the dependent variables (absence/presence of landslide) and independent variables (lithology and 13 DEM-derivatives). Multivariate Adaptive Regression Splines (MARS) were applied to model landslide susceptibility whereas receiver operating characteristic (ROC) curves and the area under the ROC curve (AUC) were used to evaluate model performance. To evaluate the robustness of the whole procedure, we prepared 10 different samples of positive (landslide presence) and negative (landslide absence) cases for each area. Absences were selected through two different methods: (i) extraction from randomly distributed circles with a diameter corresponding to the mean width of the landslide source areas; and (ii) selection as randomly distributed individual grid cells. A comparison was also made between the predictive performances of models including and not including the lithology parameter. The models trained and tested on the same area demonstrated excellent to outstanding fit (AUC > 0.8). On the other hand, predictive skill decreases when measured outside the calibration area, although most of the landslides occur where susceptibility is high and the overall model performance is acceptable (AUC > 0.7). The results also showed that the accuracy of the landslide susceptibility models is higher when lithology is included in the statistical analysis. Models whose absences were selected using random circles showed a

  3. The impact of downsizing on remaining workers' sickness absence.

    PubMed

    Østhus, Ståle; Mastekaasa, Arne

    2010-10-01

    It is generally assumed that organizational downsizing has considerable negative consequences, not only for workers that are laid off, but also for those who remain employed. The empirical evidence with regard to effects on sickness absence is, however, inconsistent. This study employs register data covering a major part of the total workforce in Norway over the period 2000-2003. The number of sickness absence episodes and the number of sickness absence days are analysed by means of Poisson regression. To control for both observed and unobserved stable individual characteristics, we use conditional (fixed effects) estimation. The analyses provide some weak indications that downsizing may lead to slightly less sickness absence, but the overall impression is that downsizing has few if any effects on the sickness absence of the remaining employees.

  4. Assessing Consumer Emotional Responses in the Presence and Absence of Critical Quality Attributes: A Case Study with Chicken Eggs.

    PubMed

    Wardy, Wisdom; Sae-Eaw, Amporn; Sriwattana, Sujinda; No, Hong Kyoon; Prinyawiwatkul, Witoon

    2015-07-01

    Effects of attribute presence and absence on the emotional profile and consumer acceptability of products with varying qualities were assessed using eggs as an example. An online survey (n = 320) was used to evaluate emotional responses and acceptability to 5 types of egg quality attributes: intrinsic, aesthetic, extrinsic, expediency, and wholesome/safety, for both present and absent conditions. Attribute absence rather than presence evoked greater consumer discriminating emotions associated with eggs. Mean emotion intensity elicited by the presence of all quality attributes ranged from 1.67 (intrinsic; guilty) to 4.05 (wholesome; good) versus 2.01 (wholesome; satisfied) to 3.29 (wholesome; disgusted) when absent. Key positive emotions elicited by presence of attributes were active, calm, good, interested, happy, safe, and satisfied; while dominant negative emotions elicited by absence of attributes included disgusted and worried. Wholesome quality (constituted by egg freshness, "packing/best-before-date" and absence of visible cracks) exhibited the highest liking (7.65) and emotion intensities, while the emotional responses to both the presence and absence of intrinsic quality (constituted by nutrient-fortified egg, organic egg, and USDA-certified farm egg) were similar, reflecting their dynamic effects on emotions. Emotions and acceptability were more correlated for attribute absence than presence; and good, happy, and satisfied emotions were strongly related to egg acceptability (r ≥ 0.6). Egg product/packaging design can be oriented toward emphasizing wholesome and expedient attributes, since they enhance good, safe, and satisfied emotions, while minimizing disgust, worry, and boredom. The use of emotional responses and hedonic testing regarding attribute presence and absence would allow for improved selection of attributes critical to consumer acceptance of products. Assessing effects of attribute presence compared with absence on food-evoked emotions may

  5. Electronic Mail, a New Written-Language Register: A Study with French-Speaking Adolescents

    ERIC Educational Resources Information Center

    Volckaert-Legrier, Olga; Bernicot, Josie; Bert-Erboul, Alain

    2009-01-01

    The aim of this study was to determine the extent to which the linguistic forms used by adolescents in electronic mail (e-mail) differ from those used in standard written language. The study was conducted in French, a language with a deep orthography that has strict, addressee-dependent rules for using second person personal pronouns (unfamiliar…

  6. Electronic Mail, a New Written-Language Register: A Study with French-Speaking Adolescents

    ERIC Educational Resources Information Center

    Volckaert-Legrier, Olga; Bernicot, Josie; Bert-Erboul, Alain

    2009-01-01

    The aim of this study was to determine the extent to which the linguistic forms used by adolescents in electronic mail (e-mail) differ from those used in standard written language. The study was conducted in French, a language with a deep orthography that has strict, addressee-dependent rules for using second person personal pronouns (unfamiliar…

  7. Fracture Rates and Fracture Sites in Patients With Osteogenesis Imperfecta: A Nationwide Register-Based Cohort Study.

    PubMed

    Folkestad, Lars; Hald, Jannie Dahl; Ersbøll, Annette Kjaer; Gram, Jeppe; Hermann, Anne Pernille; Langdahl, Bente; Abrahamsen, Bo; Brixen, Kim

    2017-01-01

    Osteogenesis imperfecta (OI) is a hereditary, clinically heterogeneous, connective tissue disorder. The population prevalence of OI in Denmark is 10.6 in 100,000. A hallmark of the disease is frequent fractures that are often precipitated by minimal trauma. The aim of the current study was to compare the fracture rates across the lifespan of patients with OI with that of a reference population from the general population. The present study was a Danish nationwide, population-based, cohort study using register data. We identified 644 (55.6% females) patients in the OI cohort through the Danish National Patient Register and 3361 (55.2% females) persons, randomly selected from the Civil Registry System. A total of 416 patients with OI experienced a total of 1566 fractures during the observation period of median 17.9 years (interquartile range [IQR], 12.4 to 18.0 years), summing to 10137 person years. In comparison, 709 persons in the reference population experienced a total of 1018 fractures during follow-up. Both male and female patients with OI had an increased fracture rate throughout their life. The fracture rate ratio for participants aged 0 to 19 years was 10.7, for participants aged 20 to 54 years 17.2, and for participants aged 55 years and over 4.1 when compared to the reference population. The highest fracture rate was seen in males with OI aged 0 to 19 years (257 fractures per 1000 person-years). The fractures appear to follow the same pattern as in the general population, with a peak during the toddler and adolescent years (incidence rate [IR] 233.9 per 1000 person years), fewer fractures during adulthood (IR 84.5 per 1000 person years), and increased fracture rates in older women (IR 111.9 per 1000 person years). This is the largest register-based nationwide study on the fracture epidemiology of patients with OI. The risk of fractures seems largest in the childhood and adolescent years, and the relative risk of fracture declines with age in patients with

  8. Association of classroom ventilation with reduced illness absence: a prospective study in California elementary schools.

    PubMed

    Mendell, M J; Eliseeva, E A; Davies, M M; Spears, M; Lobscheid, A; Fisk, W J; Apte, M G

    2013-12-01

    Limited evidence associates inadequate classroom ventilation rates (VRs) with increased illness absence (IA). We investigated relationships between VRs and IA in California elementary schools over two school years in 162 3rd-5th-grade classrooms in 28 schools in three school districts: South Coast (SC), Bay Area (BA), and Central Valley (CV). We estimated relationships between daily IA and VR (estimated from two year daily real-time carbon dioxide in each classroom) in zero-inflated negative binomial models. We also compared IA benefits and energy costs of increased VRs. All school districts had median VRs below the 7.1 l/s-person California standard. For each additional 1 l/s-person of VR, IA was reduced significantly (p<0.05) in models for combined districts (-1.6%) and for SC (-1.2%), and nonsignificantly for districts providing less data: BA (-1.5%) and CV (-1.0%). Assuming associations were causal and generalizable, increasing classroom VRs from the California average (4 l/s-person) to the State standard would decrease IA by 3.4%, increase attendance-linked funding to schools by $33 million annually, and increase costs by only $4 million. Further increasing VRs would provide additional benefits. These findings, while requiring confirmation, suggest that increasing classroom VRs above the State standard would substantially decrease illness absence and produce economic benefits.

  9. The impact of prophylactic pancreatic stenting on post-ERCP pancreatitis: A nationwide, register-based study

    PubMed Central

    Lübbe, Jeanne; Arnelo, Urban; Jonas, Eduard; Törnqvist, Björn; Lundell, Lars; Enochsson, Lars

    2016-01-01

    Background and objectives The role of prophylactic pancreatic stenting (PS) in preventing post-endoscopic retrograde cholangio-pancreatography (ERCP) pancreatitis (PEP) has yet to be determined. Most previous studies show beneficial effects in reducing PEP when prophylactic pancreatic stents are used, especially in high-risk ERCP procedures. The present study aimed to address the use of PS in a nationwide register-based study in which the primary outcome was the prophylactic effect of PS in reducing PEP. Methods All ERCP-procedures registered in the nationwide Swedish Registry for Gallstone Surgery and ERCP (GallRiks) between 2006 and 2014 were studied. The primary outcome was PEP but we also studied other peri- and postoperative complication rates. Results Data from 43,595 ERCP procedures were analyzed. In the subgroup of patients who received PS with a total diameter ≤ 5 Fr, the risk of PEP increased nearly four times compared to those who received PS with a total diameter of >5 Fr (OR 3.58; 95% CI 1.40–11.07). Furthermore, patients who received PS of >5 Fr and >5 cm had a significantly lower pancreatitis frequency compared to those with shorter stents of the same diameter (1.39% vs 15.79%; p = 0.0033). Conclusions PS with a diameter of >5 Fr and a length of >5 cm seems to have a better protective effect against PEP, compared to shorter and thinner stents. However, in the present version of GallRiks it is not possible to differentiate the exact type of pancreatic stent (apart from material, length and diameter) that has been introduced, so our conclusion must be interpreted with caution. PMID:28405329

  10. What factors contribute to the risk of depression in epilepsy?--Tasmanian Epilepsy Register Mood Study (TERMS).

    PubMed

    Lacey, Cameron J; Salzberg, Michael R; D'Souza, Wendyl J

    2016-03-01

    To model the factors associated with depression in a community sample of people with epilepsy. The factors investigated were derived from proposed risk factors for depression from patients with epilepsy, other chronic illness, and the general population. Multivariate analysis using general linear regression models of factors associated with depression in the Tasmanian Epilepsy Register Mood Study (TERMS), a cross-sectional community sample of 440 patients with epilepsy. A model with acceptable fit was created that explained 66% of the variance of depression. Associated factors included in this model were neuroticism, physical functioning, social support, past history of depression, and stressful life events. In this cross-sectional study designed specifically to investigate depression in epilepsy, we showed that general risk factors for depression in other illness and in the general population are also important in patients with epilepsy, with little support for disease-related risk factors. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

  11. Comparative analysis of premature mortality among urban immigrants in Bremen, Germany: a retrospective register-based linkage study

    PubMed Central

    Makarova, Nataliya; Brand, Tilman; Brünings-Kuppe, Claudia; Pohlabeln, Hermann; Luttmann, Sabine

    2016-01-01

    Objectives The main objective of this study was to explore differences in mortality patterns among two large immigrant groups in Germany: one from Turkey and the other from the former Soviet Union (FSU). To this end, we investigated indicators of premature mortality. Design This study was conducted as a retrospective population-based study based on mortality register linkage. Using mortality data for the period 2004–2010, we calculated age-standardised death rates (SDR) and standardised mortality ratios (SMR) for premature deaths (study, we made use of the unique possibilities of register-based research in relation to migration and health. Analyses were performed in three population groups in the federal state of Bremen, Germany: immigrants from Turkey, those from the FSU and the general population. Results The SDRs for premature deaths of the two immigrant groups were lower compared to those of the general population. The SMRs remained under 1. Using the indicator of YPLL, we observed higher age-standardised YPLL rates among immigrant populations, particularly among males from the FSU compared to females and population groups 4238/100 000, 95% CI (4119 to 4358). Regarding main causes of premature death, we found larger contributions of infant mortality and diseases of the respiratory system among Turkish immigrants, and of injuries and poisonings, and mental and behavioural disorders among immigrants from the FSU. Conclusions While the overall trends favour the immigrant populations, the indicator of YPLL and cause-specific results indicate areas where the healthcare systems responsiveness may need to be improved, including preventive services. Further work with broader databases providing a similar level of differentiation is necessary to substantiate these findings. PMID:27000782

  12. Upper Secondary French Students, Chemical Transformations and the "Register of Models": A Cross-Sectional Study

    ERIC Educational Resources Information Center

    Cokelez, Aytekin; Dumon, Alain; Taber, Keith S.

    2008-01-01

    The purpose of this study is to identify how upper secondary school French students (Grade 10-12) interpret chemical transformation with regards to the changes within molecules and atoms, and in terms of intramolecular and/or intermolecular bond breaking. In order to identify and describe the students' assimilated knowledge, four questions were…

  13. Ten-Year Trend Analysis of Autism Severity: A Nationwide Population-Based Register Study

    ERIC Educational Resources Information Center

    Lin, Jin-Ding; Sung, Chang-Lin; Lin, Lan-Ping; Hsu, Shang-Wei; Chien, Wu-Chien; Su, Sui-Lung; Wu, Jia-Ling

    2011-01-01

    The severity of autism spectrum disorder was strongly related to the education and service outcome. Without a clear profile of autistic population and its change, efforts to understand its nature and improve the quality of service or education will be impossible. The present study aims to describe the over time reported rate of autism severity…

  14. Enhancing Literacy in the Second Grade: Five Related Studies Using the Register Music/Reading Curriculum

    ERIC Educational Resources Information Center

    Darrow, Alice-Ann; Cassidy, Jane W.; Flowers, Patricia J.; Register, Dena; Sims, Wendy; Standley, Jayne M.; Menard, Elizabeth; Swedberg, Olivia

    2009-01-01

    The purpose of these five related studies was to ascertain the effects of a music curriculum designed to enhance reading skills of second-grade students. The dependent variables were subtest scores on the Gates-MacGinitie Reading Test administered pre and post the music/reading intervention. Results showed that the total test gain scores of…

  15. A Register Study of Life Events in Young Adults Born to Mothers with Mild Intellectual Disability

    ERIC Educational Resources Information Center

    Lindblad, Ida; Billstedt, Eva; Gillberg, Christopher; Fernell, Elisabeth

    2014-01-01

    Background: Young adults, born to population-representative mothers with intellectual disability (ID), were targeted for psychosocial/life event follow-up. Methods: The whole group originally comprised 42 individuals but 3 had died and 1 had moved abroad. The remaining 38 were approached and 10 consented to participate in an interview study.…

  16. Perceptions of Writing Confidence, Critical Thinking, and Writing Competence among Registered Nurse-Learners Studying Online

    ERIC Educational Resources Information Center

    Carter, Lorraine

    2008-01-01

    Historically, nursing education has recognized that writing enhances critical thinking, the basis of the clinical reasoning process. The online learning recently adopted by Nursing involves considerable writing, which may enhance critical thinking more than face-to-face courses. In the study reported here, the critical thinking and writing…

  17. Forensic Psychiatric Perspective on Criminality Associated with Intellectual Disability: A Nationwide Register-Based Study

    ERIC Educational Resources Information Center

    Mannynsalo, L.; Putkonen, H.; Lindberg, N.; Kotilainen, I.

    2009-01-01

    Background: Contrasting views exist over the association of intellectual disability (ID) and criminal offending. This nationwide study attempts to shed further light to expand understanding to substantiate the relation between socio-demographic characteristics, psychiatric co-morbidity and criminal behaviour among the Finnish forensic population…

  18. Forensic Psychiatric Perspective on Criminality Associated with Intellectual Disability: A Nationwide Register-Based Study

    ERIC Educational Resources Information Center

    Mannynsalo, L.; Putkonen, H.; Lindberg, N.; Kotilainen, I.

    2009-01-01

    Background: Contrasting views exist over the association of intellectual disability (ID) and criminal offending. This nationwide study attempts to shed further light to expand understanding to substantiate the relation between socio-demographic characteristics, psychiatric co-morbidity and criminal behaviour among the Finnish forensic population…

  19. Perceptions of Writing Confidence, Critical Thinking, and Writing Competence among Registered Nurse-Learners Studying Online

    ERIC Educational Resources Information Center

    Carter, Lorraine

    2008-01-01

    Historically, nursing education has recognized that writing enhances critical thinking, the basis of the clinical reasoning process. The online learning recently adopted by Nursing involves considerable writing, which may enhance critical thinking more than face-to-face courses. In the study reported here, the critical thinking and writing…

  20. Upper Secondary French Students, Chemical Transformations and the "Register of Models": A Cross-Sectional Study

    ERIC Educational Resources Information Center

    Cokelez, Aytekin; Dumon, Alain; Taber, Keith S.

    2008-01-01

    The purpose of this study is to identify how upper secondary school French students (Grade 10-12) interpret chemical transformation with regards to the changes within molecules and atoms, and in terms of intramolecular and/or intermolecular bond breaking. In order to identify and describe the students' assimilated knowledge, four questions were…

  1. Gender-Specific Risk Factors for Intimate Partner Homicide: A Nationwide Register-Based Study

    ERIC Educational Resources Information Center

    Weizmann-Henelius, Ghitta; Gronroos, Matti; Putkonen, Hanna; Eronen, Markku; Lindberg, Nina; Hakkanen-Nyholm, Helina

    2012-01-01

    The present study examined gender differences in intimate partner homicide (IPH) and offender characteristics with the focus on putative gender-specific risk factors in a nationwide consecutive sample of homicide offenders. Data on all offenders (N = 642; 91 females, 551 males) convicted of homicide and subjected to a forensic psychiatric…

  2. Gender-Specific Risk Factors for Intimate Partner Homicide: A Nationwide Register-Based Study

    ERIC Educational Resources Information Center

    Weizmann-Henelius, Ghitta; Gronroos, Matti; Putkonen, Hanna; Eronen, Markku; Lindberg, Nina; Hakkanen-Nyholm, Helina

    2012-01-01

    The present study examined gender differences in intimate partner homicide (IPH) and offender characteristics with the focus on putative gender-specific risk factors in a nationwide consecutive sample of homicide offenders. Data on all offenders (N = 642; 91 females, 551 males) convicted of homicide and subjected to a forensic psychiatric…

  3. Enhancing Literacy in the Second Grade: Five Related Studies Using the Register Music/Reading Curriculum

    ERIC Educational Resources Information Center

    Darrow, Alice-Ann; Cassidy, Jane W.; Flowers, Patricia J.; Register, Dena; Sims, Wendy; Standley, Jayne M.; Menard, Elizabeth; Swedberg, Olivia

    2009-01-01

    The purpose of these five related studies was to ascertain the effects of a music curriculum designed to enhance reading skills of second-grade students. The dependent variables were subtest scores on the Gates-MacGinitie Reading Test administered pre and post the music/reading intervention. Results showed that the total test gain scores of…

  4. A Register Study of Life Events in Young Adults Born to Mothers with Mild Intellectual Disability

    ERIC Educational Resources Information Center

    Lindblad, Ida; Billstedt, Eva; Gillberg, Christopher; Fernell, Elisabeth

    2014-01-01

    Background: Young adults, born to population-representative mothers with intellectual disability (ID), were targeted for psychosocial/life event follow-up. Methods: The whole group originally comprised 42 individuals but 3 had died and 1 had moved abroad. The remaining 38 were approached and 10 consented to participate in an interview study.…

  5. Associations between Stroke Mortality and Weekend Working by Stroke Specialist Physicians and Registered Nurses: Prospective Multicentre Cohort Study

    PubMed Central

    Bray, Benjamin D.; Ayis, Salma; Campbell, James; Cloud, Geoffrey C.; James, Martin; Hoffman, Alex; Tyrrell, Pippa J.; Wolfe, Charles D. A.; Rudd, Anthony G.

    2014-01-01

    Background Observational studies have reported higher mortality for patients admitted on weekends. It is not known whether this “weekend effect” is modified by clinical staffing levels on weekends. We aimed to test the hypotheses that rounds by stroke specialist physicians 7 d per week and the ratio of registered nurses to beds on weekends are associated with mortality after stroke. Methods and Findings We conducted a prospective cohort study of 103 stroke units (SUs) in England. Data of 56,666 patients with stroke admitted between 1 June 2011 and 1 December 2012 were extracted from a national register of stroke care in England. SU characteristics and staffing levels were derived from cross-sectional survey. Cox proportional hazards models were used to estimate hazard ratios (HRs) of 30-d post-admission mortality, adjusting for case mix, organisational, staffing, and care quality variables. After adjusting for confounders, there was no significant difference in mortality risk for patients admitted to a stroke service with stroke specialist physician rounds fewer than 7 d per week (adjusted HR [aHR] 1.04, 95% CI 0.91–1.18) compared to patients admitted to a service with rounds 7 d per week. There was a dose–response relationship between weekend nurse/bed ratios and mortality risk, with the highest risk of death observed in stroke services with the lowest nurse/bed ratios. In multivariable analysis, patients admitted on a weekend to a SU with 1.5 nurses/ten beds had an estimated adjusted 30-d mortality risk of 15.2% (aHR 1.18, 95% CI 1.07–1.29) compared to 11.2% for patients admitted to a unit with 3.0 nurses/ten beds (aHR 0.85, 95% CI 0.77–0.93), equivalent to one excess death per 25 admissions. The main limitation is the risk of confounding from unmeasured characteristics of stroke services. Conclusions Mortality outcomes after stroke are associated with the intensity of weekend staffing by registered nurses but not 7-d/wk ward rounds by stroke

  6. Mortality and Causes of Death in Patients With Osteogenesis Imperfecta: A Register-Based Nationwide Cohort Study.

    PubMed

    Folkestad, Lars; Hald, Jannie Dahl; Canudas-Romo, Vladimir; Gram, Jeppe; Hermann, Anne Pernille; Langdahl, Bente; Abrahamsen, Bo; Brixen, Kim

    2016-12-01

    Osteogenesis imperfecta (OI) is a hereditary connective tissue disease that causes frequent fractures. Little is known about causes of death and length of survival in OI. The objective of this work was to calculate the risk and cause of death, and the median survival time in patients with OI. This study was a Danish nationwide, population-based and register-based cohort study. We used National Patient Register data from 1977 until 2013 with complete long-term follow-up. Participants comprised all patients registered with the diagnosis of OI from 1977 until 2013, and a reference population matched five to one to the OI cohort. We calculated hazard ratios for all-cause mortality and subhazard ratios for cause-specific mortality in a comparison of the OI cohort and the reference population. We also calculated all-cause mortality hazard ratios for males, females, and age groups (0 to 17.99 years, 18.00 to 34.99 years, 35.00 to 54.99 years, 55.00 to 74.99 years, and >75 years). We identified 687 cases of OI (379 women) and included 3435 reference persons (1895 women). A total of 112 patients with OI and 257 persons in the reference population died during the observation period. The all-cause mortality hazard ratio between the OI cohort and the reference population was 2.90. The median survival time for males with OI was 72.4 years, compared to 81.9 in the reference population. The median survival time for females with OI was 77.4 years, compared to 84.5 years in the reference population. Patients with OI had a higher risk of death from respiratory diseases, gastrointestinal diseases, and trauma. We were limited by the lack of clinical information about phenotype and genotype of the included patients. Patients with OI had a higher mortality rate throughout their life compared to the general population. © 2016 American Society for Bone and Mineral Research.

  7. Gender differences in patients scheduled for lumbar disc herniation surgery: a National Register Study including 15,631 operations.

    PubMed

    Strömqvist, Fredrik; Strömqvist, Björn; Jönsson, Bo; Karlsson, Magnus K

    2016-01-01

    Previous studies have shown gender differences in preoperative status and outcome of spine surgery. This study explores whether gender differences in preoperative demographics exist in patients scheduled for lumbar disc herniation (LDH) surgery. This study includes the preoperative data of the 15,631 patients operated for LDH between years 2000 and 2010, registered in the national Swedish spine register (SweSpine). We analysed preoperative gender differences in age, smoking habits, walking distance, consumption of analgesics, back and leg pain (Visual Analogue Scale; VAS), quality of life (EuroQol; EQ 5D and Short Form-36 Questionnaire; SF-36) and disability (Oswestry Disability Index; ODI). 44 % of the patients were women (mean age 45 ± 13) and 56 % men (mean age 44 ± 13). More women than men were smokers (26 versus 21 %, p < 0.001). Women also reported inferior walking ability (less than 100 metre walking ability 37 vs 30 %; p < 0.001), consumed more analgesics (92 versus 84 %; p < 0.001), reported higher level of pain (mean difference VAS leg 6 (95 % CI 5-7)), had inferior health-related quality of life (mean difference EQ 5D 0.07 (95 % CI 0.05-0.08)) and had higher disability (mean difference ODI 6 (95 % CI 5-6)). Women scheduled for LDH surgery report inferior clinical status than men scheduled for the same operation. We have in the literature found no evidence-based data that support such a difference, and the reason for the discrepancy is unclear.

  8. Towards non-conventional methods of designing register-based epidemiological studies: An application to pediatric research.

    PubMed

    Gong, Tong; Brew, Bronwyn; Sjölander, Arvid; Almqvist, Catarina

    2017-07-01

    Various epidemiological designs have been applied to investigate the causes and consequences of fetal growth restriction in register-based observational studies. This review seeks to provide an overview of several conventional designs, including cohort, case-control and more recently applied non-conventional designs such as family-based designs. We also discuss some practical points regarding the application and interpretation of family-based designs. Definitions of each design, the study population, the exposure and the outcome measures are briefly summarised. Examples of study designs are taken from the field of low birth-weight research for illustrative purposes. Also examined are relative advantages and disadvantages of each design in terms of assumptions, potential selection and information bias, confounding and generalisability. Kinship data linkage, statistical models and result interpretation are discussed specific to family-based designs. When all information is retrieved from registers, there is no evident preference of the case-control design over the cohort design to estimate odds ratios. All conventional designs included in the review are prone to bias, particularly due to residual confounding. Family-based designs are able to reduce such bias and strengthen causal inference. In the field of low birth-weight research, family-based designs have been able to confirm a negative association not confounded by genetic or shared environmental factors between low birth weight and the risk of asthma. We conclude that there is a broader need for family-based design in observational research as evidenced by the meaningful contributions to the understanding of the potential causal association between low birth weight and subsequent outcomes.

  9. A multi-wave study of organizational justice at work and long-term sickness absence among employees with depressive symptoms.

    PubMed

    Hjarsbech, Pernille U; Christensen, Karl Bang; Bjorner, Jakob B; Madsen, Ida E H; Thorsen, Sannie V; Carneiro, Isabella G; Christensen, Ulla; Rugulies, Reiner

    2014-03-01

    Mental health problems are strong predictors of long-term sickness absence (LTSA). In this study, we investigated whether organizational justice at work - fairness in resolving conflicts and distributing work - prevents risk of LTSA among employees with depressive symptoms. In a longitudinal study with five waves of data collection, we examined a cohort of 1034 employees with depressive symptoms. Depressive symptoms and organizational justice were assessed by self-administered questionnaires and information on LTSA was derived from a national register. Using Poisson regression analyses, we calculated rate ratios (RR) for the prospective association of organizational justice and change in organizational justice with time to onset of LTSA. All analyses were sex stratified. Among men, intermediate levels of organizational justice were statistically significantly associated with a decreased risk of subsequent LTSA after adjustment for covariates [RR 0.49, 95% confidence interval (95% CI) 0.26-0.91]. There was also a decreased risk for men with high levels of organizational justice although these estimates did not reach statistical significance after adjustment (RR 0.47, 95% CI 0.20-1.10). We found no such results for women. In both sexes, neither favorable nor adverse changes in organizational justice were statistically significantly associated with the risk of LTSA. This study shows that organizational justice may have a protective effect on the risk of LTSA among men with depressive symptoms. A protective effect of favorable changes in organizational justice was not found.

  10. A Study of Factors Affecting the Retention of Civilian Registered Nurses in the Army Medical Department

    DTIC Science & Technology

    1982-08-01

    significant changes occur in satisfaction or expected utilities. Hellriegel and White demonstrated that, in 60 percent of the turnovers in their study...Between Job Satisfaction and Employee Turnover," Journal of Applied Psychology 62 (February 1977): 237-239. 5D. Hellriegel and G. E. White, "Turnover of... Hellriegel , D., and White, G. E. "Turnover of Professionals in Public Accounting: A Comparative Analysis," Personnel Psychology 26 (1973): 239-249

  11. CNS infections in Greenland: A nationwide register-based cohort study

    PubMed Central

    Nordholm, Anne Christine; Søborg, Bolette; Andersson, Mikael; Hoffmann, Steen; Skinhøj, Peter; Koch, Anders

    2017-01-01

    Background Indigenous Arctic people suffer from high rates of infectious diseases. However, the burden of central nervous system (CNS) infections is poorly documented. This study aimed to estimate incidence rates and mortality of CNS infections among Inuits and non-Inuits in Greenland and in Denmark. Methods We conducted a nationwide cohort study using the populations of Greenland and Denmark 1990–2012. Information on CNS infection hospitalizations and pathogens was retrieved from national registries and laboratories. Incidence rates were estimated as cases per 100,000 person-years. Incidence rate ratios were calculated using log-linear Poisson-regression. Mortality was estimated using Kaplan-Meier curves and Log Rank test. Results The incidence rate of CNS infections was twice as high in Greenland (35.6 per 100,000 person years) as in Denmark (17.7 per 100,000 person years), but equally high among Inuits in Greenland and Denmark (38.2 and 35.4, respectively). Mortality from CNS infections was 2 fold higher among Inuits (10.5%) than among non-Inuits (4.8%) with a fivefold higher case fatality rate in Inuit toddlers. Conclusion Overall, Inuits living in Greenland and Denmark suffer from twice the rate of CNS infections compared with non-Inuits, and Inuit toddlers carried the highest risk of mortality. Further studies regarding risk factors such as genetic susceptibility, life style and socioeconomic factors are warranted. PMID:28158207

  12. Repeated addiction treatment use in Sweden: a National Register Database study.

    PubMed

    Grahn, Robert; Chassler, Deborah; Lundgren, Lena

    2014-11-01

    Sweden has a free, universal addiction treatment system, yet few studies exist examining utilization of treatment in this country. This study identified predisposing, enabling, and need factors associated with history of number of voluntary addiction treatment episodes for a national sample of 12,009 individuals assessed for an alcohol and/or drug use disorder in Sweden. On average, people reported 4.3 prior treatment episodes. Linear regression methods identified that predisposing factors such as older age and being male were associated with more voluntary addiction treatment episodes compared to younger and female clients; a higher Addiction Severity Index (ASI) employment score (an enabling factor) was associated with more voluntary addiction treatment episodes; and need factors including a history of inpatient mental health treatment, a higher ASI psychiatric score, a higher ASI alcohol score, higher levels of illicit drug use, more compulsory addiction treatment episodes, a lower ASI legal score, and a history of criminal justice involvement were all associated with more voluntary addiction treatment episodes compared to their counterparts.. There were no differences in the number of treatment episodes by education or immigrant status. (1) Need is a key factor associated with more treatment use. (2) Further studies are needed to identify gender differences in access/use of treatment. (3) Given multiple treatment histories, Swedish addiction treatment policy should reflect a chronic care model rather than an acute care model.

  13. In vivo Studies of VEGFR2 Interactions in the Presence and Absence of VEGF

    NASA Astrophysics Data System (ADS)

    King, Christopher; Hristova, Kalina, , Dr.

    Vascular Endothelial Growth Factor Receptor 2 (VEGFR2) is a receptor tyrosine kinase (RTK) that is critical for vasculogenesis and angiogenesis. Enhanced VEGFR2 signaling is often correlated with malignancy. Recently, it was shown that full-length VEGFR2 exists in a monomer-dimer equilibrium in the absence of bound VEGF. Thus, the canonical model of RTK activation does not seem to adequately describe the behavior of VEGFR2 in the cell membrane. In order to understand the role that VEGFR2 extracellular domain plays in unliganded dimerization in live cells, we utilize Fully Quantified Spectral Imaging (FSI) to probe the interactions of VEGFR2 mutant constructs with rationally truncated EC domains. In addition, we investigate the stoichiometry of ligand binding to VEGFR2 EC domain as a function of VEGF concentration and total receptor expression. Supported by NSF MCB 1157687 and NIH GM068619 (to KH) and and NSF Graduate Research Fellowship DGE-1232825 (to CK).

  14. Medical versus surgical abortion efficacy, complications and leave of absence compared in a partly randomized study.

    PubMed

    Rørbye, Christina; Nørgaard, Mogens; Nilas, Lisbeth

    2004-11-01

    To provide optimal information to women choosing between early medical and surgical abortion, rigorous comparisons of the two methods are warranted. We compared the outcome of 1135 consecutive women with gestational age (GA) < or = 63 days receiving either a medical (600 mg mifepristone and 1 mg gemeprost) or a surgical abortion (vacuum aspiration in general anesthesia). One hundred eleven of these women were randomized for abortion method. Surgical interventions and complications leading to readmission within the following 15 weeks were identified through a computer system. Information about antibiotic treatment, leave of absence and number of contacts to the health care system were obtained from mailed questionnaires. The number of complications was identical after the two methods, but surgical abortion was associated with a higher success rate [97.7% (708/725) vs. 94.1% (386/410), p < .01] and also with a higher risk of antibiotic treatment than medical abortion [7.8% (37/467) vs. 3.7% (13/356), p < .05]. The median leave of absence was shorter in women choosing a medical (1 day) than a surgical termination (2 days), p < .05. On average, one third of all the women requested at least one extra unscheduled consultation apart from a routine follow-up visit. We conclude that the chance of a primary successful termination at GA < or = 63 days is higher after a surgical abortion in general anesthesia compared to a medical abortion induced with 600 mg mifepristone and 1 mg gemeprost. A surgical abortion is associated with an increased risk of antibiotic treatment compared to medical abortion. The women's need for follow-up might be higher than we expect.

  15. The familial co-aggregation of ASD and ADHD: a register-based cohort study.

    PubMed

    Ghirardi, L; Brikell, I; Kuja-Halkola, R; Freitag, C M; Franke, B; Asherson, P; Lichtenstein, P; Larsson, H

    2017-02-28

    Autism spectrum disorders (ASD) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur. The presence of a genetic link between ASD and ADHD symptoms is supported by twin studies, but the genetic overlap between clinically ascertained ASD and ADHD remains largely unclear. We therefore investigated how ASD and ADHD co-aggregate in individuals and in families to test for the presence of a shared genetic liability and examined potential differences between low- and high-functioning ASD in the link with ADHD. We studied 1 899 654 individuals born in Sweden between 1987 and 2006. Logistic regression was used to estimate the association between clinically ascertained ASD and ADHD in individuals and in families. Stratified estimates were obtained for ASD with (low-functioning) and without (high-functioning) intellectual disability. Individuals with ASD were at higher risk of having ADHD compared with individuals who did not have ASD (odds ratio (OR)=22.33, 95% confidence interval (CI): 21.77-22.92). The association was stronger for high-functioning than for low-functioning ASD. Relatives of individuals with ASD were at higher risk of ADHD compared with relatives of individuals without ASD. The association was stronger in monozygotic twins (OR=17.77, 95% CI: 9.80-32.22) than in dizygotic twins (OR=4.33, 95% CI: 3.21-5.85) and full siblings (OR=4.59, 95% CI: 4.39-4.80). Individuals with ASD and their relatives are at increased risk of ADHD. The pattern of association across different types of relatives supports the existence of genetic overlap between clinically ascertained ASD and ADHD, suggesting that genomic studies might have underestimated this overlap.Molecular Psychiatry advance online publication, 28 February 2017; doi:10.1038/mp.2017.17.

  16. Divorce and parity progression following the death of a child: A register-based study from Finland.

    PubMed

    Finnäs, Fjalar; Rostila, Mikael; Saarela, Jan

    2017-08-09

    Most studies that have examined whether a child's death influences parental relationship stability have used small-scale data sets and their results are inconclusive. A likely reason is that child loss affects not only the risk of parental separation, but also the risk of having another child. Hence parity progression and separation must be treated as two competing events in relation to child loss. The analysis in this paper used Finnish register data from 1971 to 2003, covering over 100,000 married couples whose durations of both first marriage and parenthood could be observed. We ran parity-specific Cox regressions in which process time started from the birth of each additional child. All marriages included women of childbearing age, none of whom had experienced any child death on entering the analysis. We find that child loss only modestly influences the divorce risk, whereas its effect on the risk of parity progression is considerable.

  17. Repeated entries to the Swedish addiction compulsory care system: a national register database study.

    PubMed

    Grahn, Robert; Lundgren, Lena M; Chassler, Deborah; Padyab, Mojgan

    2015-04-01

    This study identified and described specific client groups who have repeated entries to the Swedish addiction compulsory care system. Specifically, through the use of baseline data from the Swedish government Staten's Institutions Styrelse (SiS) database, for 2658 individuals who were assessed at their compulsory care intake interview by social workers in the national social welfare system between 2001 and 2009 the study identified the associations between specific predisposing, enabling and need characteristics and repeated addiction compulsory care entries. The logistic regression model identified that individuals whose children have been mandated to the child welfare system, who have experienced prior compulsory care including compulsory treatment through LVU (law (1990:52) with specific provision about care of young people under 18), and those who have been in prison are more likely to have two or more entries in the addiction compulsory care system compared to their counterparts. Individuals who have been mandated to compulsory care for their substance use disorder two or more times have significant multiple complex problems and repeated experiences of institutionalization. These individuals are a group in need of a well-coordinated and integrated system of aftercare services to reduce the likelihood of re-entry into addiction compulsory care. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Factors influencing registered nurses perception of their overall job satisfaction: a qualitative study.

    PubMed

    Atefi, N; Abdullah, K L; Wong, L P; Mazlom, R

    2014-09-01

    The purpose of this qualitative descriptive study was to explore factors related to critical care and medical-surgical nurses' job satisfaction as well as dissatisfaction in Iran. Job satisfaction is an important factor in healthcare settings. Strong empirical evidence supports a causal relationship between job satisfaction, patient safety and quality of care. A convenient sample of 85 nurses from surgical, medical and critical care wards of a large hospital was recruited. Ten focus group discussions using a semi-structured interview guide were conducted. Interviews were audio-recorded, transcribed verbatim and analysed using a thematic approach. The study identified three main themes that influenced nurses' job satisfaction and dissatisfaction: (1) spiritual feeling, (2) work environment factors, and (3) motivation. Helping and involvement in patient care contributed to the spiritual feeling reported to influence nurses' job satisfaction. For work environment factors, team cohesion, benefit and rewards, working conditions, lack of medical resources, unclear nurses' responsibilities, patient and doctor perceptions, poor leadership skills and discrimination at work played an important role in nurses' job dissatisfaction. For motivation factors, task requirement, professional development and lack of clinical autonomy contributed to nurses' job satisfaction. Nurse managers should ensure a flexible practice environment with adequate staffing and resources with opportunities for nurses to participate in hospital's policies and governance. Policy makers should consider nurses' professional development needs, and implement initiatives to improve nurses' rewards and other benefits as they influence job satisfaction. © 2014 International Council of Nurses.

  19. Effect of co-twin gender on neurodevelopmental symptoms: a twin register study.

    PubMed

    Eriksson, Jonna Maria; Lundström, Sebastian; Lichtenstein, Paul; Bejerot, Susanne; Eriksson, Elias

    2016-01-01

    Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are neurodevelopmental disorders thought to have both genetic and environmental causes. It has been hypothesized that exposure to elevated levels of prenatal testosterone is associated with elevated traits of ASD and ADHD. Assuming that testosterone levels from a dizygotic male twin fetus may lead to enhanced testosterone exposure of its co-twins, we aimed to test the prenatal testosterone hypothesis by comparing same-sex with opposite-sex dizygotic twins with respect to neurodevelopmental symptoms. Neuropsychiatric traits were assessed in a population-based twin cohort from the Child and Adolescent Twin Study in Sweden (CATSS). Parental interviews were conducted for 16,312 dizygotic twins, 9 and 12 years old, with the Autism-Tics, ADHD, and other Comorbidities inventory (A-TAC). Girls with a female co-twin had an increased risk of reaching the cut-off score for ADHD compared with girls with a male co-twin. Both boys and girls with a female co-twin displayed a larger number of traits related to attention deficit and repetitive and stereotyped behaviors than those with a male twin. In girls, this also extended to social interaction and the combined measures for ASD and ADHD, however, with small effect sizes. Our results are reverse to what would have been expected from the prenatal testosterone hypothesis but consistent with a previous study of ASD and ADHD traits in dizygotic twins. The seemingly protective effect for girls of having a twin brother may be an effect of parent report bias, but may also be an unexpected effect of sharing the intrauterine environment with a male co-twin.

  20. Hospital-Diagnosed Dementia and Suicide: A Longitudinal Study Using Prospective, Nationwide Register Data

    PubMed Central

    Erlangsen, Annette; Zarit, Steven H.; Conwell, Yeates

    2013-01-01

    Objective The current study aims to examine the risk of suicide in persons diagnosed with dementia during a hospitalization and its relationship to mood disorders. Design Event-history analysis using time-varying covariates. Setting Population-based record linkage. Participants All individuals aged 50+ living in Denmark (N = 2,474,767) during January 1, 1990 through December 31, 2000. Measurements Outcome of interest is suicide. Relative risks are calculated based on person-days spent in each stratum. Results A total of 18,648,875 person-years were observed during the 11-year study period. During this period, 136 persons who previously had been diagnosed with dementia died by suicide. Men and women aged 50–69 years with hospital presentations of dementia have a relative suicide risk of 8.5 (95% confidence interval: 6.3–11.3) and 10.8 (95% confidence interval: 7.4–15.7), respectively. Those who are aged 70 or older with dementia have a threefold higher risk than persons with no dementia. The time shortly after diagnosis is associated with an elevated suicide risk. The risk among persons with dementia remains significant when controlling for mood disorders. As many as 26% of the men and 14% of the women who died by suicide died within the first 3 months after being diagnosed whereas 38% of the men and 41% of the women died more than 3 years after initial dementia diagnosis. Conclusions Dementia, determined during hospitalization, was associated with an elevated risk of suicide for older adults. Preventive measures should focus on suicidal ideation after initial diagnosis but also acknowledge that suicides can occur well after a dementia diagnosis has been established. PMID:18310552

  1. Parental history of psychiatric diagnoses and unipolar depression: a Danish National Register-based cohort study.

    PubMed

    Musliner, K L; Trabjerg, B B; Waltoft, B L; Laursen, T M; Mortensen, P B; Zandi, P P; Munk-Olsen, T

    2015-10-01

    Depression is known to run in families, but the effects of parental history of other psychiatric diagnoses on depression rates are less well studied. Few studies have examined the impact of parental psychopathology on depression rates in older age groups. We established a population-based cohort including all individuals born in Denmark after 1954 and alive on their 10th birthday (N = 29 76 264). Exposure variables were maternal and paternal history of schizophrenia, bipolar disorder, depression, anxiety or 'other' psychiatric diagnoses. Incidence rate ratios (IRRs) were estimated using Poisson regressions. Parental history of any psychiatric diagnosis increased incidence rates of outpatient (maternal: IRR 1.88, p < 0.0001; paternal: IRR 1.68, p < 0.0001) and inpatient (maternal: IRR 1.99, p < 0.0001; paternal: IRR 1.83, p < 0.0001) depression relative to no parental history. IRRs for parental history of non-affective disorders remained relatively stable across age groups, while IRRs for parental affective disorders (unipolar or bipolar) decreased with age from 2.29-3.96 in the youngest age group to 1.53-1.90 in the oldest group. IRR estimates for all parental diagnoses were similar among individuals aged ⩾41 years (IRR range 1.51-1.90). Parental history of any psychiatric diagnosis is associated with increased incidence rates of unipolar depression. In younger age groups, parental history of affective diagnoses is more strongly associated with rates of unipolar depression than non-affective diagnoses; however, this distinction disappears after age 40, suggesting that parental psychopathology in general, rather than any one disorder, confers risk for depression in middle life.

  2. Hospitalizations Due to Adverse Drug Events in the Elderly—A Retrospective Register Study

    PubMed Central

    Laatikainen, Outi; Sneck, Sami; Bloigu, Risto; Lahtinen, Minna; Lauri, Timo; Turpeinen, Miia

    2016-01-01

    Adverse drug events (ADEs) are more likely to affect geriatric patients due to physiological changes occurring with aging. Even though this is an internationally recognized problem, similar research data in Finland is still lacking. The aim of this study was to determine the number of geriatric medication-related hospitalizations in the Finnish patient population and to discover the potential means of recognizing patients particularly at risk of ADEs. The study was conducted retrospectively from the 2014 emergency department patient records in Oulu University Hospital. A total number of 290 admissions were screened for ADEs, adverse drug reactions (ADRs) and drug-drug interactions (DDIs) by a multi-disciplinary research team. Customized Naranjo scale was used as a control method. All admissions were categorized into “probable,” “possible,” or “doubtful” by both assessment methods. In total, 23.1% of admissions were categorized as “probably” or “possibly” medication-related. Vertigo, falling, and fractures formed the largest group of ADEs. The most common ADEs were related to medicines from N class of the ATC-code system. Age, sex, residence, or specialty did not increase the risk for medication-related admission significantly (min p = 0.077). Polypharmacy was, however, found to increase the risk (OR 3.3; 95% CI, 1.5–6.9; p = 0.01). In conclusion, screening patients for specific demographics or symptoms would not significantly improve the recognition of ADEs. In addition, as ADE detection today is largely based on voluntary reporting systems and retrospective manual tracking of errors, it is evident that more effective methods for ADE detection are needed in the future. PMID:27761112

  3. Hospital care for primary hyperparathyroidism in Italy: a 6-year register-based study

    PubMed Central

    Cipriani, Cristiana; Carnevale, Vincenzo; Biamonte, Federica; Piemonte, Sara; Pepe, Jessica; Nieddu, Luciano; Bilezikian, John P; Minisola, Salvatore

    2015-01-01

    Objective Primary hyperparathyroidism (PHPT) is one of the most frequently diagnosed endocrine disorders, but few studies have focused on hospital management of the disease in Europe. We investigated the frequency of hospital admission for diagnosis and surgical treatment of PHPT in Italy. Design A retrospective study was conducted for investigating the hospital care for PHPT in Italy. Methods We retrieved data from the ‘Record of Hospital Discharge’ of the Italian Health Ministry, from 2006 to 2011, and analyzed the codes corresponding to PHPT-related diagnoses and surgical procedures. Results Overall, 46 275 hospitalization episodes for PHPT were identified during the entire period (69% in women and 31% in men; mean age 63.3±39.8 years). Patients’ mean age significantly increased during the years (P<0.001). The mean length of stay was 8.2±10.5 days (28% of the episodes requiring <3 days of stay). Admissions for surgical procedures were 12 457 accounting for 26.9% of the total hospitalizations. There was a trend to a significant increase in the percentage of surgery (P<0.05). The mean hospitalization rate for PHPT was 12.9/100 000 inhabitants per year and the trend showed a significant decrease during the period of 2006–2011 (P<0.0001). The mean hospitalization rate for PHPT surgery was 3.65/100 000 per year, which significantly increased over time (P<0.001). Conclusions PHPT considerably influences the Italian Hospital healthcare system. We observed a tendency to a decrease in the frequency of hospitalization during the period of 2006–2011, most probably because of economic issues, a concomitant increased age of patients, and, interestingly, also a progressive increase in the percentage of surgical treatment among patients admitted for PHPT. PMID:25015979

  4. Mode of delivery and the probability of subsequent childbearing: a population-based register study.

    PubMed

    Elvander, C; Dahlberg, J; Andersson, G; Cnattingius, S

    2015-11-01

    To investigate the relationship between mode of first delivery and probability of subsequent childbearing. Population-based study. Nationwide study in Sweden. A cohort of 771 690 women who delivered their first singleton infant in Sweden between 1992 and 2010. Using Cox's proportional-hazards regression models, risks of subsequent childbearing were compared across four modes of delivery. Hazard ratios (HRs) were calculated, using 95% confidence intervals (95% CIs). Probability of having a second and third child; interpregnancy interval. Compared with women who had a spontaneous vaginal first delivery, women who delivered by vacuum extraction were less likely to have a second pregnancy (HR 0.96, 95% CI 0.95-0.97), and the probabilities of a second childbirth were substantially lower among women with a previous emergency caesarean section (HR 0.85, 95% CI 0.84-0.86) or an elective caesarean section (HR 0.82, 95% CI 0.80-0.83). There were no clinically important differences in the median time between first and second pregnancy by mode of first delivery. Compared with women younger than 30 years of age, older women were more negatively affected by a vacuum extraction with respect to the probability of having a second child. A primary vacuum extraction decreased the probability of having a third child by 4%, but having two consecutive vacuum extraction deliveries did not further alter the probability. A first delivery by vacuum extraction does not reduce the probability of subsequent childbearing to the same extent as a first delivery by emergency or elective caesarean section. © 2014 Royal College of Obstetricians and Gynaecologists.

  5. Differences in medication knowledge and risk of errors between graduating nursing students and working registered nurses: comparative study.

    PubMed

    Simonsen, Bjoerg O; Daehlin, Gro K; Johansson, Inger; Farup, Per G

    2014-11-21

    Nurses experience insufficient medication knowledge; particularly in drug dose calculations, but also in drug management and pharmacology. The weak knowledge could be a result of deficiencies in the basic nursing education, or lack of continuing maintenance training during working years. The aim of this study was to compare the medication knowledge, certainty and risk of error between graduating bachelor students in nursing and experienced registered nurses. Bachelor students in closing term and registered nurses with at least one year job experience underwent a multiple choice test in pharmacology, drug management and drug dose calculations: 3x14 questions with 3-4 alternative answers (score 0-42). Certainty of each answer was recorded with score 0-3, 0-1 indicating need for assistance. Risk of error was scored 1-3, where 3 expressed high risk: being certain that a wrong answer was correct. The results are presented as mean and (SD). Participants were 243 graduating students (including 29 men), aged 28.2 (7.6) years, and 203 registered nurses (including 16 men), aged 42.0 (9.3) years and with a working experience of 12.4 years (9.2). The knowledge among the nurses was found to be superior to that of the students: 68.9%(8.0) and 61.5%(7.8) correct answers, respectively, (p < 0.001). The difference was largest in drug management and dose calculations. The improvement occurred during the first working year. The nurses expressed higher degree of certainty and the risk of error was lower, both overall and for each topic (p < 0.01). Low risk of error was associated with high knowledge and high sense of coping (p < 0.001). The medication knowledge among experienced nurses was superior to bachelor students in nursing, but nevertheless insufficient. As much as 25% of the answers to the drug management questions would lead to high risk of error. More emphasis should be put into the basic nursing education and in the introduction to medication procedures in

  6. Reproductive Outcomes Following Ectopic Pregnancy: Register-Based Retrospective Cohort Study

    PubMed Central

    Bhattacharya, Sohinee; McLernon, David J; Lee, Amanda J; Bhattacharya, Siladitya

    2012-01-01

    Background We aimed to compare reproductive outcomes following ectopic pregnancy (EP) versus livebirth, miscarriage, or termination in a first pregnancy. Methods And Findings A retrospective cohort study design was used. Scottish national data on all women whose first pregnancy occurred between 1981 and 2000 were linked to records of a subsequent pregnancy. The exposed cohort comprised women with an EP in their first pregnancy. There were three unexposed cohorts: women with livebirth, miscarriage, and termination of their first pregnancies. Any differences in rates of second pregnancy, livebirth, EP, miscarriage, or terminations and complications of a second ongoing pregnancy and delivery were assessed among the different exposure groups. A total of 2,969 women had an initial EP; 667,299 had a livebirth, 39,705 women miscarried, and 78,697 terminated their first pregnancies. Women with an initial EP had an increased chance of another pregnancy within 2 years (adjusted hazard ratio (AHR) 2.76 [95% CI 2.58–2.95]) or after 6 years (AHR 1.57 [95% CI 1.29–1.91]) compared to women with a livebirth. In comparison with women with an initial miscarriage, women who had an EP had a lower chance of a second pregnancy (AHR 0.53 [95% CI 0.50–0.56]). Compared to women with an initial termination, women with an EP had an increased chance of a second pregnancy (AHR 2.38 [95% CI 2.23–2.55]) within 2 years. Women with an initial EP suffered an increased risk of another EP compared to women with a livebirth (AHR 13.0 [95% CI 11.63–16.86]), miscarriage (AHR 6.07 [95% CI 4.83–7.62]), or termination (AHR 12.84 [95% CI 10.07–16.37]). Perinatal complications in a pregnancy following EP were not significantly higher than those in primigravidae or in women with a previous miscarriage or termination. Conclusion Women with an initial EP have a lower chance of conception than those who miscarry but an increased risk of a repeat EP in comparison with all three comparison groups. A

  7. Compassion satisfaction, compassion fatigue, anxiety, depression and stress in registered nurses in Australia: study 1 results.

    PubMed

    Hegney, Desley G; Craigie, Mark; Hemsworth, David; Osseiran-Moisson, Rebecca; Aoun, Samar; Francis, Karen; Drury, Vicki

    2014-05-01

    To explore compassion fatigue and compassion satisfaction with the potential contributing factors of anxiety, depression and stress. To date, no studies have connected the quality of work-life with other contributing and co-existing factors such as depression, anxiety and stress. A self-report exploratory cross sectional survey of 132 nurses working in a tertiary hospital. The reflective assessment risk profile model provides an excellent framework for examining the relationships between the professional quality of work factors and contributing factors within the established risk profiles. The results show a definite pattern of risk progression for the six factors examined for each risk profile. Additionally, burnout and secondary traumatic stress were significantly related to higher anxiety and depression levels. Higher anxiety levels were correlated with nurses who were younger, worked full-time and without a postgraduate qualification. Twenty percent had elevated levels of compassion fatigue: 7.6% having a very distressed profile. At-risk nurses' stress and depression scores were significantly higher than nurses with higher compassion satisfaction scores. The employed nurse workforce would benefit from a psychosocial capacity building intervention that reduces a nurse's risk profile, thus enhancing retention. © 2013 John Wiley & Sons Ltd.

  8. School grades, parental education and suicide--a national register-based cohort study.

    PubMed

    Björkenstam, Charlotte; Weitoft, Gunilla Ringbäck; Hjern, Anders; Nordström, Peter; Hallqvist, Johan; Ljung, Rickard

    2011-11-01

    To investigate whether school performance is a risk factor for suicide death later in life and, if so, to what extent this is explained by intergenerational effects of parental education. This population-based cohort study comprises national birth cohorts between 1972 and 1981 in Sweden. We followed 898,342 students, graduating between 1988 and 1997 from the 9 years of compulsory school, equivalent to junior high school, until 31 December 2006, generating 11,148,758 person-years and 1490 suicides. Final school grades, in six categories, and risk of suicide were analysed with Poisson regression. The incidence rate ratio (RR) for suicide death for students with the lowest grades was 4.57 (95% CI 2.82 to 7.40) for men and 2.67 (1.42 to 5.01) for women compared to those with highest grades after adjustment for a number of sociodemographic and parental morbidity variables, such as year of graduation, parental education, lone parenthood, household receiving social welfare or disability pension, place of schooling, adoption, maternal age and parent's mental illness. Students with grades in the middle categories had RRs in between. These relationships were not modified by parental education. The strong association between low school grades and suicide in youth and young adulthood emphasises the importance of both primary and secondary prevention in schools.

  9. Persistent Spatial Clusters of Prescribed Antimicrobials among Danish Pig Farms – A Register-Based Study

    PubMed Central

    Fertner, Mette; Sanchez, Javier; Boklund, Anette; Stryhn, Henrik; Dupont, Nana; Toft, Nils

    2015-01-01

    The emergence of pathogens resistant to antimicrobials has prompted political initiatives targeting a reduction in the use of veterinary antimicrobials in Denmark, especially for pigs. This study elucidates the tendency of pig farms with a significantly higher antimicrobial use to remain in clusters in certain geographical regions of Denmark. Animal Daily Doses/100 pigs/day were calculated for all three age groups of pigs (weaners, finishers and sows) for each quarter during 2012–13 in 6,143 commercial indoor pig producing farms. The data were split into four time periods of six months. Repeated spatial cluster analyses were performed to identify persistent clusters, i.e. areas included in a significant cluster throughout all four time periods. Antimicrobials prescribed for weaners did not result in any persistent clusters. In contrast, antimicrobial use in finishers clustered persistently in two areas (157 farms), while those issued for sows clustered in one area (51 farms). A multivariate analysis including data on antimicrobial use for weaners, finishers and sows as three separate outcomes resulted in three persistent clusters (551 farms). Compared to farms outside the clusters during this period, weaners, finishers and sows on farms within these clusters had 19%, 104% and 4% higher use of antimicrobials, respectively. Production type, farm type and farm size seemed to have some bearing on the clustering effect. Adding these factors as categorical covariates one at a time in the multivariate analysis reduced the persistent clusters by 24.3%, 30.5% and 34.1%, respectively. PMID:26317206

  10. Gender-specific risk factors for intimate partner homicide--a nationwide register-based study.

    PubMed

    Weizmann-Henelius, Ghitta; Matti Grönroos, Licphil; Putkonen, Hanna; Eronen, Markku; Lindberg, Nina; Häkkänen-Nyholm, Helinä

    2012-05-01

    The present study examined gender differences in intimate partner homicide (IPH) and offender characteristics with the focus on putative gender-specific risk factors in a nationwide consecutive sample of homicide offenders. Data on all offenders (N = 642; 91 females, 551 males) convicted of homicide and subjected to a forensic psychiatric examination in Finland were obtained for the years 1995 and 2004. IPH offenders, 39 female and 106 male, were compared for risk factors with female and male offenders whose victims were not spouses. The forensic psychiatric examination reports were retrospectively analyzed, and the Hare Psychopathy Checklist-Revised (PCL-R) was rated. Significant gender differences were found in four risk factors: employment, intoxication of victim, self-defense, and quarrel, mostly related to alcohol as a factor of the offense. The findings support the notion that female IPH is linked to defensive reactions resulting from prior abuse, and that IPH offenders resemble the general population more than offenders of other types of homicide.

  11. Weapons used in serious violence against a parent: retrospective comparative register study.

    PubMed

    Liettu, Anu; Säävälä, Hannu; Hakko, Helinä; Joukamaa, Matti; Räsänen, Pirkko

    2012-08-01

    Our aim was to compare the weapons used in lethal or potentially lethal violence against parents according to the age (adolescent vs. adult) of the offender and victim (mother vs. father) of the offence. All forensic psychiatric examination statements of male offenders who had offended violently against one of their parents during 1973-2004 in Finland (n=192) were reviewed retrospectively. Data on the weapons used by adolescent and adult offenders in relation to the sex of the victim, mental disorder, criminal responsibility and intelligence were gathered. In the whole sample, sharp-edged weapons were the most commonly used weapons. Firearms were more commonly used in offences against fathers (i.e. patricidal offences) than against mothers (i.e. matricidal offences). Adolescent offenders were more likely to use firearms than adult offenders in violent acts against a parent. Among personality-disordered subjects, patricidal offenders used firearms more commonly than did matricidal offenders. Homicidal matricidal offenders had higher full-scale and verbal IQ scores as compared to homicidal patricidal offenders. The matricidal offenders using firearms were shown to be more intelligent as measured by full-scale and verbal scale IQs than the patricidal offenders using firearms. Consistent with the physical strength hypothesis, firearms are used more often in lethal or potentially lethal violence against parents by adolescents than by adults in Finland. As firearms legislation in Finland is currently under reform the study findings suggest that restriction of gun availability may have an influence on intrafamilial homicides, particularly those committed by adolescents.

  12. Incidence and prevalence of psoriatic arthritis in Denmark: a nationwide register linkage study.

    PubMed

    Egeberg, Alexander; Kristensen, Lars Erik; Thyssen, Jacob P; Gislason, Gunnar Hilmar; Gottlieb, Alice B; Coates, Laura C; Jullien, Denis; Gisondi, Paolo; Gladman, Dafna D; Skov, Lone; Mallbris, Lotus

    2017-09-01

    To examine the incidence and temporal trends of psoriatic arthritis (PsA) in the general population in Denmark. Using nationwide registry data, we estimated the number of patients with incident PsA within each 1-year period between 1997 and 2011 and calculated the rate of PsA cases within gender and age subgroups. Incidence rates were presented per 100 000 person-years. There was a female predominance ranging from 50.3% (1998) to 59.2% (2010), and the mean age at time of diagnosis was 47-50 years. We identified a total of 12 719 patients with PsA (prevalence=0.22%), including 9034 patients where the PsA diagnosis was made by a rheumatologist (prevalence=0.16%). Incidence rates of PsA (per 100 000 person-years) increased from 7.3 in 1997 to a peak incidence of 27.3 in 2010. Incidence rates were highest for women and patients aged 50-59 years, respectively. The use of systemic non-biologic agents, that is, methotrexate, leflunomide, ciclosporin or sulfasalazine increased over the 15-year study course and were used in 66.3% of all patients. Biologic agents (etanercept, infliximab, adalimumab, certolizumab pegol, golimumab or ustekinumab) were used in 17.7% of patients with PsA. We found a clear trend of rising PsA incidence on a national level. While the cause remains unclear, our findings might be explained by increased attention by patients and physicians. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. Cesarean delivery rates and obstetric culture - an Italian register-based study.

    PubMed

    Plevani, Cristina; Incerti, Maddalena; Del Sorbo, Davide; Pintucci, Armando; Vergani, Patrizia; Merlino, Luca; Locatelli, Anna

    2017-03-01

    Cesarean delivery rates are rising due to multiple factors, including less use of operative vaginal delivery and vaginal birth after cesarean delivery, which often reflect local obstetric practices. Objectives of the study were to analyze the relations between cesarean delivery, these practices, and perinatal outcomes. We included all deliveries in the 72 hospitals of Lombardia, a region in northern Italy, during the year 2013. The delivery certificate was used as data source. Pearson's correlation coefficient and logistic regression were used for statistical analysis. We included 87 896 deliveries. The number of deliveries per hospital ranged from 140 to 6123. The rate of cesarean delivery was 28.3% (range 9.9-86.4%), operative vaginal delivery 4.7% (range 0.2-10.0%), and vaginal birth after cesarean 17.3% (range 0-79.2%). We found a significant inverse correlation between rates of overall cesarean delivery and operative vaginal delivery (r = -0.25, p = 0.04). The correlation between rate of overall cesarean delivery and vaginal birth after cesarean was also inverse and significant (r = -0.57, p < 0.001). There was no association between overall cesarean delivery rate and the rates of Apgar score at 5 min <7 in term and late preterm neonates (r = -0.92, p = 0.46) and of perinatal mortality (r = -0.19, p = 0.13), respectively. The associations were independent of hospital volume of activity. An obstetric practice that encourages vaginal instrumental delivery in delayed second stage of labor or vaginal birth after previous cesarean delivery, could reduce the rising cesarean delivery rate. This will require a change in obstetric culture, continuing education of healthcare providers, and leadership. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

  14. Reoperation for rhegmatogenous retinal detachment as quality indicator for disease management: a register study.

    PubMed

    Hajari, Javad N; Christensen, Ulrik; Kiilgaard, Jens F; Bek, Toke; la Cour, Morten

    2015-09-01

    To establish a quality indicator that could be used in optimizing treatment for rhegmatogenous retinal detachment (RRD). The Danish National Patient Registry was used to identify surgery conducted in Denmark for RRD in the period 01 January 2001-31 December 2009. Cases were identified by diagnosis and surgical codes. A total of 6522 cases were operated for a primary RRD in the study period, and 22% (1434 patients) were reoperated for a redetachment. A Cox regression analysis showed that the risk of redetachment was equal to or less than detachment on the fellow eye 1 year after primary surgery with techniques not using silicone oil. The same was true 1.5 years after surgery for techniques using silicone oil. Based on this, we established a quality indicator defining failure as the need for operation for redetachment within 1 year from initial surgery when using techniques without oil and after 1.5 years for techniques using oil. Also the lack of oil removal within 1 year from initial surgery should be noted as an operational failure. We applied the quality indicators on the cohort of 6522 RRDs and found that in Denmark the need for redetachment surgery has decreased over time and also that high-volume departments have better outcome compared to smaller ones. The risk of reoperation for redetachment after initial surgery fulfils the criteria for a good quality indicator and can be used in RRD surgery. This indicator could aid in optimizing the management of RRD patients to minimize morbidity. © 2015 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  15. Reproductive outcomes following induced abortion: a national register-based cohort study in Scotland

    PubMed Central

    Bhattacharya, Siladitya; Lowit, Alison; Raja, Edwin Amalraj; Lee, Amanda Jane; Mahmood, Tahir; Templeton, Allan

    2012-01-01

    Objective To investigate reproductive outcomes in women following induced abortion (IA). Design Retrospective cohort study. Setting Hospital admissions between 1981 and 2007 in Scotland. Participants Data were extracted on all women who had an IA, a miscarriage or a live birth from the Scottish Morbidity Records. A total of 120 033, 457 477 and 47 355 women with a documented second pregnancy following an IA, live birth and miscarriage, respectively, were identified. Outcomes Obstetric and perinatal outcomes, especially preterm delivery in a second ongoing pregnancy following an IA, were compared with those in primigravidae, as well as those who had a miscarriage or live birth in their first pregnancy. Outcomes after surgical and medical termination as well as after one or more consecutive IAs were compared. Results IA in a first pregnancy increased the risk of spontaneous preterm birth compared with that in primigravidae (adjusted RR (adj. RR) 1.37, 95% CI 1.32 to 1.42) or women with an initial live birth (adj. RR 1.66, 95% CI 1.58 to 1.74) but not in comparison with women with a previous miscarriage (adj. RR 0.85, 95% CI 0.79 to 0.91). Surgical abortion increased the risk of spontaneous preterm birth compared with medical abortion (adj. RR 1.25, 95% CI 1.07 to 1.45). The adjusted RRs (95% CI) for spontaneous preterm delivery following two, three and four consecutive IAs were 0.94 (0.81 to 1.10), 1.06 (0.76 to 1.47) and 0.92 (0.53 to 1.61), respectively. Conclusions The risk of preterm birth after IA is lower than that after miscarriage but higher than that in a first pregnancy or after a previous live birth. This risk is not increased further in women who undergo two or more consecutive IAs. Surgical abortion appears to be associated with an increased risk of spontaneous preterm birth in comparison with medical termination of pregnancy. Medical termination was not associated with an increased risk of preterm delivery compared to primigravidae. PMID:22869092

  16. Reproductive outcomes following induced abortion: a national register-based cohort study in Scotland.

    PubMed

    Bhattacharya, Siladitya; Lowit, Alison; Bhattacharya, Sohinee; Raja, Edwin Amalraj; Lee, Amanda Jane; Mahmood, Tahir; Templeton, Allan

    2012-01-01

    To investigate reproductive outcomes in women following induced abortion (IA). Retrospective cohort study. Hospital admissions between 1981 and 2007 in Scotland. Data were extracted on all women who had an IA, a miscarriage or a live birth from the Scottish Morbidity Records. A total of 120 033, 457 477 and 47 355 women with a documented second pregnancy following an IA, live birth and miscarriage, respectively, were identified. Obstetric and perinatal outcomes, especially preterm delivery in a second ongoing pregnancy following an IA, were compared with those in primigravidae, as well as those who had a miscarriage or live birth in their first pregnancy. Outcomes after surgical and medical termination as well as after one or more consecutive IAs were compared. IA in a first pregnancy increased the risk of spontaneous preterm birth compared with that in primigravidae (adjusted RR (adj. RR) 1.37, 95% CI 1.32 to 1.42) or women with an initial live birth (adj. RR 1.66, 95% CI 1.58 to 1.74) but not in comparison with women with a previous miscarriage (adj. RR 0.85, 95% CI 0.79 to 0.91). Surgical abortion increased the risk of spontaneous preterm birth compared with medical abortion (adj. RR 1.25, 95% CI 1.07 to 1.45). The adjusted RRs (95% CI) for spontaneous preterm delivery following two, three and four consecutive IAs were 0.94 (0.81 to 1.10), 1.06 (0.76 to 1.47) and 0.92 (0.53 to 1.61), respectively. The risk of preterm birth after IA is lower than that after miscarriage but higher than that in a first pregnancy or after a previous live birth. This risk is not increased further in women who undergo two or more consecutive IAs. Surgical abortion appears to be associated with an increased risk of spontaneous preterm birth in comparison with medical termination of pregnancy. Medical termination was not associated with an increased risk of preterm delivery compared to primigravidae.

  17. Type and Extent of Somatic Morbidity before and after the Diagnosis of Hypothyroidism. A Nationwide Register Study

    PubMed Central

    Thvilum, Marianne; Brandt, Frans; Almind, Dorthe; Christensen, Kaare; Brix, Thomas Heiberg; Hegedüs, Laszlo

    2013-01-01

    Background Hypothyroidism has been linked with an increased risk of other morbidities, such as cardiovascular diseases and diabetes mellitus. However, the temporal relationship between these diseases and the diagnosis of hypothyroidism is not well illuminated. Such information may provide insight into causal relationships between hypothyroidism and other morbidities. Aim To investigate the type and extent of somatic morbidity before and after a diagnosis of hypothyroidism. Methods Observational cohort study. From official Danish health registers, 2822 hypothyroid singletons were identified and matched 1:4 with non-hypothyroid controls and observed over a mean period of 6 years. Frequency of different morbidities was obtained by person-to-person linking in the registers. Logistic and Cox regression models were used to assess the risk of morbidity before and after the diagnosis of hypothyroidism, respectively. Results Prior to the diagnosis of hypothyroidism there was a significantly increased risk of being diagnosed with cardiovascular diseases (odds ratio (OR) 1.37; 95% confidence interval (CI): 1.19–1.58), lung diseases (OR 1.25; 95% CI: 1.13–1.39), diabetes mellitus (OR 1.92; 95% CI: 1.61–2.29), as well as malignant diseases (OR 1.24; 95% CI: 1.06–1.45). Following the diagnosis of hypothyroidism there was a significantly increased risk of being diagnosed with cardiovascular diseases (hazard ratio (HR) 1.36; 95% CI: 1.15–1.60); lung diseases (HR 1.51; 95% CI: 1.30–1.75); and diabetes mellitus (HR 1.40; 95% CI: 1.11–1.77). Conclusions Prior to the diagnosis of hypothyroidism there is an excess risk of being diagnosed with cardiovascular diseases, lung diseases, diabetes mellitus, and malignant diseases. Following the diagnosis of hypothyroidism we demonstrate an increased frequency of cardiovascular diseases, lung diseases, and diabetes mellitus. PMID:24066186

  18. Heavy lifting at work and risk of retinal detachment: a population-based register study in Denmark.

    PubMed

    Curti, Stefania; Coggon, David; Hannerz, Harald; Mattioli, Stefano

    2016-01-01

    To investigate the relationship between rhegmatogenous retinal detachment (RRD) and frequent heavy lifting in a Danish working population through national register data. A dynamic cohort of all men aged 20-59 years in Denmark was followed through the Danish Occupational Hospitalisation Register from 1995 to 2010 for diagnosed RRD. Occupational categories were classified according to their potential for heavy lifting in 4 main groups: heavy lifters, manual workers unlikely to be heavy lifters, other manual workers and non-manual workers unlikely to be heavy lifters. The age-standardised rate of diagnosed RRD for heavy lifting occupations was compared with that experienced by the other 3 occupational categories. Rate ratios (RRs) and 95% CIs were estimated through a Poisson regression model adjusted for calendar period and age group. The highest age-standardised rate of diagnosed RRD was recorded among non-manual workers performing occupational activities unlikely to be associated with heavy lifting (18.0 cases per 100,000 person-years). The RR for workers in jobs expected to entail a high frequency of heavy lifting compared with manual workers whose occupation was unlikely to be associated with heavy lifting was 0.91 (95% CI 0.73 to 1.14), while in comparison with other manual workers, it was 0.93 (95% CI 0.78 to 1.11). The RR compared with non-manual workers in occupations unlikely to entail heavy lifting was 0.51 (95% CI 0.43 to 0.60). These findings do not support an association of occupational heavy lifting with diagnosed RRD. The epidemiological evidence for this association is still inconclusive. Future studies should use a more specific measure of exposure to resolve the outstanding uncertainties. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  19. Monitoring the use of lipid-lowering medication among persons with newly diagnosed diabetes: a nationwide register-based study

    PubMed Central

    Vehko, Tuulikki; Sund, Reijo; Arffman, Martti; Manderbacka, Kristiina; Ilanne-Parikka, Pirjo; Keskimäki, Ilmo

    2013-01-01

    Objectives To develop a register-based monitoring system to provide information on the use of lipid-lowering medication among persons with diabetes in different patient groups and by socioeconomic position. Design Longitudinal and register-based, before and after diabetes diagnosis. Setting Finnish population. Participants A total of 121 053 persons aged 30–79 years with a new diagnosis of diabetes during 2000–2006. The annual cohorts were divided at the time of diabetes diagnosis by coronary heart disease (CHD) status. Primary and secondary outcome measures Lipid-lowering medication purchases after diabetes diagnosis and prior to the diagnosis. Results According to the health insurance reimbursement data the use of lipid-lowering medication advanced rapidly among people with diabetes in the early 2000s in Finland. Of the patients diagnosed with diabetes in 2000 only one-fourth used lipid-lowering medication in 6–12 months after their diagnosis. For those diagnosed in 2006, the utilization rate was 46%. Among those with a history of CHD the use of medication was markedly higher; 51–58% in 2000 and 77–79% in 2006. Taking into account the increasing trend and measuring the independent effect of the diagnosis of diabetes on lipid-lowering medication, setting the diagnosis increased the use by 10–50%. Despite increasing overall utilisation rates, socioeconomic difference in the use of lipid-lowering medication remained throughout the study period. In particular, the lowest income quintile differed from other income groups and in 2006 its use of lipid-lowering medication remained approximately 10% points lower compared with the overall level. Conclusions The lipid-lowering medication is being applied in an increasing population of new diabetes cases; however, modelling the independent effect of the diagnosis of diabetes on lipid-lowering medication shows that the diagnosis increased use, but did not abolish socioeconomic differences. PMID:24189078

  20. Heavy lifting at work and risk of retinal detachment: a population-based register study in Denmark

    PubMed Central

    Curti, Stefania; Coggon, David; Hannerz, Harald; Mattioli, Stefano

    2016-01-01

    Objectives To investigate the relationship between rhegmatogenous retinal detachment (RRD) and frequent heavy lifting in a Danish working population through national register data. Methods A dynamic cohort of all men aged 20–59 years in Denmark was followed through the Danish Occupational Hospitalisation Register from 1995 to 2010 for diagnosed RRD. Occupational categories were classified according to their potential for heavy lifting in 4 main groups: heavy lifters, manual workers unlikely to be heavy lifters, other manual workers and non-manual workers unlikely to be heavy lifters. The age-standardised rate of diagnosed RRD for heavy lifting occupations was compared with that experienced by the other 3 occupational categories. Rate ratios (RRs) and 95% CIs were estimated through a Poisson regression model adjusted for calendar period and age group. Results The highest age-standardised rate of diagnosed RRD was recorded among non-manual workers performing occupational activities unlikely to be associated with heavy lifting (18.0 cases per 100 000 person-years). The RR for workers in jobs expected to entail a high frequency of heavy lifting compared with manual workers whose occupation was unlikely to be associated with heavy lifting was 0.91 (95% CI 0.73 to 1.14), while in comparison with other manual workers, it was 0.93 (95% CI 0.78 to 1.11). The RR compared with non-manual workers in occupations unlikely to entail heavy lifting was 0.51 (95% CI 0.43 to 0.60). Conclusions These findings do not support an association of occupational heavy lifting with diagnosed RRD. The epidemiological evidence for this association is still inconclusive. Future studies should use a more specific measure of exposure to resolve the outstanding uncertainties. PMID:26561504

  1. Insomnia symptoms and subsequent cardiovascular medication: a register-linked follow-up study among middle-aged employees.

    PubMed

    Haaramo, Peija; Rahkonen, Ossi; Hublin, Christer; Laatikainen, Tiina; Lahelma, Eero; Lallukka, Tea

    2014-06-01

    Sleep disturbances have been associated with an increased risk of cardiovascular disease outcomes. The associations of insomnia with hypertension and dyslipidaemia, the main modifiable cardiovascular risk factors, are less studied. We especially lack understanding on the longitudinal effects of insomnia on dyslipidaemia. We aimed to examine the associations of insomnia symptoms with subsequent prescribed medication for hypertension and dyslipidaemia using objective register-based follow-up data. Baseline questionnaire surveys among 40-60-year-old employees of the City of Helsinki, Finland, were conducted in 2000-2002 (n = 6477, response rate 67%, 78% women) and linked to a national register on prescribed reimbursed medication 5-7 years prior to and 5 years after baseline. Associations between the frequency of insomnia symptoms (difficulties in initiating and maintaining sleep, non-restorative sleep) and hypertension and dyslipidaemia medication during the follow-up were analysed using logistic regression analysis (odds ratios with 95% confidence intervals). Analyses were adjusted for pre-baseline medication, sociodemographic and work-related factors, health behaviours, mental health, and diabetes. Frequent insomnia symptoms were reported by 20%. During the 5-year follow-up, 32% had hypertension medication and 15% dyslipidaemia medication. Adjusting for age, gender and pre-baseline medication, frequent insomnia symptoms were associated with hypertension medication (odds ratio 1.57, 95% confidence interval 1.23-2.00) and dyslipidaemia medication (odds ratio 1.59, 95% confidence interval 1.19-2.12). Occasional insomnia symptoms were also associated with cardiovascular medication, though less strongly. Further adjustments had negligible effects. To conclude, insomnia should be taken into account in the prevention and management of cardiovascular disease and related risk factors. © 2013 European Sleep Research Society.

  2. Hypothyroidism is a predictor of disability pension and loss of labor market income: a Danish register-based study.

    PubMed

    Thvilum, Marianne; Brandt, Frans; Brix, Thomas Heiberg; Hegedüs, Laszlo

    2014-09-01

    Hypothyroidism is associated with an increased somatic and psychiatric disease burden. Whether there are any socioeconomic consequences of hypothyroidism, such as early retirement or loss of income, remains unclarified. Our aim was to examine, compared with a matched control group, the risk of receiving disability pension (before the age of 60) and the effect on labor market income in patients diagnosed with hypothyroidism. This was an observational register-based cohort study. By record linkage between different Danish health registers, 1745 hypothyroid singletons diagnosed before the age of 60 were each matched with 4 non-hypothyroid controls and followed for a mean of 5 (range 1-31) years. Additionally, we included 277 same-sex twin pairs discordant for hypothyroidism. The risk of disability pension was evaluated by the Cox regression analysis. Changes in labor market income progression over 5 years were evaluated using a difference in difference model. With a hazard ratio of 2.24 (95% confidence interval = 1.73-2.89), individuals diagnosed with hypothyroidism had a significantly increased risk of disability pension. This remained significant when adjusting for educational level and comorbidity (hazard ratio = 1.89; 95% confidence interval = 1.42-2.51). In an analysis of labor market income, 2 years before compared with 2 years after the diagnosis of hypothyroidism, the hypothyroid individuals had on average a €1605 poorer increase than their euthyroid controls (P < .001). Essentially similar results were found in the twin population. A diagnosis of hypothyroidism before the age of 60 is associated with loss of labor market income and an 89% increased risk of receiving a disability pension.

  3. Comparison of rates of adverse events in adolescent and adult women undergoing medical abortion: population register based study

    PubMed Central

    Niinimäki, Maarit; Suhonen, Satu; Mentula, Maarit; Hemminki, Elina; Gissler, Mika

    2011-01-01

    Objective To determine the risks of short term adverse events in adolescent and older women undergoing medical abortion. Design Population based retrospective cohort study. Setting Finnish abortion register 2000-6. Participants All women (n=27 030) undergoing medical abortion during 2000-6, with only the first induced abortion analysed for each woman. Main outcome measures Incidence of adverse events (haemorrhage, infection, incomplete abortion, surgical evacuation, psychiatric morbidity, injury, thromboembolic disease, and death) among adolescent (<18 years) and older (≥18 years) women through record linkage of Finnish registries and genital Chlamydia trachomatis infections detected concomitantly with abortion and linked with data from the abortion register for 2004-6. Results During 2000-6, 3024 adolescents and 24 006 adults underwent at least one medical abortion. The rate of chlamydia infections was higher in the adolescent cohort (5.7% v 3.7%, P<0.001). The incidence of adverse events among adolescents was similar or lower than that among the adults. The risks of haemorrhage (adjusted odds ratio 0.87, 95% confidence interval 0.77 to 0.99), incomplete abortion (0.69, 0.59 to 0.82), and surgical evacuation (0.78, 0.67 to 0.90) were lower in the adolescent cohort. In subgroup analysis of primigravid women, the risks of incomplete abortion (0.68, 0.56 to 0.81) and surgical evacuation (0.75, 0.64 to 0.88) were lower in the adolescent cohort. In logistic regression, duration of gestation was the most important risk factor for infection, incomplete abortion, and surgical evacuation. Conclusions The incidence of adverse events after medical abortion was similar or lower among adolescents than among older women. Thus, medical abortion seems to be at least as safe in adolescents as it is in adults. PMID:21508042

  4. Association Between Improvement in Cardiovascular Risk Profile and Changes in Sickness Absence: Results of the ICARIA Study.

    PubMed

    Calvo-Bonacho, Eva; Catalina-Romero, Carlos; Cabrera, Martha; Fernández-Labandera, Carlos; Sánchez Chaparro, Miguel Ángel; Brotons, Carlos; Ruilope, Luis Miguel

    2017-03-10

    The purpose of this study was to investigate whether changes in cardiovascular risk (CVR) are associated with the length and cost of sickness absence. A prospective cohort of 179 186 participants was evaluated. Each participant's CVR (SCORE) was assessed on 2 consecutive medical examinations, approximately 1 year apart (365 ± 90 days). Cardiovascular risk was categorized as < 4% or ≥ 4%, and participants were divided into 4 groups according to changes in their risk between the 2 assessments. After the second CVR estimate, a 1-year follow-up was carried out to assess sickness absence. Differences between the 4 groups in terms of the total count of sickness absence days during the follow-up period were tested using Poisson regression models. After adjustment for covariates, participants who showed an improvement in CVR had a lower count of sickness absence days compared with both those who showed a worsening in risk and those who remained stable at ≥ 4% (RR, 0.91; 95%CI, 0.84-0.98). In comparison with participants whose CVR did not improve, more of the participants whose risk did improve had quit smoking (+17.2%; P < .001), and had controlled their blood pressure (+26.0%, P < .001), total cholesterol (+9.3%; P < .001), low-density lipoprotein cholesterol (+14.9%; P < .001), and triglyceride levels (+14.6%; P < .001). Our results suggest that an improvement in CVR profile is accompanied by a decrease in sickness absence during a 1-year follow-up. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  5. A theory of planned behavior study of college students' intention to register as organ donors in Japan, Korea, and the United States.

    PubMed

    Bresnahan, Mary; Lee, Sun Young; Smith, Sandi W; Shearman, Sachiyo; Nebashi, Reiko; Park, Cheong Yi; Yoo, Jina

    2007-01-01

    This study investigated willingness of Americans, Koreans, and Japanese to register as organ donors using the theory of planned behavior. Although previous research showed that attitude toward donation and communication with family predicted organ donation behaviors for respondents in the United States, these variables were also significant for respondents in Japan and Korea. Perceived behavioral control predicted intention to register for Japanese participants whereas knowledge about organ donation was associated with reluctance to register for Koreans. Spiritual connection and concern were shown to be causal factors underlying attitude in all 3 countries. In spite of positive attitudes toward organ donation and comparable knowledge with Americans and Japanese, most Korean participants declined to take an application to register as a donor. Implications of these findings for future research are discussed.

  6. Long-term use of benzodiazepines: Definitions, prevalence and usage patterns - a systematic review of register-based studies.

    PubMed

    Kurko, T A T; Saastamoinen, L K; Tähkäpää, S; Tuulio-Henriksson, A; Taiminen, T; Tiihonen, J; Airaksinen, M S; Hietala, J

    2015-11-01

    Numerous treatment guidelines recommend that long-term use of benzodiazepines (BZD) should be avoided primarily due to development of tolerance and a risk for BZD dependence. Despite this, long-term BZD use remains a controversial subject in clinical patient care with "for and against" debates. However, there is no explicit understanding of what is meant by long-term BZD use in real world. The aim of this study was to assess different definitions, usage patterns, prevalence and other characteristics of long-term BZD use based on published register-based studies. Synthesis of these characteristics is essential to derive a meaningful definition of long-term BZD. Systematic review of register-based studies on long-term BZD use published in 1994-2014. Fourty-one studies met our predetermined inclusion criteria. The length of BZD use defined as "long-term" varied in these studies ranging from one month to several years. The most common definition was six months or longer during a year. The prevalence of long-term BZD use in the general population was estimated to be about 3%. The relative proportion of long-term BZD users (all definitions) in adult BZD users ranged from 6% to 76% (mean 24%; 95% CL 13-36%). The estimates were higher in studies only on the elderly (47%; 95% CL 31-64%). Long-term use involved typically steady treatment with low BZD doses. However, in elderly patients long-term BZD use and exceeding recommended doses was relatively common. Several characteristics associated with long-term use were found. Long-term BZD use is common and a clinical reality. Uniform definitions for "long-term", which is in line with population-based evidence, is needed to have more comparable results between studies. Our systematic review suggests that duration of BZD treatment over six months, the most common definition for long-term BZD use in the included studies. As also recommended previously, it is a useful starting point for further analyses on disadvantages but also

  7. Use and distribution of rehabilitation services: a register linkage study in one hospital district area in Finland.

    PubMed

    Pulkki, Jutta Maarit; Rissanen, Pekka; Raitanen, Jani A; Viitanen, Elina A

    2011-06-01

    This study focuses on a large set of rehabilitation services used between 2004 and 2005 in one hospital district area in Finland. The rehabilitation system consists of several subsystems. This complex system is suggested to produce arbitrary rehabilitation services. Despite the criticisms against the system during decades, no attempts have been made to study the performance of the system as a whole. Register data from several subsystems were linked to study the use and characteristics of rehabilitation services and users. Data consisted of 10 153 persons. We analysed differences in rehabilitation service use between age and sex groups and municipalities. Totally, 5.4% of the population used rehabilitation services in the studied 2 years. Medical rehabilitation was the most common type, users' mean age was 52.6 years, and 52.2% were women. Remarkable differences were detected between municipalities in usage rates in all rehabilitation types. The size of the population in home municipality had a varying relation to utilization in different rehabilitation types. We found differences in the service use within age groups, sex or home municipality. This study cannot rule out the possibility that these differences indicated inequitable distribution of services or whether they are explained by different needs.

  8. Does organisational justice protect from sickness absence following a major life event? A Finnish public sector study.

    PubMed

    Elovainio, M; Kivimäki, M; Linna, A; Brockner, J; van den Bos, K; Greenberg, J; Pentti, J; Virtanen, M; Vahtera, J

    2010-05-01

    It has been shown that fairness perceptions have a strong impact on health, especially under conditions of great work stress. The aim of this study was to extend previous research in studying whether working in high justice workplace would protect from health effects following environmental stressors outside work. Using a prospective longitudinal design, the relationships between organisational justice and sickness-related absences both before and after a major life event among 25 459 public sector employees working in 2551 work units were studied. Sickness absences covered the period from 36 months before the event until 30 months after the event. The increase in sickness absences after the event was larger and stayed at a higher level even 30 months after the event, among those who perceived the management practices in their work unit to be relatively unfair. Similar patterns were found for each of the distributive, procedural and interactional dimensions of organisational justice. Fair organisational and managerial procedures may buffer the negative health effects of psychosocial health risks outside work.

  9. Sickness absence from work among persons with new physician-diagnosed carpal tunnel syndrome: a population-based matched-cohort study.

    PubMed

    Atroshi, Isam; Zhou, Caddie; Jöud, Anna; Petersson, Ingemar F; Englund, Martin

    2015-01-01

    Carpal tunnel syndrome is common among employed persons. Data on sickness absence from work in relation to carpal tunnel syndrome have been usually based on self-report and derived from clinical or occupational populations. We aimed to determine sickness absence among persons with physician-diagnosed carpal tunnel syndrome as compared to the general population. In Skåne region in Sweden we identified all subjects, aged 17-57 years, with new physician-made diagnosis of carpal tunnel syndrome during 5 years (2004-2008). For each subject we randomly sampled, from the general population, 4 matched reference subjects without carpal tunnel syndrome; the two cohorts comprised 5456 and 21,667 subjects, respectively (73% women; mean age 43 years). We retrieved social insurance register data on all sickness absence periods longer than 2 weeks from 12 months before to 24 months after diagnosis. Of those with carpal tunnel syndrome 2111 women (53%) and 710 men (48%) underwent surgery within 24 months of diagnosis. We compared all-cause sickness absence and analyzed sickness absence in conjunction with diagnosis and surgery. Mean number of all-cause sickness absence days per each 30-day period from 12 months before to 24 months after diagnosis was significantly higher in the carpal tunnel syndrome than in the reference cohort. A new sickness absence period longer than 2 weeks in conjunction with diagnosis was recorded in 12% of the women (n = 492) and 11% of the men (n = 170) and with surgery in 53% (n = 1121) and 58% (n = 408) of the surgically treated, respectively; median duration in conjunction with surgery was 35 days (IQR 27-45) for women and 41 days (IQR 28-50) for men. Persons with physician-diagnosed carpal tunnel syndrome have substantially more sickness absence from work than age and sex-matched persons from the general population from 1 year before to 2 years after diagnosis. Gender differences were small.

  10. Use of antidepressants in Parkinson's disease: A Swedish register-based study of over 1.5 million older people.

    PubMed

    Haasum, Ylva; Fastbom, Johan; Johnell, Kristina

    2016-06-01

    It has been suggested that depression in Parkinson's Disease (PD) is often unrecognized and undertreated. However, few previous studies have studied the use of antidepressants in a large sample of both home-dwelling and institutionalized elderly persons with PD. We aimed to study the use of antidepressants in older persons using anti-parkinson drugs (APD, used as a proxy for PD), stratified by residential setting. We analyzed individual data on age, sex, residential setting and drug use in over 1.5 million older persons in the Swedish Prescribed Drug Register on 31th of December 2013. Twenty-two percent of the home-dwellers and 50% of the institutionalized elderly persons with APD used antidepressants. Persons with APD had a higher probability of use of any antidepressant compared to persons without APD. A selective serotonin reuptake inhibitor (SSRI) was the most commonly used antidepressants in both settings followed by mirtazapin. The high use of antidepressants among older persons with APD warrants further studies on the quality of treatment of depression in PD. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Adult body height of twins compared with that of singletons: a register-based birth cohort study of Norwegian males.

    PubMed

    Eriksen, Willy; Sundet, Jon M; Tambs, Kristian

    2013-05-01

    In the present study, we evaluated whether childhood differences in body height between singletons and twins persist into adulthood. Data from the Medical Birth Register of Norway were linked with data from the Norwegian National Conscript Service. This study used data on the 457,999 males who were born alive and without physical anomalies in single or twin births in Norway during 1967-1984 and who were examined at the mandatory military conscription (age 18-20 years; 1985-2003). For sibling comparisons, the authors selected the 1,721 sibships of full brothers that included at least 1 male born in a single birth and at least 1 male born in a twin birth (4,520 persons, including 2,493 twins and 2,027 singletons). An analysis of the total study population using generalized estimating equations showed that the twins were 0.6 cm (95% confidence interval: 0.4, 0.7) shorter than were the singletons after adjustment for a series of background factors. The fixed-effects regression analysis of the sibships that included both twins and singletons showed that the twins were 0.9 cm (95% confidence interval: 0.6, 1.2) shorter than were their singleton brothers. The study suggests that male twins born in Norway during 1967-1984 were slightly shorter in early adulthood than were singletons.

  12. Differences between homicide and filicide offenders; results of a nationwide register-based case-control study.

    PubMed

    Putkonen, Hanna; Weizmann-Henelius, Ghitta; Lindberg, Nina; Eronen, Markku; Häkkänen, Helinä

    2009-05-29

    Filicide, the killing of one's child, is an extraordinary form of homicide. It has commonly been associated with suicide and parental psychiatric illness. In the research on filicide, nationwide studies with comparison groups, specific perpetrator subgroups, and assessment of possible risk factors have been called for. The purpose of the current study was to provide all that. In this nationwide register-based case-control study all filicide offenders who were in a forensic psychiatric examination in Finland 1995-2004 were examined and compared with an age- and gender matched control group of homicide offenders. The assessed variables were psychosocial history, index offence, and psychiatric variables as well as psychopathy using the PCL-R. Filicide offenders were not significantly more often diagnosed with psychotic disorders than the controls but they had attempted suicide at the crime scene significantly more often. Filicide offenders had alcohol abuse/dependence and antisocial personality less often than the controls. Filicide offenders scored significantly lower on psychopathy than the controls. Within the group of filicide offenders, the psychopathy items with relatively higher scores were lack of remorse or guilt, shallow affect, callous/lack of empathy, poor behavioral controls, and failure to accept responsibility. Since filicide offenders did not seem significantly more mentally disordered than the other homicide offenders, psychiatry alone cannot be held responsible for the prevention of filicide. Extensive international studies are needed to replicate our findings and provide more specific knowledge in order to enhance prevention.

  13. Differences between homicide and filicide offenders; results of a nationwide register-based case-control study

    PubMed Central

    Putkonen, Hanna; Weizmann-Henelius, Ghitta; Lindberg, Nina; Eronen, Markku; Häkkänen, Helinä

    2009-01-01

    Background Filicide, the killing of one's child, is an extraordinary form of homicide. It has commonly been associated with suicide and parental psychiatric illness. In the research on filicide, nationwide studies with comparison groups, specific perpetrator subgroups, and assessment of possible risk factors have been called for. The purpose of the current study was to provide all that. Methods In this nationwide register-based case-control study all filicide offenders who were in a forensic psychiatric examination in Finland 1995–2004 were examined and compared with an age- and gender matched control group of homicide offenders. The assessed variables were psychosocial history, index offence, and psychiatric variables as well as psychopathy using the PCL-R. Results Filicide offenders were not significantly more often diagnosed with psychotic disorders than the controls but they had attempted suicide at the crime scene significantly more often. Filicide offenders had alcohol abuse/dependence and antisocial personality less often than the controls. Filicide offenders scored significantly lower on psychopathy than the controls. Within the group of filicide offenders, the psychopathy items with relatively higher scores were lack of remorse or guilt, shallow affect, callous/lack of empathy, poor behavioral controls, and failure to accept responsibility. Conclusion Since filicide offenders did not seem significantly more mentally disordered than the other homicide offenders, psychiatry alone cannot be held responsible for the prevention of filicide. Extensive international studies are needed to replicate our findings and provide more specific knowledge in order to enhance prevention. PMID:19480648

  14. Toward Synthesizing Our Knowledge of Morphology: Using Ontologies and Machine Reasoning to Extract Presence/Absence Evolutionary Phenotypes across Studies.

    PubMed

    Dececchi, T Alexander; Balhoff, James P; Lapp, Hilmar; Mabee, Paula M

    2015-11-01

    The reality of larger and larger molecular databases and the need to integrate data scalably have presented a major challenge for the use of phenotypic data. Morphology is currently primarily described in discrete publications, entrenched in noncomputer readable text, and requires enormous investments of time and resources to integrate across large numbers of taxa and studies. Here we present a new methodology, using ontology-based reasoning systems working with the Phenoscape Knowledgebase (KB; kb.phenoscape.org), to automatically integrate large amounts of evolutionary character state descriptions into a synthetic character matrix of neomorphic (presence/absence) data. Using the KB, which includes more than 55 studies of sarcopterygian taxa, we generated a synthetic supermatrix of 639 variable characters scored for 1051 taxa, resulting in over 145,000 populated cells. Of these characters, over 76% were made variable through the addition of inferred presence/absence states derived by machine reasoning over the formal semantics of the source ontologies. Inferred data reduced the missing data in the variable character-subset from 98.5% to 78.2%. Machine reasoning also enables the isolation of conflicts in the data, that is, cells where both presence and absence are indicated; reports regarding conflicting data provenance can be generated automatically. Further, reasoning enables quantification and new visualizations of the data, here for example, allowing identification of character space that has been undersampled across the fin-to-limb transition. The approach and methods demonstrated here to compute synthetic presence/absence supermatrices are applicable to any taxonomic and phenotypic slice across the tree of life, providing the data are semantically annotated. Because such data can also be linked to model organism genetics through computational scoring of phenotypic similarity, they open a rich set of future research questions into phenotype

  15. Toward Synthesizing Our Knowledge of Morphology: Using Ontologies and Machine Reasoning to Extract Presence/Absence Evolutionary Phenotypes across Studies

    PubMed Central

    Dececchi, T. Alexander; Balhoff, James P.; Lapp, Hilmar; Mabee, Paula M.

    2015-01-01

    The reality of larger and larger molecular databases and the need to integrate data scalably have presented a major challenge for the use of phenotypic data. Morphology is currently primarily described in discrete publications, entrenched in noncomputer readable text, and requires enormous investments of time and resources to integrate across large numbers of taxa and studies. Here we present a new methodology, using ontology-based reasoning systems working with the Phenoscape Knowledgebase (KB; kb.phenoscape.org), to automatically integrate large amounts of evolutionary character state descriptions into a synthetic character matrix of neomorphic (presence/absence) data. Using the KB, which includes more than 55 studies of sarcopterygian taxa, we generated a synthetic supermatrix of 639 variable characters scored for 1051 taxa, resulting in over 145,000 populated cells. Of these characters, over 76% were made variable through the addition of inferred presence/absence states derived by machine reasoning over the formal semantics of the source ontologies. Inferred data reduced the missing data in the variable character-subset from 98.5% to 78.2%. Machine reasoning also enables the isolation of conflicts in the data, that is, cells where both presence and absence are indicated; reports regarding conflicting data provenance can be generated automatically. Further, reasoning enables quantification and new visualizations of the data, here for example, allowing identification of character space that has been undersampled across the fin-to-limb transition. The approach and methods demonstrated here to compute synthetic presence/absence supermatrices are applicable to any taxonomic and phenotypic slice across the tree of life, providing the data are semantically annotated. Because such data can also be linked to model organism genetics through computational scoring of phenotypic similarity, they open a rich set of future research questions into phenotype

  16. Pancreatic cancer risk after loss of a child: a register-based study in Sweden during 1991-2009.

    PubMed

    Huang, Jiaqi; Valdimarsdóttir, Unnur; Fall, Katja; Ye, Weimin; Fang, Fang

    2013-08-15

    The potential role of psychological stress in pancreatic cancer has rarely been investigated in epidemiologic studies. During 1991-2009, we conducted a nested case-control study based on Swedish national population and health registers to investigate whether severe psychological stress induced by the death of a child was associated with subsequent risk of pancreatic cancer. The study included 16,522 cases and 82,107 controls who were matched to the cases on sex and year of birth. Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals. Overall, loss of a child was associated with an odds ratio of 1.09 for pancreatic cancer (95% confidence interval (CI): 1.02, 1.17). The risk elevation was mainly seen during the first 5 years after the loss (odds ratio (OR) = 1.27, 95% CI: 1.12, 1.45) and for loss of a child due to suicide (OR = 1.23, 95% CI: 1.03, 1.46). The association was statistically significant among women but not among men, and it appeared stronger for early-onset pancreatic cancer. Persons with a history of psychiatric illness had the greatest risk increase after child loss (OR = 1.43, 95% CI: 1.17, 1.76). Although other explanations are possible, our findings provide some evidence that psychological stress may be associated with pancreatic cancer.

  17. The relationship between socio-economic status and antidepressant prescription: a longitudinal survey and register study of young adults.

    PubMed

    von Soest, T; Bramness, J G; Pedersen, W; Wichstrøm, L

    2012-03-01

    The current study examines the relationship between socio-economic status (SES) and antidepressant prescription among young adults and investigates mechanisms that could explain such a potential social gradient. Longitudinal survey data from a population-based Norwegian sample (N = 2606) was collected in four waves over a 13-year period. The data were linked to register data on antidepressant prescription and several indicators of SES (education, income, social or unemployment benefits, disability or rehabilitation benefits and parents' education). Apart from parents' education, all indicators of low SES were related to higher rates of antidepressant prescription. A part of the relationship between SES and antidepressant prescription was due to low SES being related to higher levels of anxiety and depression. Moreover, low SES was related to more frequent use of mental health services, which again was related to higher rates of antidepressant prescription. Both contact with physicians and other mental healthcare professionals accounted for some of the relationship between SES and antidepressant prescription. The study provides information about mechanisms involved in the relationship between low SES and antidepressant prescription. More research is needed about whether a comparable social gradient in antidepressant prescription is also to be found outside the Nordic countries.

  18. The predictive effect of medical illnesses for mental health care in adolescence: a register-based study.

    PubMed

    Karukivi, Max; Haapasalo-Pesu, Kirsi-Maria

    2017-01-01

    Adolescence is a developmentally sensitive stage, during which a medical illness may have an effect on individual development, and vice versa. Chronic medical illnesses in adolescents have been associated with psychiatric symptoms. The aim of the present register-based pilot study was to assess whether, and to what extent, different medical diagnoses predict subsequent use of mental health services among adolescents. The study material comprised data on visits to a pediatric clinic by 12- to 16-year-old adolescent patients over a period of 5 years. Altogether, 10,154 visits by 1,781 patients were identified. The associations of the medical diagnoses with a subsequent visit to the adolescent psychiatry clinic were analyzed using logistic regression. During the follow-up period, 299 patients (16.8%) visited or contacted the adolescent psychiatry clinic at least once. Of various diagnoses, the highest odds ratios (ORs) were observed for diabetes mellitus (OR=4.07, p<0.001) and neoplasms (OR=3.29, p=0.047). An association was found between adolescent psychiatry clinic visits and female gender. Medical symptoms and illnesses that require a referral to a pediatrician are a marked risk factor for later use of mental health services. The results call for screening for psychological distress among patients with somatic illnesses and prompt referrals to mental health services if required.

  19. Problem Gambling Associated with Violent and Criminal Behaviour: A Danish Population-Based Survey and Register Study.

    PubMed

    Laursen, Bjarne; Plauborg, Rikke; Ekholm, Ola; Larsen, Christina Viskum Lytken; Juel, Knud

    2016-03-01

    This study compares the number of criminal charges among problem gamblers (N = 384) and non-problem gamblers including non-gamblers (N = 18,241) and examines whether problem gambling is more strongly associated with income-generating crimes like theft, fraud and forgery than other types of crimes such as violent crimes. A cohort study was carried out, based on data from the Danish Health and Morbidity Surveys in 2005 and 2010, which were linked at the individual level with data from The Danish National Criminal Register. Multiple logistic regression analyses were used to determine the association between problem gambling and charges for different categories of crime. We found that problem gamblers had significantly higher odds of being charged than non-problem gamblers (adjusted odds ratio 1.5; 95 % confidence interval 1.1-1.9). The odds ratio for economic crime charges was 2.6 (1.5-4.5), for violence charges 2.2 (1.1-4.5), and for drug charges 3.7 (1.7-8.0). For road traffic charges the odds ratio was 1.3 (1.0-1.8). Hence, there was a strong association between problem gambling and being charged except for road traffic charges; however the association was not stronger for economic charges than for violence and drug charges.

  20. Is absence related to work stress? A repeated cross-sectional study on a special police force.

    PubMed

    Magnavita, Nicola; Garbarino, Sergio

    2013-07-01

    Sickness absence due to illness is considered an indicator of work-related stress. Police work is a very stressful job. Sickness absence and sick leave are frequent among policemen. We tested whether stress variables were predictors of absenteeism in a police unit specifically assigned to the maintenance of law and order. Control, Reward, and Support were negatively related to frequency of absence and short-term absence. Demand and Effort were positively related to total lost days. Absence recorded in the previous year was the best predictor of absenteeism. We also found a positive, albeit weak association between absence in the previous year and subsequent work-related stress. Stress variables are associated with sickness absence, although the association is weak. Both short-term and prolonged sickness absence should be regarded as a warning sign for subsequent sickness absence and distress. Copyright © 2012 Wiley Periodicals, Inc.

  1. What If? Conditionals in Educational Registers

    ERIC Educational Resources Information Center

    Louwerse, Max M.; Crossley, Scott A.; Jeuniaux, Patrick

    2008-01-01

    Many corpus linguistic studies have investigated classification of texts into genres and registers, but relatively few of these studies have looked at linguistic features in educational registers. From a pedagogical perspective it is important to determine whether certain linguistic features behave differently across registers within particular…

  2. What If? Conditionals in Educational Registers

    ERIC Educational Resources Information Center

    Louwerse, Max M.; Crossley, Scott A.; Jeuniaux, Patrick

    2008-01-01

    Many corpus linguistic studies have investigated classification of texts into genres and registers, but relatively few of these studies have looked at linguistic features in educational registers. From a pedagogical perspective it is important to determine whether certain linguistic features behave differently across registers within particular…

  3. Worse survival in breast cancer among women with recent childbirth: results from a Swedish population-based register study.

    PubMed

    Bladström, Anna; Anderson, Harald; Olsson, Håkan

    2003-10-01

    This study was designed to investigate how time since childbirth affects breast cancer survival using unselected population-based data linking data from the Swedish Cancer Registry, fertility register, and population census registers. A total of 14,693 parous women < or =45 years of age with breast cancer were identified. Information on deaths was collected, and 5- and 10-year survival rates were calculated according to time since most recent childbirth. Mortality during the first 10 years of follow-up was further investigated in a Cox analysis, with adjustments for age at diagnosis, time period during which the diagnosis was made, number of children, and age at the time of the first child's birth. Women with diagnosis during pregnancy had a 5-year survival rate of 52.1% (95% CI, 41.2%-61.9%) and a 10-year survival rate of 43.9% (95% CI, 33.1%-54.2%), compared with survival rates of 80.0% (95% CI, 79.6%-81.4%) and 68.6% (95% CI, 67.5%-69.7%), respectively, in women diagnosed >10 years since childbirth. In the multivariate model, we found that time since childbirth was associated with inferior survival rates in cases of diagnosis <8 years after childbirth, in which the lowest survival rates were seen in women with diagnosis during pregnancy in the first 5 years of follow-up (adjusted relative risk compared with women with >10 years since last childbirth, 2.6; 95% CI, 1.8-3.4). The adjusted hazard ratios could be described by a decreasing function of a logarithmic transformation of years since childbirth. We found that the time of follow-up was of importance, in that women with a recent pregnancy had particularly lower survival rates during the first 5 years after diagnosis. The mechanisms behind the poor survival in breast cancer for women with recent childbirth are not known, but we suggest that one explanation might be a lower proportion of hormone receptor-positive tumors.

  4. Mortality and causes of death in patients with inflammatory bowel disease: a nationwide register study in Finland.

    PubMed

    Jussila, Airi; Virta, Lauri J; Pukkala, Eero; Färkkilä, Martti A

    2014-09-01

    Increased mortality has been reported in Crohn's disease (CD) but mostly not in ulcerative colitis (UC). We evaluated the overall and cause-specific mortality in a nationwide cohort of patients with inflammatory bowel disease (IBD) in Finland. A total of 21,964 patients with IBD (16,649 with UC and 5315 with CD) from the Special Reimbursement register were diagnosed 1987-1993 and 2000-2007 and followed up to the end of 2010 by collating these figures with the national computerized Cause-of-Death Register of Statistics Finland. In each cause-of-death category, the number of deaths reported was compared to that expected in general population, and expressed as a standardized mortality ratio (SMR). Overall mortality was increased among patients with CD (SMR 1.33, 95% confidence interval 1.21-1.46) and UC (1.10, 1.05-1.15). SMR was significantly increased for gastrointestinal causes in CD (6.53, 4.91-8.52) and UC (2.81, 2.32-3.34). Patients with UC were found also to have increased SMR from pulmonary (1.24, 1.02-1.46) and cardiovascular disease (1.14, 1.06-1.22) and cancers of the colon (1.90, 1.38-2.55), rectum (1.79, 1.14-2.69) and biliary tract (5.65, 3.54-8.54), whereas SMR from alcohol-related deaths was decreased (0.54, 0.39-0.71). Patients with CD had a significantly increased SMR for pulmonary diseases (2.01, 1.39-2.80), infections (4.27, 2.13-7.63) and cancers of the biliary tract (4.51, 1.23-11.5) and lymphoid and hematopoietic tissue (2.95, 1.85-4.45). In this Finnish nationwide study increased overall mortality in both CD and UC was observed. The excess mortality of 14% in IBD is mainly due to deaths related to inflammation in the gut. Copyright © 2014 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  5. Involvement and structure: A qualitative study of organizational change and sickness absence among women in the public sector in Sweden

    PubMed Central

    2011-01-01

    Background Organizational changes in modern corporate life have become increasingly common and there are indications that they often fail to achieve their ends. An earlier study of 24,036 employees showed that those who had repeatedly been exposed to large increases in staffing during 1991-1996 had an excess risk of both long-term sickness absence and hospital admission during 1997-1999, while moderate expansion appeared to be protective. The former was most salient among female public sector employees. We used qualitative interviews to explore work environment factors underlying the impact of organizational changes (moderate and large expansions in staffing) on sickness absence from an employee perspective. Method We interviewed 21 strategically selected women from the earlier study using semi-structured telephone interviews focusing on working conditions during the organizational changes. We identified 22 themes which could explain the association between organizational changes and sickness absence. We then used Qualitative Comparative Analysis (QCA) to reduce the number of themes and discover patterns of possible causation. Results The themes that most readily explained the outcomes were Well Planned Process of Change (a clear structure for involvement of the employees in the changes), Agent of Change (an active role in the implementation of the changes), Unregulated Work (a lack of clear limits and guidelines regarding work tasks from the management and among the employees), and Humiliating Position (feelings of low status or of not being wanted at the workplace), which had been salient throughout the analytic process, in combination with Multiple Contexts (working in several teams in parallel) and Already Ill (having already had a debilitating illness at the beginning of 1991), which may indicate degree of individual exposure and vulnerability. Well Planned Process of Change, Agent of Change and Multiple Contexts are themes that were associated with low

  6. Involvement and structure: a qualitative study of organizational change and sickness absence among women in the public sector in Sweden.

    PubMed

    Baltzer, Maria; Westerlund, Hugo; Backhans, Mona; Melinder, Karin

    2011-05-16

    Organizational changes in modern corporate life have become increasingly common and there are indications that they often fail to achieve their ends. An earlier study of 24,036 employees showed that those who had repeatedly been exposed to large increases in staffing during 1991-1996 had an excess risk of both long-term sickness absence and hospital admission during 1997-1999, while moderate expansion appeared to be protective. The former was most salient among female public sector employees. We used qualitative interviews to explore work environment factors underlying the impact of organizational changes (moderate and large expansions in staffing) on sickness absence from an employee perspective. We interviewed 21 strategically selected women from the earlier study using semi-structured telephone interviews focusing on working conditions during the organizational changes. We identified 22 themes which could explain the association between organizational changes and sickness absence. We then used Qualitative Comparative Analysis (QCA) to reduce the number of themes and discover patterns of possible causation. The themes that most readily explained the outcomes were Well Planned Process of Change (a clear structure for involvement of the employees in the changes), Agent of Change (an active role in the implementation of the changes), Unregulated Work (a lack of clear limits and guidelines regarding work tasks from the management and among the employees), and Humiliating Position (feelings of low status or of not being wanted at the workplace), which had been salient throughout the analytic process, in combination with Multiple Contexts (working in several teams in parallel) and Already Ill (having already had a debilitating illness at the beginning of 1991), which may indicate degree of individual exposure and vulnerability. Well Planned Process of Change, Agent of Change and Multiple Contexts are themes that were associated with low sickness absence. Unregulated

  7. Effects of familial risk factors and place of birth on the risk of autism: a nationwide register-based study.

    PubMed

    Lauritsen, Marlene Briciet; Pedersen, Carsten Bøcker; Mortensen, Preben Bo

    2005-09-01

    The etiology of autism is unknown. A strong genetic component has been detected but non-genetic factors may also be involved in the etiology. We used data from the Danish Psychiatric Central Register and the Danish Civil Registration System to study some risk factors of autism, including place of birth, parental place of birth, parental age, family history of psychiatric disorders, and paternal identity. A total of 943,664 children younger than ten years were followed from 1994 to 2001; of those, 818 children developed autism. The highest risks of autism were found in siblings of children with autism, or Asperger's syndrome and other pervasive developmental disorders (PDDs), with relative risks of 22 and 13, respectively. The relative risk of autism in the child was about twice as high if the mother had been diagnosed with a psychiatric disorder. The risk of autism was associated with increasing degree of urbanisation of the child's place of birth and with increasing paternal, but not maternal, age. An increased relative risk of 1.4 was found if the mother was born outside Europe, and in children of parents who were born in different countries. The highest risk of autism was found in families with a history of autism, or Asperger's syndrome and other PDDs in siblings, supporting the commonly accepted knowledge that genetic factors are involved in the etiology of autism.

  8. Male and female alcohol consumption and live birth after assisted reproductive technology treatment: a nationwide register-based cohort study.

    PubMed

    Vittrup, Ida; Petersen, Gitte Lindved; Kamper-Jørgensen, Mads; Pinborg, Anja; Schmidt, Lone

    2017-08-01

    The objective was to assess the potential association between female and male alcohol consumption and probability of achieving a live birth after assisted reproductive treatment. From a nationwide Danish register-based cohort information on alcohol consumption at assisted reproductive treatment initiation was linked to information on births and abortions. From 1 January 2006 to 30 September 2010, 12,981 women and their partners went through 29,834 treatment cycles. Of these, 22.4% and 20.4% led to a live birth for female abstainers and heavy consumers (>7 drinks/week), respectively. Concerning men, 22.6% and 20.2% of cycles resulted in a live birth for abstainers and heavy consumers (>14 drinks/week), respectively. No statistically significant associations between alcohol consumption and live birth were observed. Adjusted odds ratios from trend analyses were 1.00 (95% confidence interval (CI) 0.99-1.01) and 0.99 (95% CI 0.97-1.01) for every one-unit increase in female and male weekly alcohol consumption at assisted reproductive treatment initiation, respectively. In conclusion, this study did not show significant associations between male or female alcohol consumption and odds of live birth after assisted reproductive treatment. Copyright © 2017 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

  9. Does Moral Distress Differ Between California Certified Registered Nurse Anesthetists in Independent Versus Medically Supervised Practice: An Exploratory Study.

    PubMed

    Dumouchel, Michael; Boytim, Michael; Gorman, Nicholas; Weismuller, Penny

    2015-06-01

    The purpose of this exploratory, descriptive study was to determine if moral distress levels differed between certified registered nurse anesthetists (CRNAs) working in medically supervised versus independent practice in California. A 63-question survey was administered to 1,190 California CRNAs. Moral distress was measured by the included Ethics Stress Scale. The response rate was 14.7%, yielding demographic and Ethics Stress scores for 175 respondents. Sixty-five participants answered an open-ended question about moral distress yielding qualitative data. Medically supervised CRNAs had a lower mean moral distress scores (176.8) versus independent practice CRNAs (187.8) (p = .002). Lower scores on the ESS indicate higher moral distress. Qualitative data demonstrated that CRNAs experienced moral distress in the following situations: when pressured to give anesthesia to unoptimized patients, when differences of opinion regarding anesthetic plans occurred, in dealing with end-of-life issues, when working with incompetent providers, and during interprofessional struggles between CRNAs and anesthesiologists. In order to reduce moral distress among CRNAs, implications for practice include increased administrative support, increased communication and reciprocated collegial respect between anesthesiologists and CRNAs, and CRNA representation on ethics committees.

  10. Are familial factors underlying the association between socioeconomic position and prescription medicine? A register-based study on Danish twins

    PubMed Central

    Madsen, Mia; Andersen, Per Kragh; Gerster, Mette; Andersen, Anne-Marie Nybo; Osler, Merete; Christensen, Kaare

    2013-01-01

    Objectives Although well established, the association between socioeconomic position and health and health behaviour is not clearly understood, and it has been speculated that familial factors, for example, dispositional factors or exposures in the rearing environment, may be underlying the association. The objective was to compare prescription fillings within twin pairs who are partly or fully genetically identical and share childhood exposures. Design Twin cohort study. Setting Denmark. Participants Data from the Danish Twin Registry were linked to registers in Statistics Denmark and the Danish Registry of Medicinal Product statistics. A total of 8582 monozygotic (MZ) and 15 788 dizygotic same sex (DZSS) twins were included. Outcome measures Number of prescription fillings during follow-up (1995–2005) was analysed according to education and income. Results of unpaired and intrapair analyses were compared. Results An inverse social gradient in filling of prescriptions for all-purpose and system-specific drugs was observed in the unpaired analyses. In the intrapair analyses, associations were attenuated some in DZSS and more in MZ twins. Filling of drugs targeting the nervous system was still strongly associated with income in the intrapair analyses. Conclusions Familial factors seem to account for part of the observed social inequality in filling of prescription medicine. PMID:24227869

  11. Hand eczema in hairdressers: a Danish register-based study of the prevalence of hand eczema and its career consequences.

    PubMed

    Lysdal, Susan Hovmand; Søsted, Heidi; Andersen, Klaus Ejner; Johansen, Jeanne Duus

    2011-09-01

    Occupational hand eczema is common in hairdressers, owing to wet work and hairdressing chemicals. To estimate the prevalence of hand eczema and its career consequences among hairdressers in Denmark. A register-based study was conducted, comprising all graduates from hairdressing vocational schools from 1985 to 2007 (n = 7840). The participants received a self-administered postal questionnaire including questions on hand eczema, atopic dermatitis, and career change. A response rate of 67.9% (n = 5324) was obtained. Of the respondents, 44.3% no longer worked as hairdressers and had worked for an average of 8.4 years in the profession before leaving it. Hand eczema was more common among ex-hairdressers (48.4%) than among current hairdressers (37.6%) (p < 0.0001), and significantly more ex-hairdressers (26.8%) than current hairdressers (15.7%) had chronic hand eczema (p < 0.0001). Of the respondents with hand eczema, 75% were aged 15-24 years at onset, and 45.5% gave hand eczema as a reason for career change. In this group, logistic regression analysis showed that chronic hand eczema contributed the most to the decision to change career (odds ratio 50.12; 95% confidence interval 18.3-137). Hairdressers work an average of 8.4 years in the profession before leaving it, and hand eczema contributes significantly to this career change. © 2011 John Wiley & Sons A/S.

  12. Socioeconomic variations in hysterectomy: evidence from a linkage study of the Finnish hospital discharge register and population census.

    PubMed

    Luoto, R; Keskimäki, I; Reunanen, A

    1997-02-01

    To explore variations in rates for hysterectomy in relation to social class, education, and family income. Retrospective analysis of the 1988 Finnish hospital discharge register linked individually to the 1987 population census. Finland. All women living in Finland aged 35 and over were the denominator population. The numerators were the 8663 women who underwent hysterectomy in 1988. The overall rate for hysterectomy was 63.5/10,000 women aged 35 and over. There was a marked positive correlation between disposable family income and hysterectomy rates even after age, hospital catchment area, education, and occupational status were adjusted for. However, no linear trend for overall hysterectomy rates was observed in relation to social class or education. Procedures due to myomas, accounting for 48% of all hysterectomies, were more frequent among women of high socioeconomic status according to all socioeconomic indicators. Larger proportions of hysterectomies for myoma were also performed in patients in private hospitals and in pay beds in public hospitals than in women in worse off groups. Unlike the findings in earlier studies from other countries, there was a positive correlation between income and hysterectomy rates as a result of the high numbers of hysterectomies performed to treat myoma in the well off women. The findings are discussed in terms of socioeconomic differences in the use of private gynaecological services, and factors, such as parity and use of hormonal replacement therapy, that affect the growth of myomas.

  13. Insomnia symptoms and subsequent psychotropic medication: a register-linked study with 5-year follow-up.

    PubMed

    Haaramo, Peija; Lallukka, Tea; Lahelma, Eero; Hublin, Christer; Rahkonen, Ossi

    2014-12-01

    This study examined the associations of insomnia symptoms with subsequent psychotropic medication, reflecting mental health. Postal baseline surveys among 40- to 60-year-old employees of the city of Helsinki, Finland, were collected in 2000-2002 (N = 6,227, response rate 67%, 78% women) and longitudinally linked with national register data on prescribed reimbursed medication. Insomnia symptoms at baseline comprised difficulties in initiating and maintaining sleep, and non-restorative sleep. All purchased psychotropic medication 5-7 years prior to and 5 years after baseline was included. Outcomes were any psychotropic medication; antidepressants; and anxiolytics, hypnotics, and sedatives. Covariates included socio-demographic and work-related factors, health behaviors, lifetime mental disorders, and prior psychotropic medication. Logistic regression analysis was used to calculate odds ratios (OR) and their 95% confidence intervals (CI). Insomnia symptoms were associated with higher frequency of subsequent psychotropic medication prescriptions. The associations were strongest for frequent insomnia symptoms (women OR 3.55, 95% CI 2.64-4.77; men OR 4.64, 95% CI 2.49-8.66, adjusted for age and prior medication), but also rare and occasional symptoms were associated with psychotropic medication. Further adjustments had negligible effects. Insomnia symptoms were associated with prescribed psychotropic medication during follow-up in a dose-response manner. Attention should be given to the prevention of insomnia symptoms to curb subsequent mental problems.

  14. Long-term seizure outcome in patients with juvenile absence epilepsy; a retrospective study in a tertiary referral center.

    PubMed

    Danhofer, Pavlína; Brázdil, Milan; Ošlejšková, Hana; Kuba, Robert

    2014-06-01

    The study aim was to evaluate pharmacotherapy effects and long-term seizure outcomes in patients with juvenile absence epilepsy (JAE) during a five-year follow-up period. The secondary aim was to identify factors from patient history and determine their influence on seizure control. We retrospectively studied 46 patients with JAE in the period between 2006 and 2011. The age at seizure onset, onset seizure type, family history of epilepsy, status epilepticus in history, medication history, and the rate of seizure control were studied. There were 30 females (65.2%) and 16 males (34.8%) in the study. The mean age at seizure onset was 12.9±5.6 years (ranged from 3 to 28 years). In 30 patients (65.2%), seizure onset was with absences, in 15 patients (32.6%) with generalized tonic-clonic seizure (GTCS), and in 1 patient (2.2%) with absence status. In 43 patients (93.5%), GTCS occurred in the course of the disease. Family history for epilepsy was positive in 10 patients (21.7%). In the five-year follow-up period, seizure freedom (Group 1) was achieved in 7 patients (15.2%). In total, 22 patients (47.8%) were classified into the groups involving very poor seizure control and antiepileptic drug resistance (Groups 5 and 6). The mean number of antiepileptic drugs (AEDs) used in the course of the disease in appropriate therapeutic doses was 3.8±2.3 (1-10 AEDs). The study results show that almost half of JAE patients have poor seizure control with a high rate of pharmacoresistance. The outcome of JAE can be very uncertain. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  15. The Scottish Motor Neuron Disease Register: a prospective study of adult onset motor neuron disease in Scotland. Methodology, demography and clinical features of incident cases in 1989.

    PubMed Central

    1992-01-01

    The Scottish Motor Neuron Disease Register (SMNDR) is a prospective, collaborative, population based study of motor neuron disease (MND) in Scotland. The register started in January 1989 with the aim of studying the clinical and epidemiological features of MND by prospectively identifying incident patients. It is based on a system of registration by recruitment from multiple sources, followed by the collection of complete clinical data and follow up, mainly through general practitioners. In this report the register's methodology and the demography and incidence data for the first year of study are presented. One hundred and fourteen newly diagnosed patients were identified in 1989 giving a crude incidence for Scotland of 2.24/100,000/year. Standardised incidence ratios showed a non-significant trend towards lower rates in north eastern regions and island areas. PMID:1640227

  16. Does transfer of work from a public sector organisation to a commercial enterprise without staff reductions increase risk of long-term sickness absence among the staff? A cohort study of laboratory and radiology employees.

    PubMed

    Kokkinen, Lauri; Virtanen, Marianna; Pentti, Jaana; Vahtera, Jussi; Kivimäki, Mika

    2013-08-01

    Privatisations of public sector organisations are not uncommon, and some studies suggest that such organisational changes may adversely affect employee health. In this study, we examined whether transfer of work from public sector hospital units to commercial enterprises, without major staff reductions, was associated with an increased risk of long-term sickness absence among employees. A cohort study of 962 employees from four public hospital laboratory and radiology units in three hospitals which were privatised during the follow-up and 1832 employees from similar units without such organisational changes. Records of new long-term sick leaves (>90 days) were obtained from national health registers and were linked to the data. Mean follow-up was 9.2 years. Age- and sex-adjusted HR for long-term sickness absence after privatisation was 0.83 (95% CI 0.68 to 1.00) among employees whose work unit underwent a change from a public organisation to a commercial enterprise compared with employees in unchanged work units. Further adjustments for occupation, socioeconomic status, type of job contract, size of residence and sick leaves before privatisation had little impact on the observed association. A sensitivity analysis with harmonised occupations across the two groups replicated the finding (multivariable adjusted HR 0.92 (0.70-1.20)). In this study, transfer of work from public organisation to commercial enterprise did not increase the risk of long-term sickness absence among employees.

  17. The Association Between Self-Assessed Future Work Ability and Long-Term Sickness Absence, Disability Pension and Unemployment in a General Working Population: A 7-Year Follow-Up Study.

    PubMed

    Lundin, A; Kjellberg, K; Leijon, O; Punnett, L; Hemmingsson, T

    2016-06-01

    Purpose Work ability is commonly measured with self-assessments, in the form of indices or single items. The validity of these assessments lies in their predictive ability. Prospective studies have reported associations between work ability and sickness absence and disability pension, but few examined why these associations exist. Several correlates of work ability have been reported, but their mechanistic role is largely unknown. This study aims to investigate to what extent individual's own prognosis of work ability predicts labor market participation and whether this was due to individual characteristics and/or working conditions. Methods Self-assessed prognosis of work ability, 2 years from "now," in the Stockholm Public Health Questionnaire (2002-2003) was linked to national registers on sickness absence, disability pension and unemployment up to year 2010. Effects were studied with Cox regression models. Results Of a total of 12,064 individuals 1466 reported poor work ability. There were 299 cases of disability pension, 1466 long-term sickness absence cases and 765 long-term unemployed during follow-up. Poor work ability increased the risk of long-term sickness absence (HR 2.25, CI 95 % 1.97-2.56), disability pension (HR 5.19, CI 95 % 4.07-6.62), and long-term unemployment (HR 2.18, CI 95 % 1.83-2.60). These associations were partially explained by baseline health conditions, physical and (less strongly) psychosocial aspects of working conditions. Conclusions Self-assessed poor ability predicted future long-term sickness absence, disability pension and long-term unemployment. Self-assessed poor work ability seems to be an indicator of future labor market exclusion of different kinds, and can be used in public health monitoring.

  18. Registered nurses' perceptions of their professional work in nursing homes and home-based care: a focus group study.

    PubMed

    Carlson, Elisabeth; Rämgård, Margareta; Bolmsjö, Ingrid; Bengtsson, Mariette

    2014-05-01

    In Sweden, as well as in most industrialised countries, an increasing older population is expected to create a growing demand for health care staff. Previous studies have pointed to lack of proficient medical and nursing staff specialised in geriatric care, which poses serious threats to the care of a vulnerable population. At the same time, there are studies describing elderly care as a low-status career choice, attracting neither nurses nor student nurses. Judging from previous research it was deemed important to explore how nurses in elderly care perceive their work, thus possibly provide vital knowledge that can guide nurse educators and unit managers as a means to promote a career in elderly care. The aim of the present study was to illuminate how nurses, working in nursing homes and home-based care, perceived their professional work. This was a qualitative study using focus groups. 30 registered nurses in seven focus groups were interviewed. The participants worked in nursing homes and home-based care for the elderly in rural areas and in a larger city in southern Sweden. The interviews were analysed in line with the tradition of naturalistic inquiry. Our findings illustrate how nurses working in elderly care perceived their professional work as holistic and respectful nursing. Three categories of professional work emerged during analysis: (1) establishing long-term relationships, (2) nursing beyond technical skills, and (3) balancing independence and a sense of loneliness. The findings are important as they represent positive alternatives to the somewhat prevailing view on elderly care as depressing and undemanding. Nurse educators might use the key aspects as good examples, thus influencing student nurses' attitudes towards elderly care in a positive way. Elderly care agencies might find them helpful when recruiting and retaining nurses to a much needed area. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. Systems, Ideologies and History: A Three-Dimensional Absence in the Study of Assessment Reform Processes

    ERIC Educational Resources Information Center

    Flórez Petour, María Teresa

    2015-01-01

    This paper makes the case for the need to study assessment reform processes from a broader and more complex perspective that takes the historical, ideological and systemic aspects of assessment policies into account. It draws on a larger study to demonstrate how the understanding of Assessment for Learning (AfL) reforms is enriched by such a…

  20. Alternation between Work and Education. A Study of Educational Leave of Absence at Enterprise Level.

    ERIC Educational Resources Information Center

    Organisation for Economic Cooperation and Development, Paris (France). Centre for Educational Research and Innovation.

    The study reported here involves six countries (Germany, Italy, Yugoslavia, United Kingdom, United States, and Sweden) and focuses on the ways in which those who are actively employed have access to opportunities to alternate education and training with their employment. The first chapter discusses the study structure and defines the field covered…

  1. Specialist prescribing of psychotropic drugs to older persons in Sweden - a register-based study of 188 024 older persons

    PubMed Central

    2012-01-01

    Background The situation for older persons with mental disorders other than dementia disorders has scarcely been studied. The older population is increasing worldwide and along with this increase the prevalence of mental disorders will also rise. The treatment of older persons with mental disorders entails complex challenges, with drugs constituting the major medical treatment. Knowledge of geriatric psychiatry is essential for providing older persons with appropriate treatment and care. This study aimed to evaluate the prescription of drugs for mental disorders to older persons (≥65) in Sweden, focused on the medical specialties of the prescribing physicians. Methods Data concerning drug treatment for older persons from 2006 to 2008 was gathered from the Swedish Prescribed Drug Register. Mental disorders, defined as affective, psychotic and anxiety disorders (ICD-10 F20-42) were evaluated in order to identify associated drugs. Included was a total of 188 024 older individuals, who collectively filled 2 013 079 prescriptions for the treatment of mental disorders. Descriptive analyses were performed, including frequency distribution and 95% CI. The competence of the prescribers was analyzed by subdividing them into five groups: geriatricians, psychiatrists, general practitioners (GPs), other specialists, and physicians without specialist education. Results GPs represented the main prescribers, whereas geriatricians and psychiatrists rarely prescribed drugs to older persons. Benzodiazepines and tricyclic antidepressants were the most commonly prescribed drugs. Women were prescribed drugs from geriatricians and psychiatrists to a greater extent than men. Conclusions This study examined the prescription of psychotropic drugs to older persons. Physicians specialized in older persons’ disorders and mental health were rarely the prescribers of these drugs. Contrary to clinical guidelines, benzodiazepines and tricyclic antidepressants were commonly prescribed to older

  2. Australia's first transition to professional practice in primary care program for graduate registered nurses: a pilot study.

    PubMed

    Aggar, Christina; Bloomfield, Jacqueline; Thomas, Tamsin H; Gordon, Christopher J

    2017-01-01

    Increases in ageing, chronic illness and complex co-morbidities in the Australian population are adding pressure to the primary care nursing workforce. Initiatives to attract and retain nurses are needed to establish a sustainable and skilled future primary care nursing workforce. We implemented a transition to professional practice program in general practice settings for graduate nurses and evaluated graduate nurse competency, the graduate nurse experience and program satisfaction. This study aimed to determine whether a transition to professional practice program implemented in the general practice setting led to competent practice nurses in their first year post-graduation. A longitudinal, exploratory mixed-methods design was used to assess the pilot study. Data were collected at three times points (3, 6, 12 months) with complete data sets from graduate nurses (n = 4) and preceptors (n = 7). We assessed perceptions of the graduates' nursing competency and confidence, satisfaction with the preceptor/graduate relationship, and experiences and satisfaction with the program. Graduate nurse competency was assessed using the National Competency Standards for Nurses in General Practice. Semi-structured interviews with participants at Time 3 sought information about barriers, enablers, and the perceived impact of the program. Graduate nurses were found to be competent within their first year of clinical practice. Program perceptions from graduate nurses and preceptors were positive and the relationship between the graduate nurse and preceptor was key to this development. With appropriate support registered nurses can transition directly into primary care and are competent in their first year post-graduation. While wider implementation and research is needed, findings from this study demonstrate the potential value of transition to professional practice programs within primary care as a nursing workforce development strategy.

  3. Comorbidity of autoimmune thyroid disorders and psychiatric disorders during the postpartum period: a Danish nationwide register-based cohort study.

    PubMed

    Bergink, V; Pop, V J M; Nielsen, P R; Agerbo, E; Munk-Olsen, T; Liu, X

    2017-09-20

    The postpartum period is well-known risk period for the first onset of autoimmune thyroid disorders (AITDs) as well as first onset of psychiatric disorders. These two disorders are some of the most prevalent medical conditions postpartum, often misdiagnosed and disabling if left untreated. Our study was designed to explore the possible bidirectional association between AITDs and psychiatric disorders during the postpartum period. A population-based cohort study through linkage of Danish national registers, which comprised 312 779 women who gave birth to their first child during 1997-2010. We conducted Poisson regression analysis to estimate the incidence rate ratio (IRR) of psychiatric disorders among women with first-onset AITDs, the IRR of AITDs among women with first-onset psychiatric disorders as well as the overlap between these disorders using a comorbidity index. Women with first-onset AITDs postpartum were more likely to have first-onset psychiatric disorders than women who did not have postpartum AITDs (IRR = 1.88, 95% confidence interval (CI): 1.25-2.81). Women with first-onset postpartum psychiatric disorders had a higher risk of AITDs than women with no psychiatric disorders (IRR = 2.16, 95% CI: 1.45-3.20). The comorbidity index 2 years after delivery was 2.26 (95% CI: 1.61-2.90), indicating a comorbidity between first-onset AITDs and psychiatric disorders. First-onset AITDs and psychiatric disorders co-occur in the postpartum period, which has relevance to further studies on the etiologies of these disorders and why childbirth in particular triggers the onset.

  4. Transition from clinician to academic: an interview study of the experiences of UK and Australian Registered Nurses.

    PubMed

    Logan, Patricia A; Gallimore, David; Jordan, Sue

    2016-03-01

    The aim of this study was to explore and compare the experiences of nurses in Australia and the UK as they moved from clinical practice into higher education institutions. When nurse education moved from hospitals into higher education institutions, the roles and career pathways of nurse educators changed. The design method used in this study was qualitative interview study. Semi-structured interviews were undertaken with 14 nurse educators, seven in Australia and seven in the UK, in 2011-2012. Thematic analysis of the transcripts was undertaken and triangulated with automated content and thematic analysis by Leximancer© software. Nurse academics in Australia and the UK voiced similar enthusiasms and concerns. These coalesced around four emergent themes: adapting to change, external pressures, teaching and progress up the academic ladder. The Leximancer© analysis for both sites ranked 'research' as the primary theme, linked with 'time', 'University' and 'nursing' on both sites. Respondents were aware of the importance of research to career progression in universities, but most prioritized their teaching and clinical commitments for the sake of their organizations. Most respondents were supported in their doctoral studies, but the absence of postdoctoral research teams, mentors and role models was striking. Additional support is needed to ensure that nurse academics are able to pursue research beyond doctoral level. © 2015 John Wiley & Sons Ltd.

  5. Burnout as a predictor of self‐reported sickness absence among human service workers: prospective findings from three year follow up of the PUMA study

    PubMed Central

    Borritz, M; Rugulies, R; Christensen, K B; Villadsen, E; Kristensen, T S

    2006-01-01

    Aim To investigate whether burnout predicts sickness absence days and sickness absence spells in human service workers. Method A total of 824 participants from an ongoing prospective study in different human service sector organisations were eligible for the three year follow up analysis. Burnout was measured with the work related burnout scale of the Copenhagen Burnout Inventory. Sickness absence was measured with self‐reported number of days and spells during the last 12 months before the baseline and the follow up survey. A Poisson regression model with a scale parameter was used to account for over dispersion. A linear regression model was used for analysing changes in burnout and absence between baseline and follow up. Results Burnout was prospectively associated with both sickness absence days and sickness absence spells per year. Differences in sickness absence days varied from a mean of 5.4 days per year in the lowest quartile of the work related burnout scale to a mean of 13.6 in the highest quartile. An increase of one standard deviation on the work related burnout scale predicted an increase of 21% in sickness absence days per year (rate ratio 1.21, 95% CI 1.11 to 1.32) after adjusting for gender, age, organisation, socioeconomic status, lifestyle factors, family status, having children under 7 years of age, and prevalence of diseases. Regarding sickness absence spells, an increase of one standard deviation on the work related burnout scale predicted an increase of 9% per year (rate ratio 1.09, 95% CI 1.02 to 1.17). Changes in burnout level from baseline to follow up were positively associated with changes in sickness absence days (estimate 1.94 days/year, SE 0.63) and sickness absence spell (estimate 0.34 spells/year, SE 0.08). Conclusion The findings indicate that burnout predicts sickness absence. Reducing burnout is likely to reduce sickness absence. PMID:16421387

  6. Language and Communication in the Absence of Speech: A Case Study.

    ERIC Educational Resources Information Center

    Rogow, Sally M.

    This case study reports on the language development of a child with severe speech and multiple handicaps resulting from "severe epileptic encephalopathy" who is, however, able to competently read, write, and comprehend two languages (English and Cantonese) but does not initiate conversations. Data were gathered as a result of weekly home visits…

  7. Drug use in patients with dementia: a register-based study in the health region of Girona (Catalonia/Spain).

    PubMed

    Avila-Castells, Pilar; Garre-Olmo, Josep; Calvó-Perxas, Laia; Turró-Garriga, Oriol; Alsina, Elisabet; Carmona, Olga; Perkal, Héctor; Roig, Anna Maria; Cuy, Josep Ma; Lozano, Manuela; Molins, Albert; Vallmajó, Natàlia; López-Pousa, Secundino

    2013-05-01

    To describe the pattern of drug consumption among patients with dementia in a geographically defined general population in Catalonia (Spain), and to determine its association with age, gender, type of dementia and severity indicators. Cross-sectional study that included 1,894 cases of dementia registered by the Registry of Dementias of Girona from 2007 to 2009. Prescribed drugs were categorized according to the Anatomical Therapeutic Chemical (ATC) classification. A descriptive analysis of drug consumption was stratified according to age, gender, dementia subtypes and dementia severity. Binary logistic regression models were adjusted to detect the association of these variables with drug consumption according to the ATC groups. The most commonly prescribed drugs were for the central nervous system (CNS) (96.4 %), cardiovascular system (79.4 %) and digestive and metabolic system categories (77.7 %). No significant differences were found between the use of nervous system drugs and age, gender, dementia subtypes or dementia severity. The use of alimentary tract and metabolism related drugs, as well as cardiovascular and blood system drugs, were positively correlated with age and secondary dementia. The prevalence of use of cardiovascular and musculoskeletal drugs was higher in women than in men (OR: 1.34; OR: 1.26 respectively). A negative association was found between the severity of dementia and the use of musculoskeletal drugs (OR: 0.71), while its use was significantly higher in the youngest patients (OR: 1.71). Almost all patients with dementia received a CNS drug, being at risk of inappropriate treatment. Treatment for comorbidities in patients with dementia should not be withheld on the basis of age or dementia severity, but rather on the benefit/risk ratio of its prescription. Further studies are needed to evaluate potentially inappropriate drug use and possible untreated conditions in this population.

  8. Reproduction and mode of delivery in women with vaginismus or localised provoked vestibulodynia: a Swedish register-based study.

    PubMed

    Möller, L; Josefsson, A; Bladh, M; Lilliecreutz, C; Sydsjö, G

    2015-02-01

    To compare sociodemographics, parity and mode of delivery between women diagnosed with vaginismus or localised provoked vestibulodynia (LPV) to women without a diagnosis before first pregnancy. Retrospective, population-based register study. Sweden. All women born in Sweden 1973-83 who gave birth for the first time or remained nulliparous during the years 2001-09. Nationally linked registries were used to identify the study population. Women diagnosed with vaginismus or LPV were compared to all other women. Odds ratios for parity and mode of delivery were calculated using multinominal regression analysis and logistic regression. Parity and mode of delivery. Women with vaginismus/LPV were more likely to be unmarried (P = 0.001), unemployed (P = 0.012), have a higher educational level (P < 0.001), a lower body mass index (P < 0.001) and use nicotine during pregnancy (P = 0.008). They were less likely to give birth (adjusted odds ratio [OR] 0.61, 95% confidence interval [95% CI] 0.56-0.67). Women with vaginismus/LPV more often delivered by caesarean section (P < 0.001) especially for maternal request (adjusted OR 3.48, 95% CI 2.45-4.39). In women having vaginal delivery, those with vaginismus/LPV were more likely to suffer a perineal laceration (adjusted OR 1.87, 95% CI 1.56-2.25). Women with vaginismus/LPV are less likely to give birth and those that do are more likely to deliver by caesarean section and have a caesarean section based upon maternal request. Those women delivering vaginally are more likely to suffer perineal laceration. These findings point to the importance of not only addressing sexual function in women with vaginismus/LPV but reproductive function as well. © 2014 Royal College of Obstetricians and Gynaecologists.

  9. Psychosocial work environment and prediction of job satisfaction among Swedish registered nurses and physicians - a follow-up study.

    PubMed

    Jönsson, Sandra

    2012-06-01

    In Sweden, the health care sector was subject to considerable changes during the 1990s: decreased costs, related staff redundancies and high rates of sick leave. The situation has now changed, and the sector is not facing the same all-embracing and turbulent changes. In addition, there is a shortage of nurses and physicians and a difficulty in retaining qualified staff. Regarding the psychosocial work environment, there is a lack of studies where both physicians and nurses are in focus. It is from a managerial perspective important to take a holistic approach towards questions regarding the work environment in general and the psychosocial work environment in particular. The aims of this study were to analyse similarities and differences in Registered Nurses and physicians' experience of quantitative and qualitative demands, control, role conflicts, role clarity, social support and job satisfaction in 2002 and 2009 and to analyse the stability in the prediction of job satisfaction over time. Questionnaires regarding psychosocial work environment aspects were distributed in 2002 and 2009, and a total of 860 nurses and 866 physicians answered the questionnaire. Independent t tests and linear stepwise regression analyses were conducted. The results indicate that the work environment has improved between 2002 and 2009 and that nurses experience their psychosocial working environment as more satisfactory than physicians. Social support, control, role conflicts, role clarity and qualitative demands were the best predictors of job satisfaction in 2002 and 2009. Quantitative demands did not contribute to predicting job satisfaction. Variables predicting job satisfaction are quite stable over time and are quite comparable for both nurses and physicians.

  10. Type of hematological malignancy is crucial for the return to work prognosis: a register-based cohort study.

    PubMed

    Horsboel, Trine Allerslev; Nielsen, Claus Vinther; Nielsen, Bendt; Jensen, Chris; Andersen, Niels Trolle; de Thurah, Annette

    2013-12-01

    The aims of this study were to determine the proportion of return to work (RTW) among sick-listed patients diagnosed with one of eight subtypes of hematological malignancies; to evaluate the influence of type of hematological malignancy, comorbidity, use of anxiolytics and antidepressants, socioeconomic and demographic factors on RTW; and to investigate if these associations differ between genders. We combined data from national registers on all Danish patients diagnosed with hematological malignancies between 2000 and 2007. A total of 1,741 patients on long-term sick leave were followed until RTW, emigration, permanent withdrawal from the labor market, death, or February 2012, whichever came first. A total of 1,140 (65 %) patients returned to work. A strong association was found between type of diagnosis and RTW (p < 0.001), and the proportion of RTW was lowest for patients with multiple myeloma or acute leukemia compared to patients with Hodgkin lymphoma, diffuse large B-cell lymphoma, follicular lymphoma, chronic myeloid leukemia, and chronic lymphoid leukemia. Use of antidepressants or anxiolytics after diagnosis, gender, age, and educational level were also associated with RTW. Surprisingly, comorbidity was not associated with RTW (p = 0.94); gender only modified the association between age and RTW. Two thirds of patients with hematological malignancies on sick leave RTW. A number of factors seem to lead to a poor prognosis, the hematological diagnosis being the most important, and these should be taken into account when performing studies on work outcome for patients with hematological malignancies. Knowledge in this area should assist in identification of hematological cancer patients at risk of not returning to work so that early targeted rehabilitation interventions can be initiated.

  11. Family history of psychiatric illness as a risk factor for schizoaffective disorder: a Danish register-based cohort study.

    PubMed

    Laursen, Thomas Munk; Labouriau, Rodrigo; Licht, Rasmus W; Bertelsen, Aksel; Munk-Olsen, Trine; Mortensen, Preben Bo

    2005-08-01

    Schizoaffective disorder may be related to both schizophrenia and bipolar disorders, but no population-based studies, to our knowledge, have investigated this association in families. To determine whether a psychiatric history of schizoaffective disorder, bipolar disorder, or schizophrenia among parents and siblings is a risk factor for developing a schizoaffective disorder, and whether a specific pattern of family history of psychiatric illness exists in persons with schizoaffective disorder compared with persons with bipolar disorder or schizophrenia. Register-based cohort study. Denmark. The 2.4 million persons born in Denmark after 1952. Relative risks of the 3 illnesses estimated by Poisson regression. In total, 1925 persons had a schizoaffective disorder, 3721 had a bipolar disorder, and 12 501 had schizophrenia. The relative risk of schizoaffective disorder was 2.76 (95% confidence interval, 2.49-3.06) if a first-degree relative had a history of mental illness compared with a person with no first-degree relatives with such a history. There was an additional risk (95% confidence interval) of 2.57 (2.11-3.13), 3.23 (2.63-3.95), or 1.92 (1.43-2.57) if the first-degree relative had schizophrenia, bipolar disorder, or schizoaffective disorder, respectively, compared with other psychiatric admissions. When bipolar disorder was the outcome, bipolar disorder in first-degree relatives was by far the significantly strongest risk factor. When schizophrenia was the outcome, the significantly strongest risk factor was schizophrenia among first-degree relatives. Schizoaffective disorder is not simply a subgroup of either bipolar disorder or schizophrenia but may be genetically linked to both, with schizoaffective disorder being a subtype of each or a genetic intermediate form.

  12. Phase II study of capecitabine (Xeloda (registered) ) and concomitant boost radiotherapy in patients with locally advanced rectal cancer

    SciTech Connect

    Krishnan, Sunil; Janjan, Nora A.; Skibber, John M.; Rodriguez-Bigas, Miguel A.; Wolff, Robert A.; Das, Prajnan; Delclos, Marc E.; Chang, George J.; Hoff, Paulo M.; Eng, Cathy; Brown, Thomas D.; Crane, Christopher H.; Feig, Barry W.; Morris, Jeffrey; Vadhan-Raj, Saroj; Hamilton, Stanley R.; Lin, Edward H. . E-mail: elin@u.washington.edu

    2006-11-01

    Purpose: The aim of this study was to determine the efficacy of capecitabine (Xeloda (registered) ), an oral fluoropyrimidine, as a radiosensitizer in the neoadjuvant treatment of locally advanced rectal cancer (LARC). Methods and Materials: We conducted a phase II study of capecitabine (825 mg/m{sup 2} orally, twice daily continuous) with radiotherapy (52.5 Gy/30 fractions to the primary tumor and perirectal nodes) in 54 patients with LARC (node-negative {>=}T3 or any node-positive tumor) staged by endoscopic ultrasound (EUS). The primary endpoint was pathologic response rate; secondary endpoints included toxicity profiles and survival parameters. Results: Of the 54 patients (median age, 56.7 years; range, 21.3-78.7 years; male:female ratio, 1.7; Eastern Cooperative Oncology Group performance status 0-1: 100%), 51 patients (94%) had T3N0 or T3N1 disease by EUS. Surgery was not performed in 3 patients; 2 of these patients had metastatic disease, and the third patient refused after a complete clinical response. Of the 51 patients evaluable for pathologic response, 9 patients (18%) achieved complete response, and 12 patients (24%) had microscopic residual disease (<10% viable cells). In addition, 26 patients of all 54 patients (51%) achieved T-downstaging, and 15 patients of 29 patients (52%) achieved N-downstaging. Grade 3/4 toxicities were radiation dermatitis (9%) and diarrhea (2%). Sphincter preservation rate for tumor {<=}5 cm from the anal verge was 67% (18/27). Conclusion: This regimen of radiotherapy plus capecitabine is well tolerated and is more convenient than protracted venous infusion of 5-FU. The pathologic response rate is comparable to our previous experience using protracted venous infusion 5-FU for LARC.

  13. Depression and Anxiety in the Postpartum Period and Risk of Bipolar Disorder: A Danish Nationwide Register-Based Cohort Study.

    PubMed

    Liu, Xiaoqin; Agerbo, Esben; Li, Jiong; Meltzer-Brody, Samantha; Bergink, Veerle; Munk-Olsen, Trine

    2017-05-01

    The first-onset affective episode requiring inpatient treatment in the postpartum period can be a marker of bipolar disorder, but it is unknown whether milder postpartum affective episodes are also indicators of underlying bipolarity. Therefore, we aimed to study whether women with a nonpsychotic postpartum affective episode treated with antidepressants have an increased risk of bipolar disorder. A register-based cohort study was conducted in Denmark of 122,622 parous women without psychiatric history who received a first-time antidepressant prescription during 1997-2012. We compared women with a first-time antidepressant prescription, which was our indicator of a first-onset affective disorder, within 1 year postpartum to women with a first-time antidepressant prescription outside the postpartum period. Our outcome was psychiatric contact for bipolar disorder (ICD-10 criteria) during follow-up, and we estimated hazard ratios using Cox regressions. The risk of bipolar disorder among women with a postpartum affective episode was higher than that in women with an affective episode outside the postpartum period. The risk of bipolar disorder was 1.66 (95% CI, 1.12-2.48) for postpartum antidepressant monotherapy and 10.15 (95% CI, 7.13-14.46) for postpartum antidepressant therapy plus a subsequent prescription for anxiolytics when these therapies were compared to antidepressant monotherapy outside the postpartum period. First-onset nonpsychotic postpartum affective disorder can be a marker of underlying bipolarity. Women who fill an antidepressant prescription following childbirth should be asked about hypomanic or manic symptoms and monitored long term. Clinically, when antidepressant monotherapy is ineffective or the individual woman experiences persistent and concerning symptoms, health professionals should consider a possible bipolar spectrum disorder.

  14. Factors associated with evidence-based practice among registered nurses in Sweden: a national cross-sectional study

    PubMed Central

    2013-01-01

    Background Evidence-based practice (EBP) is emphasized to increase the quality of care and patient safety. EBP is often described as a process consisting of distinct activities including, formulating questions, searching for information, compiling the appraised information, implementing evidence, and evaluating the resulting practice. To increase registered nurses’ (RNs’) practice of EBP, variables associated with such activities need to be explored. The aim of the study was to examine individual and organizational factors associated with EBP activities among RNs 2 years post graduation. Methods A cross-sectional design based on a national sample of RNs was used. Data were collected in 2007 from a cohort of RNs, included in the Swedish Longitudinal Analyses of Nursing Education/Employment study. The sample consisted of 1256 RNs (response rate 76%). Of these 987 RNs worked in healthcare at the time of the data collection. Data was self-reported and collected through annual postal surveys. EBP activities were measured using six single items along with instruments measuring individual and work-related variables. Data were analyzed using logistic regression models. Results Associated factors were identified for all six EBP activities. Capability beliefs regarding EBP was a significant factor for all six activities (OR = 2.6 - 7.3). Working in the care of older people was associated with a high extent of practicing four activities (OR = 1.7 - 2.2). Supportive leadership and high collective efficacy were associated with practicing three activities (OR = 1.4 - 2.0). Conclusions To be successful in enhancing EBP among newly graduated RNs, strategies need to incorporate both individually and organizationally directed factors. PMID:23642173

  15. Can work ability explain the social gradient in sickness absence: a study of a general population in Sweden.

    PubMed

    Löve, Jesper; Holmgren, Kristina; Torén, Kjell; Hensing, Gunnel

    2012-03-07

    Understanding the reasons for the social gradient in sickness absence might provide an opportunity to reduce the general rates of sickness absence. The complete explanation for this social gradient still remains unclear and there is a need for studies using randomized working population samples. The main aim of the present study was to investigate if self-reported work ability could explain the association between low socioeconomic position and belonging to a sample of new cases of sick-listed employees. The two study samples consisted of a randomized working population (n = 2,763) and a sample of new cases of sick-listed employees (n = 3,044), 19-64 years old. Both samples were drawn from the same randomized general population. Socioeconomic status was measured with occupational position and physical and mental work ability was measured with two items extracted from the work ability index. There was an association between lower socioeconomic status and belonging to the sick-listed sample among both women and men. In men the crude Odds ratios increased for each downwards step in socioeconomic status, OR 1.32 (95% CI 0.98-1.78), OR 1.53 (1.05-2.24), OR 2.80 (2.11-3.72), and OR 2.98 (2.27-3.90). Among women this gradient was not as pronounced. Physical work ability constituted the strongest explanatory factor explaining the total association between socioeconomic status and being sick-listed in women. However, among men, the association between skilled non-manual, OR 2.07 (1.54-2.78), and non-skilled manual, OR 2.03 (1.53-2.71) positions in relation to being sick-listed remained. The explanatory effect of mental work ability was small. Surprisingly, even in the sick-listed sample most respondents had high mental and physical work ability. These results suggest that physical work ability may be an important key in explaining the social gradient in sickness absence, particularly in women. Hence, it is possible that the factors associated with the social gradient in

  16. The prevalence of absence of the palmaris longus--a study in a Chinese population and a review of the literature.

    PubMed

    Sebastin, S J; Puhaindran, M E; Lim, A Y T; Lim, I J; Bee, W H

    2005-10-01

    Most standard textbooks of hand surgery quote the prevalence of absence of palmaris longus at around 15%. However, this figure varies considerably in reports from different ethnic groups. We studied 329 Chinese men and women and found palmaris longus to be absent unilaterally in 3.3%, and bilaterally in 1.2%, with an overall prevalence of absence of 4.6%. There was no significant difference in its absence with regard to the body side or the sex. Our literature review revealed a low prevalence of absence in Asian, Black and Native American populations and a much higher prevalence of absence in Caucasian populations. It is clear that a standard prevalence of absence of the palmaris longus cannot be applied to all populations.

  17. Control Genes and Variability: Absence of Ubiquitous Reference Transcripts in Diverse Mammalian Expression Studies

    PubMed Central

    Lee, Peter D.; Sladek, Robert; Greenwood, Celia M.T.; Hudson, Thomas J.

    2002-01-01

    Control genes, commonly defined as genes that are ubiquitously expressed at stable levels in different biological contexts, have been used to standardize quantitative expression studies for more than 25 yr. We analyzed a group of large mammalian microarray datasets including the NCI60 cancer cell line panel, a leukemia tumor panel, and a phorbol ester induction time course as well as human and mouse tissue panels. Twelve housekeeping genes commonly used as controls in classical expression studies (including GAPD, ACTB, B2M, TUBA, G6PD, LDHA, and HPRT) show considerable variability of expression both within and across microarray datasets. Although we can identify genes with lower variability within individual datasets by heuristic filtering, such genes invariably show different expression levels when compared across other microarray datasets. We confirm these results with an analysis of variance in a controlled mouse dataset, showing the extent of variability in gene expression across tissues. The results show the problems inherent in the classical use of control genes in estimating gene expression levels in different mammalian cell contexts, and highlight the importance of controlled study design in the construction of microarray experiments. [Supplemental material available online at http://genome.mcgill.ca/∼pdlee/control_genes and and http://www.genome.org.] PMID:11827948

  18. Sorption studies of nitrate ion by a modified beet residue in the presence and absence of ultrasound.

    PubMed

    Karimi, Mahdi; Entezari, Mohammad H; Chamsaz, Mahmood

    2010-04-01

    Kinetic and thermodynamic studies were carried out for the adsorption of nitrate ion from aqueous solutions onto modified beet residue and for desorption from the sorbent to the solution in batch experiments. The beet residue was modified by epichlorohydrin in the presence of pyridine. The experiments were conducted in the presence and absence of ultrasound. The removal of this ion was examined by varying experimental conditions such as the amount of sorbent, contact time, concentration, and temperature. It was found that more than 90% of nitrate ion was removed in less than 2 min from the solution. Results indicate that the adsorption of nitrate in the presence of ultrasound was higher at lower temperature (10 degrees C) and it was lower at higher temperatures with respect to the control method (without ultrasound). In the case of desorption study, the amount of desorption was higher in the presence of ultrasound than its absence at different applied temperatures. The Langmuir isotherm model fits adequately the experimental data for adsorption and desorption studies. In point of kinetics, the second-order kinetic model describes the sorption process for this ion. The thermodynamic parameters such as DeltaG degrees , DeltaH degrees , and DeltaS degrees were determined for the sorption of NO(3)(-) from the temperature dependence of the sorption process.

  19. Aspartame exacerbates EEG spike-wave discharge in children with generalized absence epilepsy: a double-blind controlled study.

    PubMed

    Camfield, P R; Camfield, C S; Dooley, J M; Gordon, K; Jollymore, S; Weaver, D F

    1992-05-01

    There are anecdotal reports of increased seizures in humans after ingestion of aspartame. We studied 10 children with newly diagnosed but untreated generalized absence seizures. Ambulatory cassette recording of EEG allowed quantification of numbers and length of spike-wave discharges in a double-blind study on two consecutive days. On one day the children received 40 mg/kg aspartame and on the other day, a sucrose-sweetened drink. Baseline EEG was the same before aspartame and sucrose. Following aspartame compared with sucrose, the number of spike-wave discharges per hour and mean length of spike-wave discharges increased but not to a statistically significant degree. However, the total duration of spike-wave discharge per hour was significantly increased after aspartame (p = 0.028), with a 40% +/- 17% (SEM) increase in the number of seconds per hour of EEG recording that the children spent in spike-wave discharge. Aspartame appears to exacerbate the amount of EEG spike wave in children with absence seizures. Further studies are needed to establish if this effect occurs at lower doses and in other seizure types.

  20. A Unique Opportunity to Study Short and Long Term Consequences in Children Prenatally Exposed to Illicit Drugs and Opioid Maintenance Treatment Using Czech and Scandinavian Registers.

    PubMed

    Gabrhelík, Roman; Nechanská, Blanka; Mravčík, Viktor; Skurtveit, Svetlana; Lund, Ingunn Olea; Handal, Marte

    2016-09-01

    Licit and illicit drug use in pregnant women constitutes a long lasting and serious problem worldwide. Information on long-term effects of maternal drug use on the child is limited. Nationwide registers provide a great potential to study short and long-term consequences for children exposed to licit and illicit drugs during pregnancy. We discuss this potential, with a special emphasis on exposure to methamphetamine, heroin and prescription drugs used for opioid maintenance treatment (OMT). We also discuss the advantages of register data and of merging such data from different regions. The Czech and Scandinavian registers are largely comparable and provide great opportunities to conduct innovative research. For instance, using Czech and Scandinavian cohorts we can compare groups with similar characteristics, such as mothers in OMT and mothers addicted to other drugs while also controlling for important confounding factors such as health and socio-economic status. Copyright© by the National Institute of Public Health, Prague 2016.

  1. Social inequalities in mental health and mortality among refugees and other immigrants to Sweden--epidemiological studies of register data.

    PubMed

    Hollander, Anna-Clara

    2013-06-27

    The aim of this PhD project was to increase knowledge, using population-based registers, of how pre- and post-migration factors and social determinants of health are associated with inequalities in poor mental health and mortality among refugees and other immigrants to Sweden. Study I and II had cross-sectional designs and used logistic regression analysis to study differences in poor mental health (measured with prescribed psychotropic drugs purchased) between refugee and non-refugee immigrants. In Study I, there was a significant difference in poor mental health between female refugees and non-refugees (OR=1.27; CI=1.15-1.40) when adjusted for socio-economic factors. In Study II, refugees of most origins had a higher likelihood of poor mental health than non-refugees of the same origin. Study III and IV had cohort designs and used Cox regression analysis. Study III analysed mortality rates among non-labour immigrants. Male refugees had higher relative risks of mortality from cardiovascular disease (HR=1.53; CI=1.04-2.24) and external causes (HR=1.59; CI=1.01-2.50) than male non-refugees did, adjusted for socio-economic factors. Study IV included the population with a strong connection to the labour market in 1999 to analyse the relative risk of hospitalisation due to depressive disorder following unemployment. The lowest relative risk was found among employed Swedish-born men and the highest among foreign-born females who lost employment during follow-up (HR=3.47; CI=3.02-3.98). Immigrants, and particularly refugees, have poorer mental health than native Swedes. Refugee men have a higher relative mortality risk for cardiovascular disease and external causes of death than do non-refugees. The relative risk of hospitalisation due to depressive disorder following unemployment was highest among immigrant women. To promote mental health and reduce mortality among immigrants, it is important to consider pre- and post-migration factors and the general social

  2. Social inequalities in mental health and mortality among refugees and other immigrants to Sweden – epidemiological studies of register data

    PubMed Central

    Hollander, Anna-Clara

    2013-01-01

    The aim of this PhD project was to increase knowledge, using population-based registers, of how pre- and post-migration factors and social determinants of health are associated with inequalities in poor mental health and mortality among refugees and other immigrants to Sweden. Study I and II had cross-sectional designs and used logistic regression analysis to study differences in poor mental health (measured with prescribed psychotropic drugs purchased) between refugee and non-refugee immigrants. In Study I, there was a significant difference in poor mental health between female refugees and non-refugees (OR=1.27; CI=1.15–1.40) when adjusted for socio-economic factors. In Study II, refugees of most origins had a higher likelihood of poor mental health than non-refugees of the same origin. Study III and IV had cohort designs and used Cox regression analysis. Study III analysed mortality rates among non-labour immigrants. Male refugees had higher relative risks of mortality from cardiovascular disease (HR=1.53; CI=1.04–2.24) and external causes (HR=1.59; CI=1.01–2.50) than male non-refugees did, adjusted for socio-economic factors. Study IV included the population with a strong connection to the labour market in 1999 to analyse the relative risk of hospitalisation due to depressive disorder following unemployment. The lowest relative risk was found among employed Swedish-born men and the highest among foreign-born females who lost employment during follow-up (HR=3.47; CI=3.02–3.98). Immigrants, and particularly refugees, have poorer mental health than native Swedes. Refugee men have a higher relative mortality risk for cardiovascular disease and external causes of death than do non-refugees. The relative risk of hospitalisation due to depressive disorder following unemployment was highest among immigrant women. To promote mental health and reduce mortality among immigrants, it is important to consider pre- and post-migration factors and the general social

  3. Social inequalities in mental health and mortality among refugees and other immigrants to Sweden - epidemiological studies of register data.

    PubMed

    Hollander, Anna-Clara

    2013-01-01

    The aim of this PhD project was to increase knowledge, using population-based registers, of how pre- and post-migration factors and social determinants of health are associated with inequalities in poor mental health and mortality among refugees and other immigrants to Sweden. Study I and II had cross-sectional designs and used logistic regression analysis to study differences in poor mental health (measured with prescribed psychotropic drugs purchased) between refugee and non-refugee immigrants. In Study I, there was a significant difference in poor mental health between female refugees and non-refugees (OR=1.27; CI=1.15-1.40) when adjusted for socio-economic factors. In Study II, refugees of most origins had a higher likelihood of poor mental health than non-refugees of the same origin. Study III and IV had cohort designs and used Cox regression analysis. Study III analysed mortality rates among non-labour immigrants. Male refugees had higher relative risks of mortality from cardiovascular disease (HR=1.53; CI=1.04-2.24) and external causes (HR=1.59; CI=1.01-2.50) than male non-refugees did, adjusted for socio-economic factors. Study IV included the population with a strong connection to the labour market in 1999 to analyse the relative risk of hospitalisation due to depressive disorder following unemployment. The lowest relative risk was found among employed Swedish-born men and the highest among foreign-born females who lost employment during follow-up (HR=3.47; CI=3.02-3.98). Immigrants, and particularly refugees, have poorer mental health than native Swedes. Refugee men have a higher relative mortality risk for cardiovascular disease and external causes of death than do non-refugees. The relative risk of hospitalisation due to depressive disorder following unemployment was highest among immigrant women. To promote mental health and reduce mortality among immigrants, it is important to consider pre- and post-migration factors and the general social

  4. Fractures in Individuals with and without a History of Infantile Autism. A Danish Register Study Based on Hospital Discharge Diagnoses

    ERIC Educational Resources Information Center

    Mouridsen, Svend Erik; Rich, Bente; Isager, Torben

    2012-01-01

    We compared the prevalence and types of fractures in a clinical sample of 118 individuals diagnosed as children with infantile autism (IA) with 336 matched controls from the general population. All participants were screened through the nationwide Danish National Hospital Register. The average observation time was 30.3 years (range 27.3-30.4…

  5. Fractures in Individuals with and without a History of Infantile Autism. A Danish Register Study Based on Hospital Discharge Diagnoses

    ERIC Educational Resources Information Center

    Mouridsen, Svend Erik; Rich, Bente; Isager, Torben

    2012-01-01

    We compared the prevalence and types of fractures in a clinical sample of 118 individuals diagnosed as children with infantile autism (IA) with 336 matched controls from the general population. All participants were screened through the nationwide Danish National Hospital Register. The average observation time was 30.3 years (range 27.3-30.4…

  6. Absence of lymphatic vessels in the dog dental pulp: an immunohistochemical study.

    PubMed

    Martin, Anna; Gasse, Hagen; Staszyk, Carsten

    2010-11-01

    In spite of numerous investigations it has not been precisely determined whether lymphatic vessels are present in the dental pulp of dogs. Therefore, this study attempted a specific immunohistochemical detection of lymphatic endothelium. The canine teeth of 19 healthy beagle dogs were dissected into three segments (apical, intermediate and occlusal). After decalcification, specimens were embedded in paraffin wax and histologic cross-sections were stained immunohistochemically using a reliable antibody (anti-Prox-1) against the homeobox transcription factor Prox-1, which is located within the nucleus of lymphatic endothelium. Anti-Prox-1 reacted positively with canine control tissues (lymph nodes, gingiva, nasal mucosa), but showed no staining in tissue sections of the dental pulp. The dog dental pulp contained no vascular structures lined with lymphatic endothelium. This suggests that drainage of interstitial fluid makes use of other routes, i.e. extravascular pathways. © 2010 The Authors. Journal of Anatomy © 2010 Anatomical Society of Great Britain and Ireland.

  7. Absence of lymphatic vessels in the dog dental pulp: an immunohistochemical study

    PubMed Central

    Martin, Anna; Gasse, Hagen; Staszyk, Carsten

    2010-01-01

    In spite of numerous investigations it has not been precisely determined whether lymphatic vessels are present in the dental pulp of dogs. Therefore, this study attempted a specific immunohistochemical detection of lymphatic endothelium. The canine teeth of 19 healthy beagle dogs were dissected into three segments (apical, intermediate and occlusal). After decalcification, specimens were embedded in paraffin wax and histologic cross-sections were stained immunohistochemically using a reliable antibody (anti-Prox-1) against the homeobox transcription factor Prox-1, which is located within the nucleus of lymphatic endothelium. Anti-Prox-1 reacted positively with canine control tissues (lymph nodes, gingiva, nasal mucosa), but showed no staining in tissue sections of the dental pulp. The dog dental pulp contained no vascular structures lined with lymphatic endothelium. This suggests that drainage of interstitial fluid makes use of other routes, i.e. extravascular pathways. PMID:20854283

  8. Gestational Exposure to Selective Serotonin Reuptake Inhibitors and Offspring Psychiatric Disorders: A National Register-Based Study

    PubMed Central

    Malm, Heli; Brown, Alan S.; Gissler, Mika; Gyllenberg, David; Hinkka-Yli-Salomäki, Susanna; McKeague, Ian W.; Weissman, Myrna; Wickramaratne, Priya; Artama, Miia; Gingrich, Jay A.; Sourander, Andre

    2016-01-01

    Objective To investigate the impact of gestational exposure to selective serotonin reuptake inhibitors (SSRIs) on offspring neurodevelopment. Method This is a cohort study using national register data in Finland between the years 1996-2010. Pregnant women and their offspring were categorized into four groups: SSRI exposed (n=15,729); exposed to psychiatric disorder, no antidepressants (n=9,651); exposed to SSRIs only before pregnancy (n=7,980); and unexposed to antidepressants and psychiatric disorders (n=31,394). We investigated the cumulative incidence of offspring diagnoses of depression, anxiety, autism spectrum disorders (ASDs), and attention-deficit/hyperactivity disorders (ADHD) for the four groups from birth to 14 years, adjusting for confounders. Results The cumulative incidence of depression among offspring exposed prenatally to SSRIs was 8.2% (95% CI, 3.1-13.3%) by age 14.9, compared to 1.9% (95% CI, 0.9-2.9%) in the psychiatric disorder, no medication group (adjusted hazard ratio [HR], 1.78; 95% CI, 1.12-2.82; p=.02) and to 2.8% (95% CI, 1.4-4.3%) in the SSRI discontinued group (HR 1.84; 95% CI, 1.14-2.97; p=.01). Rates of anxiety, ASD, and ADHD diagnoses were comparable to rates in offspring of mothers with a psychiatric disorder but no medication during pregnancy. Comparing SSRI exposed to unexposed, the HRs were significantly elevated for each outcome. Conclusion Prenatal SSRI exposure was associated with increased rates of depression diagnoses in early adolescence but not with ASD or ADHD. Until confirmed, these findings must be balanced against the substantial adverse consequences of untreated maternal depression. PMID:27126849

  9. Labor market position after a rejection of a disability pension application: a register-based cohort study.

    PubMed

    Laaksonen, Mikko; Gould, Raija; Liukko, Jyri

    2017-08-17

    To study labor market positions of rejected disability pension applicants and to examine which characteristics predict ending up in these positions after the rejection. Nationwide Finnish register data was used to describe employment, unemployment and disability pension trajectories of rejected applicants (n = 5740) from four years before to four years after the rejection. Demographic, occupational and health-related determinants of labor market position after the rejection were examined among those employed and not employed at the time of the rejection. The proportion of the employed steeply decreased and that of unemployed increased before the rejection of a disability pension application. Four years after the rejection, 30% of the rejected applicants were employed, 24% were unemployed and 30% received disability pension. Employment at the time of the rejection, younger age, shorter unemployment history, public sector employment and milder work disability increased future employment. Manual work, public sector employment and previous long-term unemployment predicted future unemployment. Apart from higher age, associations with receiving disability pension were relatively weak. For many rejected disability pension applicants return to work is challenging. Special efforts should be targeted to support the remaining work ability and to promote employment opportunities of the rejected applicants. Implications for Rehabilitation Employment, unemployment and receiving disability pension were equally common labor market positions four years after the rejection. Rejected DP applicants with unemployment history need special efforts to increase their employability. As a disability pension application, even if rejected, clearly indicates some degree of work ability problems, rehabilitation should be targeted at this time point to support employment.

  10. Association of pneumococcal conjugate vaccination with rates of ventilation tube insertion in Denmark: population-based register study.

    PubMed

    Groth, Christina; Thomsen, Reimar W; Ovesen, Therese

    2015-06-05

    To examine if the introduction of pneumococcal conjugate vaccine (PCV) in Denmark was associated with a decrease in the rate of ventilation tube (VT) insertions performed by office-based practising ear, nose and throat (ENT) specialists. Population-based register study based on prospectively collected data. Central Denmark Region. Data on VT insertions performed by any office-based practising ENT specialist in the region were collected from the National Health Service Registry. All children below the age of 2 years with a first-time VT insertion from 2001 through 2011. Age-stratified and gender-stratified standardised incidence rates of first-time VT insertion, and incidence rate ratio for PCV period 2008-2011 compared with pre-PCV period 2001-2007. The annual incidence rate of first-time VT insertion in small children increased steadily from 64/1000 person-years in 2001 to 100/1000 person-years in 2011. The incidence rate ratio was 1.27 (95% CI 1.24 to 1.30) in the PCV period compared with the pre-PCV period. The introduction of PCV into the Danish childhood immunisation programme in 2007 was not associated with a subsequent decrease in the rate of VT insertions among children below the age of 2 years. Instead, the rate continued to rise, as before the introduction of PCV. Danish Data Protection Agency: 2007-58-0010. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  11. Advanced maternal age increases the risk of very preterm birth, irrespective of parity: a population-based register study.

    PubMed

    Waldenström, U; Cnattingius, S; Vixner, L; Norman, M

    2017-07-01

    To investigate whether advanced maternal age is associated with preterm birth, irrespective of parity. Population-based registry study. Swedish Medical Birth Register. First, second, and third live singleton births to women aged 20 years or older in Sweden, from 1990 to 2011 (n = 2 009 068). Logistic regression analysis was used in each parity group to estimate risks of very and moderately preterm births to women at 20-24, 25-29, 30-34, 35-39, and 40 years or older, using 25-29 years as the reference group. Odds ratios (ORs) were adjusted for year of birth, education, country of birth, smoking, body mass index, and history of preterm birth. Age-related risks of spontaneous and medically indicated preterm births were also investigated. Very preterm (22-31 weeks of gestation) and moderately preterm (32-36 weeks) births. Risks of very preterm birth increased with maternal age, irrespective of parity: adjusted ORs in first, second, and third births ranged from 1.18 to 1.28 at 30-34 years, from 1.59 to 1.70 at 35-39 years, and from 1.97 to 2.40 at ≥40 years. In moderately preterm births, age-related associations were weaker, but were statistically significant from 35-39 years in all parity groups. Advanced maternal age increased the risks of both spontaneous and medically indicated preterm births. Advanced maternal age is associated with an increased risk of preterm birth, irrespective of parity, especially very preterm birth. Women aged 35 years and older, expecting their first, second, or third births, should be regarded as a risk group for very preterm birth. Women aged 35 years and older should be regarded as a risk group for very preterm birth, irrespective of parity. © 2016 Royal College of Obstetricians and Gynaecologists.

  12. Insomnia symptoms and mortality: a register-linked study among women and men from Finland, Norway and Lithuania.

    PubMed

    Lallukka, Tea; Podlipskytė, Aurelija; Sivertsen, Børge; Andruškienė, Jurgita; Varoneckas, Giedrius; Lahelma, Eero; Ursin, Reidun; Tell, Grethe S; Rahkonen, Ossi

    2016-02-01

    Evidence on the association between insomnia symptoms and mortality is limited and inconsistent. This study examined the association between insomnia symptoms and mortality in cohorts from three countries to show common and unique patterns. The Finnish cohort comprised 6605 employees of the City of Helsinki, aged 40-60 years at baseline in 2000-2002. The Norwegian cohort included 6236 participants from Western Norway, aged 40-45 years at baseline in 1997-1999. The Lithuanian cohort comprised 1602 participants from the City of Palanga, aged 35-74 years at baseline in 2003. Mortality data were derived from the Statistics Finland and Norwegian Cause of Death Registry until the end of 2012, and from the Lithuanian Regional Mortality Register until the end of 2013. Insomnia symptoms comprised difficulties initiating sleep, nocturnal awakenings, and waking up too early. Covariates were age, marital status, education, smoking, alcohol, physical inactivity, obesity, diabetes, cardiovascular diseases, depression, shift work, sleep duration, and self-rated health. Cox regression analysis was used. Frequent difficulties initiating sleep were associated with all-cause mortality among men after full adjustments in the Finnish (hazard ratio 2.51; 95% confidence interval 1.07-5.88) and Norwegian (hazard ratio 3.42; 95% confidence interval 1.03-11.35) cohorts. Among women and in Lithuania, insomnia symptoms were not statistically significantly associated with all-cause mortality after adjustments. In conclusion, difficulties initiating sleep were associated with mortality among Norwegian and Finnish men. Variation and heterogeneity in the association between insomnia symptoms and mortality highlights that further research needs to distinguish between men and women, specific symptoms and national contexts, and focus on more chronic insomnia.

  13. Association of pneumococcal conjugate vaccination with rates of ventilation tube insertion in Denmark: population-based register study

    PubMed Central

    Groth, Christina; Thomsen, Reimar W; Ovesen, Therese

    2015-01-01

    Objective To examine if the introduction of pneumococcal conjugate vaccine (PCV) in Denmark was associated with a decrease in the rate of ventilation tube (VT) insertions performed by office-based practising ear, nose and throat (ENT) specialists. Design Population-based register study based on prospectively collected data. Setting Central Denmark Region. Data on VT insertions performed by any office-based practising ENT specialist in the region were collected from the National Health Service Registry. Participants All children below the age of 2 years with a first-time VT insertion from 2001 through 2011. Main outcome measures Age-stratified and gender-stratified standardised incidence rates of first-time VT insertion, and incidence rate ratio for PCV period 2008–2011 compared with pre-PCV period 2001–2007. Results The annual incidence rate of first-time VT insertion in small children increased steadily from 64/1000 person-years in 2001 to 100/1000 person-years in 2011. The incidence rate ratio was 1.27 (95% CI 1.24 to 1.30) in the PCV period compared with the pre-PCV period. Conclusions The introduction of PCV into the Danish childhood immunisation programme in 2007 was not associated with a subsequent decrease in the rate of VT insertions among children below the age of 2 years. Instead, the rate continued to rise, as before the introduction of PCV. Trial registration number Danish Data Protection Agency: 2007-58-0010. PMID:26048205

  14. Understanding the inverse care law: a register and survey-based study of patient deprivation and burnout in general practice.

    PubMed

    Pedersen, Anette Fischer; Vedsted, Peter

    2014-12-12

    According to the inverse care law, there is a mismatch between patients' medical needs and medical care supply. As an example, the number of doctors is often lower in areas with high deprivation compared to areas with no deprivation, and doctors with a deprived patient population may experience a high work pressure, have insufficient time for comprehensive tasks and be at higher risk for developing burnout. The mechanisms responsible for the inverse care law might be mutually reinforcing, but we know very little about this process. In this study, the association between patient deprivation and burnout in the general practitioners (GPs) was examined. Active GPs in the Central Denmark Region were invited to participate in a survey on job satisfaction and burnout and 601 GPs returned the questionnaire (72%). The Danish Regions provided information about which persons were registered with each practice, and information concerning socioeconomic characteristics for each patient on the list was obtained from Statistics Denmark. A composite deprivation index was also used. There was significantly more burnout among GPs in the highest quartile of the deprivation index compared to GPs in the lowest quartile (OR: 1.91; 95% CI: 1.06-3.44; p-value: 0.032). Among the eight variables included in the deprivation index, a high share of patients on social benefits was most strongly associated with burnout (OR: 2.62; 95% CI: 1.45-4.71; p-value: 0.001). A higher propensity of GP burnout was found among GPs with a high share of deprived patients on their lists compared to GPs with a low share of deprived patients. This applied in particular to patients on social benefits. This indicates that beside lower supply of GPs in deprived areas, people in these areas may also be served by GPs who are in higher risk of burnout and not performing optimally.

  15. Gestational Exposure to Selective Serotonin Reuptake Inhibitors and Offspring Psychiatric Disorders: A National Register-Based Study.

    PubMed

    Malm, Heli; Brown, Alan S; Gissler, Mika; Gyllenberg, David; Hinkka-Yli-Salomäki, Susanna; McKeague, Ian W; Weissman, Myrna; Wickramaratne, Priya; Artama, Miia; Gingrich, Jay A; Sourander, Andre

    2016-05-01

    To investigate the impact of gestational exposure to selective serotonin reuptake inhibitors (SSRIs) on offspring neurodevelopment. This is a cohort study using national register data in Finland between the years 1996 and 2010. Pregnant women and their offspring were categorized into 4 groups: SSRI exposed (n = 15,729); exposed to psychiatric disorder, no antidepressants (n = 9,651); exposed to SSRIs only before pregnancy (n = 7,980); and unexposed to antidepressants and psychiatric disorders (n = 31,394). We investigated the cumulative incidence of offspring diagnoses of depression, anxiety, autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD) for the 4 groups from birth to 14 years, adjusting for confounders. The cumulative incidence of depression among offspring exposed prenatally to SSRIs was 8.2% (95% CI = 3.1-13.3%) by age 14.9 years, compared with 1.9% (95% CI = 0.9-2.9%) in the psychiatric disorder, no medication group (adjusted hazard ratio [HR] = 1.78; 95% CI = 1.12-2.82; p = .02) and to 2.8% (95% CI = 1.4-4.3%) in the SSRI discontinued group (HR = 1.84; 95% CI = 1.14-2.97; p = .01). Rates of anxiety, ASD, and ADHD diagnoses were comparable to rates in offspring of mothers with a psychiatric disorder but no medication during pregnancy. Comparing SSRI exposed to unexposed individuals, the HRs were significantly elevated for each outcome. Prenatal SSRI exposure was associated with increased rates of depression diagnoses in early adolescence but not with ASD or ADHD. Until confirmed, these findings must be balanced against the substantial adverse consequences of untreated maternal depression. Copyright © 2016 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

  16. Comorbidities, treatment patterns and cost-of-illness of acromegaly in Sweden: a register-linkage population-based study.

    PubMed

    Lesén, Eva; Granfeldt, Daniel; Houchard, Aude; Dinet, Jérôme; Berthon, Anthony; Olsson, Daniel S; Björholt, Ingela; Johannsson, Gudmundur

    2017-02-01

    Acromegaly is a complex endocrine disease with multiple comorbidities. Treatment to obtain biochemical remission includes surgery, medical therapy and radiation. We aimed to describe comorbidities, treatment patterns and cost-of-illness in patients with acromegaly in Sweden. A nationwide population-based study. Patients with acromegaly were identified and followed in national registers in Sweden. Longitudinal treatment patterns were assessed in patients diagnosed between July 2005 and December 2013. The cost-of-illness during 2013 was estimated from a societal perspective among patients diagnosed between 1987 and 2013. Among 358 patients with acromegaly (48% men, mean age at diagnosis 50.0 (s.d. 15.3) years) at least one comorbidity was reported in 81% (n = 290). The most common comorbidities were hypertension (40%, n = 142), neoplasms outside the pituitary (30%, n = 109), hypopituitarism (22%, n = 80) and diabetes mellitus (17%, n = 61). Acromegaly treatment was initiated on average 3.7 (s.d. 6.9) months after diagnosis. Among the 301 treated patients, the most common first-line treatments were surgery (60%, n = 180), somatostatin analogues (21%, n = 64) and dopamine agonists (14%, n = 41). After primary surgery, 24% (n = 44) received somatostatin analogues. The annual per-patient cost was €12 000; this was €8700 and €16 000 if diagnosed before or after July 2005, respectively. The cost-of-illness for acromegaly and its comorbidities was 77% from direct costs and 23% from production loss. The prevalence of comorbidity is high in patients with acromegaly. The most common first-line treatment in acromegalic patients was surgery followed by somatostatin analogues. The annual per-patient cost of acromegaly and its comorbidities was €12 000. © 2017 European Society of Endocrinology.

  17. Frequency of contact with community-based psychiatric services and the lunar cycle: a 10-year case-register study.

    PubMed

    Amaddeo, F; Bisoffi, G; Micciolo, R; Piccinelli, M; Tansella, M

    1997-08-01

    The relationship between the lunar cycle and the frequency of contact with community-based psychiatric services was assessed using the South Verona Psychiatric Case Register data. For each day of the study period (January 1982-December 1991) we recorded the number of contacts made by South Verona residents with psychiatric services and the corresponding day of the lunar cycle. First, the synodic month was divided into four interval phases (usually called new moon, first quarter, full moon and third quarter), and interphase differences in the mean number of contacts were tested using one-way analysis of variance. Second. the null hypothesis of no relationship between the lunar cycle and the frequency of contact with psychiatric services was tested against the alternative hypothesis of a sinusoidal distribution according to the lunar phase. The average number of contacts with psychiatric services on each day of the lunar cycle over the 10-year period was obtained and a sine-wave curve was fitted to the data. Both for total and drop-in contacts, no significant differences in mean number of contacts were found between the four interval phases of the synodic month (new moon, first quarter, full moon and third quarter). Similarly, no significant results were found by setting the expected surge in consultations at 1-3 days after the full moon and the period of the sine-wave curve equal to 30 days. When the period of the sine-wave curve was allowed to vary in order to fit the data best, none of the statistical tests reached the level of significance required to dismiss the possibility of false-positive results. These findings did not support the theory that a relationship exists between the lunar cycle and the frequency of contact with community-based psychiatric services.

  18. Association between registered nurse staffing and management outcomes of patients with type 2 diabetes within primary care: a cross-sectional linkage study

    PubMed Central

    Lukewich, Julia; Edge, Dana S.; VanDenKerkhof, Elizabeth; Williamson, Tyler; Tranmer, Joan

    2016-01-01

    Background: As the organization of primary care continues to evolve toward more interdisciplinary team structures, demonstrating effectiveness of care delivery is becoming important, particularly for nonphysician providers. Nurses are the most common nonphysician provider within primary care. The purpose of this study was to examine the relation between primary care delivery models that incorporate registered nurses and clinical outcomes of patients with type 2 diabetes. Methods: Patient data from the Canadian Primary Care Sentinel Surveillance Network were matched with survey data from 15 Family Health Team practices in southeastern Ontario. Included patients were adults with type 2 diabetes mellitus who had at least 1 primary care encounter at a Family Health Team practice that completed the organizational survey between Apr. 1, 2013, and Mar. 31, 2014. The clinical outcomes explored included hemoglobin A1c, fasting plasma glucose, blood pressure, low-density lipoprotein cholesterol and urine albumin:creatinine ratio. Results: Of the 15 practices, 13 (86.7%) had at least 1 registered nurse. The presence of 1 or more registered nurses in the practice was associated with increased odds of patients' having their hemoglobin A1c, fasting plasma glucose, blood pressure and low-density lipoprotein cholesterol values meet recommended targets. Practices with the lowest ratios of patients with diabetes to registered nurse had a significantly greater proportion of patients with hemoglobin A1c and fasting plasma glucose values on target than did practices with the highest ratios of patients to registered nurse (p < 0.01 and p = 0.03, respectively). Interpretation: The findings suggest that registered nurse staffing within primary care practice teams contributes to better diabetic care, as measured by diabetes management indicators. This study sets the groundwork for further exploration of nursing and organizational contributions to patient care in the primary care setting

  19. Fluid stimulation elicits hearing in the absence of air and bone conduction--An animal study.

    PubMed

    Perez, Ronen; Adelman, Cahtia; Sohmer, Haim

    2016-01-01

    Conclusion Cochlea can be directly excited by fluid (soft-tissue) stimulation. Objective To determine whether there is no difference in auditory-nerve-brainstem evoked response (ABR) thresholds to fluid stimulation between normal and animal models of post radical-mastoidectomy, as seen in a previous human study. Background It has been shown in humans that hearing can be elicited with stimulation to fluid in the external auditory meatus (EAM), and radical-mastoidectomy cavity. These groups differed in age, initial hearing, and drilling exposure. To overcome this difference, experiments were conducted in sand-rats, first intact, and after inducing a radical-mastoidectomy. Methods The EAM of five sand-rats was filled with 0.3 ml saline. ABR thresholds were determined in response to vibratory stimulation by a clinical bone-vibrator with a plastic rod, applied to the saline in the EAM. Then the tympanic membrane was removed, and malleus dislocated (radical-mastoidectomy model). The cavity was filled with 0.45 ml saline and the ABR threshold was determined in response to vibratory stimulation to the cavity fluid. Results There was no difference in ABR fluid thresholds to EAM and mastoidectomy cavity stimulation. Air-conduction stimulation from the bone-vibrator was not involved (conductive loss due to fluid). Bone-conduction stimulation was not involved (large difference in acoustic impedance between fluid and bone).

  20. Absence of lymphatic vessels in human dental pulp: a morphological study.

    PubMed

    Gerli, Renato; Secciani, Ilaria; Sozio, Francesca; Rossi, Antonella; Weber, Elisabetta; Lorenzini, Guido

    2010-04-01

    Few and controversial data are available in the literature regarding the presence of lymphatic vessels in the human dental pulp. The present study was designed to examine morphologically the existence of a lymph drainage system in human dental pulp. Human dental pulp and skin sections were immunohistochemically stained with specific antibodies for lymphatic endothelium (D2-40, LYVE-1, VEGFR-3 [vascular endothelial growth factor receptor-3], and Prox-1), with the pan-endothelial markers CD31 and von Willebrand factor (vWF), and with the blood-specific marker CD34. Several blood vessels were identified in human pulps and skin. Lymphatic vessels were found in all human skin samples but in none of the pulps examined. Western blotting performed on human dermis and on pulps treated with collagenase (to remove odontoblasts) confirmed these results. Transmission electron microscopy indicated that vessels which, by light microscopy, appeared to be initial lymphatic vessels had no anchoring filaments or discontinuous basement membrane, both of which are typical ultrastructural characteristics of lymphatic vessels. These results suggest that under normal conditions human dental pulp does not contain true lymphatic vessels. The various theories about dental pulp interstitial fluid circulation should be revised accordingly.

  1. Ambiguous absence, ambiguous presence: a qualitative study of military reserve families in wartime.

    PubMed

    Faber, Anthony J; Willerton, Elaine; Clymer, Shelley R; MacDermid, Shelley M; Weiss, Howard M

    2008-04-01

    The "Global War on Terrorism" has resulted in reservists being deployed at an ever-increasing rate. However, because reservists and their families are unaccustomed to deployments, many families may experience boundary ambiguity, a state in which family members are uncertain in their perception about who is in or out of the family and who is performing which roles and tasks within the family. This qualitative description study examined boundary ambiguity in military reserve families over time. A sample of 34 reservists, spouses, and parents was interviewed 7 times within the 1st year of the reservists' return from Iraq. During deployment, all family members experienced boundary ambiguity. Gathering information and attending a family support group provided some relief for families. After the reservists returned, couples as well as those who had experienced additional life events or losses experienced the highest levels of boundary ambiguity. However, this boundary ambiguity dissipated over time, as families tended to restabilize once the reservists had returned to work and a routine had been established.

  2. Studies on the absence of photodynamic mechanism in the normal pancreas

    NASA Astrophysics Data System (ADS)

    Mang, Thomas S.; Wieman, Thomas J.; Crean, David H.

    1991-06-01

    Extraction procedures to quantitate porfimer sodium concentration in tissues were correlated with fluorescence measurements made in vivo, on hamster and rat normal pancreas and intra-pancreatic tumors. The uptake of photosensitizer has been shown to be high in both normal and malignant pancreatic tissues, in both animal models studied. Photobleaching of the drug, as evidenced by both techniques within the pancreatic tumor, occurs in a typical manner during PDT, with resultant tissue destruction. In contrast, when the normal pancreas is exposed to PDT, a negligible photobleaching effect, as well as a lack of tissue response, is observed. The lack of observable response is corroborated by a lack of measurable physiological response. Both serum amylase and serum glucose show acute changes up to 12 hours post treatment but quickly return to normal. HPLC analysis shows that the drug extracted from both the normal pancreas and intrapancreatic tumor is essentially the same as that extracted from other tissues and similar to that which has been injected into the animal. Fluorescence microscopy has shown that at time points between 12-120 hours the drug is associated with lymphatic channels. This would not, however, necessarily preclude normal tissue destruction. Similar results have been found with other photosensitizers. Understanding the lack of response in the pancreas may lead to a deeper understanding of the diseased state which is normally refractory to all therapy as well as understanding the fundamental concepts of the mechanisms of PDT.

  3. Does a Caesarean section increase the time to a second live birth? A register-based cohort study.

    PubMed

    O'Neill, Sinéad M; Khashan, Ali S; Henriksen, Tine B; Kenny, Louise C; Kearney, Patricia M; Mortensen, Preben B; Greene, Richard A; Agerbo, Esben

    2014-11-01

    Does a primary Caesarean section influence the rate of, and time to, subsequent live birth compared with vaginal delivery? Caesarean section was associated with a reduction in the rate of subsequent live birth, particularly among elective and maternal-requested Caesareans indicating maternal choice plays a role. Several studies have examined the relationship between Caesarean section and subsequent birth rate with conflicting results primarily due to poor epidemiological methods. This Danish population register-based cohort study covered the period from 1982 to 2010 (N = 832 996). All women with index live births were followed until their subsequent live birth or censored (maternal death, emigration or study end) using Cox regression models. In all 577 830 (69%) women had a subsequent live birth. Women with any type of Caesarean had a reduced rate of subsequent live birth (hazard ratio [HR] 0.86, 95% confidence intervals [CI] 0.85, 0.87) compared with spontaneous vaginal delivery. This effect was consistent when analyses were stratified by type of Caesarean: emergency (HR 0.87, 95% CI 0.86, 0.88), elective (HR 0.83, 95% CI 0.82, 0.84) and maternal-requested (HR 0.61, 95% CI 0.57, 0.66) and in the extensive sub-analyses performed. Lack of biological data to measure a woman's fertility is a major limitation of the current study. Unmeasured confounding and limited availability of data (maternal BMI, smoking, access to fertility services and maternal-requested Caesarean section) as well as changes in maternity care over time may also influence the findings. This is the largest study to date and shows that Caesarean section is most likely not causally related to a reduction in fertility. Maternal choice to delay or avoid childbirth is the most plausible explanation. Our findings are generalizable to other middle- to high-income countries; however, cross country variations in Caesarean section rates and social or cultural differences are acknowledged. Funding was

  4. Hand sanitisers for reducing illness absences in primary school children in New Zealand: a cluster randomised controlled trial study protocol

    PubMed Central

    2010-01-01

    Background New Zealand has relatively high rates of morbidity and mortality from infectious disease compared with other OECD countries, with infectious disease being more prevalent in children compared with others in the population. Consequences of infectious disease in children may have significant economic and social impact beyond the direct effects of the disease on the health of the child; including absence from school, transmission of infectious disease to other pupils, staff, and family members, and time off work for parents/guardians. Reduction of the transmission of infectious disease between children at schools could be an effective way of reducing the community incidence of infectious disease. Alcohol based no-rinse hand sanitisers provide an alternative hand cleaning technology, for which there is some evidence that they may be effective in achieving this. However, very few studies have investigated the effectiveness of hand sanitisers, and importantly, the potential wider economic implications of this intervention have not been established. Aims The primary objective of this trial is to establish if the provision of hand sanitisers in primary schools in the South Island of New Zealand, in addition to an education session on hand hygiene, reduces the incidence rate of absence episodes due to illness in children. In addition, the trial will establish the cost-effectiveness and conduct a cost-benefit analysis of the intervention in this setting. Methods/Design A cluster randomised controlled trial will be undertaken to establish the effectiveness and cost-effectiveness of hand sanitisers. Sixty-eight primary schools will be recruited from three regions in the South Island of New Zealand. The schools will be randomised, within region, to receive hand sanitisers and an education session on hand hygiene, or an education session on hand hygiene alone. Fifty pupils from each school in years 1 to 6 (generally aged from 5 to 11 years) will be randomly selected

  5. Registered Nurse (Associate Degree).

    ERIC Educational Resources Information Center

    Ohio State Univ., Columbus. Center on Education and Training for Employment.

    This document, which is designed for use in developing a tech prep competency profile for the occupation of registered nurse (with an associate degree), lists technical competencies and competency builders for 19 units pertinent to the health technologies cluster in general and 5 units specific to the occupation of registered nurse. The following…

  6. Registered Nurse (Associate Degree).

    ERIC Educational Resources Information Center

    Ohio State Univ., Columbus. Center on Education and Training for Employment.

    This document, which is designed for use in developing a tech prep competency profile for the occupation of registered nurse (with an associate degree), lists technical competencies and competency builders for 19 units pertinent to the health technologies cluster in general and 5 units specific to the occupation of registered nurse. The following…

  7. On Vocal Registers.

    ERIC Educational Resources Information Center

    Hollien, Harry

    A vocal register is a series or range of consecutive frequencies that can be produced with nearly identical voice quality. On the basis of research three fundamental registers can be defined and described: pulse, a low range of phonation; modal, a middle or "normal" range; and loft, a high range, described by some as falsetto. These…

  8. Duration of residence and psychotropic drug use in recently settled refugees in Sweden--a register-based study.

    PubMed

    Brendler-Lindqvist, Maria; Norredam, Marie; Hjern, Anders

    2014-12-20

    Recently settled refugee populations have consistently been reported to have high rates of mental health problems, particularly Post-traumatic stress disorder, depression, and anxiety disorders. The aim of this study was to investigate psychotropic drug use among young adult refugees according to duration of residence during the first 10 years in Sweden. Cross-sectional register study of a national cohort of 43 403 refugees and their families (23-35 years old) from Iraq, Iran, Eritrea, Ethiopia, Somalia and Afghanistan and a comparison population of 1.1 million Swedish-born residents. Logistic regression was used to assess the association between duration of residence in Sweden and the dispensing of at least one psychotropic medication during 2009 in four categories (any drug, neuroleptics, antidepressants and anxiolytics/hypnotics), adjusting for age, gender and domicile. Rates of dispensed psychotropic drugs among recently settled refugees were low, compared to the Swedish-born, with an increase with duration of residence. For refugee men and women from Iraq/Iran who had resided for 0-3 years the adjusted ORs compared to Swedish natives, were 0.83 (95% CI 0.77-0.90) and 0.48 (0.44-0.53) respectively; for men and women from the Horn of Africa the ORs were 0.50 (0.42-0.61) and 0.36 (0.30-0.41) respectively. After 7-10 years of residence, the ORs in these refugee groups approached the Swedish comparison population. Refugees from Afghanistan presented ORs similar to the Swedish-born, with no consistent trend by duration of residence. Women from the Horn of Africa and Iraq/Iran consumed less psychotropic drugs compared with men from these regions of origin, relative to the Swedish-born (p < 0.01). The ORs for dispensed neuroleptics were similar between the different refugee study groups, while the ORs for dispensed antidepressants differed fourfold between the group with the lowest (Horn of Africa) and the highest (Afghanistan). The rates of dispensed psychotropic

  9. Health Care Professionals' Evidence-Based Medicine Internet Searches Closely Mimic the Known Seasonal Variation of Lyme Borreliosis: A Register-Based Study.

    PubMed

    Pesälä, Samuli; Virtanen, Mikko J; Sane, Jussi; Jousimaa, Jukkapekka; Lyytikäinen, Outi; Murtopuro, Satu; Mustonen, Pekka; Kaila, Minna; Helve, Otto

    2017-04-11

    Both health care professionals and nonprofessionals seek medical information on the Internet. Using Web-based search engine searches to detect epidemic diseases has, however, been problematic. Physician's databases (PD) is a chargeable evidence-based medicine (EBM) portal on the Internet for health care professionals and is available throughout the entire health care system in Finland. Lyme borreliosis (LB), a well-defined disease model, shows temporal and regional variation in Finland. Little data exist on health care professionals' searches from Internet-based EBM databases in public health surveillance. The aim of this study was to assess whether health care professionals' use of Internet EBM databases could describe seasonal increases of the disease and supplement routine public health surveillance. Two registers, PD and the register of primary health care diagnoses (Avohilmo), were used to compare health care professionals' Internet searches on LB from EBM databases and national register-based LB diagnoses in order to evaluate annual and regional variations of LB in the whole country and in three selected high-incidence LB regions in Finland during 2011-2015. Both registers, PD and Avohilmo, show visually similar patterns in annual and regional variation of LB in Finland and in the three high-incidence LB regions during 2011-2015. Health care professionals' Internet searches from EBM databases coincide with national register diagnoses of LB. PD searches showed a clear seasonal variation. In addition, notable regional differences were present in both registers. However, physicians' Internet medical searches should be considered as a supplementary source of information for disease surveillance.

  10. Practice Leadership at the Front Line in Supporting People with Intellectual Disabilities and Challenging Behaviour: A Qualitative Study of Registered Managers of Community-Based, Staffed Group Homes

    ERIC Educational Resources Information Center

    Deveau, Roy; McGill, Peter

    2016-01-01

    Background: The front-line management role in services for people with intellectual disabilities remains rather under-researched. The aim of this study was to examine the experiences of registered managers in services for adults with intellectual disability who exhibit challenging behaviour. Method: Interviews, primarily focussed upon staff…

  11. Sick Leave and Work Participation among Parents of Children with Autism Spectrum Disorder in the Stockholm Youth Cohort: A Register Linkage Study in Stockholm, Sweden

    ERIC Educational Resources Information Center

    McEvilly, Miranda; Wicks, Susanne; Dalman, Christina

    2015-01-01

    This population-based register study explored the association between having a child with/without autism spectrum disorder (ASD) and parental sick leave and work participation. Parents of children with ASD living in Stockholm, Sweden in 2006 were more likely to be on sick leave, not in the labor force, or earning low income when compared to…

  12. Sick Leave and Work Participation among Parents of Children with Autism Spectrum Disorder in the Stockholm Youth Cohort: A Register Linkage Study in Stockholm, Sweden

    ERIC Educational Resources Information Center

    McEvilly, Miranda; Wicks, Susanne; Dalman, Christina

    2015-01-01

    This population-based register study explored the association between having a child with/without autism spectrum disorder (ASD) and parental sick leave and work participation. Parents of children with ASD living in Stockholm, Sweden in 2006 were more likely to be on sick leave, not in the labor force, or earning low income when compared to…

  13. Practice Leadership at the Front Line in Supporting People with Intellectual Disabilities and Challenging Behaviour: A Qualitative Study of Registered Managers of Community-Based, Staffed Group Homes

    ERIC Educational Resources Information Center

    Deveau, Roy; McGill, Peter

    2016-01-01

    Background: The front-line management role in services for people with intellectual disabilities remains rather under-researched. The aim of this study was to examine the experiences of registered managers in services for adults with intellectual disability who exhibit challenging behaviour. Method: Interviews, primarily focussed upon staff…

  14. External validation of two prediction models identifying employees at risk of high sickness absence: cohort study with 1-year follow-up

    PubMed Central

    2013-01-01

    Background Two models including age, self-rated health (SRH) and prior sickness absence (SA) were found to predict high SA in health care workers. The present study externally validated these prediction models in a population of office workers and investigated the effect of adding gender as a predictor. Methods SRH was assessed at baseline in a convenience sample of office workers. Age, gender and prior SA were retrieved from an occupational health service register. Two pre-defined prediction models were externally validated: a model identifying employees with high (i.e. ≥30) SA days and a model identifying employees with high (i.e. ≥3) SA episodes during 1-year follow-up. Calibration was investigated by plotting the predicted and observed probabilities and calculating the calibration slope. Discrimination was examined by receiver operating characteristic (ROC) analysis and the area under the ROC-curve (AUC). Results A total of 593 office workers had complete data and were eligible for analysis. Although the SA days model showed acceptable calibration (slope = 0.89), it poorly discriminated office workers with high SA days from those without high SA days (AUC = 0.65; 95% CI 0.58–0.71). The SA episodes model showed acceptable discrimination (AUC = 0.76, 95% CI 0.70–0.82) and calibration (slope = 0.96). The prognostic performance of the prediction models did not improve in the population of office workers after adding gender. Conclusion The SA episodes model accurately predicted the risk of high SA episodes in office workers, but needs further multisite validation and requires a simpler presentation format before it can be used to select high-risk employees for interventions to prevent or reduce SA. PMID:23379546

  15. External validation of two prediction models identifying employees at risk of high sickness absence: cohort study with 1-year follow-up.

    PubMed

    Roelen, Corné A M; Bültmann, Ute; van Rhenen, Willem; van der Klink, Jac J L; Twisk, Jos W R; Heymans, Martijn W

    2013-02-05

    Two models including age, self-rated health (SRH) and prior sickness absence (SA) were found to predict high SA in health care workers. The present study externally validated these prediction models in a population of office workers and investigated the effect of adding gender as a predictor. SRH was assessed at baseline in a convenience sample of office workers. Age, gender and prior SA were retrieved from an occupational health service register. Two pre-defined prediction models were externally validated: a model identifying employees with high (i.e. ≥30) SA days and a model identifying employees with high (i.e. ≥3) SA episodes during 1-year follow-up. Calibration was investigated by plotting the predicted and observed probabilities and calculating the calibration slope. Discrimination was examined by receiver operating characteristic (ROC) analysis and the area under the ROC-curve (AUC). A total of 593 office workers had complete data and were eligible for analysis. Although the SA days model showed acceptable calibration (slope = 0.89), it poorly discriminated office workers with high SA days from those without high SA days (AUC = 0.65; 95% CI 0.58-0.71). The SA episodes model showed acceptable discrimination (AUC = 0.76, 95% CI 0.70-0.82) and calibration (slope = 0.96). The prognostic performance of the prediction models did not improve in the population of office workers after adding gender. The SA episodes model accurately predicted the risk of high SA episodes in office workers, but needs further multisite validation and requires a simpler presentation format before it can be used to select high-risk employees for interventions to prevent or reduce SA.

  16. NMR studies of interactions between Bax and BH3 domain-containing peptides in the absence and presence of CHAPS.

    PubMed

    Yao, Shenggen; Westphal, Dana; Babon, Jeffrey J; Thompson, Geoff V; Robin, Adeline Y; Adams, Jerry M; Colman, Peter M; Czabotar, Peter E

    2014-03-01

    Activation and oligomerisation of Bax, a key pro-apoptotic Bcl-2 family protein, are key steps in the mitochondrial pathway to apoptosis. The signals for apoptosis are conveyed by the distantly related BH3-only proteins, which use their short BH3 domain, an amphipathic α-helix, to interact with other Bcl-2 family members. Here we report an NMR study of interactions between BaxΔC and BH3 domain-containing peptides in the absence and presence of CHAPS, a zwitterionic detergent. We find for the first time that CHAPS interacts weakly with BaxΔC (fast exchange on the NMR chemical shift timescale), at concentrations below micelle formation and with an estimated Kd in the tens of mM. Direct and relatively strong-interactions (slow exchange on the NMR chemical shift timescale) were also observed for BaxΔC with BaxBH3 (estimated Kd of circa 150μM) or BimBH3 in the absence of CHAPS. The interaction with either peptide alone induced widespread chemical shift perturbations to BaxΔC in solution which implies that BaxΔC might have undergone significant conformation change upon binding the BH3 peptide. However, BaxΔC remained monomeric upon binding either CHAPS or a BH3 peptide alone, but the presence of both provoked it to form a dimer.

  17. Implementing a nationwide criteria-based emergency medical dispatch system: A register-based follow-up study

    PubMed Central

    2013-01-01

    Background A criteria-based nationwide Emergency Medical Dispatch (EMD) system was recently implemented in Denmark. We described the system and studied its ability to triage patients according to the severity of their condition by analysing hospital admission and case-fatality risks. Methods This was a register-based follow-up study of all 1-1-2 calls in a 6-month period that were triaged according to the Danish Index – the new criteria-based dispatch protocol. Danish Index data were linked with hospital and vital status data from national registries. Confidence intervals (95%) for proportions with binomial data were computed using exact methods. To test for trend the Wald test was used. Results Information on level of emergency according to the Danish Index rating was available for 67,135 patients who received ambulance service. Emergency level A (urgent cases) accounted for 51.4% (n = 34,489) of patients, emergency level B for 46.3% (n = 31,116), emergency level C for 2.1% (n = 1,391) and emergency level D for 0.2% (n = 139). For emergency level A, the median time from call receipt to a