A 10-year population-based study of people with multiple sclerosis in Stockholm, Sweden: use of and satisfaction with care and the value of different factors in predicting use of care.
The national strategy for treatment of chronic diseases - including MS - and changes in the Swedish welfare system, call for analyses of the use of, and patient satisfaction with, care in a long-term perspective. The aim was therefore to explore the use of care and the predictive value of personal factors, disease-specific factors and functioning on the use of care and to explore patient satisfaction with care in a 10-year perspective.
Information regarding personal factors, disease-specific factors, functioning and satisfaction with care was collected by home-visits; use of care was collected from the Stockholm County Council computerised register.
Data from 121 people with MS (PwMS) was collected. Primary care accounted for the majority of all care. Neurology and Rehabilitation Departments together accounted for two-thirds of all hospital outpatient care. Rehabilitation Departments accounted for one-third of the total number of inpatient days. Lower coping capacity, impaired manual dexterity and activity of daily living dependency at baseline, together with progress in MS disability predicted a higher use of care. Overall, patient satisfaction with care was stable over time.
The extensive use of care offers challenges to care coordination. Implementation of person-centred care could be a strategy to increase efficacy/outcome of care.
This report describes a 12-month fever surveillance survey in a 258-bed veterans long-term care institution. There were 128 episodes of fever (one episode per 24 patient-months); 114 were studied. Lower respiratory tract infections were most frequent, 36 (32%), with 26 (23%) urinary tract infections. Streptococcus pneumoniae was the most common pathogen in the chest infections and Proteus mirabilis the most common of the urinary tract infections. In 40 (35%) there was no evidence of a lower respiratory tract, urinary tract, or other bacterial infection. Most recovered rapidly, many with no specific treatment. There was a 16% mortality associated with the febrile episodes.
Between November 1 and 22, 1985, an outbreak of acute, nonbacterial gastroenteritis occurred in a 600-bed hospital in Toronto, Ontario, Canada. Illness in 635 of 2,379 (27%) staff was characterized by fatigue, nausea, diarrhea, and vomiting and had a median duration of 24-48 hours. The finding of virus-like particles measuring 25-30 nm in six stool specimens and low rates of seroresponse to Norwalk virus (3/39) and Snow Mountain agent (1/6) suggest that a Norwalk-like virus was responsible for the outbreak. The outbreak was of abrupt onset and high incidence, affecting 79 people in a single day. No common food or water exposure could be identified. The attack rate was greatest (69%) for staff who had worked in the Emergency Room. Of 100 patients and their companions who visited the Emergency Room on November 11-12 for unrelated problems, 33 (33%) developed gastroenteritis 24-48 hours after their visit, versus 0 of 18 who visited the Emergency Room on November 8 (p less than 0.001). An analysis of housekeepers who worked at least once during the period from November 9-13, which included those who became ill during the period of November 9-14, showed that the risk of becoming ill was four times greater for those who visited or walked through the Emergency Room than for those who did not (p = 0.028). These data are consistent with the possibility of the airborne spread of a virus.
Abacavir and risk of myocardial infarction in HIV-infected patients on highly active antiretroviral therapy: a population-based nationwide cohort study.
OBJECTIVE: The aim of the study was to examine whether exposure to abacavir increases the risk for myocardial infarction (MI). DESIGN, SETTING AND SUBJECTS: This was a prospective nationwide cohort study which included all Danish HIV-infected patients on highly active antiretroviral therapy (HAART) from 1995 to 2005 (N = 2952). Data on hospitalization for MI and comorbidity were obtained from Danish medical databases. Hospitalization rates for MI after HAART initiation were calculated for patients who used abacavir and those who did not. We used Cox's regression to compute incidence rate ratios (IRR) as a measure of relative risk for MI, while controlling for potential confounders (as separate variables and via propensity score) including comorbidity. MAIN OUTCOME: Relative risk of hospitalization with MI in abacavir users compared with abacavir nonusers. RESULTS: Hospitalization rates for MI were 2.4/1000 person-years (PYR) [95% confidence interval (CI) 1.7-3.4] for abacavir nonusers and 5.7/1000 PYR (95% CI 4.1-7.9) for abacavir users. The risk of MI increased after initiation of abacavir [unadjusted IRR = 2.22 (95% CI 1.31-3.76); IRR adjusted for confounders = 2.00 (95% CI 1.10-3.64); IRR adjusted for propensity score = 2.00 (95% CI 1.07-3.76)]. This effect was also observed among patients initiating abacavir within 2 years after the start of HAART and among patients who started abacavir as part of a triple nucleoside reverse transcriptase inhibitor (NRTI) regimen. CONCLUSIONS: We confirmed the association between abacavir use and increased risk of MI. Further studies are needed to control for potential confounding not measured in research to date.
The weekly changes in ambient sulfur dioxide, nitrogen dioxide, and temperature were compared with the figures for respiratory infection in children and adults and for absenteeism from day-care centers (DCC), schools, and workplaces during a 1-year period in Helsinki. The annual average level of sulfur dioxide was 21 micrograms/m3 and of nitrogen dioxide 47 micrograms/m3; the average temperature was +3.1 degrees C. The levels of these pollutants and the temperature were significantly correlated with the number of upper respiratory infections reported from health centers. Low temperature also correlated with increased frequency of acute tonsillitis, of lower respiratory tract infection among DCC children, and of absenteeism from day-care centers, schools and workplaces. Furthermore, a significant association was found between levels of sulfur dioxide and absenteeism. After statistical standardization for temperature, no other correlations were observed apart from that between high levels of sulfur dioxide and numbers of upper respiratory tract infections diagnosed at health centers (P = 0.04). When the concentrations of sulfur dioxide were above the mean, the frequency of the upper respiratory tract infections was 15% higher than that during the periods of low concentration. The relative importance of the effects of low-level air pollution and low temperature on health is difficult to assess.
[Absenteeism as a predictor of severe morbidity. A double case-control study (myocardial infarction and industrial accident) in a large company of the Quebec Province].
Are absenteeism indicators usefull as predictor of serious morbidity in a working population? To seek an answer was the objective of a double case-control study carried out in a large company (17000 workers) of Quebec Province. In the first study, 64 cases of myocardial infarction (incidence density = 1.66% +/- 0.35) were compared with 64 controls matched for sex, age and type of work. In the second one, 142 cases of labor accident were compared with 142 controls sampled in a similar way. Absenteeism frequency and length were analysed during the period of 6 to 12 years prior to the onset of the health problem. Ratios were calculated on an individual basis for all causes of absence and for sick leave; they were adjusted for length of service. A four classes interval scale was used for the comparison. An excess of absence length exists in the two studies. The excess is not significant for the myocardial infarction cases (+ 33%, with a statistical power = 51%). It is significant for the labor accident cases (+ 52%, p less than 0.01). The corresponding odds ratio calculated in reference to the lowest absence group were 2.4 (0.9-6.6) and 2.7 (1.5-4.9). The cumulative absence length can be considered as a predictor of serious disease. A conceptual framework of the relationship between absence and natural disease history is presented. The epidemiological approach to the phenomenon of absence is certainly usefull in spite of the controversy underlined by the social sciences.
A prospective follow-up study of school accidents occurring to 21 712 city pupils and to 1584 rural pupils aged 7-18 years during the school year 1977-78 was carried out. The facilities of the pupils to be referred to the school policlinics were practically as good to all pupils. The incidence of accidents was in Turku 363 per 1000 pupils aged 7-12 years and 233 per 1000 pupils aged 13-18 years. Minor injuries were in 84.2% of cases located in the extremities. In the great majority, they were slight sprains and strains (46.9%) or cutaneous lacerations and bruises (40.0%). More severe injuries were found in 4.9% among the Turku pupils and in 2.1% of those in Lieto. The accidents met by boys was almost double that found for girls. Individual exercise and sports turned out to involve approximately the same degree of risk as team sports. The site of injury was most commonly either the upper extremity (38%), lower extremity (28%), the head (22%) or the eyes (4%), the remaining 8% of injuries having been to the trunk. More than two thirds of the cases could be treated in two or three visits to nurse or doctor, the treatment period being two to seven days in the majority of cases. No delayed effects such as postconcussive headache or other psychosomatic symptoms occurred during the follow-up period of three years.
