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1.
Background
The River Göta Älv is a source of fresh-water for the City of Gothenburg (Sweden). We recently identified a clear association between upstream precipitation and indicator bacteria concentrations in the river water outside the intake to the drinking water utility. This study aimed to determine if variation in the incidence of acute gastrointestinal illnesses is associated with upstream precipitation.Methods
We acquired data, covering 1494 days, on the daily number of telephone calls to the nurse advice line from citizens in Gothenburg living in areas with Göta Älv as a fresh-water supply. We separated calls relating to gastrointestinal illnesses from other medical concerns, and analyzed their association with precipitation using a distributed lag non-linear Poisson regression model, adjusting for seasonal patterns and covariates. We used a 0–21-day lag period for precipitation to account for drinking water delivery times and incubation periods of waterborne pathogens.Results
The study period contained 25,659 nurse advice calls relating to gastrointestinal illnesses. Heavy rainfall was associated with increased calls the same day and around 5–6 days later. Consecutive days of wet weather were also found to be associated with an increase in the daily number of gastrointestinal concerns. No associations were identified between precipitation and nurse advice calls relating to other medical concerns.Conclusion
An increase in nurse advice calls relating to gastrointestinal illnesses around 5–6 days after heavy rainfall is consistent with a hypothesis that the cause could be related to drinking water due to insufficient barriers in the drinking water production, suggesting the need for improved drinking water treatment. 相似文献2.
Introduction
Recent studies suggest that heat is associated with an increase in the number of ambulance calls and emergency department visits. We investigated the association between heat and daily number of emergency department visits at the University Hospital of Verona during the warm seasons 2011–2012 and we assessed the magnitude of the impact in terms of attributable events, focusing on the role of age and triage codification.Materials and methods
We used a Poisson model to analyse the association between daily number of visits and daily mean apparent temperature, accounting for air pollution level and seasonality. The analyses were stratified by age group and were performed both on the total number of emergency department visits and on the subsample of high-priority visits. Impact estimates were obtained only for this subsample, using a Monte Carlo approach to account for sampling variability. Number of attributable events and attributable community rate were calculated.Results
We found a positive and immediate association between event occurrence and mean apparent temperatures exceeding a threshold located around 28–29°C. The estimated percent change in the total number of visits per 1°C increase of exposure above the threshold was equal to 3.75 (90% CI: 3.01; 4.49). Focusing only on high-priority visits, the estimated percent change was larger and the greatest effect was among children. We estimated that apparent temperatures above the threshold were responsible for 1177 high-priority visits during the study period. Due to the record high temperatures observed in 2012 in Italy and in Europe, the impact in 2012 was much larger than in 2011, and consisted in 34 high-priority visits every 10000 children, 30 every 10000 people aged 15–64, and 38 every 10000 people aged 65 and over.Discussion
Our results indicate that heat affects not only the elderly, but also children and non-elderly adults, stressing the need for developing public health preparedness plans for the entire community. 相似文献3.
Fei-Yuan Hsiao Li-Ning Peng Yu-Wen Wen Chih-Kuang Liang Pei-Ning Wang Liang-Kung Chen 《PloS one》2015,10(5)
Objective
To explore the healthcare resource utilization, psychotropic drug use and mortality of older people with dementia.Design
A nationwide propensity score-matched cohort study.Setting
National Health Insurance Research database.Participants
A total of 32,649 elderly people with dementia and their propensity-score matched controls (n=32,649).Measurements
Outpatient visits, inpatient care, psychotropic drug use, in-hospital mortality and all-cause mortality at 90 and 365 days.Results
Compared to the non-dementia group, a higher proportion of patients with dementia used inpatient services (1 year after index date: 20.91% vs. 9.55%), and the dementia group had more outpatient visits (median [standard deviation]: 7.00 [8.87] vs. 3.00 [8.30]). Furthermore, dementia cases with acute admission had the highest psychotropic drug utilization both at baseline and at the post-index dates (difference-in-differences: all <0.001). Dementia was associated with an increased risk of all-cause mortality (90 days, Odds ratio (OR)=1.85 [95%CI 1.67-2.05], p<0.001; 365 days, OR=1.59 [1.50-1.69], p<0.001) and in-hospital mortality (90 days, OR=1.97 [1.71-2.27], p<0.001; 365 days, OR=1.82 [1.61-2.05], p<0.001) compared to matched controls.Conclusions
When older people with dementia are admitted for acute illnesses, they may increase their use of psychotropic agents and their risk of death, particularly in-hospital mortality. 相似文献4.
Importance
Hypertension is common and costly. Over the past decade, new antihypertensive therapies have been developed, several have lost patent protection and additional evidence regarding the safety and effectiveness of these agents has accrued.Objective
To examine trends in the use of antihypertensive therapies in the United States between 1997 and 2012.Design, Setting and Participants
We used nationally representative audit data from the IMS Health National Disease and Therapeutic Index to examine the ambulatory pharmacologic treatment of hypertension.Outcome Measures
Our primary unit of analysis was a visit where hypertension was a reported diagnosis and treated with a pharmacotherapy (treatment visit). We restricted analyses to the use of six therapeutic classes of antihypertensive medications among individuals 18 years or older.Results
Annual hypertension treatment visits increased from 56.9 million treatment visits (95% confidence intervals [CI], 53.9–59.8) in 1997 to 83.3 million visits (CI 79.2–87.3) in 2008, then declined steadily to 70.9 million visits (CI 66.7–75.0) by 2012. Angiotensin receptor blocker utilization increased substantially from 3% of treatment visits in 1997 to 18% by 2012, whereas calcium channel blocker use decreased from 27% to 18% of visits. Rates of diuretic and beta-blocker use remained stable and represented 24%–30% and 14–16% of visits, respectively. Use of direct renin inhibitor accounted for fewer than 2% of annual visits. The proportion of visits treated using fixed-dose combination therapies increased from 28% to 37% of visits.Conclusions
Several important changes have occurred in the landscape of antihypertensive treatment in the United States during the past decade. Despite their novel mechanism of action, the adoption rate of direct renin inhibitors remains low. 相似文献5.
Shinsuke Inoue Fumio Kobayashi Makoto Nishihara Young-Chang P. Arai Tatsunori Ikemoto Takashi Kawai Masayuki Inoue Tomomi Hasegawa Takahiro Ushida 《PloS one》2015,10(6)
Background
Chronic pain is recognized as a public health problem that affects the general population physically, psychologically, and socially. However, there is little knowledge about the associated factors of chronic pain, such as the influence of weather, family structure, daily exercise, and work status.Objectives
This survey had three aims: 1) to estimate the prevalence of chronic pain in Japan, 2) to analyze these associated factors, and 3) to evaluate the social burden due to chronic pain.Methods
We conducted a cross-sectional postal survey in a sample of 6000 adults aged ≥20 years. The response rate was 43.8%.Results
The mean age of the respondents was 57.7 years (range 20–99 years); 39.3% met the criteria for chronic pain (lasting ≥3 months). Approximately a quarter of the respondents reported that their chronic pain was adversely influenced by bad weather and also oncoming bad weather. Risk factors for chronic pain, as determined by a logistic regression model, included being an older female, being unemployed, living alone, and no daily exercise. Individuals with chronic pain showed significantly lower quality of life and significantly higher psychological distress scores than those without chronic pain. The mean annual duration of absence from work of working-age respondents was 9.6 days (range 1–365 days).Conclusions
Our findings revealed that high prevalence and severity of chronic pain, associated factors, and significant impact on quality of life in the adult Japanese population. A detailed understanding of factors associated with chronic pain is essential for establishing a management strategy for primary care. 相似文献6.
Background
The river Göta Älv is a source of freshwater for 0.7 million swedes. The river is subject to contamination from sewer systems discharge and runoff from agricultural lands. Climate models projects an increase in precipitation and heavy rainfall in this region. This study aimed to determine how daily rainfall causes variation in indicators of pathogen loads, to increase knowledge of variations in river water quality and discuss implications for risk management.Methods
Data covering 7 years of daily monitoring of river water turbidity and concentrations of E. coli, Clostridium and coliforms were obtained, and their short-term variations in relation with precipitation were analyzed with time series regression and non-linear distributed lag models. We studied how precipitation effects varied with season and compared different weather stations for predictive ability.Results
Generally, the lowest raw water quality occurs 2 days after rainfall, with poor raw water quality continuing for several more days. A rainfall event of >15 mm/24-h (local 95 percentile) was associated with a three-fold higher concentration of E. coli and 30% higher turbidity levels (lag 2). Rainfall was associated with exponential increases in concentrations of indicator bacteria while the effect on turbidity attenuated with very heavy rainfall. Clear associations were also observed between consecutive days of wet weather and decreased water quality. The precipitation effect on increased levels of indicator bacteria was significant in all seasons.Conclusions
Rainfall elevates microbial risks year-round in this river and freshwater source and acts as the main driver of varying water quality. Heavy rainfall appears to be a better predictor of fecal pollution than water turbidity. An increase of wet weather and extreme events with climate change will lower river water quality even more, indicating greater challenges for drinking water producers, and suggesting better control of sources of pollution. 相似文献7.
Christine Soong Bochra Kurabi David Wells Lesley Caines Matthew W. Morgan Rebecca Ramsden Chaim M. Bell 《PloS one》2014,9(11)
Importance
The transition from hospital to home can expose patients to adverse events during the post discharge period. Post discharge care including phone calls may provide support for patients returning home but the impact on care transitions is unknown.Objective
To examine the effect of a 72-hour post discharge phone call on the patient''s transition of care experience.Design
Cluster-randomized control trial.Setting
Urban, academic medical center.Participants
General medical patients age 18 and older discharged home after hospitalization.Main Outcomes and Measures
Primary outcome measure was the Care Transition Measure (CTM-3) score, a validated measure of the quality of care transitions. Secondary measures included self-reported adherence to medication and follow up plans, and 30-day composite of emergency department (ED) visits and hospital readmission.Results
328 patients were included in the study over an 6-month period. 114 (69%) received a post discharge phone call, and 214 of all patients in the study completed the follow outcome survey (65% response rate). A small difference in CTM-3 scores was observed between the intervention and control groups (1.87 points, 95% CI 0.47–3.27, p = 0.01). Self-reported adherence to treatment plans, ED visits, and emergency readmission rates were similar between the two groups (odds ratio 0.57, 95% CI 0.13–2.45, 1.20, 95% CI 0.61–2.37, and 1.18, 95% CI 0.53–2.61, respectively).Conclusions and Relevance
A single post discharge phone call had a small impact on the quality of care transitions and no effect on hospital utilization. Higher intensity post discharge support may be required to improve the patient experience upon returning home.Trial Registration
ClinicalTrials.gov NCT01580774 相似文献8.
Karen K. Wong Jianrong Shi Hongjiang Gao Yenlik A. Zheteyeva Kimberly Lane Daphne Copeland Jennifer Hendricks LaFrancis McMurray Kellye Sliger Jeanette J. Rainey Amra Uzicanin 《PloS one》2014,9(12)
Introduction
We describe characteristics of unplanned school closures (USCs) in the United States over two consecutive academic years during a non-pandemic period to provide context for implementation of school closures during a pandemic.Methods
From August 1, 2011 through June 30, 2013, daily systematic internet searches were conducted for publicly announced USCs lasting ≥1 day. The reason for closure and the closure dates were recorded. Information on school characteristics was obtained from the National Center for Education Statistics.Results
During the two-year study period, 20,723 USCs were identified affecting 27,066,426 students. Common causes of closure included weather (79%), natural disasters (14%), and problems with school buildings or utilities (4%). Only 771 (4%) USCs lasted ≥4 school days. Illness was the cause of 212 (1%) USCs; of these, 126 (59%) were related to respiratory illnesses and showed seasonal variation with peaks in February 2012 and January 2013.Conclusions
USCs are common events resulting in missed school days for millions of students. Illness causes few USCs compared with weather and natural disasters. Few communities have experience with prolonged closures for illness. 相似文献9.
Anne Pauly Carolin Wolf Andreas Mayr Bernd Lenz Johannes Kornhuber Kristina Friedland 《PloS one》2015,10(10)
Background
In psychiatry, hospital stays and transitions to the ambulatory sector are susceptible to major changes in drug therapy that lead to complex medication regimens and common non-adherence among psychiatric patients. A multi-dimensional and inter-sectoral intervention is hypothesized to improve the adherence of psychiatric patients to their pharmacotherapy.Methods
269 patients from a German university hospital were included in a prospective, open, clinical trial with consecutive control and intervention groups. Control patients (09/2012-03/2013) received usual care, whereas intervention patients (05/2013-12/2013) underwent a program to enhance adherence during their stay and up to three months after discharge. The program consisted of therapy simplification and individualized patient education (multi-dimensional component) during the stay and at discharge, as well as subsequent phone calls after discharge (inter-sectoral component). Adherence was measured by the “Medication Adherence Report Scale” (MARS) and the “Drug Attitude Inventory” (DAI).Results
The improvement in the MARS score between admission and three months after discharge was 1.33 points (95% CI: 0.73–1.93) higher in the intervention group compared to controls. In addition, the DAI score improved 1.93 points (95% CI: 1.15–2.72) more for intervention patients.Conclusion
These two findings indicate significantly higher medication adherence following the investigated multi-dimensional and inter-sectoral program.Trial Registration
German Clinical Trials Register DRKS00006358 相似文献10.
Lamberto Manzoli Maria Elena Flacco Maria Fiore Carlo La Vecchia Carolina Marzuillo Maria Rosaria Gualano Giorgio Liguori Giancarlo Cicolini Lorenzo Capasso Claudio D'Amario Stefania Boccia Roberta Siliquini Walter Ricciardi Paolo Villari 《PloS one》2015,10(6)
Objective
To evaluate the safety and efficacy as a tool of smoking cessation of electronic cigarettes (e-cigarettes), directly comparing users of e-cigarettes only, smokers of tobacco cigarettes only, and smokers of both.Design
Prospective cohort study. Final results are expected in 2019, but given the urgency of data to support policies on electronic smoking, we report the results of the 12-month follow-up.Data Sources
Direct contact and structured questionnaires by phone or via internet.Methods
Adults (30–75 years) were included if they were smokers of ≥1 tobacco cigarette/day (tobacco smokers), users of any type of e-cigarettes, inhaling ≥50 puffs weekly (e-smokers), or smokers of both tobacco and e-cigarettes (dual smokers). Carbon monoxide levels were tested in a sample of those declaring tobacco smoking abstinence.Main Outcome Measures
Sustained smoking abstinence from tobacco smoking at 12 months, reduction in the number of tobacco cigarettes smoked daily.Data Synthesis
We used linear and logistic regression, with region as cluster unit.Results
Follow-up data were available for 236 e-smokers, 491 tobacco smokers, and 232 dual smokers (overall response rate 70.8%). All e-smokers were tobacco ex-smokers. At 12 months, 61.9% of the e-smokers were still abstinent from tobacco smoking; 20.6% of the tobacco smokers and 22.0% of the dual smokers achieved tobacco abstinence. Adjusting for potential confounders, tobacco smoking abstinence or cessation remained significantly more likely among e-smokers (adjusted OR 5.19; 95% CI: 3.35–8.02), whereas adding e-cigarettes to tobacco smoking did not enhance the likelihood of quitting tobacco and did not reduce tobacco cigarette consumption. E-smokers showed a minimal but significantly higher increase in self-rated health than other smokers. Non significant differences were found in self-reported serious adverse events (eleven overall).Conclusions
Adding e-cigarettes to tobacco smoking did not facilitate smoking cessation or reduction. If e-cigarette safety will be confirmed, however, the use of e-cigarettes alone may facilitate quitters remaining so.Registration Number
NCT01785537. 相似文献11.
Michelle Helena van Velthoven Ye Li Wei Wang Li Chen Xiaozhen Du Qiong Wu Yanfeng Zhang Igor Rudan Josip Car 《PloS one》2015,10(3)
Introduction
To capitalise on mHealth, we need to understand the use of mobile phones both in daily life and for health care.Objective
To assess the prevalence and factors that influence usage of mobile phones by caregivers of young children.Materials and Methods
A mixed methods approach was used, whereby a survey (N=1854) and semi-structured interviews (N=17) were conducted concurrently. The quantitative and qualitative data obtained were compared and integrated. Participants were caregivers of young children in Zhao County, Hebei Province, China.Results
Four main themes were found: (i) trends in mobile phone ownership; (ii) usage of mobile phone functions; (iii) factors influencing replying to text messages; and (iv) uses of mobile phones for health care. The majority of 1,854 survey participants (1,620; 87.4%) used mobile phones, but usage was much higher among mothers (1,433; 92.6%) and fathers (41; 100.0%) compared to grandparents (142; 54.6%). Parents were able to send text messages, grandparents often not. Factors influencing the decision to reply to text messages in daily life were checking the mobile phone, trusting the sender, emotion or feeling when receiving a text message, the importance of replying and ease of use of text messages. Of 1,620 survey participants who used a mobile phone, about one in four (432; 26.7%) had used it for health care in the past three months and most (1,110; 93.5%) of 1,187 who had not wished to use their phone to receive health information.Conclusion
We found that usage of mobile phones is high, several factors influencing usage and an interest of caregivers to use phones for health care in Zhao County, rural China, which can be used to inform studies in settings with similar characteristics. Future work needs to assess factors influencing mobile phone usage in-depth to optimize experiences of users for specific mHealth-based interventions. 相似文献12.
Shoko Matsumoto Kazue Yamaoka Machiko Inoue Mariko Inoue Shinsuke Muto Teikyo Ishinomaki Research Group 《PloS one》2015,10(6)
Study Objectives
This study aimed to investigate the role of social factors, especially social support for sleep, among victims living at home around 1–2 years after the Great East Japan Earthquake and tsunami.Design
A cross-sectional household survey was conducted between May and December 2012 (14–21 months after the disaster) in the Ishinomaki area, Japan. Univariate and multivariate logistic regression models were used to examine the association between social factors, including social support, and prolonged sleep difficulties (persisting over 1 month). Social support was divided into three functions: emotional, informational, and instrumental support.Participants
Data were obtained on 2,593 individuals who were living at home after the disaster.Results
The prevalence of prolonged sleep difficulties was 6.9% (5.8% male, 7.7% female). This study showed that lack of social support has a stronger association with prolonged sleep difficulties than non-modifiable or hardly modifiable consequences caused directly by the disaster, i.e., severity of home damage, change in family structure and income. Among the three dimensions of social support, lack of emotional support showed the strongest association with prolonged sleep difficulties.Conclusions
Social support, especially emotional support, may positively affect sleep among victims living at home around 1–2 years after a disaster. 相似文献13.
Wei Chen Ya Fang Fanzhen Mao Shichao Hao Junze Chen Manqiong Yuan Yaofeng Han Y. Alicia Hong 《PloS one》2015,10(6)
Background
The unprecedented number of elderly individuals in China presents a serious public health challenge. Limited data are available on the prevalence of disability or factors resulting in disability among the elderly in China.Objective
We aimed to assess the prevalence of disability and related risk factors among the elderly of Xiamen, China.Methods
A cross-sectional study was performed on individuals who were ≥60 years of age. The subjects were recruited by multi-stage sampling; a total of 14,292 valid questionnaires were received. Study measurements included activities of daily living (ADL), demographics, and health status. The ADL was assessed by the Katz Index Scale to evaluate disability. Chi-square tests and binary logistic regression were used to identify factors associated with disabilities.Results
Among the valid participants, 4.27% had at least one disability. Bathing was the most frequently reported disability and feeding was the least frequently reported disability. Disabilities were significantly associated with female gender, older age, unmarried status, living with family, urban residence, illiteracy, poor economic status, self-rated bad health, chronic illnesses, lower life satisfaction, bad mood, and feelings of loneliness.Conclusion
Functional disability among the elderly requires more public attention. Culturally appropriate policies and programs are also needed to address the care for the disabled elderly. 相似文献14.
Sonia Gaucher Isabelle Boutron Florence Marchand-Maillet Gabriel Baron Richard Douard Jean-Pierre Béthoux AMBUPROG Group Investigators 《PloS one》2016,11(2)
Objectives
To assess the impact of a standardized pre-operative telephone checklist on the rate of late cancellations of ambulatory surgery (AMBUPROG trial).Design
Multicenter, two-arm, parallel-group, open-label randomized controlled trial.Setting
11 university hospital ambulatory surgery units in Paris, France.Participants
Patients scheduled for ambulatory surgery and able to be reached by telephone.Intervention
A 7-item checklist designed to prevent late cancellation, available in five languages and two versions (for children and adults), was administered between 7 and 3 days before the planned date of surgery, by an automated phone system or a research assistant. The control group received standard management alone.Main Outcome Measures
Rate of cancellation on the day of surgery or the day before.Results
The study population comprised 3900 patients enrolled between November 2012 and September 2013: 1950 patients were randomized to the checklist arm and 1950 patients to the control arm. The checklist was administered to 68.8% of patients in the intervention arm, 1002 by the automated phone system and 340 by a research assistant. The rate of late cancellation did not differ significantly between the checklist and control arms (109 (5.6%) vs. 113 (5.8%), adjusted odds ratio [95% confidence interval] = 0.91 [0.65–1.29], (p = 0.57)). Checklist administration revealed that 355 patients (28.0%) had not undergone tests ordered by the surgeon or anesthetist, and that 254 patients (20.0%) still had questions concerning the fasting state.Conclusions
A standardized pre-operative telephone checklist did not avoid late cancellations of ambulatory surgery but enabled us to identify several frequent causes.Trial Registration
ClinicalTrials.gov NCT01732159 相似文献15.
Objectives
It is crucial for policy makers to monitor the evolution of tobacco smoking prevalence. In France, this monitoring is based on a series of cross-sectional general population surveys, the Health Barometers, conducted every five years and based on random samples. A methodological study has been carried out to assess the reliability of a monitoring system based on regular quota sampling surveys for smoking prevalence.Design / Outcome Measures
In 2010, current and daily tobacco smoking prevalences obtained in a quota survey on 8,018 people were compared with those of the 2010 Health Barometer carried out on 27,653 people. Prevalences were assessed separately according to the telephone equipment of the interviewee (landline phone owner vs “mobile-only”), and logistic regressions were conducted in the pooled database to assess the impact of the telephone equipment and of the survey mode on the prevalences found. Finally, logistic regressions adjusted for sociodemographic characteristics were conducted in the random sample in order to determine the impact of the needed number of calls to interwiew “hard-to-reach” people on the prevalence found.Results
Current and daily prevalences were higher in the random sample (respectively 33.9% and 27.5% in 15-75 years-old) than in the quota sample (respectively 30.2% and 25.3%). In both surveys, current and daily prevalences were lower among landline phone owners (respectively 31.8% and 25.5% in the random sample and 28.9% and 24.0% in the quota survey). The required number of calls was slightly related to the smoking status after adjustment for sociodemographic characteristics.Conclusion
Random sampling appears to be more effective than quota sampling, mainly by making it possible to interview hard-to-reach populations. 相似文献16.
17.
Background and Objectives
Pre-dialysis care by a nephrology out-patient department (OPD) may affect the outcomes of patients who ultimately undergo maintenance dialysis. This study examined the effect of pre-dialysis care by a nephrology OPD on the incidence of one-year major cardiovascular events after initiation of dialysis.Design, Setting Participants, & Measurements
The study consisted of Taiwanese patients with chronic kidney disease (CKD) who commenced dialysis from 2006 to 2008. The number of nephrology OPD visits during the critical care period (within 6 months of initiation of dialysis) and the early care period (6–36 months before initiation of dialysis) were analyzed. The primary outcome measure was one-year major cardiovascular events.Results
A total of 1191 CKD patients who initiated dialysis from 2006 to 2008 were included. Binary logistic regression showed that patients with ≧3 visits during the critical care period and those with ≧11 visits during the early care period had fewer composite major cardiovascular events than those with 0 visits. Patients with early referral are less likely to experience composite major cardiovascular events than those with late referral, with aOR 0.574 (95% CI = 0.43–0.77, P<0.001). Patients with both ≧3 visits during critical care period and ≧11 visits during early care period were less likely to experience composite major cardiovascular events (aOR = 0.25, 95% CI = 0.16–0.39, P < 0.001).Conclusions
Patients with adequate pre-dialysis nephrology OPD visits, not just early referral, may had fewer one-year composite major cardiovascular events after initiation of dialysis. This information may be important to medical care providers and public health policy makers in their efforts to improve the well-being of CKD patients. 相似文献18.
Objectives
The 2013 World Health Organization Status Report on Road Safety estimated that approximately 1.24 million deaths occur annually due to road traffic crashes with most of the burden falling on low- and middle-income countries. The objective of this research is to study the prevalence of road traffic crashes in Mekelle, Tigray, Northern Ethiopia and to identify risk factors with the ultimate goal of informing prevention activities and policies.Methods
This study used a cross-sectional design to measure the prevalence and factors associated with road traffic crashes among 4-wheeled minibus (n = 130) and 3-wheeled Bajaj (n = 582) taxi drivers in Mekelle, Ethiopia. Bivariate and multivariate logistic regression were used to evaluate the association between risk factors and drivers’ involvement in a road traffic crash within the 3 years prior to the survey.Findings
Among the 712 taxi drivers, 26.4% (n = 188) of them reported involvement in a road traffic crash within the past 3 years. Drivers who listened to mass media had decreased likelihood of road traffic crash involvement (AOR = 0.51, 0.33–0.78), while speedy driving (AOR = 4.57, 3.05–7.44), receipt of a prior traffic punishment (AOR = 4.57, 2.67–7.85), and driving a mechanically faulty taxi (AOR = 4.91, 2.81–8.61) were strongly associated with road traffic crash involvement. Receiving mobile phone calls while driving (AOR = 1.91, 1.24–2.92) and history of alcohol use (AOR = 1.51, 1.00–2.28) were also associated with higher odds of road traffic crash involvement.Conclusion
The results of this study show that taxi drivers in Mekelle habitually place themselves at increased risk of road traffic crashes by violating traffic laws, especially related to speedy driving, mobile phone use, and taxi maintenance. This research can be used to support re-evaluation of the type, severity, and enforcement of traffic violation penalties. 相似文献19.
Steffie H. A. Brouns Patricia M. Stassen Suze L. E. Lambooij Jeanne Dieleman Irene T. P. Vanderfeesten Harm R. Haak 《PloS one》2015,10(8)
Study objective
To assess the association of patient and organisational factors with emergency department length of stay (ED-LOS) in elderly ED patients (226565 years old) and in younger patients (<65 years old).Methods
A retrospective cohort study of internal medicine patients visiting the emergency department between September 1st 2010 and August 31st 2011 was performed. All emergency department visits by internal medicine patients 226565 years old and a random sample of internal medicine patients <65 years old were included. Organisational factors were defined as non-medical factors. ED-LOS is defined as the time between ED arrival and ED discharge or admission. Prolonged ED-LOS is defined as ≥75th percentile of ED-LOS in the study population, which was 208 minutes.Results
Data on 1782 emergency department visits by elderly patients and 597 emergency department visits by younger patients were analysed. Prolonged ED-LOS in elderly patients was associated with three organisational factors: >1 consultation during the emergency department visit (odds ratio (OR) 3.2, 95% confidence interval (CI) 2.3–4.3), a higher number of diagnostic tests (OR 1.2, 95% CI 1.16–1.33) and evaluation by a medical student or non-trainee resident compared with a medical specialist (OR 4.2, 95% CI 2.0–8.8 and OR 2.3, 95% CI 1.4–3.9). In younger patients, prolonged ED-LOS was associated with >1 consultation (OR 2.6, 95% CI 1.4–4.6). Factors associated with shorter ED-LOS were arrival during nights or weekends as well as a high urgency level in elderly patients and self-referral in younger patients.Conclusion
Organisational factors, such as a higher number of consultations and tests in the emergency department and a lower seniority of the physician, were the main aspects associated with prolonged ED-LOS in elderly patients. Optimisation of the organisation and coordination of emergency care is important to accommodate the needs of the continuously growing number of elderly patients in a better way. 相似文献20.