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PubMed2002

Ultrasound guidance versus the landmark technique for the placement of central venous catheters in the emergency department.

OBJECTIVE: To compare ultrasound (US)-guided vs. landmark-guided techniques for central venous access (CVA) in the emergency department. METHODS: This was a prospective study of consecutive patients enrolled at a university teaching hospital with an annual census of approximately 100,000. On even days patients had CVA with ultrasonic assistance; patients presenting on odd days had CVA via traditional landmark techniques. Ultrasound users were emergency medicine faculty or residents who completed a one-hour training session. A data collection tool with 17 variables was completed for each central line placed. Variables were compared using the independent t-test, Fisher's exact test, and the non-parametric Mann-Whitney U test. RESULTS: Between August 1, 2000, and February 1, 2001, data for 122 subjects (n = 51 for US, and n = 71 for landmark) were collected. Variables with statistically significant differences are as follows. Mean (+/-SD) time from skin puncture to blood flash was 115 (+/-184) seconds for the US group vs. 512 (+/-698) seconds for the landmark group (p < 0.0001). The mean number of CVA attempts in the US group was 1.6 (+/-1.0) vs. 3.5 (+/-2.7) in the landmark group (p < 0.0001). Acute complications were comparable between groups. Comparisons for time, number of CVA attempts, and complications were done specifically for a subset of patients considered to be "difficult stick" due to predefined criteria regarding body habitus or vascular disease. Patients considered to be "difficult sticks" required a significantly longer amount of time (p < 0.001) for CVA via the landmark technique than patients considered to be "difficult sticks" who had CVA with ultrasonic guidance. Time to line placement for the landmark group was 462.7 (+/-627) seconds vs. 93.3 (+/-176) seconds in the US group. Comparing the same subset also revealed an increase in number of required CVA attempts for the landmark technique group. The number of acute complications in the "difficult stick" patients did not show statistical significance (p = 1.00). The landmark group had 60% "difficult sticks," while the ultrasound group had 80%, although the difference was not statistically significant (p = 0.08). CONCLUSIONS: Emergency physicians with limited training and experience are able to use ultrasound as an adjunct for central venous access. Ultrasound technology may decrease the number of CVA attempts required to cannulate a central vein and will decrease the amount of time required to cannulate the vein starting from the time when the needle is on the skin, after the ultrasound machine has been set up and turned on. These results are especially true for those patients considered to be "difficult sticks."

Adult↗
PubMed2005

The association between hyperkinesis and breakdown of parenting in clinic populations.

BACKGROUND: There is increasing recognition that child based, as well as parent based factors may be associated with children being excluded from their families. Despite the distress routinely observed among the parents of hyperactive children, there is little research on this in clinic populations. AIMS: To examine removals from home in a typical secondary care population, where hyperkinesis was accurately diagnosed. METHODS: A total of 201 cases were coded using mulitaxial ICD-10 criteria and Jarman indices derived from census data. RESULTS: Hyperkinetic children were more than three times more likely to have suffered removal from home than children with other psychiatric diagnoses, independent of any psychosocial measure. CONCLUSION: Hyperkinesis is a specific risk factor for removal from home, which can operate in the absence of other psychosocial stressors. Screening children for hyperactivity is now simple, and the routine paediatric examination for children accommodated by the local authority gives an opportunity for early detection and treatment of hyperactivity in children at risk of family breakdown.

Child↗
PubMed2001

The burden of musculoskeletal diseases in the general population of Spain: results from a national survey.

OBJECTIVE: The objective of the EPISER study was to estimate the prevalence of rheumatoid arthritis (RA), low back pain, hand and knee osteoarthritis (OA), and fibromyalgia in the adult Spanish population, and to assess the impact of these diseases on function and quality of life, and use of health and social resources. METHODS: 2998 subjects aged 20 years or above were randomly selected by stratified multistage cluster sampling from the censuses of 20 municipalities. Trained rheumatologists carried out structured visits at which subjects were asked about rheumatic symptoms and sociodemographic characteristics, completed validated instruments for measuring function (HAQ) and quality of life (SF-12), and underwent a standardised physical examination. Cases were defined by previously validated criteria. RESULTS: The estimated prevalences with 95% confidence intervals were as follows: RA lifetime cumulative: 0.5% (0.3 to 0.9); low back pain: 14.8% (12.2 to 17.4); symptomatic knee OA: 10.2% (8.5 to 11.9); hand OA: 6.2% (5.9 to 6.5); fibromyalgia: 2.4% (1.5 to 3.2). Most conditions significantly impaired function and quality of life. CONCLUSIONS: The EPISER study has internal and external validity for application of the results to the adult Spanish population. The diseases studied affect a significant proportion of the population, with various degrees of impact on disability and quality of life resulting in a significant number of physician visits, work disability, and medication use.

Adult↗
PubMed1988

Use and abuse of performance indicators.

An audit was performed by this department after allegations by the regional health authority of low productivity. It was found that the health authority had underestimated the number of operations performed in 1983 by only 5%, but an inexact classification and grading of operations had led to errors in the performance indicators of 19.8% for the "weighted number of operations" and 34.5% for the "number of major operations per consultant." When the throughput of orthopaedic departments in districts was compared by the regional health authority it was found that such errors in performance indicators had been further compounded by the inconsistent use of population data and incorrect data on medical staffing. Medical practitioners and the health authorities are alerted to this amplification of inaccurate data. Other methods for assessing trauma and orthopaedic surgery are proposed, such as a simplification of the Office of Population Censuses and Surveys classification of surgical operations, grading operations based on time spent in the operating theatre, and provision of computer programs to code for diagnosis and operation when writing discharge summaries.

Catchment Area, Health↗
PubMed1994

Allocating resources to health authorities: development of method for small area analysis of use of inpatient services.

Every year about 22 billion pounds is allocated to health authorities for hospital and community services in England. The distribution of most of these funds is based on a formula developed to reflect the population's needs, but the existing formula has been criticised on several grounds. This paper describes the development of a method to determine the health needs for small geographical areas. Data from the hospital episodes statistics and 1991 census together with information on vital statistics and supply of health care facilities were used in the model. Two stage least squares regression was used to identify true indicators of need, and these were entered into a multilevel model to take account of variations in practice in different health authorities. The resulting formula should be more statistically robust and more sensitive to needs than previous approaches.

Health Care Rationing↗
PubMed2002

Chronic pain in Canada--prevalence, treatment, impact and the role of opioid analgesia.

OBJECTIVE: To assess the prevalence, treatment and impact of chronic pain in Canada. METHODS: A stratified random sample of 2012 adult Canadians (weighted by sex, age and region according to 1996 census data) was surveyed by telephone in 2001 to determine the prevalence of chronic pain, defined as continuous or intermittent pain for at least six months. A second sample of 340 chronic pain sufferers who were taking prescription medication for their pain was studied in detail to determine current therapeutic approaches and to assess the social and economic impact of chronic pain. RESULTS: Chronic noncancer pain was reported by 29% of the respondents, with increased frequency in women and older age groups. The average duration of pain was 10.7 years and the average intensity was 6.3 (on a scale from 1 to 10), with 80% reporting moderate or severe pain. Anti-inflammatory agents were prescribed for 49% of respondents and opioid analgesics were prescribed for 22% (two-thirds of these were codeine). Almost 70% were worried about addiction potential, and one-third felt that strong analgesics should be reserved for terminal illnesses. Almost one-half were unable to attend social and family events, and the mean number of days absent from work in the past year due to chronic pain was 9.3. INTERPRETATION: Chronic noncancer pain is common in Canadian adults and has a major social and economic impact. Despite growing evidence supporting the efficacy and safety of major opioid analgesics for chronic noncancer pain, less than 10% of chronic pain patients taking prescription medication were treated with a major opioid. Chronic pain is undertreated in Canada, and major opioid analgesics are probably underutilized in the management of moderate to severe pain as part of a multidisciplinary treatment program.

Adolescent↗
PubMed2001

Access to health care for older persons in the United States: personal, structural, and neighborhood characteristics.

OBJECTIVE: To determine the contributions of personal, structural, and neighborhood characteristics to differential access to health care for older persons in the United States. METHODS: This study used the 1994 National Health Interview Survey, ages 65 and older (n = 12,341), 1990 census block group data, and data on health professional shortage areas. Logistic regression was used to model the probability of problems accessing care. RESULTS: The likelihood of access problems increased sharply with decreasing gradients of family income and for those lacking private health care insurance. Rural areas and poor areas were at a disadvantage in accessing care, whereas residents of neighborhoods that were homogeneous in ancestral heritage appeared better able to access care. DISCUSSION: Considering the high association between neighborhood and personal characteristics, it is notable that any neighborhood effects remained after combining them with personal effects.

Aged↗
PubMed2007

The effect of gender, age, and geographical location on the incidence and prevalence of renal replacement therapy in Wales.

BACKGROUND: This study used a cross sectional survey to examine the effect of gender, age, and geographical location on the population prevalence of renal replacement therapy (RRT) provision in Wales. METHODS: Physicians in renal centres in Wales and in adjacent areas of England were asked to undertake a census of patients on renal replacement therapy on 30 June 2004 using an agreed protocol. Data were collated and analysed in anonymous form. RESULTS: 2434 patients were on RRT in Wales at the census date. Median age of patients on RRT was 56 years, peritoneal dialysis 58 years, haemodialysis 66 years and transplantation 50 years. The three treatment modalities had significantly different age-specific peak prevalence rates and distributions. RRT age-specific prevalence rates peaked at around 70 years (1790 pmp), transplantation at around 60 years (924 pmp), haemodialysis at around 80 years (1080 pmp) and peritoneal dialysis did not have a clear peak prevalence rate. Age-specific incidence of RRT peaked at a rate of 488 pmp at 79 years, as did incidence rates for haemodialysis, which peaked at the same age. Age had less effect on the initiation of peritoneal dialysis, which had a broad plateau between the early fifties and late seventies. Kidney transplantation rates were highest in the early fifties but were markedly absent in old age. CONCLUSION: Differences in the provision of RRT are evident, particularly in the very elderly, where the gender difference for haemodialysis is particularly marked. The study illustrates that grouping patients over 75 years into a single age-band may mask significant diversity within this age group. Significant numbers of very elderly patients who are currently not receiving RRT may wish to receive RRT as the elderly population increases, and as technology improves survival and quality of life on RRT. The study suggests that if technologies that are more effective were developed, and which had a lower impact on quality of life, there might be up to a 17% increase in demand for RRT in those aged over 75 years; around 90% of this increased demand would be for haemodialysis.

Age Distribution↗
PubMed2006

Occupation, smoking, and chronic obstructive respiratory disorders: a cross sectional study in an industrial area of Catalonia, Spain.

BACKGROUND: Few studies have investigated the independent effects of occupational exposures and smoking on chronic bronchitis and airflow obstruction. We assessed the association between lifetime occupational exposures and airflow obstruction in a cross-sectional survey in an urban-industrial area of Catalonia, Spain. METHODS: We interviewed 576 subjects of both sexes aged 20-70 years (response rate 80%) randomly selected from census rolls, using the ATS questionnaire. Forced spirometry was performed by 497 subjects according to ATS normative. RESULTS: Lifetime occupational exposure to dust, gases or fumes was reported by 52% of the subjects (63% in men, 41% in women). Textile industry was the most frequently reported job in relation to these exposures (39%). Chronic cough, expectoration and wheeze were more prevalent in exposed subjects with odds ratios ranging from 1.7 to 2.0 being highest among never-smokers (2.1 to 4.3). Lung function differences between exposed and unexposed subjects were dependent on duration of exposure, but not on smoking habits. Subjects exposed more than 15 years to dusts, gases or fumes had lower lung function values (FEV1 -80 ml, 95% confidence interval (CI) -186 to 26; MMEF -163 ml, CI -397 to 71; FEV1/FVC ratio -1.7%, CI -3.3 to -0.2) than non-exposed. CONCLUSION: Chronic bronchitis symptoms and airflow obstruction are associated with occupational exposures in a population with a high employment in the textile industry. Lung function impairment was related to the duration of occupational exposure, being independent of the effect of smoking.

Adult↗
PubMed2002

Estimating the incidence of systemic lupus erythematosus in a tropical region (Natal, Brazil).

The objective of the study was to evaluate the incidence of Systemic Lupus Erythematosus (SLE) in a tropical urban community (Natal city, Brazil). Only patients living in Natal, a city in the northeastern area of Brazil, older than 15 years, and who fulfilled at least four of the American College of Rheumatology criteria between 1 January 2000 and 31 December 2000, were included. Four sources were used to identify new cases of SLE: (1) the University Hospital; (2) 'health units' and hospitals of the public health network; (3) specialists at private hospitals and outpatient clinics; and (4) three laboratories performing antinuclear antibody (ANA) determination. Census data from 2000 for Brazilian population was used to calculate incidence rate. The standardized mortality ratio (SMR) method and 95% confidence intervals (95% CI) were calculated. Forty-three patients were diagnosed as new SLE cases in 2000. The calculated incidence was 8.7/100,000/year (95% CI 6.3-11.7). Thirty-eight patients were female 14.1/100,000/year (95% CI 10.0-19.3) and five were male 2.2/100,000/year (95% CI 0.7-5.2). The mean age of new SLE cases was 31.8 years old. (95% CI 27.8-35.8). The mean age for females was 31.4 and for males was 35.0 years old. The median of disease duration (time between onset of the first ACR criterion for SLE and diagnosis) was 10 months (1-72 months). This study demonstrated a high incidence of SLE in Natal, apparently higher than reported in other places. The mean age at diagnosis seems lower than referred by other studies. The observed differences may be due to ethnic and/or environmental factors.

Adolescent↗
PubMed1998

Nithsdale schizophrenia surveys. 17. Fifteen year review.

BACKGROUND: In recent years there has been a shift to 'community care' and the introduction of several 'atypical' antipsychotic drugs. We report the impact of these changes. METHOD: In Nithsdale, Dumfries and Galloway, Scotland, the population of patients with schizophrenia was identified in 1996. This census replicated a study carried out in 1981. The population with schizophrenia were compared on clinical and social variables. The whereabouts in 1996 of the 1981 population was determined. RESULTS: In comparison with the 1981 population, more patients in 1996 had positive, negative and non-schizophrenic symptoms. More showed tardive dyskinesia. Social adjustment had not changed. They had spent less time in hospital; fewer (13%) were living with their parents; and fewer (8%) were employed. By 1996, 35% of the 1981 cohort had died (standardised mortality rate male-154; female-162). CONCLUSIONS: The mental health of a community of people with schizophrenia living in a rural area in 1996 was poorer than in 1981.

Adult↗
PubMed2006

Digital versus local anesthesia for finger lacerations: a randomized controlled trial.

OBJECTIVES: To compare the pain of needle insertion, anesthesia, and suturing in finger lacerations after local anesthesia with prior topical anesthesia with that experienced after digital anesthesia. METHODS: This was a randomized controlled trial in a university-based emergency department (ED), with an annual census of 75,000 patient visits. ED patients aged > or = 8 years with finger lacerations were enrolled. After standard wound preparation and 15-minute topical application of lidocaine-epinephrine-tetracaine (LET) in all wounds, lacerations were randomized to anesthesia with either local or digital infiltration of 1% lidocaine. Pain of needle insertion, anesthetic infiltration, and suturing were recorded on a validated 100-mm visual analog scale (VAS) from 0 (none) to 100 (worst); also recorded were percentage of wounds requiring rescue anesthesia; time until anesthesia; percentage of wounds with infection or numbness at day 7. Outcomes were compared by using Mann-Whitney U and chi-square tests. A sample of 52 patients had 80% power to detect a 15-mm difference in pain scores. RESULTS: Fifty-five patients were randomized to digital (n = 28) or local (n = 27) anesthesia. Mean age (+/-SD) was 38.1 (+/-16.8) years, 29% were female. Mean (+/-SD) laceration length and width were 1.7 (+/-0.7) cm and 2.0 (+/-1.0) mm, respectively. Groups were similar in baseline patient and wound characteristics. There were no between-group differences in pain of needle insertion (mean difference, 1.3 mm; 95% confidence interval [CI] = -17.0 to 14.3 mm); anesthetic infiltration (mean difference, 2.3 mm; 95% CI = -19.7 to 4.4 mm), or suturing (mean difference, 7.6 mm; 95% CI = -3.3 to 21.1 mm). Only one patient in the digital anesthesia group required rescue anesthesia. There were no wound infections or persistent numbness in either group. CONCLUSIONS: Digital and local anesthesia of finger lacerations with prior application of LET to all wounds results in similar pain of needle insertion, anesthetic infiltration, and pain of suturing.

Adolescent↗
PubMed1993

[Trends of mortality from cerebrovascular disease in the State of São Paulo: 1970 to 1989].

AIM: description of proportional mortality and death rates by Stroke in adult population (20 years of age or older) of São Paulo State, Brazil. METHODS: the deaths were obtained from the statistical official bureau; the population data were based in the Federal Census (1970, 1980 and 1991); all trends whose the slope was significantly greater than zero had a calculation of the decline per year. RESULTS: proportional mortality for Stroke decreased for males (M) (-11.40%) and increased for females (F) (+7.58%); Stroke in all cardiovascular diseases showed increase in both sexes, +8.65% (M) and +3.12% (F); Stroke age-adjusted death rates declined 1.19% (M) per year and 1.76% (F) per year between 1970 and 1989; the ages whose decline was more important were those 60-years-old of age or older (M) and 40-years-old or older (F); the male/female sex ratio increased during the observed years (22% in 1970 to 45%) due to the change in the 50-59 age strata (36% in 1970 to 69% in 1989). CONCLUSION: the fall of the Stroke deaths rates could be due to increase in the detection and control of hypertension; other factors such as improve in death certification, decline of Chagasic myocarditis, new image-diagnostic tests and medical care had maybe only a secondary play in the decline of stroke mortality.

Adult↗
PubMed2005

Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002.

BACKGROUND: The purpose of this study was to quantify the procedural rate and revision burden of total hip and knee arthroplasty in the United States and to determine if the age or gender-based procedural rates and overall revision burden are changing over time. METHODS: The National Hospital Discharge Survey (NHDS) for 1990 through 2002 was used in conjunction with United States Census data to quantify the rates of primary and revision arthroplasty as a function of age and gender within the United States with use of methodology published by the American Academy of Orthopaedic Surgeons. Poisson regression analysis was used to evaluate the procedural rate and to determine year-to-year trends in primary and revision arthroplasty rates as a function of both age and gender. RESULTS: Both the number and the rate of total hip and knee arthroplasties (particularly knee arthroplasties) increased steadily between 1990 and 2002. Over the thirteen years, the rate of primary total hip arthroplasties per 100,000 persons increased by approximately 50%, whereas the corresponding rate of primary total knee arthroplasties almost tripled. The rate of revision total hip arthroplasties increased by 3.7 procedures per 100,000 persons per decade, and that of revision total knee arthroplasties, by 5.4 procedures per 100,000 persons per decade. However, the mean revision burden of 17.5% for total hip arthroplasty was more than twice that for total knee arthroplasty (8.2%), and this did not change substantially over time. CONCLUSIONS: The number and prevalence of primary hip and knee replacements increased substantially in the United States between 1990 and 2002, but the trend was considerably more pronounced for primary total knee arthroplasty. CLINICAL RELEVANCE: The reported prevalence trends have important ramifications with regard to the number of joint replacements expected to be performed by orthopaedic surgeons in the future. Because the revision burden has been relatively constant over time, we can expect that a greater number of primary replacements will result in a greater number of revisions unless some limiting mechanism can be successfully implemented to reduce the future revision burden.

Adult↗
PubMed2004

Physical activity and television viewing in relation to risk of undiagnosed abnormal glucose metabolism in adults.

OBJECTIVE: The goal of this study was to assess the associations of physical activity time and television (TV) time with risk of "undiagnosed" abnormal glucose metabolism in Australian adults. RESEARCH DESIGN AND METHODS: This population-based cross-sectional study using a stratified cluster design involving 42 randomly selected Census Collector Districts across Australia included 8,299 adults aged 25 years or older who were free from new type 2 diabetes and self-reported ischemic disease and did not take lipid-lowering or antihypertensive drugs. Abnormal glucose metabolism (impaired fasting glycemia [IFG], impaired glucose tolerance [IGT], or new type 2 diabetes) was based on an oral glucose tolerance test. Self-reported physical activity time and TV time (previous week) were assessed using interviewer-administered questionnaires. RESULTS: After adjustment for known confounders and TV time, the odds ratio (OR) of having abnormal glucose metabolism was 0.62 (95% CI 0.41-0.96) in men and 0.71 (0.50-1.00) in women for those engaged in physical activity >or=2.5 h/week compared with those who were sedentary (0 h/week). The ORs of having abnormal glucose metabolism were 1.16 (0.79-1.70) in men and 1.49 (1.12-1.99) in women who watched TV >14 h/week compared with those who watched 14 h/week) was also associated with an increased risk of new type 2 diabetes in men and women and IGT in women compared with those watching <14 h/week. Total physical activity of >or=2.5 h/week was associated with a reduced risk of IFG, IGT, and new type 2 diabetes in both sexes; however, only the association with IGT in women was statistically significant. CONCLUSIONS: These findings suggest a protective effect of physical activity and a deleterious effect of TV time on the risk of abnormal glucose metabolism in adults. Population strategies to reduce risk of abnormal glucose metabolism should focus on reducing sedentary behaviors such as TV time, as well as increasing physical activity.

Adult↗
PubMed2000

Regional variation in varicose vein operations in England 1989-1996.

AIM: To determine accuracy of Office of Population Censuses and Surveys (OPCS) codes for varicose vein (VV) operations and differences in regional activity over 7 years. METHODS: OPCS codes were obtained for VV operations (L85, L87) for the 8 English regions 1989/90-1995/96. Data were also obtained for the 4 districts of the old Oxford Region. Centrally collected codes for one hospital were compared with audit data from the same hospital. RESULTS: There was a marked inter-regional variation in VV activity, e.g. in 1995/96 the range of operations/100,000 population was 102 (Anglia & Oxford) to 138 (West Midlands). There was a gradual increase in the number of operations carried out nationally from 98/100,000 in 1989/90 to 121/100,000 in 1995/96. The numbers peaked in 1991/92, coinciding with a 'waiting list initiative'. When compared with audit data, accuracy of coding improved throughout the study period. There was a 55% inaccuracy in 1989/90 compared with 2% in 1995/96. In each year, codes overestimated the volume of work actually carried out. CONCLUSION: OPCS codes broadly reflect VV activity. Difference in VV activity in different parts of the country are apparent.

Documentation↗
PubMed2000

Utilization and effectiveness of an emergency department initiated smoking cessation program

OBJECTIVE: To determine which method of intervention will best assist ED patients who smoke and are interested in quitting. METHODS: This was a prospective, controlled randomized survey of patients seen at a military ED with an annual census of approximately 30,000. All patients 18 years old or older who were medically stable and who admitted to smoking were eligible. Exclusion criteria included: predominantly psychiatric complaints, patients going directly to labor and delivery, those who left without being seen, those referred to acute care, and those who lived outside a 30 mile radius. Research assistants kept track of all patients who presented for care during four-hour time blocks representing peak census hours and asked all eligible patients if they smoked. Those who responded yes were asked if they were interested in quitting. Those who were interested were enrolled in the study and given a questionnaire. This instrument assessed demographic factors, attitudes towards quitting, and included the previously validated Fagerstrom Test for Nicotine Dependence. Once the questionnaire was complete, the subject was randomized into one of two groups. The first group was given no information or advice from the emergency department physician (EDP), but was referred to a formal smoking cessation program. The second group was not enrolled in any formal program, but was given brief counseling from the EDP. Those in the first group who completed the smoking cessation program and all patients in the second group were contacted by telephone for six-month follow-up to assess success in quitting. RESULTS: A total of 747 patients were seen during the study period, 423 of whom were eligible for the study. Of these, 86 (20%) admitted to smoking. Of these smokers, 42 (49%) were interested in quitting. These 42 patients comprised our study group and filled out questionnaires. The questionnaires showed that 35% of our study group stated they wanted to quit smoking within the next 30 days, 30% stated that they had never been advised to quit by a physician, and 43% were considered moderately to highly nicotine addicted. Twenty-one patients were randomized to each sub-group, but one was lost in each sub-group secondary to lost paper-work. This left 20 in each sub-group for data analysis. In the formal smoking cessation group, none completed the class. Of those assigned to the EDP intervention subgroup who were followed-up at six months, only one patient was able to quit smoking and stay tobacco free. However, this patient was not considered a success because she attributed her successful effort to the fact she was diagnosed with a CVA two days after enrolling in the study. Most patients who were contacted felt that other pharmacological interventions may have assisted their efforts. CONCLUSIONS: ED based smoking cessation programs in our population will likely require more than brief EDP intervention or referral to a smoking cessation program if they are going to be effective. Future studies could evaluate the possibility of initiating other medical interventions like nicotine replacement therapy, or coordination with the patient's primary care provider.

Journal Article↗
PubMed2001

Becoming a disability pensioner with rheumatoid arthritis in Norway 1971-1990.

OBJECTIVE: Physically demanding occupations have been associated with becoming a disability pensioner with rheumatoid arthritis (DPRA), but not with the disease of RA. The association with becoming DPRA probably reflects that patients with RA have difficulties in maintaining employment in a physically demanding occupation. However, the attitudes of the employers concerning employment of persons with RA might vary. For example, the patient's age may influence the strength of the association between a physically demanding occupation and becoming DPRA. We assessed whether the association between the predictors and becoming DPRA was stronger for the youngest or the oldest age group. METHODS: The study was prospective with data on persons in Norway 30-56 years old either in the census of 1970 or 1980. All new cases of DPRA during the 2 followup periods 1971-80 and 1981-90 were identified and analyzed by logistic regression. RESULTS: For women the predictors employment, low level of education, and period ( 1981-90 compared to 1971-80) were more strongly associated with becoming DPRA for the youngest compared to the oldest persons, while manual work and part time work were not predictors of becoming DPRA. For men, all the predictors in the study were more strongly associated with becoming DPRA for the youngest compared to the oldest age group. CONCLUSION: The higher risk of becoming DPRA was associated with most predictors for persons aged 30-39 years than the group aged 50-56 years. Our results appear to indicate that the consequences of having RA in the labor market are greater for the youngest age group.

Adult↗