Employment status at time of first hospitalization for heart failure is associated with a higher risk of death and rehospitalization for heart failure

Aims

Employment status at time of first heart failure (HF) hospitalization may be an indicator of both self‐perceived and objective health status. In this study, we examined the association between employment status and the risk of all‐cause mortality and recurrent HF hospitalization in a nationwide cohort of patients with HF.

Methods and results

We identified all patients of working age (18–60 years) with a first HF hospitalization in the period 1997–2015 in Denmark, categorized according to whether or not they were part of the workforce at time of the index admission. The primary outcome was death from any cause and the secondary outcome was readmission for HF. Cumulative incidence curves, binomial regression and Cox regression models were used to assess outcomes. Of 25 571 patients with a first hospitalization for HF, 15 428 (60%) were part of the workforce at baseline. Patients in the workforce were significantly younger (53 vs. 55 years) more likely to be male (75% vs 64%) and less likely to have diabetes (13% vs 22%) and chronic obstructive pulmonary disease (5% vs 10%) (all P < 0.0001). Not being part of the workforce was associated with a significantly higher risk of death [hazard ratio (HR) 1.59; 95% confidence interval (CI) 1.50–1.68] and rehospitalization for HF (HR 1.09; 95% CI 1.05–1.14), in analyses adjusted for age, sex, co‐morbidities, education level, calendar time, and duration of first HF hospitalization.

Conclusion

Not being part of the workforce at time of first HF hospitalization was independently associated with increased mortality and recurrent HF hospitalization.

     

Employment Discrimination Against Schizophrenia

This paper addresses the issue of employment discrimination against individuals with a history of schizophrenia. There are three illustrations, two of which come from Asian countries, where the discrimination tends to be more openly expressed than in the West. Maintaining competitive employment is crucially important for individuals who are recovering from schizophrenia; indeed, employment is an inherent part of recovery. The paper makes recommendations for clinicians, advocates, patients, and employers.     

医学生赴基层医疗机构就业意愿探究

目的 了解北京某高等医学院校医学生对医学教育、职业规划以及基层医疗机构就业的认识,探究影响医学生赴基层就业意愿的主要因素.方法 对380名医学生进行问卷调查,采用描述性与多因素统计分析方法进行分析.结果 医学生择业首选东部发达地区,仅有16.3%的医学生愿意在基层医疗机构就业,但有93.0%的医学生希望有基层医疗机构工作的经历;在校教育满意度、职业晋升空间认知与起点年薪期望值是影响基层就业意愿的主要因素.结论 医学生对职业认知不理性;学校应当通过通识教育与职业规划引导医学生面向基层就业.     

医学院校毕业生就业指导工作的探讨

随着高等医学院校毕业生就业体制改革的不断深化,医学毕业生就业形势不容乐观,医学院校毕业生就业指导工作面临前所未有的压力和挑战。我校通过实施就业工作“一把手”工程,落实毕业生就业工作责任制,建立健全规章制度及医学生就业服务体系,积极开展各种形式的就业指导,从而做好医学生的就业工作。     

唐氏综合征高风险孕妇拒绝羊膜腔穿刺术原因调查

提高唐氏综合征高风险孕妇的羊膜腔穿刺率,降低出生缺陷儿的发生。方法对来产前咨询门诊就诊具有羊膜腔穿刺指征而拒绝行羊膜腔穿刺者进行原因调查。结果2年产前咨询预约羊膜腔穿刺3845人,其中有l614例如约行羊膜腔穿刺术,羊膜腔穿刺率为41．98％,2231例拒绝羊膜腔穿刺的孕妇中孕妇自身心理因素占了绝大部分,包括担心流产（57．15％）、怕痛苦（8．74％）、心存侥幸（11．52％）、对医院的错误认识（3．68％）等。〈35岁组和≥35岁拒绝穿刺的主要原因不同。结论某妇幼保健院拒绝羊膜腔穿刺比例较高,原因以心理因素为主,不同年龄段所担心的原因不同,应分别对待给予相应的心理干预。     

外伤性腮腺导管断离吻合术失败原因分析

目的:通过临床资料的分析,探讨腮腺导管损伤手术治疗失败的原因。方法:33例因外伤而造成腮腺导管断离的病例,在行清创缝合术中,游离减张导管断端并用塑料管做支架进行导管吻合手术。其中8例初次手术失败,导管断裂,形成导管瘘,进行了第二次手术。结果:8例失败病例,均经Ⅱ期导管端端吻合术后治愈。结论:在施行吻合术中,导管两断端是否充分显露,游离减张是手术成败的关键,术后适当加压包扎,使用促涎液分泌的药物,抗感染,加强口腔护理,防止塑料管滑脱和过早拔除也是减少手术失败的重要因素。     

Predictors of Participation Enfranchisement After Spinal Cord Injury: The Mediating Role of Depression and Moderating Role of Demographic and Injury Characteristics

Objectives

(1) To examine the mediating effects of depressive symptoms on the relations between employment, grief, depression treatment, and participation enfranchisement after spinal cord injury (SCI); and (2) to examine the moderating role of demographic and injury characteristics, including sex, race, marital status, education, and injury level, and completeness on these relations.

Design

Cross-sectional survey as part of the Project to Improve Symptoms and Mood after SCI (PRISMS).

Setting

Rehabilitation facilities.

Participants

Persons with SCI (N=522; average age, 42y; 76% men; 64% white; 64% completed at least a high school education) enrolled from 2007 to 2011.

Interventions

Not applicable.

Main Outcome Measure

Participation enfranchisement.

Results

The final model fit the data relatively well (comparative fix index=.939; Tucker-Lewis Index=.894; root mean square error of approximation=.066; 90% confidence interval, .043–.089), explaining 32% of the variance in participation enfranchisement. Enfranchisement was positively related to employment and negatively related to depression. Grieving the loss of a loved one and the use of an antidepressant or psychotherapy were related to participation enfranchisement; these relations were mediated by depressive symptoms. Multigroup analyses supported the model's invariance across sex, marital status, severity of injury, and level of injury.

Conclusions

Depression appears to mediate the influence of employment, grief, and depression treatments on participation enfranchisement after SCI. These relations are applicable regardless of sex, marital status, and injury completeness and level. These findings highlight efforts to improve the detection and treatment of depression in SCI rehabilitation programs that may enhance participation.     

护理专业与涉外护理专业学生专业方向及就业情况的调查分析

目的:调查分析护理专业与涉外护理专业学生在就业方面是否存在差别以及影响就业的因素。方法:以2013届护理专业与涉外护理108名毕业生为研究对象,采取问卷调查的形式从在校情况与自身能力、大学英语水平以及毕业走向3个方面进行比较,并通过统计学方法整理数据以了解其对本专业学生专业方向及就业情况的看法。结果:在校情况方面护理与涉外护理学生对自身专业的满意度差别不大;涉外护理学生大学期间已具有就业规划的人数远超于护理专业;在英语水平方面护理和涉外护理的学生在雅思、托福报考率,CET-4、CET-6通过率方面差异不大;护理专业学生对其专业的满意度高于涉外护理的学生。在毕业走向方面大部分护理和涉外护理学生认为招聘时用人单位对于自身能力最为关注。结论:在校情况及英语水平对于护理和涉外护理的学生就业方面有一定影响,并且两个专业的学生存在一定的差异。但是在就业情况方面没有具体差别。     

83例护理不良事件分析与对策

目的 ：了解护理不良事件发生的类别、原因及特点,为制定护理对策提供参考。方法 ：针对某医院3年内各护理单元上报护理部的83例护理不良事件,运用护理质量管理工具进行护理不良事件分析。结果 ：关注主要危险因素及事件,加强过程督导,完善流程与制度,减少护理不良事件的发生。结论 ：针对本院护理不良事件高发时段、高发人群,给予高度关注,提出针对性的防范措施,确保护理安全。