Health status,work limitations,and return-to-work trajectories in injured workers with musculoskeletal disorders

BACKGROUND: The purpose of this study was to describe the health status and work limitations in injured workers with musculoskeletal disorders at 1 month post-injury, stratified by return-to-work status, and to document their return-to-work trajectories 6 months post-injury. METHODS: A sample of 632 workers with a back or upper extremity musculoskeletal disorder, who filed a Workplace Safety and Insurance Board lost-time claim injury, participated in this prospective study. Participants were assessed at baseline (1 month post-injury) and at 6 months follow-up. RESULTS: One month post-injury, poor physical health, high levels of depressive symptoms and high work limitations are prevalent in workers, including in those with a sustained first return to work. Workers with a sustained first return to work report a better health status and fewer work limitations than those who experienced a recurrence of work absence or who never returned to work. Six months post-injury, the rate of recurrence of work absence in the trajectories of injured workers who have made at least one return to work attempt is high (38%), including the rate for workers with an initial sustained first return to work (27%). CONCLUSIONS: There are return-to-work status specific health outcomes in injured workers. A sustained first return to work is not equivalent to a complete recovery from musculoskeletal disorders.     

老年心功能不全血浆心钠素浓度的变化

采用放射免疫法测定31例老年心功能不全患者血浆心钠素(ANP)浓度,发现老年心功能不全组ANP明显低于对照组(P<0.01)。血浆ANP含量随心功能不全的严重程度而明显减少(P<0.05)。病程与ANP浓度呈负相关 (r=-0.441,P<0.05)。不同病种、不同受累部位及有或无房颤之间ANP差异无显著性(P<0.05)。     

上海道契所保存的历史记忆——以《上海道契》英册1—300号道契为例

上海道契是1843年后上海土地永租的原始记录，它为研究开埠前后上海城郊由乡村形态向近代城市发展的历史提供了丰富的史料。本文系统整理了英册前300号道契，将道契分地逐一定位，在此基础上，根据道契资料提供的自然、人文景观信息，复原了开埠前上海北关外乡保、人口、墓冢、河道等景观要素的分布，揭示了开埠初至1861年城市景观从沿外滩一线逐步向西扩张的历史过程。     

Disease Management and the Medical Home Model

For the past decade, US physicians have failed to embrace disease management (DM) approaches offered by private DM companies and health plans. Until recently, physicians have not offered an alternative, systematic approach to caring for patients with chronic illnesses and conditions.The medical home model has become the centerpiece of reforms proposed by associations that represent family medicine physicians (the American Academy of Family Physicians [AAFP]) and general internal medicine physicians (the American College of Physicians [ACP]). In February 2007, the AAFP and the ACP were joined by the American Academy of Pediatrics and the American Osteopathic Association in issuing joint principles for the patient-centered medical home. While the medical home model is promoted primarily as a comprehensive approach to primary care reform, there is one aspect where the medical home and DM overlap: care coordination.Medicare has been exploring alternative mechanisms to manage and reimburse chronic care and care-coordination activities. In 2003, the US Congress passed legislation to require pilot projects for chronic care improvement programs; the program implementing this legislation is Medicare Health Support (MHS). To date, very little information has been available about the progress of MHS projects. The three early announcements about MHS progress have not been encouraging: the expected financial results are not being achieved.In December 2006, Congress passed legislation authorizing the Medicare Medical Home Demonstration (MMHD) project. MHS and MMHD are directed at similar patient populations: high-cost, frail, elderly patients with multiple co-morbid conditions. The medical home concept being advanced by primary care physicians has the potential to be competitive with DM companies. Health plans that have built their own DM programs are more likely to be supportive of the medical home model. Do physicians have the ability to compete at providing care-coordination services? There are strong arguments suggesting ‘no’ and strong arguments suggesting ‘yes’.While the medical home model is focused on primary care reform, its effect could be competitive to DM companies and others. The medical home model could affect the flow of hundreds of billions of dollars — money that over time might flow either to physicians or to private companies.     

茶水中锌含量分析方法研究

目的:建立测定茶水中锌含量的方法。方法:采用锌试剂吸光光度法测定茶水中锌含量。结果:在一定条件下,锌含量在0~80μg/25 ml范围内遵守朗伯比耳定律,方法的精密度(RSD)在1.38%~3.27%之间,回收率在94%~107%之内,检测限为5.2μg/L,表观摩尔吸光系数为2.2×104L/mol.cm。结论:本方法经用于茶水样品分析,结果符合要求。     

OXYGEN FREE RADICAL IN HUMAN OSTEOARTHRITIS

The xanthine oxidase catalysed release of superoxide free radicals (O2-) from endogenous hypoxanthine was determined in homogenates of synovium obtained from three groups of patients, those undergoing primary or revision total hip replacement (THR) for osteoarthritis and those undergoing arthroscopy of the knee for semilunar disc injuries. The concentrations of hypoxanthine in homogenates obtained during THR were found to be significantly higher than those in the group with semilunar disc injuries. The results suggest that there is a greater predisposition to free radical release and tissue damage in osteoarthritis.     

One-stage voice rehabilitation in total laryngectomy

The posterior wall of the upper trachea was used to make a T-E shunt. An intelligible shunt speech could thus develop two weeks postoperatively. This procedure is reliable, easy and safe, and is applicable in almost all of total laryngectomy cases. A big horizontal tuck-situated above the shunt and made of mucous membrane of the inferior pharyngeal wall and the posterior cricoid was helpful in preventing aspiration.