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Chu‐Lin Tsai MD MPH Justin A. Sobrino BS Carlos A. Camargo Jr MD DrPH 《Academic emergency medicine》2008,15(12):1275-1283
Objectives: Little is known about recent trends in U.S. emergency department (ED) visits for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) or about ED management of AECOPD. This study aimed to describe the epidemiology of ED visits for AECOPD and to evaluate concordance with guideline‐recommended care. Methods: Data were obtained from National Hospital Ambulatory Medical Care Survey (NHAMCS). ED visits for AECOPD, during 1993 to 2005, were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) codes. Concordance with guideline recommendations was evaluated using process measures. Results: Over the 13‐year study period, there was an average annual 0.6 million ED visits for AECOPD, and the visit rates for AECOPD were consistently high (3.2 per 1,000 U.S. population; Ptrend = 0.13). The trends in the use of chest radiograph, pulse oximetry, or bronchodilator remained stable (all Ptrend > 0.5). By contrast, the use of systemic corticosteroids increased from 29% in 1993–1994 to 60% in 2005, antibiotics increased from 14% to 42%, and methylxanthines decreased from 15% to <1% (all Ptrend < 0.001). Multivariable analysis showed patients in the South (vs. the Northeast) were less likely to receive systemic corticosteroids (odds ratio [OR] = 0.6; 95% confidence interval [CI] = 0.4 to 0.9). Conclusions: The high burden of ED visits for AECOPD persisted. Overall concordance with guideline‐recommended care for AECOPD was moderate, and some emergency treatments had improved over time. 相似文献
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LISA HARNACK DrPH RD GLADYS BLOCK PHD AMY SUBAR PhD RD SYLVIA LANE PhD RICHARD BRAND PhD 《Journal of the American Dietetic Association》1997,97(9):957-965
Objective To examine the relationship of cancer prevention-related nutrition knowledge, beliefs, and attitudes to cancer prevention dietary behavior.Subjects/setting Noninstitutionalized US adults aged 18 years and older.Methods Data collected in the 1992 National Health Interview Survey Cancer Epidemiology Supplement were analyzed. The supplement included questions to ascertain knowledge, beliefs, and attitudes and a food frequency questionnaire to ascertain nutrient intake.Statistics Multivariate linear regression modeling was conducted to assess the hypothesized relationships.Results After adjustment for relevant covariates (age, sex, education, total energy, perceived barriers to eating a more healthful diet), knowledge and belief constructs were predictive of dietary behavior. Specifically, fat, fiber, and fruit and vegetable intakes more closely approximated dietary recommendations for persons with more cancer-prevention knowledge. The strength of the associations between these constructs and dietary behavior varied in some cases according to level of education and perceived barriers to eating a healthful diet. Of the perceived barriers to eating a healthful diet, perceived ease of eating a healthful diet was most strongly and consistently predictive of intake.Conclusions Research findings challenge dietetics practitioners to design diet- and health-promotion programs and activities that not only educate the public about the importance of diet to health, but also address barriers to dietary change. 相似文献
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Abstract: Spontaneous intracranial hypotension (SIH) is a postural headache syndrome unrelated to dural puncture. Because of the increasing failure of epidural blood patch (EBP) to relieve headache in SIH, we retrospectively investigated the epidemiological features and treatment outcomes in 55 cases of SIH. The study population was stratified by age and sex; continuous variables were compared for differences by t -tests; categorical variables were compared by Chi-squared analysis or Fisher exact tests. Significant differences were identified by P values of 0.05 or less. The mean age of the study population was 44 ± 12 years with a female to male ratio of 1.3:1.0. Men presented with subdural hematomas ( P = 0.001) more often than women. Meningeal enhancement on contrast magnetic resonance imaging (MRI) was the most consistent radiographic finding. Radionuclide cisternography (RC) demonstrated thoracolumbar dural leaks in 16 of 22 patients. EBP failures were more common in patients aged 40 and younger than in older patients ( P = 0.003). Postural headache from SIH was not uniformly responsive to EBP, and had significant comorbidities, especially in men. The management of postural headache in SIH by other techniques to restore brain position and cerebrospinal fluid dynamics should be investigated. 相似文献
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Martha Kasper Keintz ScM Linda Fleisher MPH Barbara K. Rimer DrPH 《Journal of community health》1994,19(1):25-40
Younger women smoke at disproportionately higher rates than other women and their smoking has a major impact on the health of their young children. To address this problem, a smoking cessation intervention combining minimal advice and assistance from a community health nurse and a tailored self-help guide was developed for low-income women with young children. The program evaluation results reported here were gathered from women using publicly funded pediatric services in four agencies with 32 clinic sites in central and eastern Pennsylvania. Unlike volunteers in formal cessation programs, the women varied widely in their readiness to quit smoking. Follow-up data were obtained from 1,230 female smokers, aged 18 to 39, after receiving brief, individualized smoking cessation advice and encouragement to read the self-help guide. One year later, 12.5 percent reported quitting smoking, and 20.2 percent reported having made a serious quit attempt that lasted at least 7 days. These results suggest that, even among smokers with low socioeconomic status and wide variation in their readiness to quit, minimal intervention programs requiring modest resources can promote cessation.This work was funded under contracts from the Cancer Control Program, Pennsylvania Department of Health (SPC-883141 and SPC-979425). The Quitting Times STOP IT quit smoking protocol was adapted from the Smoking Cessation Project, Maternal and Child Health, Massachusetts Department of Public Health. The authors also wish to express appreciation to the staff of the Division of Population Science, Fox Chase Cancer Center for their contributions to this project and especially those of Chris Jepson, Eunice King, C. Tracy Orleans, and Marjorie Utt. 相似文献
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The event of preterm birth represents a significant risk to the equilibrium of the family, often placing the family under significant stress. This paper is intended to assist neonatal nurses in understanding factors related to a family's appraisal of stress and strategies used for coping. Such factors are an important consideration in planning the most effective interventions to support optimal family adaptation to their preterm infant's birth. In identifying the best clinical approaches to supporting a family coping with the event of a preterm birth, nurses need to consider levels of the evidence that supports adoption of clinical intervention strategies. Working to reduce family stress and improve family coping ensures the most optimal home environment for the preterm infant to grow and thrive in after discharge. 相似文献