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AbstractGaining a better grasp on factors related to changes in alcohol use is of particular interest for clinicians. Past research has highlighted a negative link between future time perspective (i.e. a disposition guiding how individuals consider and act regarding their future) and alcohol misuse. However, much remains at stake in the understanding of this association. The objective of this research was to explore bidirectional relationships between future time perspective and severity of alcohol-related problems, in a clinical setting. The sample includes 79 patients followed up in an outpatient alcohol treatment centre. Two measurement times were planned: at entry into care and 6 months later. Multiple linear regression analyses were carried out, controlling for sociodemographic variables. We found that baseline future time perspective predicted level of alcohol-related problems after 6 months in treatment, even when effects of baseline alcohol-related problems and sociodemographic variables were controlled. This study shows that the way patients see and position themselves regarding their future can affect level of alcohol-related problems. It may be useful for clinicians to identify patients with low future time perspective to offer tailored interventions and consider this dimension as a resource for change. 相似文献
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Mark Koday DDS Stephen Davis DDS Molly Melbye DDS MPH 《Journal of public health dentistry》2020,80(Z2):S114-S116
The Yakima Valley Farm Workers Clinic (YVFWC) is one of the largest community health centers in the country with clinics throughout south-central Washington and northern Oregon. Its dental program consists of 14 dental clinics providing general and specialty services to the low-income populations it serves. Modeling itself after the YVFWC medical managed care program; the Dental program recently added value-based metrics to its dental practice after Oregon offered a value-based dental reimbursement plan in 2019. This is the first-step YVFWC's dental program that has taken to prepare for value-based reimbursement and transform its dental practice in order to reduce the disease burden in its patient population. The purpose of this article is to describe the processes YVFWC undertook to prepare itself for the new reimbursement model, which included the development of metrics, a metric validation process, a clinical dashboard, and a method for improving metrics. It also outlines its medical/dental integration improvement brought about by embedding hygienists into the medical primary care teams. 相似文献
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Stephan Koter Tina U. Cohnert Korbinian B. Hindermayr Jörg Lindenmann Maximilian Brückner Wolfgang K. Oswald Georg Werkgartner Doris Wagner 《Journal of vascular surgery》2019,69(4):1227-1232
Objective
Low psoas muscle area is shown to be an indicator for worse postoperative outcome in patients undergoing vascular surgical. Additionally, it has been associated with longer durations of hospital stay in patients with cancer who undergo surgery and subsequently greater health care costs in Europe and the United States. We sought to evaluate this effect on hospital expenditure for patients undergoing vascular repair in a health care system with universal access.Methods
Skeletal muscle mass was assessed on preoperative abdominal computed tomography scans of patients undergoing open aortic aneurysm repair in a retrospective fashion. The skeletal muscle index (SMI) was used to define low muscle mass. Health care costs were obtained for all patients and the relationship between a low SMI and higher costs was explored using linear regression and cross-sectional analysis.Results
We included 156 patients (81.5% male) with a median age of 72 years undergoing elective surgery for infrarenal abdominal aortic aneurysm in this analysis. The median SMI for patients with low skeletal muscle mass was 53.21 cm2/kg and for patients without, 70.07 cm2/kg. Hospital duration of stay was 2 days longer in patients with low skeletal muscle mass as compared with patients with normal (14 days vs 11 days; P = .001), as was duration of intensive care stay (3 days vs 1 day; P = .01). The median overall hospital costs were €10,460 higher for patients with a low SMI as compared with patients with a normal physical constitution (€53,739 [interquartile range, €45,007-€62,471] vs €43,279 [interquartile range, €39,509-€47,049]; P = .001). After confounder adjustment, a low SMI was associated with a 14.68% cost increase in overall hospital costs, for a cost increase of €6521.Conclusions
Low skeletal muscle mass is independently associated with higher hospital as well as intensive care costs in patients undergoing elective aortic aneurysm repair. Strategies to reduce this risk factor are warranted for these patients. 相似文献7.
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Molly Orcutt Wendy C. King Melissa A. Kalarchian Michael J. Devlin Marsha D. Marcus Luis Garcia Kristine J. Steffen James E. Mitchell 《Surgery for obesity and related diseases》2019,15(2):295-303
Background
A history of childhood maltreatment and psychopathology are common in adults with obesity.Objectives
To report childhood maltreatment and to evaluate associations between severity and type of childhood maltreatment and lifetime history of psychopathology among adults with severe obesity awaiting bariatric surgery.Setting
Four clinical centers of the Longitudinal Assessment of Bariatric Surgery Research Consortium.Methods
The Childhood Trauma Questionnaire, which assesses presence/severity (i.e., none, mild, moderate, severe) of physical abuse, mental abuse, physical neglect, mental neglect, and sexual abuse, was completed by 302 female and 66 male bariatric surgery patients. Presurgery lifetime history of psychopathology and suicidal ideation/behavior were assessed with the Structured Clinical Interview for DSM-IV and the Suicidal Behavioral Questionnaire-Revised, respectively. Presurgery lifetime history of antidepressant use was self-reported.Results
Two thirds (66.6%) of females and 47.0% of males reported at least 1 form of childhood trauma; 42.4% and 24.2%, respectively, at greater than or equal to moderate severity. Among women, presence/greater severity of childhood mental or physical abuse or neglect was associated with a higher risk of history of psychopathology (i.e., major depressive disorder, posttraumatic stress disorder, other anxiety disorder, alcohol use disorder, binge eating disorder), suicidal ideation/behavior and antidepressant use (P for all ≤ .02). These associations were independent of age, race, education, body mass index, and childhood sexual abuse. Childhood sexual abuse was independently associated with a history of suicidal ideation/behavior and antidepressant use only (P for both ≤ .05). Statistical power was limited to evaluate these associations among men.Conclusion
Among women with obesity, presence/severity of childhood trauma was positively associated with relatively common psychiatric disorders. 相似文献9.
Oliver Sartor MD Daniel Heinrich MD Neil Mariados MD Maria José Méndez Vidal MD Daniel Keizman MD Camilla Thellenberg Karlsson MD Avivit Peer MD Giuseppe Procopio MD Stephen J. Frank MD Kalevi Pulkkanen MD Eli Rosenbaum MD Stefano Severi MD José Trigo MD Lucia Trandafir MD Volker Wagner MD Rui Li MS Luke T. Nordquist MD 《The Prostate》2019,79(14):1683-1691
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Brenda Laky Isabella Alram Julia K. Frank Leo Pauzenberger Werner Anderl Karl-Heinz Wagner Philipp R. Heuberer 《Journal of orthopaedic research》2020,38(9):2074-2082
Increasing numbers of arthroplasties are also accompanied by postoperative infections. The main purpose was to evaluate preoperative serum bilirubin levels between patients with and without infections after shoulder and knee arthroplasties. For this retrospective case-control single-center study, a total of 108 patients were extracted from a prospectively collected database. Eighteen patients with infections after shoulder (n = 8) and knee (n = 10) arthroplasty were matched by age, gender, and implant type in a 1:5-scenario to 90 patients (40 shoulders and 50 knees) without postoperative infection. Demographic data, preoperative blood parameters, and postoperative infection-related outcomes were evaluated. Total bilirubin was the only preoperative parameter significantly different between the infection (8.21 ± 3.25 μmol/L or 0.48 ± 0.19 mg/dL) and noninfection (10.78 ± 4.62 μmol/L or 0.63 ± 0.27 mg/dL; P = .014) group, while C-reactive protein and other liver parameters were similar between the groups. Significantly more controls (92.1%) had preoperative bilirubin levels above 8.72 μmol/L or 0.51 mg/dL than cases (7.9%; P = .007). The 5-year infection survival-rate was 65.6% for patients with preoperative bilirubin levels < 8.72 μmol/L or < 0.51 mg/dL and 91.2% with ≥ 8.72 μmol/L or ≥ 0.51 mg/dL. Mildly decreased preoperative bilirubin levels with a cutoff at 8.72 μmol/L or 0.51 mg/dL were significantly associated to patients with infections after shoulder and knee arthroplasty. There were no differences in other blood parameters or comorbidities between patients with infections and their matched-controls. 相似文献