Emergency Care EMTALA Alterations During the COVID-19 Pandemic in the United States

The coronavirus 2019 pandemic has affected almost every aspect of health care delivery in the United States, and the emergency medicine system has been hit particularly hard while dealing with this public health crisis. In an unprecedented time in our history, medical systems and clinicians have been asked to be creative, flexible, and innovative, all while continuing to uphold the important standards in the US health care system. To continue providing quality services to patients during this extraordinary time, care providers, organizations, administrators, and insurers have needed to alter longstanding models and procedures to respond to the dynamics of a pandemic. The Emergency Medicine Treatment and Active Labor Act of 1986, or EMTALA, is 1 example of where these alterations have allowed health care facilities and clinicians to continue their work of caring for patients while protecting both the patients and the clinicians themselves from infectious exposures at the same time.     

Associations of accelerometer-based sleep duration and self-reported sleep difficulties with cognitive function in late mid-life: the Finnish Retirement and Aging Study

ObjectivesPrior evidence suggests that sleep duration and sleep difficulties may be associated with cognitive function in old age, but little is known about the sleep–cognition association in late mid-life. Our aim was to examine the associations of accelerometer-based sleep duration as well as subjective sleep difficulties with different domains of cognitive function among aging workers.MethodsThe study population consisted of 289 participants (mean age 62.4 years, SD 1.02; 83% women) from the Finnish Retirement and Aging Study (FIREA). Sleep difficulties were measured using Jenkins Sleep Problem Scale (difficulties falling asleep, difficulties maintaining sleep, waking up too early in the morning, and nonrestorative sleep). Sleep duration was measured with wrist-worn accelerometer and self-report, and participants were divided into short (<7 h/night), mid-range (7–9 h/night) and long (≥9 h/night) sleepers. Participants underwent extensive cognitive testing covering three domains: (1) memory, (2) executive function, and (3) attention and information processing.ResultsGreater difficulties in waking up too early in the morning were associated with poorer executive function measured with Spatial Working Memory (SWM) test (p = 0.005). Additionally, nonrestorative sleep was associated with poorer executive function measured with Trail Making Test, B–A, (p = 0.036) and borderline significantly with lower SWM (p = 0.056). Compared to mid-range sleepers, long sleepers tended to have poorer cognitive function (all memory function tests and SWM), but the associations were not statistically significant due to small number of long sleepers.ConclusionsSubjective sleep difficulties may be linked to poorer executive function in a relatively healthy population of older workers in their 60 s. Thus, promoting good sleep quality may translate into better cognitive health in late mid-life.     

Relationships Among Factors Related to Childbirth and Breastfeeding Outcomes in Primiparous Women

ObjectivesTo explore the relationships among potentially modifiable factors related to childbirth and effective breastfeeding initiation at approximately 36 hours after birth and duration and exclusivity at hospital discharge, 2 weeks, 2 months, and 6 months after birth in primiparous women and to explore whether modifiable and nonmodifiable secondary factors and covariates influenced the relationships among factors related to childbirth and these breastfeeding outcomes.DesignA prospective, longitudinal, cohort study.SettingThe postpartum units of two general hospitals in eastern Canada.ParticipantsNinety-seven mother–infant dyads.MethodsWe recorded demographic, childbirth, obstetric history, and breastfeeding data through chart review. A breastfeeding observation was completed at approximately 36 hours after birth by unit nurses. Participants maintained breastfeeding logs in hospital and for 6 months after birth and completed three self-report questionnaires before discharge. We analyzed outcomes using backward stepwise linear and logistic regression.ResultsOne childbirth factor, labor induced with oxytocin, was negatively associated with effective initiation of breastfeeding, and none was related to breastfeeding duration and exclusivity at any time point. Maternal weight; professional support; and newborn’s gestational age at birth, 5-minute Apgar score, weight loss, LATCH score, and active feeds (newborn actively suckled at the breast) were significantly associated with breastfeeding outcomes.ConclusionInduction of labor with oxytocin should be used judiciously; when used, nurses must be hypervigilant to assess the mother–infant dyad for breastfeeding issues and to intervene to prevent or remediate them.     

某医疗机构核医学工作场所劳务派遣保洁人员的职业健康管理

近几年，"劳务派遣"成了医疗机构终末消毒、保洁、垃圾回收等工作新的用工形式。由于多数用工单位和用人单位不清楚对劳务派遣人员职业健康管理中各自应承担的责任和义务，以至于劳务派遣工在劳动过程中应享有的劳动保护权益未获得切实保障。本文就某医疗机构核医学工作场所劳务派遣保洁人员的职业健康管理监督案例进行讨论。     

The effect of short or long sleep duration on quality of life and depression: an internet-based survey in Japan

BackgroundTo date, no previous studies have evaluated the relationship between sleep duration and quality of life (QOL) or depression in the general population after controlling for daytime sleepiness and sleep disturbances.MethodsA web-based cross-sectional survey was conducted with 8698 subjects aged 20–69 years. We examined the relationships between weekday sleep duration and daytime sleepiness, sleep disturbance, QOL and depression, using the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index (without the item for sleep duration), 8-item Short Form and Center for Epidemiological Studies Depression Scale (CES-D).ResultsDaytime sleepiness tended to increase in proportion to shorter weekday sleep durations. Sleep disturbances, physical and mental QOL, and CES-D scores were worse in both the shorter and longer sleep groups compared with the group with 7–8 h of sleep. Hierarchical logistic regression analyses revealed that short sleep duration but not long sleep duration was significantly associated with reduction of both physical and mental QOL, even after controlling for the presence of daytime sleepiness and sleep disturbance. Both short and long sleep duration were independently and significantly correlated with depression after controlling for daytime sleepiness; however, there was no statistically significant association after adjusting for the effects of sleep disturbance.ConclusionsThe results suggested adverse effects of short sleep but not long sleep on both physical and mental QOL. In addition, the negative impact of specific types of sleep disturbance on depression may be greater than the impact of shortening of sleep duration.     

102例海洛因依赖患者者戒毒出院后复吸原因分析

对１０２例海洛因依赖患者戒毒出院后操守时间及复吸原因进行分析，发现复吸原因主要与精神依赖及对精神依赖的错误认识等有关，用药维持治疗可明显操守时间．提出在戒毒出院后应采用象治疗神经症或精神病那样的方法来长期维持治疗。     

Nerve conduction as a means of estimating early post-mortem interval

Summary Methods in current practice for ascertaining time of death are largely based on the cooling of the body after death and are somewhat unreliable. A theoretica relationship is known to exist between the decline in the properties defining nerve conduction and time after death caused by the gradual cessation of metabolic activity in nerves. A number of such properties were measured in rats during life and after death. In most cases the relationship was found to be inconsistent. The chronaxie of the strength duration curve for the sciatic nerve was, however, found to increase consistently and reproducibly in a linear fashion over the first 90 min after death to a plateau value which was maintained beyond 135 min. These findings are discussed as the possible basis of a forensic method of determining the duration of the “post mortem interval” within the first few hours after death.