Delayed return to work is common after acute respiratory distress syndrome (ARDS), but has undergone little detailed evaluation. We examined factors associated with the timing of return to work after ...ARDS, along with lost earnings and shifts in healthcare coverage.
Five-year, multisite prospective, longitudinal cohort study of 138 2-year ARDS survivors hospitalised between 2004 and 2007. Employment and healthcare coverage were collected via structured interview. Predictors of time to return to work were evaluated using Fine and Grey regression analysis. Lost earnings were estimated using Bureau of Labor Statistics data.
Sixty-seven (49%) of the 138 2-year survivors were employed prior to ARDS. Among 64 5-year survivors, 20 (31%)
returned to work across 5-year follow-up. Predictors of delayed return to work (HR (95% CI)) included baseline Charlson Comorbidity Index (0.77 (0.59 to 0.99) per point; p=0.04), mechanical ventilation duration (0.67 (0.55 to 0.82) per day up to 5 days; p<0.001) and discharge to a healthcare facility (0.49 (0.26 to 0.93); p=0.03). Forty-nine of 64 (77%) 5-year survivors incurred lost earnings, with average (SD) losses ranging from US$38 354 (21,533) to US$43 510 (25,753) per person per year. Jobless, non-retired survivors experienced a 33% decrease in private health insurance and concomitant 37% rise in government-funded coverage.
Across 5-year follow-up, nearly one-third of previously employed ARDS survivors never returned to work. Delayed return to work was associated with patient-related and intensive care unit/hospital-related factors, substantial lost earnings and a marked rise in government-funded healthcare coverage. These important consequences emphasise the need to design and evaluate vocation-based interventions to assist ARDS survivors return to work.
Background: Little is known about the development of anxiety symptoms from late childhood to late adolescence. The present study determined developmental trajectories of symptoms of separation ...anxiety disorder (SAD), social phobia (SoPh), generalized anxiety disorder (GAD), panic disorder (PD), and obsessive‐compulsive disorder (OCD) in a large prospective community cohort.
Methods: Anxiety symptoms were assessed in a community sample of 2220 boys and girls at three time‐points across a 5‐year interval. The Revised Child Anxiety and Depression Scale (RCADS) was used to assess anxiety symptoms, and multilevel growth‐curve analyses were performed.
Results: All subtypes of anxiety first showed a decrease in symptoms (beta for age ranged from –.05 to –.13, p < .0001), followed by a leveling off of the decrease, and a subsequent slight increase in symptoms (beta for age‐squared ranged from .006 to .01, p < .0001) from middle adolescence (GAD, SoPh, SAD) or late adolescence (PD and OCD) onwards. This increase in anxiety symptoms could not be explained by a co‐occurring increase in depression symptoms. Girls had more anxiety symptoms than boys, and this difference remained stable during adolescence (p < .0001). Gender differences were strongly attenuated by adjustment for symptoms of depression.
Conclusions: The current study shows that, in the general population, anxiety symptoms first decrease during early adolescence, and subsequently increase from middle to late adolescence. These findings extend our knowledge on the developmental course of anxiety symptoms during adolescence. This is the first study to separate the development of anxiety symptoms from that of symptoms of depression.
The current study evaluated a brief, informant-based autism interview: the Developmental, Dimensional and Diagnostic Interview - Adult Version (3Di-Adult). Feasibility, reliability and validity of ...the Dutch 3Di-Adult was tested amongst autistic participants (n = 62) and a non-autistic comparison group (n = 30) in the Netherlands. The 3Di-Adult consists of two scales based on DSM-5 criteria: A scale 'Social communication and social interaction' and B scale 'Restricted, repetitive patterns of behavior, interests or activities'. ROC curves were used to determine cut-off scores for the A and the B scale, using an ASD diagnosis made by an independent clinician as the criterion. Mean administration time was 42 min. Internal consistency of the A scale (α = 0.92) and the B scale (α = 0.85) were good. Inter-rater reliability (ICCs = 0.99) and inter-rater agreement (ICCs ≥ 0.90) were promising. The 3Di-Adult showed good sensitivity (80.6%) and specificity (93.3%). Positive and negative predictive value were 96.2% and 70.0% respectively. Comparisons with the Autism-Spectrum Quotient-Short to investigate the convergent validity showed moderate, significant correlations with the 3Di-Adult in the total sample. Males, as compared to females, displayed significantly more autistic features on the 3Di-Adult. No relationship was found of the 3Di-Adult with education level, intelligence and age of the participants or informants. The feasibility and psychometric properties of the Dutch 3Di-Adult are promising, indicating that it can be a time-efficient, valid and reliable tool to use in diagnosing autism in adults according to DSM-5 criteria.
To characterize attitudes toward and perceptions of free-roaming cats among individuals living in Ohio.
Cross-sectional study.
Households in Ohio.
A random-digit-dial telephone survey was performed, ...and 1,250 households were contacted.
703 of the 1,250 (56.2%) households completed interviews. Five hundred fifty-three (78.7%) participants reported seeing free-roaming cats at least occasionally, and 184 (26.2%) reported having fed free-roaming cats during the previous year. However, only 42 (22.8%) participants who fed free-roaming cats had ever taken one to a veterinarian, and 43 (23.4%) participants who fed free-roaming cats reported that at least one of the free-roaming cats had produced a litter in the preceding year. Differences existed between cat owners and other participants and among urban, suburban, and rural residents in regard to their attitudes toward free-roaming cats and the need for government regulations.
Results suggested that free-roaming cats were common in Ohio, but that attitudes toward and perceptions of free-roaming cats differed between cat owners and other participants and among participants grouped on the basis of residential area. Thus, developing statewide approaches for regulating free-roaming cats may be challenging or unrealistic.
Throughout the world there are problems recruiting ethnic minority patients into cancer clinical trials. A major barrier to trial entry may be distrust of research and the medical system. This may be ...compounded by the regulatory framework governing research with an emphasis on written consent, closed questions and consent documentation, as well as fiscal issues. The Leicester UK experience is that trial accrual is better if British South Asian patients are approached by a senior doctor rather than someone of perceived lesser hierarchical status and a greater partnership between the hospital and General Practitioner may increase trial participation of this particular ethnic minority. In Los Angeles, USA, trial recruitment was improved by a greater utilisation of Hispanic staff and a Spanish language-based education programme. Involvement of community leaders is essential. While adhering to national, legal and ethnical standards, information sheets and consent, it helps if forms can be tailored towards the local ethnic minority population. Written translations are often of limited value in the recruitment of patients with no or limited knowledge of English. In some cultural settings, tape-recorded verbal consent (following approval presentations) may be an acceptable substitute for written consent, and appropriate legislative changes should be considered to facilitate this option. Approaches should be tailored to specific minority populations, taking consideration of their unique characteristics and with input from their community leadership.
The utilization of farming operations specializing in rearing dairy heifer calves has increased since the early 1990s. However, these operations have not been as well characterized as US dairy ...operations with respect to demographic and health-related measures, particularly during the preweaning period. The objective of this study was to characterize morbidity, mortality, antibiotic use, and biosecurity and biocontainment practices on operations rearing preweaned heifers only or preweaned heifer and bull calves (mixed) in the United States. A cross-sectional survey was performed using a standardized method that included a preletter, initial survey, postcard follow-up, and second survey delivered by mail. Additional follow-up contacts were attempted by telephone. Descriptive statistics for morbidity, mortality, antibiotic use, and biosecurity and biocontainment practices were computed at both the operation and calf levels. The overall response rate was 50%. Crude yearly mortality averaged 6.9% at the calf level, with the median operation reporting 3.6% mortality. Diarrhea was experienced by 18% of calves, with 73% receiving an antibiotic. The median operation reported 20% diarrhea morbidity with 83% receiving an antibiotic. Respiratory disease was experienced by 9.0% of calves, with 82% receiving an antibiotic. The median operation reported 5.3% respiratory morbidity, with 100% receiving an antibiotic. Heifer-only and mixed operations did not differ in operation median morbidity, mortality, or antibiotic treatment rates. Written antibiotic protocols were available on 65% of operations. Medicated milk replacer was used by 56% of operations. Passive immunity was routinely measured by 46% of operations. Direct contact between calves in housing units was not allowed by 45% of operations. Of all farms informed of disease concerns at the source farm, 76% changed their daily routine as a result. Almost all operations uniquely identified calves and recorded mortality. The heifer-only and mixed operations in this study were similar to US dairy operations for key health, antibiotic use, and biosecurity and biocontainment metrics. This research provides initial estimates of key demographics usable by calf ranches, veterinarians, and other professionals serving this segment of the US dairy industry.
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