Associations between body mass index and suicide in the veterans affairs health system

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102714/1/oby20422.pd

Predictors of injury-related and non-injury-related mortality among veterans with alcohol use disorders

To describe the association between alcohol use disorders (AUDs) and mortality and to examine risk factors for and all-cause, injury-related and non-injury-related mortality among those diagnosed with an AUD.Department of Veterans Affairs, Veterans Health Administration (VHA).A cohort of individuals who received health care in VHA during the fiscal year (FY) 2001 ( n  = 3 944 778), followed from the beginning of FY02 through the end of FY06.Demographics and medical diagnoses were obtained from VHA records. Data on mortality were obtained from the National Death Index.Controlling for age, gender and race and compared to those without AUDs, individuals with AUDs were more likely to die by all causes [hazard ratio (HR) = 2.30], by injury-related (HR = 3.29) and by non-injury-related causes (HR = 2.21). Patients with AUDs died 15 years earlier than individuals without AUDs on average. Among those with AUDs, Caucasian ethnicity and all mental illness diagnoses that were assessed were associated more strongly with injury-related than non-injury-related mortality. Also among those with AUDs, individuals with medical comorbidity and older age were at higher risk for non-injury related compared to injury-related mortality.In users of a large health-care system, a diagnosis of an AUD is associated significantly with increased likelihood of dying by injury and non-injury causes. Patients with a diagnosis of an AUD who die from injury differ significantly from those who die from other medical conditions. Prevention and intervention programs could focus separately upon selected groups with increased risk for injury or non-injury-related death.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79146/1/j.1360-0443.2010.03024.x.pd

Opioid dose and risk of suicide

Chronic pain is associated with increased risk of suicide, and opioids are commonly used to treat moderate to severe pain. However, the association between opioid dose and suicide mortality has not been examined closely. This retrospective data analysis described the risk of suicide associated with differing prescribed opioid doses. Data were from Veterans Affairs health care system treatment records and the National Death Index. Records analyzed were those of Veterans Affairs patients with chronic pain receiving opioids in fiscal years 2004 to 2005 (N = 123,946). Primary predictors were maximum prescribed morphine-equivalent daily opioid dose and opioid fill type. The main outcome measured was suicide death, by any mechanism, and intentional overdose death during 2004 to 2009. Controlling for demographic and clinical characteristics, higher prescribed opioid doses were associated with elevated suicide risk. Compared with those receiving ≤20 milligrams/day (mg/d), hazard ratios were 1.48 (95% confidence intervals [CI], 1.25-1.75) for 20 to <50 mg/d, 1.69 (95% CI, 1.33-2.14) for 50 to <100 mg/d, and 2.15 (95% CI, 1.64-2.81) for 100+ mg/d. The magnitude of association between opioid dose and suicide by intentional overdose was not substantially different from that observed for the overall measure of suicide mortality. Risk of suicide mortality was greater among individuals receiving higher doses of opioids, and treatment providers may want to view high opioid dose as a marker of elevated risk for suicide. Additional research is needed on opioid use, pain treatment, and suicide

Recent Suicidal Ideation Among Patients in an Inner City Emergency Department

The rates and associated features of suicidal ideation among 5,641 patients seeking routine, nonsuicide related care in an inner-city emergency department were examined. Approximately 8% of patients seeking routine care in the emergency department reported some form of suicidal ideation within the past 2 weeks. Suicidal ideation was common in individuals who were single with poorer mental health, had higher depression, and had received some drug or alcohol treatment in the past 3 months or had used cocaine or marijuana in the past 30 days. Improved screening procedures could help to identify routine care patients who are at risk for suicide.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79197/1/suli.2009.39.5.508.pd

Managing the complexity of doing it all : an exploratory study on students' experiences when trained stepwise in conducting consultations

Background: At most medical schools the components required to conduct a consultation, medical knowledge, communication, clinical reasoning and physical examination skills, are trained separately. Afterwards, all the knowledge and skills students acquired must be integrated into complete consultations, an art that lies at the heart of the medical profession. Inevitably, students experience conducting consultations as complex and challenging. Literature emphasizes the importance of three didactic course principles: moving from partial tasks to whole task learning, diminishing supervisors' support and gradually increasing students' responsibility. This study explores students' experiences of an integrated consultation course using these three didactic principles to support them in this difficult task. Methods: Six focus groups were conducted with 20 pre-clerkship and 19 clerkship students in total. Discussions were audiotaped, transcribed and analysed by Nvivo using the constant comparative strategy within a thematic analysis. Results: Conducting complete consultations motivated students in their learning process as future physician. Initially, students were very much focused on medical problem solving. Completing the whole task of a consultation obligated them to transfer their theoretical medical knowledge into applicable clinical knowledge on the spot. Furthermore, diminishing the support of a supervisor triggered students to reflect on their own actions but contrasted with their increased appreciation of critical feedback. Increasing students' responsibility stimulated their active learning but made some students feel overloaded. These students were anxious to miss patient information or not being able to take the right decisions or to answer patients' questions, which sometimes resulted in evasive coping techniques, such as talking faster to prevent the patient asking questions. Conclusion: The complex task of conducting complete consultations should be implemented early within medical curricula because students need time to organize their medical knowledge into applicable clinical knowledge. An integrated consultation course should comprise a step-by-step teaching strategy with a variety of supervisors' feedback modi, adapted to students' competence. Finally, students should be guided in formulating achievable standards to prevent them from feeling overloaded in practicing complete consultations with simulated or real patients

Reduction of Low-Thrust Continuous Controls for Trajectory Dynamics

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/76670/1/AIAA-40619-128.pd

Usporedba dinamičke analize para iznad otopine i mikroekstrakcije analita na čvrstoj fazi za plinskokromatografsko određivanje BTEX-a u urinu

The aim of this study was to compare two extraction procedures: dynamic headspace-purge and trap (PT) and headspace solid-phase microextraction (HS-SPME) for gas chromatographic determination of benzene, toluene, ethylbenzene, and isomeric xylenes (BTEX) in urine with photoionization (PID) and mass spectrometric (MS) detection, respectively. Both methods showed linearity in the range of interest [(50-2000) ng L-1], good accuracy (80% to 100 %), and repeatability (RSD≤11 %). Detection limits were in the low ng L-1 level for both methods, although slightly greater sensitivity was found for the PT method. In comparison with PT, HS-SPME was simpler and required less time for analysis. Although the analytical features of both examined methods are appropriate for biomonitoring of environmental exposure to BTEX, only the HS-SPME-GC-MS method is recommended for routine analysis of BTEX in urine. The method was applied for the quantitative analysis of BTEX in urine samples collected from non-smokers (n=10) and smokers (n=10).Cilj ovog rada bio je usporediti dva postupka ekstrakcije za plinskokromatografsko određivanje benzena, toluena, etilbenzena i izomera ksilena u urinu. Uspoređene su dinamička analiza para iznad otopine (tzv. purge and trap) uz fotoionizacijski detektor i mikroekstrakcija analita na čvrstoj fazi uz detektor spektrometar masa. Rezultati upućuju na linearnost odziva detektora u ispitivanome koncentracijskom području [(50- 2000) ng L-1], zadovoljavajuću točnost (80 %-100 %) i ponovljivost (RSD ≤11 %). Postignute su niske granice detekcije za obje metode. Mikroekstrakcija analita na čvrstoj fazi uz detektor spektrometar masa pokazala se jednostavnijom i bržom za izvođenje pa se preporučuje za rutinsko određivanje BTEX-a u urinu. Metoda je primijenjena za analizu tih spojeva u uzorcima urina nepušača (n=10) i pušača (n=10)

Work-Unit Absenteeism: Effects of Satisfaction, Commitment, Labor Market Conditions, and Time

Prior research is limited in explaining absenteeism at the unit level and over time. We developed and tested a model of unit-level absenteeism using five waves of data collected over six years from 115 work units in a large state agency. Unit-level job satisfaction, organizational commitment, and local unemployment were modeled as time-varying predictors of absenteeism. Shared satisfaction and commitment interacted in predicting absenteeism but were not related to the rate of change in absenteeism over time. Unit-level satisfaction and commitment were more strongly related to absenteeism when units were located in areas with plentiful job alternatives

THE ROLE OF INTERDEPENDENCE IN THE MICRO-FOUNDATIONS OF ORGANIZATION DESIGN: TASK, GOAL, AND KNOWLEDGE INTERDEPENDENCE

Interdependence is a core concept in organization design, yet one that has remained consistently understudied. Current notions of interdependence remain rooted in seminal works, produced at a time when managers’ near-perfect understanding of the task at hand drove the organization design process. In this context, task interdependence was rightly assumed to be exogenously determined by characteristics of the work and the technology. We no longer live in that world, yet our view of interdependence has remained exceedingly task-centric and our treatment of interdependence overly deterministic. As organizations face increasingly unpredictable workstreams and workers co-design the organization alongside managers, our field requires a more comprehensive toolbox that incorporates aspects of agent-based interdependence. In this paper, we synthesize research in organization design, organizational behavior, and other related literatures to examine three types of interdependence that characterize organizations’ workflows: task, goal, and knowledge interdependence. We offer clear definitions for each construct, analyze how each arises endogenously in the design process, explore their interrelations, and pose questions to guide future research

UvA-DARE (Digital Academic Repository) Facing differences with an open mind: Openness to experience, salience of intra-group differences, and performance of diverse work groups

. (2008). Facing differences with an open mind: Openness to experience, salience of intra-group differences, and performance of diverse work groups