Sairauspoissaolotarpeen määrittäminen : Kyselytutkimus lääkäreille

Kelan tutkimusosasto ja Suomen Lääkäriliitto toteuttivat vuonna 2014 lääkäreille kohdistetun kyselyn, jonka tarkoituksena on kartoittaa lääkäreiden näkemyksiä ja kokemuksia sairauspoissaoloihin liittyvistä käytännöistä ja kehittämistarpeista. Kysely perustuu vuonna 2012 Ruotsissa tehtyyn kyselyyn. Vastaava kysely toteutettiin myös Norjassa. Kysymykset on muokattu kunkin maan järjestelmään sopiviksi. Kyselylomake lähetettiin 8 867 lääkärille loppuvuodesta 2014, ja siihen saattoi vastata joko paperisella tai sähköisellä lomakkeella. Vastausprosentti oli 34,8. Rakenteeltaan aineisto edusti perusjoukkoa, joskin työterveyshuolto oli hieman yliedustettuna. Lääkärit pitivät julkisen sektorin palvelujen saatavuutta keskeisenä syynä sairauspoissaolojen pitkittymiseen. Myös vajaakuntoisten työntekijöiden työssä jaksamista tukevien toimenpiteiden saatavuus vaikutti sairauspoissaolojen kirjoittamiseen. Kelalta toivottiin enemmän palautetta lääkärien omasta toiminnasta. Lääkärien osaamisen kehittämistarpeet korostuivat erityisesti terveyskeskuksissa, mutta koulutusta tarvitsevien osuus on varsin suuri muillakin toimintasektoreilla. Lääkärit toivoivat laajasti, erikoistumisalasta tai toimipaikasta riippumatta, vähintäänkin joitakin sairauksia koskevia kansallisia suosituksia sairauspoissaolojen kestosta. Nykyisiä käytettävissä olevia ohjeita ja suosituksia monet lääkärit pitivät tärkeinä. Työterveyslääkärit erottuivat monissa kohdin omaksi ryhmäkseen. He näyttävät hallitsevan työkyvyn ja sairauspoissaolon tarpeen arviointiin liittyvät tehtävät parhaiten. Suomalaiset lääkärit kokivat ruotsalaisia ja norjalaisia perusterveydenhuollon lääkäreitä vähemmän ongelmia sairauspoissaoloon liittyvissä asioissa. Tutkimuksen perusteella annetuissa suosituksissa esitetään puuttumista jatkohoidon ja kuntoutukseen pääsyn viiveisiin, työkyvyn arviointiin liittyvän koulutuksen lisäämistä, sairauspoissaolotarpeen siirtämistä enemmän työterveyshuollon vastuulle sekä sairauspoissaolojen kestoa koskevien suositusten laatimista ainakin joistakin sairauksista

Mapping the categories of the Swedish primary health care version of ICD-10 to SNOMED CT concepts: Rule development and intercoder reliability in a mapping trial

<p>Abstract</p> <p>Background</p> <p>Terminologies and classifications are used for different purposes and have different structures and content. Linking or mapping terminologies and classifications has been pointed out as a possible way to achieve various aims as well as to attain additional advantages in describing and documenting health care data.</p> <p>The objectives of this study were:</p> <p>• to explore and develop rules to be used in a mapping process</p> <p>• to evaluate intercoder reliability and the assessed degree of concordance when the 'Swedish primary health care version of the International Classification of Diseases version 10' (ICD-10) is matched to the Systematized Nomenclature of Medicine, Clinical Terms (SNOMED CT)</p> <p>• to describe characteristics in the coding systems that are related to obstacles to high quality mapping.</p> <p>Methods</p> <p>Mapping (interpretation, matching, assessment and rule development) was done by two coders. The Swedish primary health care version of ICD-10 with 972 codes was randomly divided into an allotment of three sets of categories, used in three mapping sequences, A, B and C. Mapping was done independently by the coders and new rules were developed between the sequences. Intercoder reliability was measured by comparing the results after each set. The extent of matching was assessed as either 'partly' or 'completely concordant'</p> <p>Results</p> <p>General principles for mapping were outlined before the first sequence, A. New mapping rules had significant impact on the results between sequences A - B (p < 0.01) and A - C (p < 0.001). The intercoder reliability in our study reached 83%. Obstacles to high quality mapping were mainly a lack of agreement by the coders due to structural and content factors in SNOMED CT and in the current ICD-10 version. The predominant reasons for this were difficulties in interpreting the meaning of the categories in the current ICD-10 version, and the presence of many related concepts in SNOMED CT.</p> <p>Conclusion</p> <p>Mapping from ICD-10-categories to SNOMED CT needs clear and extensive rules. It is possible to reach high intercoder reliability in mapping from ICD-10-categories to SNOMED CT. However, several obstacles to high quality mapping remain due to structure and content characteristics in both coding systems.</p

Revisiting the association between candidal infection and carcinoma, particularly oral squamous cell carcinoma

Background: Tobacco and alcohol are risk factors associated with cancer of the upper aerodigestive tract, but increasingly the role of infection and chronic inflammation is recognized as being significant in cancer development. Bacteria, particularly Helicobacter pylori, and viruses such as members of the human papilloma virus family and hepatitis B and C are strongly implicated as etiological factors in certain cancers. There is less evidence for an association between fungi and cancer, although it has been recognized for many years that white patches on the oral mucosa, which are infected with Candida, have a greater likelihood of undergoing malignant transformation than those that are not infected. Objective: This article reviews the association between the development of oral squamous cell carcinoma in potentially malignant oral lesions with chronic candidal infection and describes mechanisms that may be involved in Candida-associated malignant transformation

The Effects of Debonding on the Low-Velocity Impact Response of Steel-CFRP Fibre Metal Laminates

The effect of metal-composite debonding on low-velocity impact response, i.e. on contact force–central deflection response, deformation profiles and strains on the free surfaces was studied. We focused on type 2/1 fibre metal laminate specimens made of stainless steel and carbon fibre epoxy layers, and tested them with drop-weight impact and quasi-static indentation loadings. Local strains were measured with strain gauges and full-field strains with a 3-D digital image correlation method. In addition, finite element simulations were performed and the effects of debonding were studied by exploiting cohesive elements. Our results showed that debonding, either the initial debonding or that formed during the loading, lowers the slope of the contact force–central deflection curve during the force increase. The debonding formation during the rebound phase was shown to amplify the rebound of the impact side, i.e. to lower the ultimate post-impact deflection. The free surface strains were studied on the laminate’s lower surface at the area outside the debond damage. In terms of in-plane strains, debonding formation during impact and indentation, as well as the initial debonding, lowered the peripheral strain and resulted in a positive change in the radial strain

Antibiotic resistance in European wastewater treatment plants mirrors the pattern of clinical antibiotic resistance prevalence

Integrated antibiotic resistance (AR) surveillance is one of the objectives of the World Health Organization global action plan on antimicrobial resistance. Urban wastewater treatment plants (UWTPs) are among the most important receptors and sources of environmental AR. On the basis of the consistent observation of an increasing north-to-south clinical AR prevalence in Europe, this study compared the influent and final effluent of 12 UWTPs located in seven countries (Portugal, Spain, Ireland, Cyprus, Germany, Finland, and Norway). Using highly parallel quantitative polymerase chain reaction, we analyzed 229 resistance genes and 25 mobile genetic elements. This first trans-Europe surveillance showed that UWTP AR profiles mirror the AR gradient observed in clinics. Antibiotic use, environmental temperature, and UWTP size were important factors related with resistance persistence and spread in the environment. These results highlight the need to implement regular surveillance and control measures, which may need to be appropriate for the geographic regions.This work was financed by the Water JPI through the national funding agencies supporting the consortium WaterJPI/0001/2013 STARE—“Stopping Antibiotic Resistance Evolution” (Cyprus, RPF; Germany, BMBF; Spain, MINECO; Finland, AKA; Ireland, EPA; Norway, RCN; Portugal, FCT). I.V.-M. was supported by the FCT grant SFRH/BPD/87360/2012, C.N.-d.-R. by the FCT grant SFRH/BD/97131/2013, and I.H. by the FCT contract IF/00492/2013. Other funders: A grant from the Michigan State University Center for Health Impacts of Agriculture (CHIA) and the National Natural Science Foundation of China (21677149)

Participatory design of a persuasive mobile application for helping entrepreneurs to recover from work

Abstract Involving end-users in a participatory design process may help researchers and developers to gain better understanding of the end users’ views about the target system. In this study, we utilized participatory design approach with focus group meetings and participatory design workshops to figure out requirements for persuasive features of a mobile application for entrepreneurs to recover from work related strain and stress. In many cases, end-user participation in the design process may lead into building more efficient persuasive technology solutions and at least avoidance of many of the design pitfalls, but setting up meetings and organizing workshops can be time-consuming

Experimental and Numerical Investigation of Metal Type and Thickness Effects on the Impact Resistance of Fiber Metal Laminates

The impact response of fiber metal laminates (FMLs), has been investigated with experiments and numerical simulations, which is reported in this article. Low-velocity impacts were carried out to study the effects of metal type and thickness within FMLs. Glare5-3/2 laminates with two aluminum layer thicknesses and a similar FML containing magnesium sheets were impacted by drop weight tests. Also, a major part of this study was to accomplish a dynamic non-linear transient analysis to study the impact response of FMLs using the commercial finite element (FE) analysis code ABAQUS. By reviewing different approaches of modeling constituents of an FML, it is shown that the appropriate selection of elements hasmore significant role than failure criterion to predict acceptable results for this type of laminate and loading. The good agreement obtained between experimental and numerical results verifies the possibility of relatively simpler simulation by FE-analysis to predict overall response of FMLs under impact loading.Aerspace Structures and MaterialsAerospace Engineerin