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Olfactory Dysfunction in Healthcare Workers with COVID-19: Prevalence and Associated Factors.

The COVID-19 pandemic is a real global health crisis. Its clinical presentation has evolved over time with an increasing number of symptoms. Olfactory dysfunction (OD) has recently been recognized as a frequent symptom relevant to screening for COVID-19, especially in pauci-asymptomatic forms. However, the underlying mechanisms of OD are not yet fully understood. To determine the prevalence of OD in healthcare workers with SARS-CoV-2 and to identify its associated factors. This is a cross-sectional, analytical study, carried out during a period of six months and including all healthcare workers at Farhat Hached Academic Hospital (Tunisia) who were diagnosed with SARS-CoV-2 by PCR, RAT, or chest CT scan. A total of 474 healthcare workers were included, representing a participation rate of 85.4%. The mean age was 41.02±10.67 years with a sex ratio of 0.2. The distribution of this population by department noted that it was mainly maternity (13.9%). The most presented workstation was nursing (31.4%). OD represented 39.2% of the reasons for consultation. Hospitalization was indicated in 16 patients (3.4%). The average duration of hospitalization was 8.87 ± 7.8 days. The average time off work was 17.04 ± 11.6 days. OD persisted for more than 90 days in 35 patients (7.4%). After multiple binary logistic regression, OD was statistically associated with female gender (p =0.001; OR 95% CI: 2.46 [1.4-4.2]) and blue-collar occupational category (p =0.002; OR IC95%:3.1 [1.5-6.5]). A significant association was also noted between OD and professional seniority and absence from work duration (p =0.019; OR 95% CI: 0.97 [0.95-0.99] and p =0.03; OR 95% CI: 0.97 [0.95-0.99]) respectively. OD is common in COVID-19 patients. The identification of its associated factors may contribute to enhancing the understanding of its mechanism and drive therapeutic options.

Social adjustment in survivors of acute lymphoblastic leukemia without cranial radiation therapy.

To evaluate group differences in social adjustment in survivors of pediatric acute lymphoblastic leukemia (ALL) compared to survivor siblings and controls; identify disease-related predictors of social adjustment in survivors; and explore whether executive functioning explained differences in social adjustment across groups and between disease-related predictors. Survivors of pediatric ALL (n=38, average age at diagnosis=4.27years [SD=1.97]; average time off treatment=4.83years [SD=1.52]), one sibling (if available, n=20), and one parent from each family were recruited from a long-term survivor clinic. Healthy age- and sex-matched controls (n=38) and one parent from each family were recruited from the community. Parents completed the Behavioral Assessment System for Children, Parent Rating Scale (BASC-3) Social Withdrawal subscale as a measure of social adjustment, and the Behavior Rating Inventory of Executive Functions (BRIEF-2) as a measure of executive function for each of their children. Multilevel modeling and mediation analysis were used to achieve the study aims. Parents reported that survivors had significantly worse social adjustment compared to controls (b=6.34, p=.004), but not survivor siblings. Among survivors, greater time off treatment (b=2.06, p=.058) and poorer executive functioning (b=0.42, p=.006) were associated with worse social adjustment. Executive function did not mediate differences in social withdrawal between survivors and controls or the relationship between time off treatment and social withdrawal among survivors. Survivors of pediatric ALL presenting to follow-up programs should be screened for difficulties with social adjustment. Future research should examine treatment- and nontreatment-related factors contributing to poorer social outcomes.

Indications, functional results and patient satisfaction after isolated second ray resection following traumatic injury: A retrospective review of 25 patients

Amputation of the second ray is a surgical treatment option when reconstruction and/or reimplantation fail. The aim of our study was to review the outcomes after transmetacarpal resection of the second ray following a post-traumatic injury and to assess indications, functional outcomes, and patient satisfaction. Between January 2003 and December 2013, 25 patients (6 women and 19 men with a mean age of 51 years) underwent transmetacarpal resection of their second ray after a post-traumatic injury. Sixteen patients were right-handed and 9 were left-handed. Injuries involved the dominant hand in 14 cases (60%). In order to differentiate patients with preserved index finger length preoperatively from those with a shorter, amputated index finger stump, patients were divided into 2 groups. Group 1 included those with an “intact finger” and Group 2 included patients with an “amputated stump”. Data collection, including patient satisfaction and functional outcomes, was performed at 83 months postoperative on average. Average length of follow-up was 7.0±1.0 years (range 5–12 years). Group 1 (intact finger) and 2 (amputated stump) included 15 and 10 patients, respectively. Six patients (24%) had primary ray amputation and 19 (76%) had secondary ray amputation. No surgical revision was necessary. In Group 1, the indications were purely functional in all but two cases, whereas aesthetic indications played a role in all patients in Group 2. The average total time off work was 3 months. There was no difference between Group 1 and 2 (P>0.05). However, patients with primary ray resection averaged 10 weeks of lost work compared to 17 weeks for secondary amputation. There was no functional difference between Groups 1 and 2. Scores for cosmetic appearance and patient satisfaction were higher in Group 2. In certain specific situations after complex hand trauma, transmetacarpal amputation of the second ray is indicated as soon as possible, in order to reduce the time off work. Patient satisfaction following this surgical procedure is high, especially in groups with amputated stumps. A 30% decrease in pinch and grip strength is the rule. No secondary surgery is normally required.

Evaluation treatment modalities of the pilonidal disease

Background: The pilonidal disease is a minor surgical pathology that has distressful complications. Many original and newer treatment modalities have been used in its management (including excisional and conservative surgical approaches). However, there is non-consensus on any one of them and the main reason is the significant recurrence rate. The objective of the study was to evaluate the excisional surgical modalities and conservative surgical approach in management the pilonidal disease.Methods: A prospective study enrolled 98 patients (80 males vs. 18 females) with chronic sacrococcygeal pilonidal disease. The ages range is 15-42 years. Group IA were treated by simple excision with primary closure, group IB by simple excision with Z- plasty and group II by conservative surgical approach. The wound complications (wound disruption and infection), length of hospital stays, recurrence rate, patients' satisfaction, and the cosmetic appearance were recorded.Results: The excision and Z-plasy has the least recurrence rate, wound complications rate and average time off work days. The simple excision with primary closure has the highest patient's cosmetic satisfaction. Conservative surgical approach has the worst results (recurrence rate 75%, wound infection rate 65%, 21 days average time off work and two days average length of hospital stay)..Conclusions: The Z-plasty is superior to other methods (has the least recurrence rate). The conservative treatment has non-encouraging results, we recommend it for patients unwilling excisional surgery.

Hip and groin pain in sub-elite South African footballers

Background. Groin injuries are common in football. This can be attributed to the nature of the sport involving rapid accelerations, decelerations, abrupt directional changes and kicking. Groin injuries require lengthy rehabilitation times and predispose players to further injuries. Previous groin injury is a risk factor for future groin injuries, suggesting players are inadequately rehabilitated or the original cause has not been addressed. Objectives. To describe the prevalence, nature and treatment patterns of groin injuries in sub-elite players, and to investigate differences in hip strength and range of motion between players with and without a history of groin injury. Method. Thirty sub-elite, senior university male players were interviewed and questioned regarding groin injuries sustained in the preceding three years. They were assessed using the HAGOS questionnaire, and underwent isokinetic hip flexion/extension strength, adductor squeeze and range of motion tests. Results. Seventeen players (57%) reported having a previous groin injury, with an average score of 83 (16) [mean (SD)] on the HAGOS, compared with 92 (5) for non-injured players. Of the previously injured players, 29% did not seek treatment from a medical professional. Injuries included adductor strain (35%), inguinal-related (18%), iliopsoas-related (12%) and hip joint pathology (6%). The average time off was 25 days. There were no significant differences in isokinetic hip flexion/extension strength, adductor strength and range of motion. Conclusion. The prevalence of groin injuries in this population is relatively high (57%) and requires lengthy rehabilitation time. The HAGOS is a suitable tool to identify groin pain in this population within the sports and recreation and quality of life subscales. Isokinetic hip strength and range of motion testing lacked sensitivity in detecting deficits in players with a previous groin injury. Only two-thirds of injured players consulted a medical practitioner, increasing the likelihood that rehabilitation was inadequate. It is therefore recommended that player/coach education regarding injury management improve in order to reduce subsequent injuries. Keywords. HAGOS, groin injury, prevalence, range of motion, isokinetic strength

The incidence of injuries and exposure time of professional football club players in the Premier Soccer League during football season

Background. Data on the incidence of football injuries and exposure time of players during matches and training in the South African (SA) Premier Soccer League (PSL) are lacking. Objective. To calculate the incidence of injuries and the exposure time (practice and match) of the players of a PSL team over a full season. Methods. Injury and training data of the players in the squad (N=32) were recorded on a daily basis by the medical support staff, according to the methods of the Football Medical Assessment and Research Centre (F-MARC) protocol. Results. One hundred and thirty injuries were recorded in the season. The most affected body parts were the thigh (n=27, 21%) and ankle (n=27, 21%). The overall incidence was 13.4 injuries per 1 000 player-hours. The incidence during training was 6.6 injuries/1 000 playerhours and during matches 88.9 injuries/1 000 player-hours. The most frequent injury was haematoma/contusion/bruising (n=43, 33%). Of the total injuries, 12% were recurrent. Injury through contact with another player was high (62%). Seventy-six per cent of the injuries were not associated with any violation of the laws of the game. The average time off due to injury was 8 days. The total exposure time over the full season resulted in a combined average of 18 162 minutes (~303 hours). Conclusion. These data differ from the data in European studies. Injury and exposure data measured throughout the season have the potential to identify risks and mechanisms of injuries. This study highlights the necessity for all clubs in the PSL to adopt a standardised injury monitoring programme, using standardised methodology, so that the management of professional players in SA may be improved.

Mid-term results after surgical resection of calcifying enthesiopathy of the Achilles tendon

Purpose The purpose of this study was to present the surgical technique together with the mid-term results for patients with calcifying tendinitis of the distal insertional part of the Achilles tendon. Materials and methods A total of 43 patients (23 female and 20 male), with a mean age of 54.8 (range: 21–71) years at the time of surgery, were operated between 1999 and 2012. Four patients underwent bilateral surgery, with a total of 47 feet undergoing the resection of the calcifying enthesiopathy of the Achilles tendon. A total of five patients were lost to follow-up including two patients who withdrew from the study. Subsequently, 39 patients were followed up with an average of 57.4 (6–144) months after surgery. Clinical and radiological evaluations were carried out and the hindfoot American Orthopedic Foot and Ankle Society score was used before and after the surgery. Results The postoperative American Orthopedic Foot and Ankle Society score at the time of the final follow-up was 88.9 (69–100) points. No ruptures of the Achilles tendon were documented in this study. There were two wound infections in need of revision surgery, and two cases of distal deep vein thrombosis. Overall, 70% of the patients worked at the time of the final follow-up. The average time off work reported in this cohort of patients was 10.5 (6–24) weeks. Conclusion The longitudinal incision of the Achilles tendon with distal release of the tendon and reinsertion with a suture anchor is a reliable procedure for the treatment of calcifying tendinitis of the Achilles tendon with good to excellent results for the majority of patients.

The incidence of injuries and exposure time of professional football club players in the Premier Soccer League during football season

Background. Data on the incidence of football injuries and exposure time of players during matches and training in the South African (SA) Premier Soccer League (PSL) are lacking. Objective. To calculate the incidence of injuries and the exposure time (practice and match) of the players of a PSL team over a full season. Methods. Injury and training data of the players in the squad (N=32) were recorded on a daily basis by the medical support staff, according to the methods of the Football Medical Assessment and Research Centre (F-MARC) protocol. Results. One hundred and thirty injuries were recorded in the season. The most affected body parts were the thigh (n=27, 21%) and ankle (n=27, 21%). The overall incidence was 13.4 injuries per 1 000 player-hours. The incidence during training was 6.6 injuries/1 000 playerhours and during matches 88.9 injuries/1 000 player-hours. The most frequent injury was haematoma/contusion/bruising (n=43, 33%). Of the total injuries, 12% were recurrent. Injury through contact with another player was high (62%). Seventy-six per cent of the injuries were not associated with any violation of the laws of the game. The average time off due to injury was 8 days. The total exposure time over the full season resulted in a combined average of 18 162 minutes (~303 hours). Conclusion. These data differ from the data in European studies. Injury and exposure data measured throughout the season have the potential to identify risks and mechanisms of injuries. This study highlights the necessity for all clubs in the PSL to adopt a standardised injury monitoring programme, using standardised methodology, so that the management of professional players in SA may be improved.

Hip and groin pain in sub-elite South African footballers

Background. Groin injuries are common in football. This can be attributed to the nature of the sport involving rapid accelerations, decelerations, abrupt directional changes and kicking. Groin injuries require lengthy rehabilitation times and predispose players to further injuries. Previous groin injury is a risk factor for future groin injuries, suggesting players are inadequately rehabilitated or the original cause has not been addressed. Objectives. To describe the prevalence, nature and treatment patterns of groin injuries in sub-elite players, and to investigate differences in hip strength and range of motion between players with and without a history of groin injury. Method. Thirty sub-elite, senior university male players were interviewed and questioned regarding groin injuries sustained in the preceding three years. They were assessed using the HAGOS questionnaire, and underwent isokinetic hip flexion/extension strength, adductor squeeze and range of motion tests. Results. Seventeen players (57%) reported having a previous groin injury, with an average score of 83 (16) [mean (SD)] on the HAGOS, compared with 92 (5) for non-injured players. Of the previously injured players, 29% did not seek treatment from a medical professional. Injuries included adductor strain (35%), inguinal-related (18%), iliopsoas-related (12%) and hip joint pathology (6%). The average time off was 25 days. There were no significant differences in isokinetic hip flexion/extension strength, adductor strength and range of motion. Conclusion. The prevalence of groin injuries in this population is relatively high (57%) and requires lengthy rehabilitation time. The HAGOS is a suitable tool to identify groin pain in this population within the sports and recreation and quality of life subscales. Isokinetic hip strength and range of motion testing lacked sensitivity in detecting deficits in players with a previous groin injury. Only two-thirds of injured players consulted a medical practitioner, increasing the likelihood that rehabilitation was inadequate. It is therefore recommended that player/coach education regarding injury management improve in order to reduce subsequent injuries. Keywords. HAGOS, groin injury, prevalence, range of motion, isokinetic strength

Les transferts articulaires pédiculés au niveau des doigts

Objectives We report a retrospective series of 27 cases of composite island homodigital distal interphalangeal joint to replace proximal destroyed interphalangeal joint. Results of our series are compared with other procedures available in order to specify the place of pedicled articular transfers mainly for the proximal interphalangeal joint which is recognized as the most important joint in the finger. Methods The series included 27 cases of destroyed proximal interphalangeal joints with preservation of the distal interphalangeal joint, the flexor tendon and vascular pedicles. The mean age was 32 years, 26 male, all manual workers. All fingers were concerned mainly the third (13 cases) and the fourth (10 cases). Results No vascular failure. Pain cotation improved from 7 preoperatively to 2 postoperatively. Average flexion-extension motion arc was 43°. The grip strength was 54% compared to the opposite side. The average time off work was 7 months. Complications were few, all of them due to technical imperfections underlining the difficulty of this procedure. This transfer deserves his use due to the better mobility he gives compared to the other techniques available. Conclusions Reconstruction of important articular loss of substance in a digit remains an unsolved problem, especially for the proximal interphalangeal joint representing the anatomical and functional center of the digit. However, in certain good indications, especially in emergency it deserves to be used.

Time Off Work in Hand Injury Patients

To evaluate the average time off work for patients with hand injuries as well as factors influencing the length of time off work for subjects who had returned to work. A total of 124 subjects were recruited and followed up 2 weeks after being discharged from therapy or until they resumed work. Factors affecting the time off work such as the severity of injury, number of operations, educational level, physical job demand, and presence of compensation claims, complications, and posttraumatic stress were also examined by multiple regression. The relationship between the severity of injury, time off work, and length of rehabilitation time was also examined. In 124 subjects, 109 resumed their previous jobs, with an average of 8 weeks off work and 9 weeks in regular rehabilitation. The result shows that the severity of injury, number of operations, and presence of compensation claims were the predictors for the length of time off work in hand injury patients. In addition, the time off work and length of rehabilitation time increased with more severe injury. However, a cross-over was noted in the severe grade of severity of injury; that is, the time off work was shorter than the length of rehabilitation time for those with a less severe level of injury (minor to moderate level) and vice versa for those with major severity of injury. To a certain extent, the result enhances our understanding of prolonged time off work after hand injury and may help to optimize rehabilitation after injury. For those who are in the high-risk group with factors that are not under control, early planning and retraining should be given to avoid prolonged time off work.

Lower Recurrence Rate for Limberg vs . V-Y Flap for Pilonidal Sinus

Pilonidal sinus is a disease that does not have a standardized surgical treatment method. This study was designed to compare the outcomes of Limberg fasciocutaneous transposition and V-Y fasciocutaneous advancement flaps in the treatment of patients with pilonidal sinus. A total of 111 patients (98 males; 88.3 percent; mean age, 27.1 years) who received reconstruction after pilonidal sinus excision in our clinics with Limberg flap (Group 1, n = 66, 59.5 percent) or V-Y flaps (Group 2, n = 45, 40.5 percent) between 1997 and 2004 were investigated retrospectively. No significant difference was detected between Groups 1 and 2 in terms of gender, history of infection or abscess, mean duration of operation, requirement for analgesics, wound-related complications, such as necrosis, seroma, and infection, and average time off work. Mean follow-up periods were 45.4 vs. 48.8 months in Group 1 and Group 2, respectively (P = 0.337). On the other hand, rate of recurrence was significantly lower in Group 1 (n = 1, 1.5 percent) compared with Group 2 (n = 5, 11.1 percent; P = 0.039). We conclude that, if the defect is to be reconstructed with a flap in pilonidal sinus cases, reconstruction with Limberg flap should be preferred over reconstruction with V-Y flap because of its lower rate of recurrence.

TBI and Allogeneic BMT Do Not Appear To Hinder Growth in Pediatirc Patients with AML Treated on POG 9421 (Now Children's Oncology Group).

The role of allogeneic bone marrow transplantation (BMT) in the treatment of pediatric patients (PT) with de novo AML continues to be discussed: Who should receive BMT? Should BMT be done during the first complete remission (CR)? In the POG 9421 trial 654 PTs with AML were genetically randomized between allogeneic BMT or a chemotherapy regimen; this protocol has been previously published. If a matched sibling was identified during induction, and CR was achieved, the PT received BMT after the second course of induction chemotherapy. The BMT preparative regimen consisted of Total Body Irradiation (TBI; 1200 cGy given as 150 cGy bid for 4 days) and high dose etoposide (60 mg/Kg IV over 4 hrs on day -3). Methotrexate and cyclosporine comprised the GVHD prophylaxis. The use of TBI in prepubertal children is a concern of many clinicians. We are analyzing growth and development data from the PTs who completed the induction and BMT regimen of POG9421 and present here the body mass index (BMI) findings from those PTs whose height and weight data were supplied to the COG Data Center. Of the 654 PTs registered on POG 9421, 32 were ineligible due to wrong diagnosis or major protocol violation. 501 non-Down Syndrome PTs were eligible for BMT if a matched sibling donor was located. 89 (17.8%) of the patients had a donor, proceeded to BMT, and were eligible for evaluation. Of those, 53 (60%) had data supplied for height (ht) and weight (wt) after BMT. Time from BMT ranged from 6 months to 5 yrs and PTs age at diagnosis ranged from 1–20 years. The height data were divided into 2 age groups, <= 10 yrs at diagnosis and > 10 yrs at diagnosis. The younger group consisted of 19 males and 12 females. Of these, 2 males and 2 females had heights that were below the 3rd percentile at last follow-up. The BMI data were then sorted into 2 age groups: <= 14 yrs and > 14 yrs at the time most recent ht and wt data were supplied. The mean age of the younger group was 7.6 yrs and and that of the older group was 17 yrs. The average BMI of the younger group was 18.19, and that of the older group was 22.85. The average time off therapy when the BMI was calculated was 2.3 yrs for both groups. In the young group, 3 males and 1 female were obese; in the older group, 2 males were overweight and 1 male and 1 female were obese. The median BMIs in the young group were 17 at the 84th percentile for females and 17.8 at the 65th percentile for males; those values in the older group were 19.6 for females and 21.3 for males. Percentile is not given for older patients. In conclusion, the BMT preparative regimen did not cause a severe acute change in BMI in this population. Overweight or obesity was not a common problem in this group, and after 4 yrs follow-up, short stature was not evident. Further data regarding stature will need to be evaluated to determine other long term growth effects of TBI and allogeneic BMT in the younger population with AML.

Results of secondary single ray resection without transposition of an adjacent digit

In this study, we retrospectively reviewed and analysed results of secondary single ray resection in ten patients (eight males and two females) whose average age was 40.5 years (range, 27–64 years). The mean time for surgery after initial injury was 34.5 months (range, 1–300 months). There were seven manual workers, two intellectual workers, and one student. Cases were reviewed 3–12 years after surgery (median, 6 years). Nine patients were right-handed and one was left-handed. The injuries involved five dominant hands (50%) and five nondominant hands. Lesions touched preferably border digits in eight cases (seven index and one fifth), and central digits in two cases (one long and one ring). Patients had an average total time off from work of 5.1 months (range, 3–8 months), and an average time of 2.4 months (1–4 months) if considered only the post-operative period after ray resection. The patients were all re-evaluated questionnaires, physical examination, and functional testing. Seven of the ten patients (70%) returned to their pre-injury activity. On the whole, seven results have been considered as excellent; two as good and one as medium. However, despite these good results and in order to decrease the long time period lost off work, to avoid disability and high social cost, we believe that primary ray resection could be proposed to patients in some elective cases as an alternative choice for a better result, taking into consideration certain decisional factors particularly age, sex, occupation, dominant hand, severity of injuries, as well as the advantages and inconveniences of primary or secondary ray resection.

Consecutive Versus Simultaneous Bilateral Carpal Tunnel Release

Many patients have symptoms of bilateral carpal tunnel syndrome and require surgical release of both hands. Despite the intuitive savings to both the patient and the institution of simultaneous carpal tunnel release, many surgeons choose to repair one hand at a time under the assumption that the morbidity and disability following surgery, such as pain and hand incapacity, would be too great if both hands were repaired simultaneously. We reviewed the charts of 108 patients who underwent bilateral carpal tunnel release to ascertain information on both the relative costs and morbidities of the 2 approaches; mean follow-up time was 2.6 years. With regard to costs, the average number of clinic visits for the simultaneous group was 2 versus 4.5 for the consecutive group (P < 0.0001). The mean total operating room time for the simultaneous group was 48.5 minutes versus 72.5 minutes for the consecutive group (P < 0.0001). The average time off work for the simultaneous group was 3.25 weeks versus 6 weeks for the consecutive group (P = 0.08). To evaluate morbidity, 62 patients consented to telephone interviews regarding the outcome of their surgery, 51 of whom had undergone simultaneous release. Of the 51 patients who underwent simultaneous release, 48 (94%) were satisfied with the overall results of their surgery, and 38 (75%) stated that they would undergo simultaneous release again. All 11 patients in the consecutive group were satisfied with the results of their surgery and would do it again (P = 0.21 and 0.03, respectively). On the basis of these findings, we conclude first, the overall costs associated with simultaneous release are considerably less than consecutive bilateral release, and second, the disability following simultaneous bilateral carpal tunnel release is no greater than that following consecutive bilateral release. We, therefore, recommend simultaneous bilateral carpal tunnel release in patients who have bilateral carpal tunnel syndrome.

Return-to-Work Interval and Surgery for Carpal Tunnel Syndrome. Results of a Prospective Series of 233 Patients

To evaluate the connection between the type of patient insurance and the time taken to return to work after carpal tunnel surgery. Two hundred and thirty-three patients in full-time work were operated on for carpal tunnel syndrome between 1 January and 30 June 1998. They were divided into three groups: independent workers (n=87), wage earners in the private sector (n=90) and civil servants (n=56). Four categories were defined: manual workers, non-manual workers, patients with social security insurance and patients with workers compensation. The average return-to-work interval after surgery for each of the groups was evaluated and compared group by group. For independent workers the average time off work is 17 days, for those in the private sector it is 35 days, and for civil servants it is 56 days. Patients with social security insurance were off work for 32 days and those with workers compensation for 49 days. The comparison shows significant differences with regard to social security insurance: the return-to-work interval in civil servants is larger than for private sector workers, and this is higher than in independent workers. The difference between patients with workers compensation and those with social security insurance is 17 days and significant. There is a significant difference between manual and non-manual workers in independent and private sector workers. There is no significant difference between the sub-groups in the civil servants. These cross references enable us to work out the influence that social security status has on the return-to-work time following surgery.

Pacientes hiperfrecuentadores de un centro de atención primaria: características sociodemográficas, clínicas y de utilización de los servicios sanitarios

To find the social and clinical characteristics of patients over-using (OUP) our centre. To find how much these patients use the health services. Observational, descriptive study. Urban primary care centre (36 408 inhabitants). Patients over 15 seen at the centre during the year 2000, who exceeded in their number of attendances the mean plus two standard deviations for their age group. The records of OUPS were reviewed to analyse their social and demographic characteristics, kinds of attendance, reasons for consultation, further tests, medication, referrals, and time off work this year. The sample was of 954 OUPs, 50.9% of whom were male with an average age of 50.54 (SD, 19.68). 86.3% had some risk factor recorded (34% hypertension, 32.4% mental health, 27.7% obesity, 25.7% tobacco dependency, 17.7% diabetes mellitus). They generated a mean of 9.6 visits to the doctor per year, with 95% CI (8.09-11.19), with the most common reason for attendance the monitoring of acute pathology (19.29%), followed by monitoring of chronic pathology (14.32%). There was an average of 1 analysis per OUP per year, and 0.68 image tests per OUP per year (48.38% were simple x-rays). 46.8% of the medication prescribed were analgesics. Average time off work was 0.5 periods off per OUP per year, with a mean period of 49.4 days off (SD, 113.69). They engendered an average of 4.15 nursing visits per OUP per year, 95% CI (2.60-5.70), with monitoring of chronic pathology the most common reason for consultation. 30.3% of OUP had a visit to hospital casualty recorded, with osteo-muscular pathology the most common reason for consultation (34.29%). Mean referrals were 0.88 OUP per year, with traumatology being the department to which most referrals were made (13.92%). OUP are middle-aged, have associated chronic pathology and use programmed appointments a lot. The additional tests conducted matched the centre's procedures for monitoring chronic pathologies. The most common reason for attendance at casualty was traumatology, as was the specialist clinic to which most referrals were made.

Gaps in use of antipsychotics after discharge by first-admission patients with schizophrenia, 1989 to 1996.

The authors examined gaps in the use of antipsychotic medications during the one-year period after discharge in an epidemiological sample of 189 first-admission patients with schizophrenia between July 1989 and January 1996. Sixty-three percent of the patients had one or more such gaps, and 51 percent had gaps of 30 days or longer, with an average total time off medication of about seven months. Most gaps occurred soon after discharge, and 73 percent were initiated by the patient. These data, which were obtained before the widespread use of atypical antipsychotic agents, provide a benchmark against which to examine the impact of the newer medications on adherence and continuity of treatment in the critical early stages of schizophrenia.

Calcaneal fractures in the industrial patient.

A retrospective review was performed on industrial patients who sustained calcaneal fractures within the State of Idaho during the years 1992 to 1994, and these patients were insured by the Idaho State Insurance Fund. Of 48 calcaneal fractures that occurred during this period, 18 were non-displaced extra-articular fractures and 30 were displaced intra-articular fractures. An independent evaluator contacted each patient and performed chart reviews regarding the work history, period of time off work, and cost incurred with the injury. A total of 24 primary surgical procedures were performed on patients who sustained a displaced intra-articular calcaneal fracture and 31 secondary procedures were performed including wound debridement, hardware removal, skin grafting, and secondary subtalar fusion. For patients whose calcaneal fractures could be treated with non-operative care, the average time from injury until return to work was 18 weeks, and the average total cost of injury was $14,230. For patients whose calcaneal fractures required open reduction and internal fixation, the average time loss from work was 35 weeks, and the average total cost of injury was $31,004. Seven patients whose calcaneal fractures were initially treated with an open reduction, internal fixation later underwent a hindfoot arthrodesis. The average time off work for these patients was 69 weeks and the average total cost of injury was $65,384. Fractures were rated on postoperative radiographs according to the quality of their operative reduction. Fractures that were non-anatomically reduced had an increased tendency to require a subtalar fusion. Nine patients sustained other injuries associated with their calcaneal fracture and three patients sustained an open fracture. Both concurrent injuries and open fractures were associated with increased total cost and increased time off work. The total cost of injury was doubled as was time off work when an open reduction and internal fixation was followed later by a secondary subtalar arthrodesis.

Duración de la incapacidad temporal por tuberculosis

To determine the average length of time off work in working persons ill with tuberculosis in a health district. Descriptive and retrospective. Community level, within a health district. Persons diagnosed between 1989 and 1998 with tuberculosis which caused time off work. An epidemiological data base of people with tuberculosis was crossed with the time-off-work records of the district's medical inspectorate, producing 58 patients. Average time off work was 220.3 days. Mean age was 37, almost all men (93.1%). 36.2% of the workers were miners, with their time off work greater than other workers (p = 0.003). No significant differences in the length of time off work were found for the variables of age, sex, health district, type of tuberculosis or year of diagnosis. We found that time off work lasted much longer than is customary, and was related to the hardship of the physical work. Return to work should be posed when there is clinical improvement in the patient and a definitive response to the tuberculosis treatment.