Suchergebnisse

Seit den 1960er-Jahren ist die Kopplung von Stress und Vorsorge unter dem Stichwort der »Risikofaktoren« zunehmend populär geworden. Wahrscheinlichkeitskalküle, die auf die Steuerung und Verbesserung der kollektiven Gesundheit der Bevölkerung zielen, werden als Grundlage herangezogen, um dem Individuum eine Selbstverantwortlichkeit für seine Risikovorsorge zuzuschreiben. Dieser Ansatz ermöglicht die Übersetzung statistischer Wahrscheinlichkeiten in eine Hermeneutik des Selbst. Im Rahmen der Prävention verschiebt sich der Akzent von der Krankheitsdiagnostik auf die Gesundheitsvorsorge. Durch die Propaganda zur Risikoverhütung – dass der Gesunde pathogene Faktoren vermeiden solle – verschwimmt allerdings die Grenze zwischen Gesundheit und Krankheit. Das gilt auch für das Phänomen Stress. Obschon Stress selbst nicht als Krankheit gilt, wird in ihm doch ein potentieller Verursacher vermutet: eben ein »Risikofaktor«. Und auch wenn er damit als mögliche Ursache für viele Krankheiten verhandelbar wird, gibt es bestimmte pathologische Erscheinungen, mit denen er eine besonders innige Beziehung unterhält – dazu zählt der Herzinfarkt. Dieser wird zum Synonym für die Folgen eines von zu viel Stress bestimmten Lebens. Die Relation von Stress und Herzinfarkt lässt sich nicht nur medizinisch begründen; ihre kulturelle Plausibilität verweist auch auf eine symbolische Dimension. Das Herz als symbolischer Träger menschlicher Aktivität und Emotionalität gerät unter dem Eindruck der modernen Hetze außer Takt.

Cover -- Half Title -- Title Page -- Table of Contents -- Kleiner / Suter: Stress und Unbehagen -- Stoff: Leistung, Erfolg, Glück und Stress -- Gruner: Erschöpfte Menschen -- Peeters: Der Steppenwolf als Messie -- Ingold: Fitness als Glück? -- Rothe: Autismus -- Wiede: Die glücklichen Arbeitslosen -- Leanza: Stress und Resilienz -- Abbildungsverzeichnis -- Colophon

In Australia, there is documented confusion from producers around the clinical disease of footrot, and anecdotally, knowledge of what tools are available for the diagnosis and management of footrot. When discussing footrot with producers, the authors noted a hesitation to discuss, with denial often expressed. The disease can be debilitating, both on the sheep's welfare and the producer's well-being, as it is a very difficult disease to manage and eradicate. Gaining an understanding of producer perceptions of the disease may help ensure any future actions for management and control are in-line with those identified by producers. A combination of a web-based, and manually distributed surveys of 45 sheep producers was conducted. This included closed- and open-ended questions, multi check box, and Likert scales. Responses were quantified by descriptive statistics and a thematic analysis conducted of short answers. The results of this survey indicate satisfaction with footrot diagnostics is low, while satisfaction with control methods is high. There was also a poor general understanding of footrot as a disease, and a general distrust in peers when it comes to correct management of footrot. This research addresses a gap in the literature about how sociological conditions affect diagnosis and control of footrot disease. It provides three main recommendations—simplifying the diagnostic message, encouraging a culture of trust among sheep producers and increasing governmental support—as a way to tackle this problem.

<p class="Pa7"><strong>Objective: </strong>This study aimed to define the ethnographic composition and assess the health-related quality of life (HRQoL) of a large population of undocumented patients with end-stage renal disease (ESRD) seeking emergent dialysis in the emergency depart­ment (ED) of a large public hospital in the United States.</p><p class="Pa7"><strong>Design: </strong>All ESRD patients presenting to the hospital's main ED were identified during a 4-week consecutive enrollment period. Consenting patients completed two surveys—an ethnographic questionnaire and the validated kidney disease quality of life-36 (KDQOL-36) instrument.</p><p class="Pa7"><strong>Setting: </strong>The study was conducted at a large county hospital in Dallas, Texas. In 2013, the hospital recorded &gt;50,000 ED visits and administered approximately 6,000 dialysis treatments to ED patients.</p><p class="Pa7"><strong>Participants: </strong>88 of 101 unfunded patients presenting to the ED during the study period consented to participate, resulting in an 87.1% response rate. 65 of these patients were undocumented immigrants.</p><p class="Pa7"><strong>Main Outcome Measures: </strong>Quantitative scores for the 5 subscales of the KDQOL-36 were calculated for the study population.</p><p class="Pa7"><strong>Results: </strong>Measures of physical and mental health in our study population were lower than those published for scheduled dialysis patients. 79.5% of our patients lost employ­ment due to their dialysis requirements. At least 71.4% of the study patients were unaware that they required dialysis before immigrating to the United States.</p><p class="Pa7"><strong>Conclusions: </strong>Quality of life scores were found to be low among our population of undocumented emergent dialysis patients. Our data also provide some evidence that availability of dialysis at no cost is not a primary driver of illegal immigration of ESRD patients to the United States.</p><p class="Pa7"><em>Ethn Dis. </em>2017;27(1):39-44; doi:10.18865/ed.27.1.39.</p>

Insurance status affects access to care, which may affect health outcomes. The objective was to determine whether patients without insurance or with government-sponsored insurance had worse quality of care or in-hospital outcomes in acute ischemic stroke. Multivariable logistic regressions with generalized estimating equations stratified by age under or at least 65years were adjusted for patient demographics and comorbidities, presenting factors, and hospital characteristics to determine differences in in-hospital mortality and postdischarge destination. We included 589320 ischemic stroke patients treated at 1604 US hospitals participating in the Get With The Guidelines-Stroke program between 2012 and 2015. Uninsured patients with hypertension, high cholesterol, or diabetes mellitus were less likely to be taking appropriate control medications prior to stroke, to use an ambulance to arrive to the ED, or to arrive early after symptom onset. Even after adjustment, the uninsured were more likely than the privately insured to die in the hospital (<65years, OR 1.33 [95% CI 1.22-1.45]; ≥65years OR 1.54 [95% CI 1.34-1.75]), and among survivors, were less likely to go to inpatient rehab (<65 OR 0.63 [95% CI 0.6-0.67]; ≥65 OR 0.56 [95% CI 0.5-0.63]). In contrast, patients with Medicare and Medicaid were more likely to be discharged to a Skilled Nursing Facility (<65years OR 2.08 [CI 1.96-2.2]; OR 2.01 [95% CI 1.91-2.13]; ≥65years OR 1.1 [95% CI 1.07-1.13]; OR 1.41 [95% CI 1.35-1.46]). Preventative care prior to ischemic stroke, time to presentation for acute treatment, access to rehabilitation, and in-hospital mortality differ by patient insurance status.

BackgroundInsurance status affects access to care, which may affect health outcomes. The objective was to determine whether patients without insurance or with government-sponsored insurance had worse quality of care or in-hospital outcomes in acute ischemic stroke.Methods and resultsMultivariable logistic regressions with generalized estimating equations stratified by age under or at least 65years were adjusted for patient demographics and comorbidities, presenting factors, and hospital characteristics to determine differences in in-hospital mortality and postdischarge destination. We included 589320 ischemic stroke patients treated at 1604 US hospitals participating in the Get With The Guidelines-Stroke program between 2012 and 2015. Uninsured patients with hypertension, high cholesterol, or diabetes mellitus were less likely to be taking appropriate control medications prior to stroke, to use an ambulance to arrive to the ED, or to arrive early after symptom onset. Even after adjustment, the uninsured were more likely than the privately insured to die in the hospital (<65years, OR 1.33 [95% CI 1.22-1.45]; ≥65years OR 1.54 [95% CI 1.34-1.75]), and among survivors, were less likely to go to inpatient rehab (<65 OR 0.63 [95% CI 0.6-0.67]; ≥65 OR 0.56 [95% CI 0.5-0.63]). In contrast, patients with Medicare and Medicaid were more likely to be discharged to a Skilled Nursing Facility (<65years OR 2.08 [CI 1.96-2.2]; OR 2.01 [95% CI 1.91-2.13]; ≥65years OR 1.1 [95% CI 1.07-1.13]; OR 1.41 [95% CI 1.35-1.46]).ConclusionsPreventative care prior to ischemic stroke, time to presentation for acute treatment, access to rehabilitation, and in-hospital mortality differ by patient insurance status.