Unemployment and mortality--a longitudinal prospective study on selection and causation in 49321 Swedish middle-aged men.

BACKGROUND: Unemployment is associated with increased risk of mortality. It is, however, not clear to what extent this is causal, or whether other risk factors remain uncontrolled for. The aim of this study was to investigate the association between unemployment and all-cause and cause-specific mortality, adjusting for indicators of mental disorder, behavioural risk factors and social factors over the life course. METHODS: This study was based on a cohort of 49321 Swedish males, born 1949/51, tested for compulsory military conscription in 1969/70. Data on employment/unemployment 1990-4 was based on information from the Longitudinal Register of Education and Labour Market Statistics. Information on childhood circumstances was drawn from National Population and Housing Census 1960. Information on psychiatric diagnosis and behavioral risk factors was collected at conscription testing in 1969/70. Data on mortality and hospitalisation 1973-2004 were collected in national registers. RESULTS: An increased risk of mortality 1995-2003 was found among individuals who experienced 90 days or more of unemployment during 1992-4 compared with those still employed (all-cause mortality HR 1.91, 95% CI 1.58 to 2.31. Adjustment for risk factors measured along the life course considerably lowered the relative risk (all cause mortality HR 1.30, 95% CI 1.06 to 1.58). Statistically significant increased relative risk was found during the first 4 years of follow up (all-cause mortality, adjusted HR 1.57, 95% CI 1.13 to 2.18, but not the following 4 years (all cause mortality, adjusted HR 1.17, 95% CI 0.91 to 1.50). CONCLUSION: The results suggest that a substantial part of the increased relative risk of mortality associated with unemployment may be attributable to confounding by individual risk factors.

[Theme: High utilizers of health care services. How do we help the patients who constantly top visitors' statistics?]. / Tema: sjukvårdens storkonsumenter. Hur skall vi hjälpa de patienter som ständigt toppar besöksstatistiken?

UNLABELLED: A series of articles reviews the problem of patients with high utilization of health care. Many of these patients display somatization behaviour, presenting with physical symptoms unaccounted for by any demonstrable medical condition. High utilizers often get insufficient help from doctors and other health care providers, who are not trained to understand and manage the underlying psychosocial problems. The same problem occurs in different settings of health care, such as: Primary care: Seven out of ten high utilizers of primary care have no physical disease; they attend primarily for somatic symptoms, although there is a predominance of psycho-social problems. Emergency room care: High utilizers of emergency room care are characterized by insufficient social support, often in combination with substance abuse. Physical symptoms are often perceived as life-threatening, even though there is no known underlying disease. Non-psychiatric hospital care: There is a six fold increase in high utilization of non-psychiatric hospital care among patients with a somatoform diagnosis. MEDICATION: Patients treated with anti-depressants--implying depressive disorder--have a two or three fold increased utilization of non-psychopharmacological drugs, of primary care and of non-psychiatric hospital care as compared to those with no treatment for depression.

The role of the nephrologist in patient rehabilitation.

The justification for the enactment of the End-Stage Renal Disease (ESRD) Program in 1972 was to provide the lifesaving potential of dialysis and transplant to patients with terminal renal failure. Implied as a return on cost was that many of those whose lives were prolonged would contribute to society through work and taxes. It is not surprising at a time of growing concern about health-care costs that vocational rehabilitation for patients undergoing dialysis and transplant has again come to the attention of Congress and others. The nephrologist, the leader of the health-care team caring for patients on dialysis and outpatients with transplants, plays a crucial role if an increasing number of patients are to be rehabilitated. The attitudes of the nephrologist can establish the belief in staff and suitable patients for or against the possibility of attending school, retraining, or working. Identification of medical problems as impediments to rehabilitation and their resolution, where possible, is an essential function of the nephrologist and other team members. Any process that seems at first glance to be difficult requires an evangelist if success is to come. The nephrologist must be the primary motivator. There are a number of extrinsic barriers to rehabilitative success including employer health insurance, disability regulations, and attitudes toward people with disabilities. The nephrologist, as a respected figure and patient advocate, must be willing to deal aggressively with these barriers whenever the occasion arises.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of digital chest radiography using stimulable phosphor.

In this pilot study, conventional and digital radiography of the chest was compared in 170 patients. Two digitized radiographs, one frequency modified and one simulating the conventional film-screen combination, and the conventional films were reviewed independently by 5 radiologists with different experience. In spite of the smaller size and lower spatial resolution of the digitized compared with the conventional radiograph, only slight differences were revealed in the observation of different pulmonary and mediastinal changes. Digitized radiography is therefore considered suitable for chest examinations.