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181.
Objective
In order to be reimbursed for the care they provide, hospitals in the United States are required to use a standard system to code all discharge diagnoses: the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9). Although ICD-9 codes specific for child maltreatment exist, they do not identify all maltreatment-related hospital and emergency department discharges. To increase the usefulness of medical data for public health surveillance of child maltreatment, this project sought to identify ICD-9 codes that are suggestive of child maltreatment.Methods
After review of the literature and discussions with experts, injuries and conditions that should raise suspicion of child maltreatment (physical or sexual abuse or neglect) were identified and a list of corresponding ICD codes was compiled. Using a statewide electronic database of hospital discharges and emergency department (ED) visits for the year 2000, visits by children assigned these ICD codes were identified, a sample of visits was selected, and medical records were reviewed to assess the circumstances of the injury or illness that led to the visit. Based on information in the medical record, the injury or illness was classified as maltreatment-related, or not.Results
There were 3,684 visits selected for review. Of these, 2,826 records were reviewed and classified; 1,200 (43%) records met the criteria for being maltreatment-related, 1,419 (50%) contained adequate information indicating the injury/condition was not likely maltreatment-related, and 207 (7%) records did not contain enough information to classify. Sixty-eight ICD codes had >66% of visits classified as maltreatment-related, the a priori criteria for a code to be considered suggestive of maltreatment. Codes suggestive of maltreatment include specific fractures, burns, and injuries of undetermined intent, among others.Conclusion
Several ICD codes were found that, when used with age restrictions and other specific exclusion criteria, are suggestive of maltreatment. This information may increase the usefulness of hospital discharge data for public health surveillance of child maltreatment.Practice implications
Use of these suggestive codes facilitates identifying conditions and injuries that are likely maltreatment-related in hospital discharge and ED visit data. When used in conjunction with ICD maltreatment-specific codes, these suggestive codes may enhance the use of medical data for monitoring child maltreatment trends. 相似文献182.
THE PSYCHIATRIC LITERATURE has described profoundly prelingually deaf people with psychosis who report hearing voices. The present study proposes that such reports in fact reflect the beliefs of professionals in mental health and deafness and not the hallucinatory experience of psychotic deaf people. The study demonstrates that it is functionally meaningless to assert that a prelingually profoundly deaf psychotic patient "hears voices," and provides a theoretical structure from which to consider more appropriately the internal experiences of deaf people with psychosis, and to encourage the clinically relevant articulation of these experiences. The authors also suggest that the "true" phenomenological experience is of secondary clinical interest to the meaning imposed upon it by the client and the distress caused by it. 相似文献
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Simone J.J.M.Verswijveren Karen E.Lamb Josep A.Martín-Fernández Elisabeth Winkler Rebecca M.Leech Anna Timperio Jo Salmon Robin M.Daly Ester Cerin David W.Dunstan Rohan M.Telford Richard D.Telford Lisa S.Olive Nicola D.Ridgers 《运动与健康科学(英文)》2022,11(2):234-243
Purpose:The study aimed to describe youth time-use compositions,focusing on time spent in shorter and longer bouts of sedentary behavior and physical activity(PA),and to examine associations of these time-use compositions with cardiometabolic biomarkers.Methods:Accelerometer and cardiometabolic biomarker data from 2 Australian studies involving youths 7-13 years old were pooled(complete cases with accelerometry and adiposity marker data,n=782).A 9-component time-use composition was formed using compositional data analysis:time in shorter and longer bouts of sedentary behavior;time in shorter and longer bouts of light-,moderate-,or vigorous-intensity PA;and"other time"(i.e.,non-wear/sleep).Shorter and longer bouts of sedentary time were defined as<5 min and>5 min,respectively.Shorter bouts of light-,moderate-,and vigorous-intensity PA were defined as<1 min;longer bouts were defined as≥1 min.Regression models examined associations between overall time-use composition and cardiometabolic biomarkers.Then,associations were derived between ratios of longer activity patterns relative to shorter activity patterns,and of each intensity level relative to the other intensity levels and"other time",and cardiometabolic biomarkers.Results:Confounder-adjusted models showed that the overall time-use composition was associated with adiposity,blood pressure,lipids,and the summary score.Specifically,more time in longer bouts of light-intensity PA relative to shorter bouts of light-intensity PA was significantly associated with greater body mass index z-score(zBMI)(β=1.79;SE=0.68)and waist circumference(β=18.35,SE=4.78).When each activity intensity was considered relative to all higher intensities and"other time",more time in light-and vigorous-intensity PA,and less time in sedentary behavior and moderate-intensity PA,were associated with lower waist circumference.Conclusion:Accumulating PA,particularly light-intensity PA,in frequent short bursts may be more beneficial for limiting adiposity compared to accumulating the same amount of PA at these intensities in longer bouts. 相似文献
185.
In this paper we investigate the role of workers’ training history in determining current training-incidence. The analysis is conducted on an unbalanced sample comprising information on approximately 5000 employees from the first seven waves of the BHPS. Training participation is modelled as a dynamic random effects probit model where the effects of unobserved heterogeneity and initial conditions are accounted for in a fashion consistent with methods proposed by Chamberlain (1984) and Wooldridge (2005), respectively. The results suggest that prior training experience is a significant determinant of a worker's participation in a current training episode comparable with other formal educational qualifications. 相似文献
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188.
There is a substantial and documented need for policies to provide comprehensive health, social work, and early education services for young children and their families. Public subsidies to support other enterprises deemed in the public interest are public transportation, higher education, and social security. Childcare would seem to be another such responsibility. The majority of parents with children under the age of five are in the work force, there is documentation of the importance of early experience to brain growth, and further evidence that current child care provisions are often mediocre to poor. This article presents a decision making matrix, which displays major policy options for early childhood and a range of criteria by which to judge the relative efficacy of those options. Several special issues connected with the decision making are discussed. 相似文献
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190.
Government R&D subsidies as a signal for private investors 总被引:1,自引:0,他引:1
Robin Kleer 《Research Policy》2010,39(10):1361-1374
Government subsidies for R&D are intended to promote projects with high returns to society but too little private returns to be beneficial for private investors. This may be caused by spillovers or a low appropriability rate. Apart from the direct funding of these projects, government grants may serve as a signal for good investments for private investors. We use a simple signaling model with different types of R&D projects to capture this phenomenon. The agency has a preference for basic research projects as they promise high expected social returns, while banks prefer applied research projects with high private returns. In a setup where the subsidy can only be used to distinguish between basic and applied research projects, government agency’s signal is not very helpful for banks. However, if the subsidy is accompanied by a quality signal, it can lead to increased or better selected private investments. 相似文献