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Using Multivariate Statistics

admission. This proportion could already be greater in some parts of the country and may increase if referrals of cases of self-poisoning increase faster than the facilities for their assessment and management. The provision of social work and psychiatric expertise in casualty departments may be one means of preventing unnecessary medical admissions without risk to the patients. Dr Blake's and Dr Bramble's figures do not demonstrate, however, that any advantage would attach to medical teams taking over assessment from psychiatrists except that, by implication, assessments would be completed sooner by staff working on the ward full time. What the figures actually suggest is that if assessment of overdoses were left to house doctors there would be an increase in admissions to psychiatric units (by 19°U), outpatients (by 5O°'), and referrals to social services (by 140o). So for house doctors to assess overdoses would provide no economy for the psychiatric or social services. The study does not tell us what the consequences would have been for the six patients who the psychiatrists would have admitted but to whom the house doctors would have offered outpatient appointments. E J SALTER

Vitamin D deficiency.

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Part I: AN INTRODUCTION TO INQUIRY. 1. Human Inquiry and Science. 2. Paradigms, Theory, and Research. 3. The Ethics and Politics of Social Research. Part II: THE STRUCTURING OF INQUIRY: QUANTITATIVE AND QUALITATIVE. 4. Research Design. 5. Conceptualization, Operationalization, and Measurement. 6. Indexes, Scales, and Typologies. 7. The Logic of Sampling. Part III: MODES OF OBSERVATION: QUANTITATIVE AND QUALITATIVE. 8. Experiments. 9. Survey Research. 10. Qualitative Field Research. 11. Unobtrusive Research. 12. Evaluation Research. Part IV: ANALYSIS OF DATA:QUANTITATIVE AND QUALITATIVE . 13. Qualitative Data Analysis. 14. Quantitative Data Analysis. 15. Reading and Writing Social Research. Appendix A. Using the Library. Appendix B. Random Numbers. Appendix C. Distribution of Chi Square. Appendix D. Normal Curve Areas. Appendix E. Estimated Sampling Error.

社会研究方法基础 = The Basics of Social Research

List of Figures List of Tables Foreword Introduction Robin P. Fawcett, M.A.K. Halliday, Sydney M. Lamb and Adam Makkai 1 Language as Code and Language as Behaviour: A Systemic-Functional Interpretation of the Nature and Ontogenesis of Dialogue M.A.K. Halliday 2 Metaphors of Information John Regan 3 How Universal is a Localist Hypothesis? A Linguistic Contribution to the Study of 'Semantic Styles' of Language Yoshihiko Ikegami 4 Some Speculations on Language Contact in a Wider Setting Jeffrey Ellis 5 Ways of Saying: Ways of Meaning Ruqaiya Hasan Index

Language as social semiotic

Screening asylum seekers for infectious diseases is widely performed, but economic evaluations of such are scarce. We performed a policy analysis and economic evaluation of such screening in Germany, and analysed the effect of screening policies on cost differences between federal states. Of the 16 states, screening was compulsory for tuberculosis (TB) in asylum seekers ≥ 16 years of age in all states as well as in children < 16 years of age and pregnant women in six states, hepatitis B and enteropathogens in three, syphilis in two and human immunodeficiency virus (HIV) in one state. Of 441,899 asylum seekers, 88.0% were screened for TB, 22.9% for enteropathogens, 16.9% for hepatitis B, 13.1% for syphilis and 11.3% for HIV. The total costs for compulsory screening in 2015 were 10.3 million euros (EUR). Costs per case were highest for infections with Shigella spp. (80,200 EUR), Salmonella spp. (8,000 EUR), TB in those ≥ 16 years of age (5,300 EUR) and syphilis (1,150 EUR). States with extended screening had per capita costs 2.84 times those of states that exclusively screened for TB in asylum seekers ≥ 16 years of age (p < 0.0001, 95% confidence interval (CI): 1.96–4.10). Screening practices in Germany entailed high costs; evidence-based approaches to infectious disease screening are needed.

Infectious disease screening in asylum-seekers: range, coverage and economic evaluation in Germany (2015)

ZusammenfassungHintergrundBisher ist wenig über die Inanspruchnahme medizinischer Rehabilitation bei ausländischen Staatsangehörigen und (Spät‑)Aussiedlern/(Spät‑)Aussiedlerinnen bekannt.Ziel der Arbeit (Fragestellung)Vergleich der Inanspruchnahme medizinischer Rehabilitation bei deutschen und ausländischen Staatsangehörigen im Vorfeld der Erwerbsminderungsrente unter besonderer Berücksichtigung von (Spät‑)Aussiedlern/(Spät‑)Aussiedlerinnen.Material und MethodenAnalyse von Routinedaten der Deutschen Rentenversicherung. Informationen von 17.369 Personen standen zur Verfügung, die 2015 erstmalig eine Erwerbsminderungsrente erhielten. Der (Spät‑)Aussiedler-Status wurde über das Fremdrentenmerkmal definiert. Outcome war die Inanspruchnahme medizinischer Rehabilitation in den letzten 5 Jahren vor der Erwerbsminderungsrente. Der Einfluss demografischer/sozioökonomischer Faktoren wurde mithilfe einer logistischen Mehrebenenregression kontrolliert.ErgebnisseAusländische Staatsangehörige wiesen im Vergleich zu Deutschen ohne (Spät‑)Aussiedler-Status eine geringere Chance der Inanspruchnahme medizinischer Rehabilitation auf. Die adjustierten Odds Ratios (OR) betrugen 0,79 (95 %-Konfidenzintervall [95 %-KI]: 0,67–0,92) für türkische und 0,56 (95 %-KI: 0,45–0,71) für EU-Ausländer/‑innen. (Spät‑)Aussiedler/‑innen hatten demgegenüber eine höhere Chance der Inanspruchnahme von Rehabilitation (adjustiertes OR = 1,40, 95 %-KI: 1,20–1,64).SchlussfolgerungAusländische Staatsangehörige nehmen die Rehabilitation im Vorfeld der Erwerbsminderungsrente seltener als deutsche Staatsangehörige in Anspruch. Dies ist vermutlich durch Barrieren beim Zugang zur Rehabilitation zu erklären, die durch Schnittstellenprobleme beim Übergang von der Hausarztversorgung in die Rehabilitation sowie durch Informationsdefizite verursacht werden. (Spät‑)Aussiedler/‑innen scheinen beim Zugang nicht benachteiligt zu sein.AbstractBackgroundSo far little is known about the utilization of medical rehabilitation among non-German nationals and ethnic German resettlers.ObjectiveThe aim of this study was to examine the utilization of medical rehabilitation in non-German nationals and ethnic German resettlers prior to disability retirement.Material and methodsRoutine data from the German statutory pension insurance scheme were used. Information on 17,369 individuals who retired due to disability in 2015 was available. Ethnic German resettlers were defined by means of information stemming from a prior occupation in the country of origin. The outcome of interest was the utilization of medical rehabilitation in the past 5 years prior to the disability pension. Multilevel logistic regression was used to control the influence of demographic and socioeconomic factors.ResultsCompared to Germans without resettler status, non-German nationals had a lower chance of utilizing medical rehabilitation. The adjusted odds ratios (OR) were 0.79 (95% confidence interval, CI: 0.67–0.92) for Turkish nationals and 0.56 (95% CI: 0.45–0.71) for nationals from EU countries. Ethnic German resettlers had a higher chance of utilizing medical rehabilitation (adjusted OR = 1.40, 95% CI: 1.20–1.64).ConclusionNon-German nationals utilized medical rehabilitation prior to disability retirement less frequently than German nationals. This is presumably because of the barriers non-Germans experience in utilization, resulting from poor information and problems emerging in the transition from general practitioner to rehabilitative care. Ethnic German resettlers do not seem to be disadvantaged in terms of access to rehabilitation.

Inanspruchnahme medizinischer Rehabilitation im Vorfeld der Erwerbsminderungsrente: Vergleich ausländischer und deutscher Staatsangehöriger unter besonderer Berücksichtigung von (Spät‑)Aussiedler/‑innen

Mit ihrem Gesundheitsbericht „Primary Health Care: Now more than ever“ revitalisierte die Weltgesundheitsorganisation im Oktober 2008 eine Strategie, die 1978 in Alma Ata formuliert wurde. Nur 2 Tage spater erschien der alternative Weltgesundheitsbericht „Global Health Watch 2“, der aus der weltweiten Unterstutzung zivilgesellschaftlicher Akteure entstand. Beide Berichte eint trotz unterschiedlicher Perspektiven die Kritik an der globalen Pravalenz vermeidbarer gesundheitlicher Ungleichheit. In dem vorliegenden Beitrag wird zunachst eine vergleichende Darstellung der Kernaussagen beider Berichte vorgenommen. Aus den Kernthesen wird der Handlungsbedarf fur Deutschland in der nationalen und weltweiten Gesundheitsforderung abgeleitet. In Deutschland mussen Politik, Wissenschaft und Zivilgesellschaft eine starkere Rolle bei der Umsetzung einer umfassenden Primary-Health-Care-Strategie einnehmen. So konnte sich eine Chance bieten, das Recht auf gleiche Gesundheitschancen fur alle Menschen sowohl in Deutschland als auch weltweit umzusetzen.

„Primary Health Care“ von Alma Ata bis Almaty

Traditional medicine is an important part of healthcare delivery in Africa. Although a substantial majority still rely on this kind of healing as their primary source of healthcare, the practice is fraught with a number of paradoxes. This chapter addresses the meaning, contributions, challenges and progress of traditional medicine as an alternative healthcare approach and the ways in which African traditional medicine conforms—to a degree—with modern standards. Specifically, the chapter examines the progress on the recognition, development and prospect of traditional medicine in Africa. Recently, the WHO has been working with African nations to integrate scientific and medical models of health to enhance the potentials of traditional medicine in the control of endemic diseases.

Traditional Medicine in Africa

Despite racism and its impact on health inequities being increasingly studied in health care settings, racism in public health services has so far been neglected in public health research. Studying racism in public health services provides many opportunities to explore the relationship between racism and health protection. We identify several research themes to be explored on (1) non-stigmatizing and community-driven risk communication, (2) surveillance by public health authorities of racialized minority groups, (3) racism experiences in everyday interactions with public health authorities, (4) legal consequences of encounters with public health authorities and (5) public health infrastructure, structural racism and the intersectionality of marginalization. Tackling these research themes will help to start building an evidence base on how racism interferes with equitable health protection and how to dismantle it.

https://www.frontiersin.org/articles/10.3389/fpubh.2022.1039963/pdf

Oliver Razum

Papers

Infectious disease screening in asylum-seekers: range, coverage and economic evaluation in Germany (2015)

Inanspruchnahme medizinischer Rehabilitation im Vorfeld der Erwerbsminderungsrente: Vergleich ausländischer und deutscher Staatsangehöriger unter besonderer Berücksichtigung von (Spät‑)Aussiedler/‑innen

„Primary Health Care“ von Alma Ata bis Almaty

Traditional Medicine in Africa

Racism in public health services: A research agenda