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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

Hintergrund Chronische Muskel-Skelett-Erkrankungen (MSE) verursachen erhebliche Kosten fur das deutsche Gesundheitssystem, weshalb sowohl von Seiten der Leistungserbringer als auch von der Politik Informationen uber die Nutzung der unterschiedlichen Versorgungsangebote benotigt werden. Wir untersuchen gemas dem Verhaltensmodell nach Andersen Pradiktoren der Inanspruchnahme ambulanter medizinischer Leistungen der fur chronische MSE relevanten Fachrichtungen Allgemeinmedizin, Orthopadie und Physiotherapie in der von einer Arthrose, rheumatoiden Arthritis oder Osteoporose betroffenen 65–79-jahrigen Wohnbevolkerung Deutschlands. Methoden Auf Grundlage der Daten der ersten Welle der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1) wurden Zusammenhange zwischen der ambulanten Inanspruchnahme und erklarender Variablen mithilfe von Zahldatenmodellen analysiert. Ergebnisse Eine erhohte Inanspruchnahme der Allgemeinmedizin ist mit individuellen Krankheitsfaktoren (erhebliche gesundheitliche Einschrankung: Incidence Rate Ratio (IRR) 1,64 (1,18–2,27); Gelenkschmerzen: IRR 1,38 (1,06–1,79)) assoziiert. Eine erhohte Inanspruchnahme der Orthopadie geht mit einer vermehrten Inanspruchnahme der Allgemeinmedizin (IRR 1,05 (1,01–1,10)) einher. Die erhohte Inanspruchnahme der Physiotherapie wird von strukturellen wie individuellen Faktoren bestimmt (Region Ost (inklusive Berlin)): IRR 0,66 (0,47–0,93); erhebliche gesundheitliche Einschrankung: IRR 1,84 (1,09–3,12); vermehrte Inanspruchnahme der Orthopadie: IRR 1,07 (1,01–1,14)). Schlussfolgerung Erwartungsgemas nehmen individuelle Krankheitsfaktoren eine bedeutende Rolle in der Erklarung der Nutzung medizinischer Versorgungsangebote ein. Zugleich zeigt sich mit dem Nichtvorhandensein einer Komorbiditat ein bislang noch nicht berichteter Pradiktor fur die reduzierte Inanspruchnahme der Allgemeinmedizin durch Personen mit einer MSE.

Prädiktoren der Inanspruchnahme ambulanter medizinischer Leistungen älterer Erwachsener mit einer Arthrose, rheumatoiden Arthritis oder Osteoporose

Difficulties in polio eradication [letter]

Fragestellung Ist bei Frauen mit Migrationshintergrund (MH)
 (=Proxy-Variable fur erhohtes Risiko
 kultureller/sprachlicher Kommunikationsprobleme) die neonatale
 Morbiditat auserhalb der Regelarbeitszeit
 erhoht? Methoden Datenerhebung an 3 Berliner Geburtskliniken mit
 Fragebogenset (soziodemografische, Versorgungsaspekten, Migration);
 Erganzung durch Mutterpassangaben und Klinik-Perinataldaten.
 Surrogatmarker fur kindliche Morbiditat: Apgar-,
 Nabelschnur-pH-Wert, Verlegung in eine Kinderklinik. Deskriptive und
 logistische Regressions-Analysen wurden durchgefuhrt. Ergebnisse Datensatze von 2014 Migrantinnen der 1., 771
 Frauen der 2. Generation, 2564 Frauen ohne MH wurden einbezogen, darunter
 39,7% sog. Tagesgeburten (Montag – Freitag, jeweils
 7:00–18:00 Uhr). In 2 Modellen wurde fur die beiden
 Proxy-Parameter der kindlichen Morbiditat der Einfluss der
 Geburtszeit und verschiedener anderer Parameter uberpruft.
 Die Chancen fur ungunstige Apgar- oder Nabelschnur-pH-Werte
 waren z. B. bei einer Geburt in den Abend- und Nachtstunden, am
 Wochenende und an Feiertagen (OR 1,84; 95% CI 1,23–2,76;
 p=0,003), bei vaginal-operativen Geburten (OR 3,36; 95% CI
 2,07–5,46, p<0,001) oder einer sekundaren Sectio (OR
 1,94; 95 CI 1,28–2,96, p=0,002) erhoht, nicht aber
 bei einem MH der Gebarenden. Zusammenfassung Gebarende mit MH werden trotz
 moglicher interkultureller und sprachlicher Kommunikationsprobleme
 unabhangig von Tageszeit und Wochentag ebenso gut versorgt wie
 Schwangere ohne MH.

Oliver Razum

Papers

Prädiktoren der Inanspruchnahme ambulanter medizinischer Leistungen älterer Erwachsener mit einer Arthrose, rheumatoiden Arthritis oder Osteoporose

Difficulties in polio eradication [letter]

[Is There a Negative Night or Weekend Effect on the Child's Postnatal State Among Migrant Women?]

Editorial: Gesundheitsmonitoring muss die Vielfalt derBevölkerung berücksichtigen

Reha-Erfolg bei Migrant(inn)en: Herkunftsländer im Vergleich