Identifying elderly patients at risk of readmission after discharge from a short-stay unit in the emergency department using performance-based tests of daily activities.

BACKGROUND: Readmission is a serious and adverse event for elderly patients. Despite efforts, predicting the risk of readmission remains imprecise. The objective of this study is to examine if performance-based tests of daily activities can identify elderly patients at risk of readmission within 26 weeks after discharge from a short-stay unit in the emergency department. METHODS: The current study is an observational study based on data from 144 elderly patients included in a previous non-randomised controlled trial. Before discharge, patients were assessed for limitations in performing daily activities using three performance-based tests with predetermined cut-off values: the Assessment of Motor and Process Skills, Timed Up and Go and the 30s-Chair Stand Test. Outcome was risk of readmission within 26 weeks after discharge. RESULTS: Limitations in performing daily activities were associated with risk of readmission as measured by the Assessment of Motor and Process Skills motor scale (Crude OR = 4.38 [1.36; 14.12]), (Adjusted OR = 4.17 [1.18; 14.75]) and the 30s-Chair Stand Test (Adjusted OR = 3.36 [1.42; 7.93]). No significant associations were found in regards to other measures. CONCLUSION: The Assessment of Motor and Process Skills motor scale and the age, gender and comorbidity adjusted 30s-Chair Stand Test can identify elderly patients at increased risk of readmission after discharge from the emergency department. The results were limited by one-third of the patients did not perform the Assessment of Motor and Process Skills and the association between 30s-Chair Stand Test and risk of readmission were only positive when adjusted for age, gender and comorbidity.

Measures to reduce the exposure of waste collection workers to handborne and airborne microorganisms and inflammogenic dust.

Waste collection is associated with various health symptoms. The aims of this study were to obtain knowledge about exposure to bacteria, fungi, and endotoxin during waste collection, and to study whether it is possible to reduce the exposures and the total inflammatory potential (TIP) of those exposures through simple interventions. The study was performed with an initial baseline exposure assessment, a second assessment with intervention workers only, and a third with intervention and reference workers. The waste collection workers were exposed to 7.8 × 103 cfu bacteria/m3, 1.4 × 104 cfu fungi/m3, and 92 endotoxin units/m3 (geometric mean values). The potential exposures in the truck cabs were up to 23 times higher than outdoor reference concentrations. For the intervention trucks and workers, airborne fungi in the truck cab were reduced; fungi, bacteria, and yeasts on the steering wheels were reduced; and the concentration of fungi on the workers' hands was reduced. Exposures were typically highest during collection of mixed household waste, in the summer, and for collection using trucks with low loading height. The TIP was highest for the reference group sampling mixed household waste, using trucks with low loading height, in the summer. Endotoxin, bacteria, and fungi contributed to the TIP of 42 personal exposure assessments. CONCLUSION: Motivating workers to reduce exposure through simple interventions improved hand and truck cab hygiene, but only slightly reduced personal exposure to airborne bioaerosols. Exposure can be reduced by only using trucks with high loading height.

Effects of smartphone diaries and personal dosimeters on behavior in a randomized study of methods to document sunlight exposure.

Dosimeters and diaries have previously been used to evaluate sun-related behavior and UV exposure in local samples. However, wearing a dosimeter or filling in a diary may cause a behavioral change. The aim of this study was to examine possible confounding factors for a questionnaire validation study. We examined the effects of wearing dosimeters and filling out diaries, measurement period and recall effect on the sun-related behavior in Denmark in 2012. Our sample included 240 participants eligible by smartphone status and who took a vacation during weeks 26-32 in 2012, randomized by gender, age, education and skin type to six groups: 1) Control + diary, 2) Control, 3) 1-week dosimetry measurement, 4) 1-week dosimetry measurement + diary, 5) 3-week dosimetry measurement and 6) 1-week dosimetry measurement with 4 week delayed questionnaire. Correlation coefficients between reported outdoor time and registered outdoor time for groups 3-6 were 0.39, 0.45, 0.43 and 0.09, respectively. Group 6 was the only group not significantly correlated. Questionnaire reported outdoor exposure time was shorter in the dosimeter measurement groups (3-6) than in their respective controls. We showed that using a dosimeter or keeping a diary seems to increase attention towards the behavior examined and therefore may influence this behavior. Receiving the questionnaire with 4 week delay had a significant negative influence on correlation and recall of sunburn. When planning future UV behavior questionnaire validations, we suggest to use a 1-week interval for dosimetry measurements, no diary, and to minimize the time from end of measurement to filling out questionnaires.

Feasibility of smartphone diaries and personal dosimeters to quantitatively study exposure to ultraviolet radiation in a small national sample.

BACKGROUND: In 2007, a national skin cancer prevention campaign was launched to reduce the UV exposure of the Danish population. To improve campaign evaluation a questionnaire validation using UV-dosimeters was initiated. AIM: To show the feasibility of dosimeters for national representative studies and of smartphones as a data collection tool. MATERIALS AND METHODS: Participants were sent a dosimeter which they wore for 7 days, received a short diary questionnaire by text message each day and subsequently a longer questionnaire. Correlation between responses from questionnaire, smartphone diaries and dosimeters were examined. RESULTS: This study shows a 99.5% return rate (n = 205) of the dosimeters by ordinary mail and high response-rates for a smartphone questionnaire dairy. Correlation coefficients for outdoor-time reported through smartphones and dosimeters as average by week 0.62 (0.39-0.77), P < 0.001 (n = 40). Correlation coefficient for outdoor time estimated by questionnaire and dosimeters were 0.42 (0.11-0.64), P = 0.008. The subjective perception of the weather was the only covariate significantly influencing questionnaire estimates of actual outdoor exposure. We showed that dosimeter studies are feasible in national settings and that smartphones are a useful tool for monitoring and collecting UV behavior data. CONCLUSION: We found diary data reported on a daily basis through smartphones more strongly associated with actual outdoor time than questionnaire data. Our results demonstrate tools and possible considerations for executing a UV behavior questionnaire validation.