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Iglesias, Katia
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Iglesias, Katia
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- PublicationAccès libreCharacterizing the vulnerability of frequent emergency department users by applying a conceptual framework: a controlled, cross-sectional study(2015)
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Frequent emergency department (ED) users meet several of the criteria of vulnerability, but this needs to be further examined taking into consideration all vulnerability’s different dimensions. This study aimed to characterize frequent ED users and to define risk factors of frequent ED use within a universal health care coverage system, applying a conceptual framework of vulnerability.
Methods A controlled, cross-sectional study comparing frequent ED users to a control group of non-frequent users was conducted at the Lausanne University Hospital, Switzerland. Frequent users were defined as patients with five or more visits to the ED in the previous 12 months. The two groups were compared using validated scales for each one of the five dimensions of an innovative conceptual framework: socio-demographic characteristics; somatic, mental, and risk-behavior indicators; and use of health care services. Independent t-tests, Wilcoxon rank-sum tests, Pearson’s Chi-squared test and Fisher’s exact test were used for the comparison. To examine the -related to vulnerability- risk factors for being a frequent ED user, univariate and multivariate logistic regression models were used.
Results We compared 226 frequent users and 173 controls. Frequent users had more vulnerabilities in all five dimensions of the conceptual framework. They were younger, and more often immigrants from low/middle-income countries or unemployed, had more somatic and psychiatric comorbidities, were more often tobacco users, and had more primary care physician (PCP) visits. The most significant frequent ED use risk factors were a history of more than three hospital admissions in the previous 12 months (adj OR:23.2, 95%CI = 9.1-59.2), the absence of a PCP (adj OR:8.4, 95%CI = 2.1-32.7), living less than 5 km from an ED (adj OR:4.4, 95%CI = 2.1-9.0), and household income lower than USD 2,800/month (adj OR:4.3, 95%CI = 2.0-9.2).
Conclusions Frequent ED users within a universal health coverage system form a highly vulnerable population, when taking into account all five dimensions of a conceptual framework of vulnerability. The predictive factors identified could be useful in the early detection of future frequent users, in order to address their specific needs and decrease vulnerability, a key priority for health care policy makers. Application of the conceptual framework in future research is warranted. - PublicationAccès libreElectric Bicycles as a New Active Transportation Modality to Promote Health(2011)
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Purpose : We hypothesized that using an EAB in a hilly city allows sedentary subjects to commute comfortably, while providing a sufficient effort for health-enhancing purposes.
Methods : Sedentary subjects performed four different trips at a self-selected pace: walking 1.7 km uphill from the train station to the hospital (WALK), biking 5.1 km from the lower part of town to the hospital with a regular bike (BIKE), or EAB at two different power assistance settings (EABhigh, EABstd). HR, oxygen consumption, and need to shower were recorded.
Results : Eighteen sedentary subjects (12 female, 6 male) age 36 ± 10 yr were included, with V˙O2max of 39.4 ± 5.4 mL·min−1·kg−1. Time to complete the course was 22 (WALK), 19 (EABhigh), 21 (EABstd), and 30 (BIKE) min. Mean %V˙O2max was 59.0%, 54.9%, 65.7%, and 72.8%. Mean %HRmax was 71.5%, 74.5%, 80.3%, and 84.0%. There was no significant difference between WALK and EABhigh, but all other comparisons were different (P < 0.05). Two subjects needed to shower after EABhigh, 3 needed to shower after WALK, 8 needed to shower after EABstd, and all 18 needed to shower after BIKE. WALK and EABhigh elicited 6.5 and 6.1 METs (no difference), whereas it was 7.3 and 8.2 for EABstd and BIKE.
Conclusions : EAB is a comfortable and ecological transportation modality, helping sedentary people commute to work and meet physical activity guidelines. Subjects appreciated ease of use and mild effort needed to activate the engine support climbing hills, without the need to shower at work. EAB can be promoted in a challenging urban environment to promote physical activity and mitigate pollution issues.