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SUMMARYA sample of 160 hospitalized, acute myocardial infarction patients and 138 individuals who died prior to hospitalization from acute coronary heart disease were studied to determine the incidence and duration of prodromal symptoms and action taken to cope with the symptoms. Seventy percent of the in-hospital subsample (IHS) and 64% of the out-hospital subsample (OHS) reported prodromata. The AS ONE POSSIBLE POINT OF INTERVENTIONin acute myocardial infarction and sudden cardiac death, prodromal symptoms which often precede these events are increasingly being investigated.'-' Two-thirds of those who die suddenly or are hospitalized for an acute myocardial infarction have prodromata or a health deviation, which, in retrospect, heralded the acute and sometimes fatal episode. In order to assess the use of prodromal symptoms as a means of intervening to prevent acute cardiac events, to hasten placement of stricken individuals in definitive care facilities, and to reduce out-of-hospital mortality, a study of the nature, duration, and course of prodromal symptoms was undertaken.The purpose of this study was to elucidate the incidence and duration of prodromata of acute coronary events for a group of patients hospitalized with an acute myocardial infarction and for a group of individuals who died prior to hospitalization whose cause of death was acute coronary heart disease (CHD). In addition, attention was given to predisposing factors of prodromata and action taken to control, alleviate, or modify the course of the symptoms.From the Field Epidemiology Research Section, National Heart and Lung Institute, National Institutes of Health, Bethesda, Maryland.This study was done during the tenure of two of the authors (Alonzo and Simon) as Commissioned Officers, U. MethodsThe method of case selection has been described in detail elsewhere.5 Briefly, residents of 25 census tracts in southeastern Montgomery County, Maryland, who died of cardiovascular disease outside of a hospital or who were hospitalized at the study hospital with an admission diagnosis of acute CHD were screened to represent the universe for the two subsamples. Additional criteria for inclusion were: age, 35-75 years; no complicating malignant disease, pulmonary or renal insufficiency, or other debilitating illness.A diagnosis of acute myocardial infarction was based on a combination of three factors: a compatible clinical history, characteristic electrocardiographic changes of acute infarction, and a characteristic increase in appropriate serum enzyme determinations.Patients were interviewed as soon as possible after hospital admission -usually within 48 hours; spouses and other informed witnesses were also questioned, whenever possible, and these sources were used exclusively for the 21 (13%) patients who died before they could be questioned directly. The interviews with informed witnesses in this latter group and for the out-hospital subsample were made 4-6 weeks after death.The out-hospital subsample was obtained from a monthly review of all dea...

A B S T R AC TThe goal of this study was to describe locum tenens physicians in the context of contingent, nonstandard employment in the US. The target population for this study was 1662 physicians who accepted at least one locum tenens assignment. Response rate for the 50-item questionnaire was 47 percent. One third of respondents considered a locum tenens practice pattern permanent. Female physicians were younger and disproportionately represented in primary care specialism; 64 percent used locum income as sole source of support and were motivated by a need for flexible scheduling. Male locum physicians were older, weighted toward the sub-specialisms and motivated to practice part-time. Overall, locum physicians were satisfied with contingent work. Shifts towards part-time employment among women and a desire for flexibility are changing the nature of physician employment. Locum physicians, as 'gold collar' contingent workers are very different from contingent workers in manufacturing and service sectors of the economy. K E Y WO R D Sbad jobs / contingent professionals / gold collar / locum tenens / non-standard employment / temporary physician employment 635

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