Background: Frequent attenders (FAs) place a disproportionate burden on emergency department (ED) resources. Objectives: Our study aimed to describe characteristics of ED visits by FAs to our hospital so as to identify potential strategies to better manage ED demand. Methods: This was a retrospective observational study. All visits to the ED from 1 January 2011 to 31 December 2011 were included. FAs were defined as patients with ⩾5 visits to the ED over the study period. They were further stratified by visit frequency. Results: FAs showed a bimodal age distribution, with visits by FAs aged 16-25 years old and the elderly aged 66 years and above accounting for the largest proportion of ED visits relative to the number of visits by their non-FA counterparts. Using the age group of 26-45 years as reference, the odds ratio (OR) of FAs being 16-25 years old was 3.037 (95% confidence interval (CI) 2.708-3.407, p < 0.001). Above the age of 65, the OR of FAs falling into a given age group increased for every additional decade of life, up to 3.118 (2.495-3.898, p <0.001) for the age group of 86 and above. FAs were more likely to be male. Diagnoses which accounted for a higher percentage of visits with increasing visit frequency were asthma, chronic obstructive pulmonary disease, upper respiratory tract infection and headache. Conclusions: FAs include the high-acuity chronic sick as well as young adults with low-acuity complaints. Disease optimisation programmes, case management, robust community-based healthcare and public education are possible avenues to optimise ED resources in an ageing society.
Introduction: Foreign workers (FWs) on work permit face unique health challenges and potential barriers to healthcare. We aimed to examine the epidemiology, attendance patterns, disposition, and adherence to follow-up, by FWs on work permit to two emergency departments (EDs) in Singapore. Methods: In this retrospective observational study, we included consecutive FWs on work permit who registered at the EDs of two public restructured hospitals from 1 May 2016 to 31 October 2016. Data obtained from electronic medical records included patient demographics, triage acuity, disposition, ED diagnoses and bill information. Results: There were 6,429 individual FWs on work permit who contributed to 7,157 ED visits over the 6-month study period, with male predominance (72.7%, 4672/6429), and median age of 31 (interquartile range 26 to 38) years. A high proportion of these FWs were triaged to low-acuity status compared to the general ED population (66.9% versus 45.9%, P<0.001). Trauma-related injuries contributed to 34.4% of their visits, and were more likely to result in admission compared to non-trauma-related conditions (18.7% vs 15.2%, P<0.001). FWs engaged in shipyard, construction and process industries were more likely to be discharged “against medical advice” (14.8% vs 3.2%, P<0.001), and default their specialist outpatient follow-up (50.1% vs 34.2%, P<0.001) for non-trauma-related conditions compared to trauma-related injuries. Conclusion: In Singapore, the EDs of public restructured hospitals provide healthcare safety nets to FWs on work permit. These workers made more low-acuity visits compared to the general population during the study period and may face potential barriers to admission and follow-up. Keywords: Emergency medicine, epidemiology, migrant workers, occupational medicine, public health
Immune cells migration at the ocular surface is an active process involving the formation of intrastromal channels, and cell egression through intact basement membrane pores. The preferential migration of CD4 T cells indicates that this is a specific response of conjunctival lymphoid tissue and not a passive movement of cells. A wide range of immune cell phenotypes exist at the ocular surface. This model can serve to test in vitro the effects of injurious agents on the ocular surface.
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