Spousal Concordance in the Development of Functional Limitations Among Married Adults in China

Article


Wang, Jingwen, Wang, Qian, Hou, Xiang-Yu, Chen, Sunan, Guo, Zhen, Du, Wei and Fan, Lijun. 2021. "Spousal Concordance in the Development of Functional Limitations Among Married Adults in China." JAMA Network Open. 4 (9), pp. 1-14. https://doi.org/10.1001/jamanetworkopen.2021.25577
Article Title

Spousal Concordance in the Development of Functional Limitations Among Married Adults in China

ERA Journal ID213045
Article CategoryArticle
AuthorsWang, Jingwen (Author), Wang, Qian (Author), Hou, Xiang-Yu (Author), Chen, Sunan (Author), Guo, Zhen (Author), Du, Wei (Author) and Fan, Lijun (Author)
Journal TitleJAMA Network Open
Journal Citation4 (9), pp. 1-14
Article Numbere2125577
Number of Pages14
Year2021
PublisherAmerican Medical Association (AMA)
Place of PublicationUnited States
ISSN2574-3805
Digital Object Identifier (DOI)https://doi.org/10.1001/jamanetworkopen.2021.25577
Web Address (URL)https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2784546
Abstract

Importance: Functional limitation is increasingly common as people age and is often associated with negative consequences. Evidence of the dynamics of functional limitation within couples in China is still inadequate.

Objectives: To examine whether functional limitation was associated within middle-aged and older couples and to explore sex differences in spousal associations.

Design, setting, and participants: In this nationwide, population-based cohort study performed from January 1, 2011, to December 31, 2018, participants were selected using multistage probability sampling, and 5207 community-dwelling couples (10 414 individuals) 45 years or older were included in the nationally representative China Health and Retirement Longitudinal Study. Data analysis was performed from January 1 to February 28, 2021.

Exposures: The exposure variable was the presence of functional limitation in spouses. Functional limitation was measured by the activities of daily living (ADLs) and instrumental activities‎ of daily ‎living (IADLs) scales and was defined as having difficulty in independently performing at least 1 ADL or IADL item.

Main outcomes and measures: The main outcome was functional limitation in index participants. Multivariable logistic regression with generalized estimating equations was used to estimate the reciprocal association of functional limitation within couples over time.

Results: A total of 5207 married, different-sex couples (mean [SD] age, 59.1 [8.8] years for husbands and 57.0 [8.2] years for wives) were included in the study. For husbands, the number (percentage) of participants classified with baseline functional limitation was 1140 (21.9%), the number (percentage) with ADL limitation was 684 (13.1%), and the number (percentage) with IADL limitation was 834 (16.0%). For wives, the number (percentage) of participants classified with baseline functional limitation was 1502 (28.8%), the number (percentage) with ADL limitation was 887 (17.0%), and the number (percentage) with IADL limitation was 1183 (22.7%). Longitudinal results demonstrated an association in spouses developing functional limitation (adjusted odds ratio [OR], 2.55; 95% CI, 2.41-2.69; P < .001), ADL limitation (adjusted OR, 2.26; 95% CI, 2.11-2.41; P < .001), and IADL limitation (adjusted OR, 2.58; 95% CI, 2.43-2.73; P < .001). Subgroup analyses by sex revealed similar patterns of spousal health concordance in terms of all studied outcomes, indicating no sex specificity.

Conclusions and relevance: This population-based cohort study suggests that among Chinese middle-aged and older couples there is significant concordance in the development of functional limitation. This study of spousal functional ability from a dyadic perspective may help in the understanding of health risks within a wider familial context and offers novel insights for prioritizing policy focus from individual centered to couple based.

KeywordsSpousal Concordance, Functional Limitations, Elderly, China
ANZSRC Field of Research 2020420201. Behavioural epidemiology
420210. Social epidemiology
Byline AffiliationsSoutheast University, China
Guangdong Academy of Medical Sciences, China
School of Health and Wellbeing
Institution of OriginUniversity of Southern Queensland
Permalink -

https://research.usq.edu.au/item/q6q39/spousal-concordance-in-the-development-of-functional-limitations-among-married-adults-in-china

  • 87
    total views
  • 86
    total downloads
  • 2
    views this month
  • 1
    downloads this month

Export as

Related outputs

Failure envelopes of rigid tripod pile foundation under combined vertical-horizontal-moment loadings in clay
Zhao, Zihao, Zhang, Hao, Shiau, Jim, Du, Wei, Ke, Lijun, Wu, Fengyuan and Bao, Xu. 2024. "Failure envelopes of rigid tripod pile foundation under combined vertical-horizontal-moment loadings in clay." Applied Ocean Research. 150. https://doi.org/10.1016/j.apor.2024.104131
The impact of workplace factors, workload and culture on the medication safety practices of paramedics
Walker, Dennis, Hou, Janet, Long, David, SueSee, Brendan and Moloney, Clint. 2024. "The impact of workplace factors, workload and culture on the medication safety practices of paramedics." Australasian College of Paramedicine International Conference 2023. Melbourne, Australia 14 - 15 Sep 2023 United Kingdom .
Factors Influencing Medication Errors in the Prehospital Paramedic Environment: A Mixed Method Systematic Review
Walker, Dennis, Moloney, Clint, SueSee, Brendan, Sharples, Renee, Blackman, Rosanna, Long, David and Hou, Xiang-Yu. 2023. "Factors Influencing Medication Errors in the Prehospital Paramedic Environment: A Mixed Method Systematic Review." Prehospital Emergency Care. 27 (5), pp. 669-686. https://doi.org/10.1080/10903127.2022.2068089
Association of sensory impairment with healthcare use and costs among middle-aged and older adults in China
Ding, Yue, Liu, Yingyan, Hou, Xiang-Yu, Tian, Yong, Du, Wei and Fan, Lijun. 2022. "Association of sensory impairment with healthcare use and costs among middle-aged and older adults in China." Public Health. 206, pp. 20-28. https://doi.org/10.1016/j.puhe.2022.02.012
Catastrophic health expenditure associated with frailty in community-dwelling Chinese older adults: a prospective cohort analysis
Fan, Lijun, Hou, Xiang-Yu, Liu, Yingyan, Chen, Sunan, Wang, Qian and Du, Wei. 2021. "Catastrophic health expenditure associated with frailty in community-dwelling Chinese older adults: a prospective cohort analysis." Frontiers in Public Health. 9, pp. 1-10. https://doi.org/10.3389/fpubh.2021.718910
Flood fatalities in contemporary Australia (1997-2008): disaster medicine
Fitzgerald, Gerry, Du, Weiwei, Jamal, Aziz, Clark, Michele and Hou, Xiang-Yu. 2010. "Flood fatalities in contemporary Australia (1997-2008): disaster medicine." Emergency Medicine Australasia. 22 (2), pp. 180-186. https://doi.org/10.1111/j.1742-6723.2010.01284.x
Educational stress scale for adolescents: development, validity, and reliability with Chinese students
Sun, Jiandong, Dunne, Michael P., Hou, Xiang-Yu and Xu, Ai-qiang. 2011. "Educational stress scale for adolescents: development, validity, and reliability with Chinese students." Journal of Psychoeducational Assessment. 29 (6), pp. 534-546. https://doi.org/10.1177/0734282910394976
Progress and challenges of disaster health management in China: a scoping review
Zhong, Shuang, Clark, Michele, Hou, Xiang-Yu, Zang, Yuli and FitzGerald, Gerard. 2014. "Progress and challenges of disaster health management in China: a scoping review." Global Health Action. 7, pp. 1-9. https://doi.org/10.3402/gha.v7.24986
Validation of a framework for measuring hospital disaster resilience using factor analysis
Zhong, Shuang, Clark, Michele, Hou, Xiang-Yu, Zang, Yuli and FitzGerald, Gerard. 2014. "Validation of a framework for measuring hospital disaster resilience using factor analysis." International Journal of Environmental Research and Public Health. 11 (6), pp. 6335-6353. https://doi.org/10.3390/ijerph110606335
Factors affecting antihypertensive medications adherence among hypertensive patients in Saudi Arabia
Alsolami, Fatmah, Correa-Velez, Ignacio and Hou, Xiang-Yu. 2015. "Factors affecting antihypertensive medications adherence among hypertensive patients in Saudi Arabia." American Journal of Medicine and Medical Sciences. 5 (4), pp. 181-189. https://doi.org/10.5923/j.ajmms.20150504.07
Interventions targeting the elderly population to reduce emergency department utilisation: a literature review
Fan, Lijun, Lukin, William, Zhao, Jingzhou, Sun, Jiandong and Hou, Xiang-Yu. 2015. "Interventions targeting the elderly population to reduce emergency department utilisation: a literature review." Emergency Medicine Journal. 32 (9), pp. 738-743. https://doi.org/10.1136/emermed-2014-203770
The Australian emergency medical system
FitzGerald, Gerard, Hou, Xiang-Yu and Hang, H.. 2008. "The Australian emergency medical system." Chinese Journal of Emergency Medicine. 17 (7), pp. 774-778.
Towards understanding self-development coaching programs
Aboalshamat, Khalid, Hou, Xiang-Yu and Strodl, Esben. 2014. "Towards understanding self-development coaching programs." International Journal of Psychology and Behavioral Science. 4 (4), pp. 136-145. https://doi.org/10.5923/j.ijpbs.20140404.04
Health impacts of floods: a comprehensive review
Du, Weiwei, FitzGerald, Gerard, Clark, Michele and Hou, Xiang-Yu. 2010. "Health impacts of floods: a comprehensive review." Prehospital and Disaster Medicine. 25 (3), pp. 265-272. https://doi.org/10.1017/S1049023X00008141
A qualitative study of the determinants of dieting and non-dieting approaches in overweight/obese Australian adults
Leske, Stuart, Strodl, Esben and Hou, Xiang-Yu. 2012. "A qualitative study of the determinants of dieting and non-dieting approaches in overweight/obese Australian adults." BMC Public Health. 12 (1), pp. 1-13. https://doi.org/10.1186/1471-2458-12-1086
Doctor's knowledge and practices of traumatic brain injury management in Chinese prehospital settings
Kou, Kou, Hou, Xiang-Yu, Sun, Jian-Dong and Chu, Kevin. 2015. "Doctor's knowledge and practices of traumatic brain injury management in Chinese prehospital settings." Prehospital and Disaster Medicine. 30 (6), pp. 560-568. https://doi.org/10.1017/s1049023x15005257
Acuity and severity of patients attending 28 Queensland hospitals emergency departments in 2008-09 [Conference Abstract]
Hou, Xiang-Yu, Toloo, Sam and FitzGerald, Gerard. 2011. "Acuity and severity of patients attending 28 Queensland hospitals emergency departments in 2008-09 [Conference Abstract]." Australasian Epidemiologist. 18 (2), p. 89.
What health problems overcrowd hospital emergency departments in Queensland and has this changed over time? A case study of two hospitals in Queensland 2001 - 2009
Hou, Xiang-Yu, Toloo, Sam and FitzGerald, Gerard. 2011. "What health problems overcrowd hospital emergency departments in Queensland and has this changed over time? A case study of two hospitals in Queensland 2001 - 2009." Australasian Epidemiologist. 18 (1), pp. 10-14.
Is language a barrier for quality care in hospitals? A case series from an Emergency Department of a teaching hospital in Brisbane
Mahmoud, Ibrahim, Hou, Xiang-Yu, Chu, Kevin and Clark, Michele. 2011. "Is language a barrier for quality care in hospitals? A case series from an Emergency Department of a teaching hospital in Brisbane." Australasian Epidemiologist. 18 (1), pp. 6-9.
Weight bias on psychological and physical health
Leske, Stuart, Strodl, Esben and Hou, Xiang-Yu. 2012. "Weight bias on psychological and physical health." Australasian Epidemiologist. 19 (1), pp. 18-20.
Immigrants and the utilization of hospital emergency departments
Mahmoud, Ibrahim and Hou, Xiang-Yu. 2012. "Immigrants and the utilization of hospital emergency departments." World Journal of Emergency Medicine. 3 (4), pp. 245-250. https://doi.org/10.5847/wjem.j.issn.1920-8642.2012.04.001
The potential contributions of traditional Chinese medicine to emergency medicine
He, Jun and Hou, Xiang-Yu. 2013. "The potential contributions of traditional Chinese medicine to emergency medicine." World Journal of Emergency Medicine. 4 (2), pp. 92-97.
Introduction of emergency medicine in China
Hou, Xiang-Yu and FitzGerald, Gerard. 2008. "Introduction of emergency medicine in China." Emergency Medicine Australasia. 20 (4), pp. 363-369. https://doi.org/10.1111/j.1742-6723.2008.01108.x
Impact of a government triple zero awareness campaign on emergency department patient characteristics
Hou, Xiang-Yu, Zhao, Jingzhou and Chu, Kevin. 2012. "Impact of a government triple zero awareness campaign on emergency department patient characteristics." Emergency Medicine Australasia. 24 (4), pp. 393-400. https://doi.org/10.1111/j.1742-6723.2012.01560.x
Language and utilisation of emergency care in Queensland
Mahmoud, Ibrahim, Hou, Xiang-Yu, Chu, Kevin and Clark, Michele. 2013. "Language and utilisation of emergency care in Queensland." Emergency Medicine Australasia. 25 (1), pp. 40-45. https://doi.org/10.1111/1742-6723.12017
2010-2011 Queensland floods: using Haddon's Matrix to define and categorise public safety strategies
Zhong, Shuang, Clark, Michele, Hou, Xiang-Yu, Zang, Yu-Li and FitzGerald, Gerry. 2013. "2010-2011 Queensland floods: using Haddon's Matrix to define and categorise public safety strategies." Emergency Medicine Australasia. 25 (4), pp. 345-352. https://doi.org/10.1111/1742-6723.12097
Satisfaction with emergency department service among non-English-speaking background patients
Mahmoud, Ibrahim, Hou, Xiang-Yu, Chu, Kevin, Clark, Michele and Eley, Robert. 2014. "Satisfaction with emergency department service among non-English-speaking background patients." Emergency Medicine Australasia. 26 (3), pp. 256-261. https://doi.org/10.1111/1742-6723.12214
Paramedic education opportunities and challenges in Australia
Hou, Xiang-Yu, Rego, Joanna and Service, Melinda. 2013. "Paramedic education opportunities and challenges in Australia." Emergency Medicine Australasia. 25 (2), pp. 114-119. https://doi.org/10.1111/1742-6723.12034
The impact of globalisation on health
Hou, Xiang-Yu. 2008. "The impact of globalisation on health." Fleming, Mary Louise and Parker, Elizabeth (ed.) Introduction to public health. Chatswood, NSW, Australia. Elsevier. pp. 307-331
Emergency department in hospitals, a window of the world: a preliminary comparison between Australia and China
Hou, Xiang-Yu and Chu, Kevin. 2010. "Emergency department in hospitals, a window of the world: a preliminary comparison between Australia and China." World Journal of Emergency Medicine. 1 (3), pp. 180-184.
The impact of globalisation on health
Hou, Xiang-Yu. 2011. "The impact of globalisation on health." Fleming, Mary Louise and Parker, Elizabeth (ed.) Introduction to public health. Chatswood, NSW, Australia. Elsevier. pp. 326-349
Factors affecting antihypertensive treatment adherence: a Saudi Arabian perspective
Alsolami, Fatmah, Hou, Xiang-Yu and Correa-Velez, Ignacio. 2012. "Factors affecting antihypertensive treatment adherence: a Saudi Arabian perspective." Clinical Medicine and Diagnostics. 2 (4), pp. 27-32. https://doi.org/10.5923/j.cmd.20120204.02
Assessing the overuse of antibiotics in children with URTIs in Saudi Arabia: development of the parental perception on antibiotics scale (PAPA scale)
Alumran, Arwa, Hou, Xiang-Yu and Hurst, Cameron. 2013. "Assessing the overuse of antibiotics in children with URTIs in Saudi Arabia: development of the parental perception on antibiotics scale (PAPA scale)." Journal of Epidemiology and Global Health. 3 (1), pp. 3-10. https://doi.org/10.1016/j.jegh.2012.11.005
The current workforce status of prehospital care in china
Hou, Xiang-Yu and Lu, Chuan-Zhu. 2005. "The current workforce status of prehospital care in china." Journal of Emergency Primary Health Care. 3 (3), pp. 1-11.
Psychological health of medical and dental students in Saudi Arabia: a longitudinal study
Aboalshamat, Khalid, Hou, Xiang-Yu and Strodl, Esben. 2014. "Psychological health of medical and dental students in Saudi Arabia: a longitudinal study." Public Health Research. 4 (5), pp. 179-184. https://doi.org/10.5923/j.phr.20140405.05
Predictors of dieting and non-dieting approaches among adults living in Australia
Leske, Stuart, Strodl, Esben and Hou, Xiang-Yu. 2017. "Predictors of dieting and non-dieting approaches among adults living in Australia." BMC Public Health. 17, pp. Article number: 214 1-18. https://doi.org/10.1186/s12889-017-4131-0
Modification of the effects of air pollutants on mortality by temperature: A systematic review and meta-analysis
Li, Jing, Woodward, Alistair, Hou, Xiang-Yu, Zhu, Tong, Zhang, Jinliang, Brown, Helen, Yang, Jun, Qin, Rennie, Gao, Jinghong, Gu, Shaohua, Li, Jing, Xu, Lei, Liu, Xiaobo and Liu, Qiyong. 2017. "Modification of the effects of air pollutants on mortality by temperature: A systematic review and meta-analysis." Science of the Total Environment. 575, pp. 1556-1570. https://doi.org/10.1016/j.scitotenv.2016.10.070
Family childcare types and conduct problem behaviors in young children: The mediation role of caregiver-child interaction
Liu, Li, Fan, Lijun, Hou, Xiang-Yu, Wu, Chuan-An, Yin, Xiao-Na, Wen, Guo-Min, Sun, Dengli, Xian, Dan-Xia, Jiang, Hui, Jing, Jin, Jin, Yu and Chen, Wei-Qing. 2018. "Family childcare types and conduct problem behaviors in young children: The mediation role of caregiver-child interaction." Frontiers in Pediatrics. 6, pp. 1-11. https://doi.org/10.3389/fped.2018.00217
Sugar-sweetened beverages and school students' hypertension in urban areas of Nanjing, China
Qin, Zhenzhen, Xu, Fei, Ye, Qing, Zhou, Hairong, Li, Chao, He, Jing, Wang, Zhiyong, Hong, Xin and Hou, Xiang-Yu. 2018. "Sugar-sweetened beverages and school students' hypertension in urban areas of Nanjing, China." Journal of Human Hypertension. 32, pp. 392-396. https://doi.org/10.1038/s41371-018-0030-9
Interpersonal conflict, school connectedness and depressive symptoms in Chinese adolescents: Moderation effect of gender and grade level
He, Guan-Hao, Strodl, Esben, Chen, Wei-Qing, Liu, Fan, Hayixibayi, Alimila and Hou, Xiang-Yu. 2019. "Interpersonal conflict, school connectedness and depressive symptoms in Chinese adolescents: Moderation effect of gender and grade level." International Journal of Environmental Research and Public Health. 16 (12), pp. 1-16. https://doi.org/10.3390/ijerph16122182
How much can our universities do in the development of cultural intelligence? A cross-sectional study among health care students
Wang, Chen, Shakespeare-Finch, Jane, Dunne, Michael P., Hou, Xiang-Yu and Khawaja, Nigar G.. 2021. "How much can our universities do in the development of cultural intelligence? A cross-sectional study among health care students." Nurse Education Today. 103, pp. 1-6. https://doi.org/10.1016/j.nedt.2021.104956
Director of nursing experiences of a hospital in the nursing home program in South East Queensland
Barnard, Alan, Hou, Xiang-Yu and Lukin, Bill. 2016. "Director of nursing experiences of a hospital in the nursing home program in South East Queensland." Collegian: The Australian Journal of Nursing Practice, Scholarship and Research. 23 (4), pp. 341-348. https://doi.org/10.1016/j.colegn.2016.03.001
Hospital in the Nursing Home program reduces emergency department presentations and hospital admissions from residential aged care facilities in Queensland, Australia: a quasi-experimental study
Fan, Lijun, Hou, Xiang-Yu, Zhao, Jingzhou, Sun, Jiandong, Dingle, Kaeleen, Purtill, Rhonda, Tapp, Sam and Lukin, Bill. 2016. "Hospital in the Nursing Home program reduces emergency department presentations and hospital admissions from residential aged care facilities in Queensland, Australia: a quasi-experimental study." BMC Health Services Research. 16, pp. 1-9. https://doi.org/10.1186/s12913-016-1275-z
Qualitative study of patients' choice between public and private hospital emergency departments
He, Jun, Toloo, Ghasem-Sam, Hou, Xiang-Yu and FitzGerald, Gerry. 2016. "Qualitative study of patients' choice between public and private hospital emergency departments." Emergency Medicine Australasia. 28 (2), pp. 159-163. https://doi.org/10.1111/1742-6723.12530
Teaching epidemiology to undergraduate paramedics [Round table]
Lim, David, Hou, Xiang-Yu and Tippett, Vivienne. 2016. "Teaching epidemiology to undergraduate paramedics [Round table]." Australasian Epidemiologist. 23 (1), pp. 24-26.
Emergency department use among patients from residential aged care facilities under a Hospital in the Nursing Home scheme in public hospitals in Queensland Australia
Lukin, Bill, Fan, Li-jun, Zhao, Jing-zhou, Sun, Jian-dong, Dingle, Kaeleen, Purtill, Rhonda, Tapp, Sam and Hou, Xiang-Yu. 2016. "Emergency department use among patients from residential aged care facilities under a Hospital in the Nursing Home scheme in public hospitals in Queensland Australia." World Journal of Emergency Medicine. 7 (3), pp. 183-190. https://doi.org/10.5847/wjem.j.1920-8642.2016.03.004
Patients' choice between public and private hospital emergency departments: a cross-sectional survey
He, Jun, Hou, Xiang-Yu, Toloo, Ghasem (Sam) and FitzGerald, Gerry. 2017. "Patients' choice between public and private hospital emergency departments: a cross-sectional survey." Emergency Medicine Australasia. 29 (6), pp. 635-642. https://doi.org/10.1111/1742-6723.12841
Prenatal exposure to environmental tobacco smoke and hyperactivity behavior in Chinese young children
Lin, Qingmei, Hou, Xiang-Yu, Yin, Xiao-Na, Wen, Guo-Min, Sun, Dengli, Xian, Dan-Xia, Fan, Lijun, Jiang, Hui, Jing, Jin, Jin, Yu, Wu, Chuan-An and Chen, Wei-Qing. 2017. "Prenatal exposure to environmental tobacco smoke and hyperactivity behavior in Chinese young children." International Journal of Environmental Research and Public Health. 14 (10), pp. 1-12. https://doi.org/10.3390/ijerph14101132
Biomarkers of the health outcomes associated with ambient particulate matter exposure
Yang, Lixin, Hou, Xiang-Yu, Wei, Yongjie, Thai, Phong and Chai, Fahe. 2017. "Biomarkers of the health outcomes associated with ambient particulate matter exposure." Science of the Total Environment. 579, pp. 1446-1459. https://doi.org/10.1016/j.scitotenv.2016.11.146
Incidence and outcome of subarachnoid haemorrhage in the general and emergency department populations in Queensland from 2010 to 2014
Chu, Kevin H., Mahmoud, Ibrahim, Hou, Xiang-Yu, Winter, Craig D., Jeffree, Rosalind L., Brown, Nathan J. and Brown, Anthony F. T.. 2018. "Incidence and outcome of subarachnoid haemorrhage in the general and emergency department populations in Queensland from 2010 to 2014." Emergency Medicine Australasia. 30 (4), pp. 503-510. https://doi.org/10.1111/1742-6723.12936
Cost analysis of improving emergency care for aged care residents under a Hospital in the Nursing Home program in Australia
Fan, Lijun, Lukin, Bill, Zhao, Jingzhou, Sun, Jiandong, Dingle, Kaeleen, Purtill, Rhonda, Tapp, Sam and Hou, Xiang-Yu. 2018. "Cost analysis of improving emergency care for aged care residents under a Hospital in the Nursing Home program in Australia." PLoS One. 13 (7). https://doi.org/10.1371/journal.pone.0199879
Disaster resilience in tertiary hospitals: a cross-sectional survey in Shandong Province, China
Zhong, Shuang, Hou, Xiang-Yu, Clark, Michele, Zang, Yuli, Wang, Lu, Xu, Ling-Zong and FitzGerald, Gerard. 2014. "Disaster resilience in tertiary hospitals: a cross-sectional survey in Shandong Province, China." BMC Health Services Research. 14, pp. 1-10. https://doi.org/10.1186/1472-6963-14-135
Emergency medicine in China
Hou, Xiang-Yu. 2012. "Emergency medicine in China." Blaivas, Michael (ed.) Emergency medicine: an international perspective. Croatia. In-Tech. pp. 73-94