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Biomedical subjects

L D Saunders

Publications and source records attributed to L D Saunders.

At least 37 records · Page 2Linked to original sources
PubMed1998

Who gets missed: coverage in a provincial newborn screening program for metabolic disease.

OBJECTIVE: To determine coverage of the newborn screening program (NSP) for metabolic disease in Alberta, Canada, and to determine reasons for not being screened. STUDY DESIGN: Coverage was estimated by deterministic matching of live birth registration data with newborn screening data for the year 1992. Demographic characteristics of not-matched infants were compared with good-match infants using logistic regression. RESULTS: For 42 392 live births, there were 41 553 screening records, of which 40 593 infants were very good matches to NSP records. Another 960 were possible matches. A total of 839 infants were not matched at all, and coverage was estimated at 98.0%. Determinants of infant not-matched status were death in week 1 (adjusted odds ratio [OR]: 383); birth weight of <1500 g (adjusted OR: 18.9) or between 1500 and 2500 g (adjusted OR: 3.2); having a mother who was single (adjusted OR: 2.7) or formerly married (adjusted OR: 12.9); or being born out of hospital (OR: 19. 2). The calculated 98% coverage is close to an estimate of 98.3% made by the NSP comparing total births with initial screenings. CONCLUSION: The matched data give insight as to who was missed and point to the need for closer attention for infants at greater risk of not being screened for metabolic disease.

Alberta↗
PubMed1996

Considerations for regional health authorities in the provision of environmental health services.

As population health programs, environmental health services differ fundamentally from other forms of health service delivery. At a time when the health sector is striving for integration, the incorporation of these unique services into the delivery system presents a unique challenge to policy makers and administrators across the country. The University of Alberta recently completed a comprehensive review and redesign of locally governed and delivered environmental health protection services in Alberta. This paper outlines the key issues and unique features surrounding the delivery of environmental health services and presents the study team's suggested approach to addressing these issues.

Alberta↗
PubMed1996

Toward a framework for health service research.

Fiscal concerns have provided the impetus for wide-ranging attempts to reform the delivery of health care in Canada. Health reform has in turn stimulated great interest and activity in health service research. For health service research to be of maximum use in addressing current and future challenges to the health care system, closer liaison is needed between researchers and decision makers--the users of research. The purpose of this paper is to promote greater interaction between decision makers and researchers by proposing a framework for health predicated on types of information needed for decision-making rather than on study methodologies. We distinguish between decision makers at the societal, health system, program and service levels. Types of studies are classified by their purpose and by the phase of the management cycle for which they provide information for decision-making.

Canada↗
PubMed1996

Epidemiology of recreational and old-timer ice hockey injuries.

OBJECTIVE: To examine the nature and incidence of injuries suffered by a sample of recreational and old-timer ice hockey players. DESIGN: Random sample of teams followed prospectively. SETTING: Various hockey rinks in the Greater Edmonton Region. PARTICIPANTS: Four hundred and thirty-one subjects--287 adult male recreational (AMRL) and 144 male old-timer (OTL) from five leagues were followed over the 1992-93 hockey season. MAIN OUTCOME MEASURES: Injuries sustained during the duration of a hockey season. RESULTS: A total of 151 injuries (100 AMRL and 51 OTL) were reported. The aggregate injury rate was 12.2/1000 player-exposures (12.3 AMRL and 12.0 OTL). The anatomic region most often injured by AMRL players was the head/neck/facial area (32%) while OTL players reported a greater proportion of lower extremity injuries (40%). Both groups reported sprains/strains as the most common diagnosis (35% AMRL and 47% OTL). The predominant injury mechanism for AMRL players was stick contact (24%) and for OTL players was puck contact (23%). No significant differences were detected between the anatomic, diagnostic, and mechanistic distributions of injury between AMRL and OTL players. Seventy-five percent of injuries occurred during league games, 10% during playoff games, 5% during tournament games, and 10% during practices. Penalties were assessed in 31% of injury instances. Forty-two percent of head/neck/facial injuries, 32% of upper extremity injuries, 13% of torso injuries, and 15% of lower extremity occurred as a result of penalizable behavior (p = 0.01). Three percent of players wearing full or half face protectors suffered facial injuries while 9% of players not wearing facial protection reported facial injuries (p = 0.03; Relative Risk = 2.56). CONCLUSIONS: The injury rates observed were lower than reported rates for major/elite hockey. The proportion of players injured through body contact was lower than that observed in adult major/elite hockey while the diagnostic and anatomic distribution of injury was similar. Studies such as this are useful in the development of injury prevention strategies.

Adult↗
PubMed1995

Use of second line drugs for the treatment of rheumatoid arthritis in Edmonton, Alberta. Patterns of prescription and longterm effectiveness.

OBJECTIVE: Our purpose was to compare the patterns of prescription of 2nd line drugs for the treatment of rheumatoid arthritis (RA) among rheumatologists in Edmonton, Alberta, and to examine the longterm effectiveness of these drugs. METHODS: A 1985 inception cohort of 128 patients with RA was assessed between 1991 and 1992, using measures of disease activity, radiological scores and physical functional status. Use of different therapies was retrieved from the medical charts. RESULTS: All patients had seen a rheumatologist at any time between January, 1985 and December, 1991, 88% within the first 3 years of disease. Most (85%) had received at least one 2nd line drug, the majority within the first 2 years. Overall, gold salts were the most frequently prescribed drugs. Patterns of prescription varied among different rheumatologists; some drugs were never prescribed by some and very often by others (e.g., auranofin). Terminations because of toxicity and lack of efficacy were high. Methotrexate (MTX) had the lowest termination rate and sulfasalazine the highest, mostly due to lack of efficacy. CONCLUSION: In this cohort, patients were treated early in the course of RA. Patterns of prescription of 2nd line drugs varied among rheumatologists. Termination rates were highest for sulfasalazine and lowest for MTX.

Adrenal Cortex Hormones↗
PubMed1994

Outcome in rheumatoid arthritis. A 1985 inception cohort study.

OBJECTIVE: Our purpose was to describe the clinical status and outcome of a 1985 inception cohort of patients with rheumatoid arthritis (RA), retrospectively established. METHODS: All patients with RA in Edmonton, with a possible onset of disease in 1985, and who consulted a rheumatologist at any time from January, 1985 through June, 1991 were considered for inclusion in the cohort. Patients were contacted and assessed between August, 1991 and June, 1992. The following indices were used as outcome measures: joint counts, radiological scores of hand radiographs and the modified Health Assessment Questionnaire for activities of daily living (MHAQ). RESULTS: One hundred and twenty eight patients were included in the cohort (70% were women; age at onset was 52 +/- 13 years). At the time of the assessment, 41 patients (32%) had no articular swelling. Twenty-nine patients (23%) had a radiological score of 0, and 39 (31%) had no erosions. The mean MHAQ score was 0.49 +/- 0.47; 39 patients (31%) had a score of 0 (normal function). Rheumatoid factors and nodules were related to more severe outcomes. Sex, age at onset and mode of onset were not related to prognosis. Most patients had received 2nd line therapy within the first 3 years of RA. CONCLUSION: Our results suggest that the prognosis of RA after 6-7 years of disease is not as ominous as has been suggested by others. Since most of the previous studies have been conducted in prevalent cases attending tertiary centers, a selection bias may be responsible for some of these results. Since these patients were treated early in the course of the disease, the beneficial effects of prompt 2nd line therapy cannot be excluded.

Adult↗
PubMed1993

The spectrum of acquired immunodeficiency syndrome (AIDS)-associated malignancies in San Francisco, 1980-1987.

Population-based disease registries for acquired immunodeficiency syndrome (AIDS) and cancer were linked for San Francisco residents to study the pattern of AIDS-associated malignancies diagnosed during the time period 1980-1987. A total of 1,756 newly diagnosed malignancies were identified during these years among members of the AIDS cohort. Of these, 1,752 (99.7%) occurred in males, 1,454 (83%) were Kaposi's sarcoma, 235 (13%) were non-Hodgkin's lymphoma, and 16 (1%) were Hodgkin's disease. The distributions of AIDS patients with cancer differed significantly from those without cancer by race and by risk group. Malignancies known to be human immunodeficiency virus (HIV)-associated, and now diagnostic of AIDS (Kaposi's sarcoma, non-Hodgkin's lymphoma), were, as would be expected, dramatically in excess among AIDS patients. Some malignancies not traditionally thought to be HIV-associated appear to have occurred more often than expected in the study cohort. These include Hodgkin's disease, rare non-melanoma skin cancers, and cancers of the rectum, anus, and nasal cavity. Malignancies known to be HIV-associated were more likely to be diagnosed concurrent with or subsequent to first AIDS diagnosis. Conversely, malignancies not known to be HIV-associated were more likely to be diagnosed before AIDS diagnosis. Compared with the concurrent reference population of the San Francisco Bay Area, there was little or no increase in Kaposi's sarcoma over the time interval of this study. For non-Hodgkin's lymphoma, and suggestively for Hodgkin's disease, however, the temporal increase has been quite dramatic.

Acquired Immunodeficiency Syndrome↗
PubMed1993

The fluoridation of drinking water and hip fracture hospitalization rates in two Canadian communities.

OBJECTIVES: The purpose of this study was to compare hip fracture hospitalization rates between a fluoridated and a non-fluoridated community in Alberta, Canada: Edmonton, which has had fluoridated drinking water since 1967, and Calgary, which considered fluoridation in 1991 but is currently revising this decision. METHODS: Case subjects were all individuals aged 45 years or older residing in Edmonton or Calgary who were admitted to hospitals in Alberta between January 1, 1981, and December 31, 1987, and who had a discharge diagnosis of hip fracture. Edmonton rates were compared with Calgary rates, with adjustment for age and sex using the Edmonton population as a standard. RESULTS: The hip fracture hospitalization rate for Edmonton from 1981 through 1987 was 2.77 per 1000 person-years. The age-sex standardized rate for Calgary was 2.78 per 1000 person-years. No statistically significant difference was observed in the overall rate, and only minor differences were observed within age and sex subgroups, with the Edmonton rates being higher in males. CONCLUSIONS: These findings suggest that fluoridation of drinking water has no impact, neither beneficial nor deleterious, on the risk of hip fracture.

Aged↗
PubMed1991

Reducing the cesarean section rate in a rural community hospital.

OBJECTIVE: To determine the success of a program designed to reduce the cesarean section rate in a rural community hospital, to identify reasons for any reduction in the rate and to identify any accompanying increases in the maternal and neonatal morbidity and mortality rates. DESIGN: Longitudinal study of modes of delivery. SETTING: A 44-bed community hospital with a medical staff of nine family physicians serving a population of 9000. PATIENTS: All 1161 women who gave birth at the hospital from Jan. 1, 1985, to Dec. 31, 1989. Routinely recorded data were manually extracted from medical charts and entered into a computer database. INTERVENTION: The guidelines of the National Consensus Conference on Aspects of Cesarean Birth (NCCACB) for vaginal birth after cesarean section (VBAC), management of breech presentation and the diagnosis of dystocia requiring cesarean section were introduced at the hospital in 1985. OUTCOME MEASURES: The annual overall cesarean section rates and the rates among nulliparous women, multiparous women eligible for VBAC and multiparous women ineligible for VBAC. RESULTS: The overall cesarean section rate decreased from 23% in 1985 to 13% in 1989 (p = 0.001). Among the nulliparous women the rate decreased from 23% to 12%, but the difference was insignificant (p = 0.069); this decrease was due to a drop in the number of dystocia-related cesarean sections. The rate among VBAC-eligible multiparous women decreased from 93% to 36% (p less than 0.001) because of an increased acceptance of VBAC by the patients and the physicians. The rate among multiparous women ineligible for VBAC was virtually unchanged. There were 20 neonatal transfers to an intensive care unit, with no tendency toward an increase over the study period. None of the mothers died; one newborn, of a nulliparous woman, died from a prolapsed umbilical cord. CONCLUSIONS: The program was accompanied by a significant decrease in the cesarean section rate. Rural hospitals with facilities and personnel for emergency cesarean sections should consider the introduction of a similar program.

Alberta↗
PubMed1991

Cesarean sections in Alberta from April 1979 to March 1988.

OBJECTIVES: To determine (a) trends in the cesarean section rate in Alberta from April 1979 to March 1988, (b) the contribution of different primary indications to the overall increase in the cesarean section rate and (c) trends in the cesarean section rate by residence of the mother. DESIGN: Retrospective study. PARTICIPANTS: Women who gave birth in acute care hospitals in Alberta during the study period. Indications for cesarean section were defined by a hierarchic classification system. Geographic regions were identified according to the mother's residence. MAIN RESULTS: The crude cesarean section rate increased from 13.2 to 17.3 per 100 deliveries between 1979-80 and 1987-88. Previous cesarean section accounted for 54% of the increase, breech presentation for 17%, fetal distress for 17% and dystocia for 10%. The contribution of previous cesarean section was due to the substantial increase in the number of women presenting with a previous cesarean section. The cesarean section rate among women who had previously had the procedure decreased from 96.7% in 1979-80 to 84.6% in 1987-88. The crude cesarean section rates by region varied from 10.3 to 22.3 per 100 deliveries. CONCLUSIONS: Further efforts to reduce the rate of cesarean section among women who have previously undergone the procedure are needed to control the rate of cesarean section in Alberta. Decreasing the rate of primary cesarean section is also an important goal.

Adult↗
PubMed1990

Impact of AIDS on mortality in San Francisco, 1979-1986.

We used death certificate data for San Francisco residents from 1979 to 1986 to calculate the number of deaths and years of potential life lost before age 65 (YPLL) for leading causes of death. Acquired immune deficiency syndrome (AIDS)-related deaths were defined as including cytomegalovirus infection (ICD-9 078.5); cryptococcal infection (ICD-9 117.5); Pneumocystis carinii pneumonia (ICD-9 136.3); other malignant neoplasms of the skin, site unspecified (ICD-9 173.9); deficiency of cell-mediated immunity (ICD-9 279.1); and unspecified immunity deficiency (ICD-9 279.3). These deaths increased from 5 (0.1% of all deaths) in 1979 to 534 (6.6%) in 1986. Of the 1,225 deaths caused by AIDS-related diseases during this period, 1,032 (84%) occurred in men aged 20-49 years. AIDS-related deaths increased between 1979 and 1986 from 0 to 44 (25% of all deaths), 0 to 257 (44%), and 0 to 150 (35%) in men aged 20-29 years, 30-39 years, and 40-49 years, respectively. In 1986, AIDS-related diseases were the third leading cause of deaths and the leading cause of YPLL among male San Francisco residents.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Kaposi's sarcoma reporting in San Francisco: a comparison of AIDS and cancer surveillance systems.

A preliminary comparison of the reported incidence of Kaposi's sarcoma among males under 60 years of age residing in San Francisco was conducted using merged San Francisco AIDS Registry and California Tumor Registry (CTR) data. For the years 1980-1986, the number of cases reported by both registries was similar. However, only 961 (72.3%) of the 1,330 cases appearing in either registry appeared in both. Of the 160 Kaposi's sarcoma cases in the AIDS registry only, 11 (6.9%) were included in the CTR with another cancer diagnosis. Of the 209 Kaposi's sarcoma cases occurring only in the CTR, 109 (52.2%) were included in the AIDS registry with another diagnosis. The number of cases included in either or both registries was about 20% more than in either alone. Data sharing between the staff of these registries is precluded by confidentiality constraints.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Differences in the timeliness of diagnosis, breast and cervical cancer, San Francisco 1974-85.

Cancer registry data for San Francisco (1974-85) were used to identify women at greater risk of late diagnoses for breast and cervical cancers by age and ethnicity. For breast cancer, Black women were at greater risk for late diagnoses. For cervical cancer, women of all ethnic groups ages 50-69 years and Japanese and Filipino women were at greater risk for late diagnoses.

Adult↗
PubMed1989

Mortality from unintentional injuries in California, 1985.

In 1985 unintentional injuries were the fourth leading cause of death among California residents, causing 10,380 deaths. They were the leading cause of potential life lost, accounting for 278,109 years lost. This was more than twice the number of years lost due to heart disease and 1 1/2 times the number lost due to cancer. Motor vehicle traffic accidents were the leading cause of unintentional injury deaths, accounting for half (5,158) the deaths. The next two leading causes were poisoning (especially for men aged 25 to 44 years) and falls (especially among persons aged 75 and older). Drowning was second to motor vehicle accidents as a cause of death in children aged 1 to 14 years. California's age-adjusted injury mortality rates in 1985 were lower in coastal and urban counties than in inland and rural counties, and these rates were generally lower in counties having organized systems of trauma care.

Accidents↗
PubMed1987

Outbreak of Omite-CR-induced dermatitis among orange pickers in Tulare County, California.

An outbreak of dermatitis cases among 198 orange pickers employed by a Tulare County, California, packinghouse was investigated. Dermatitis was contracted by 114 (58%) of the 198 workers exposed when Omite-CR-treated fields were harvested. The dermatitis occurred predominantly in the exposed areas of the neck and chest. A dose-response association with dermatitis was suggested for Omite-CR exposure, but not for Carzol, Omite-CR + Carzol, or other pesticides. Because no violations of pesticide preharvest intervals or application rates were found, it appears that residue degradation was not given adequate consideration in the registration of Omite-CR, thus compromising the safety of the worker.

Agricultural Workers' Diseases↗