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PubMed2003

[Mortality after myocardial infarction has decreased in nearly all Swedish counties during the 1990's. Greatest improvement seen in those counties with the worst initial results].

In an international perspective, Sweden has a very low case fatality after acute myocardial infarction (AMI). The aim of this study was to present trends and regional differences in case fatality within 28 days of the first AMI for males and females in Sweden after adjusting for co-morbidity. Adjustments in order to remove random effects on the rank order of county councils were made. The study was based on national data on more than 500,000 cases of AMI. Between 1987 and 1999, case fatality after AMI decreased from 47% to 37% among men and from 44% to 34% among women. The case fatality in the individual counties varied from 29% to 37% for men and from 31% to 40% for women. Further analysis is needed in order to explain these variations.

Comorbidity↗

PubMed1992

[Ambulance services in Copenhagen, Odense and Ringkøbing County. Results from the spot test conducted by the Ministry of Health and the County Councils Association in 1990. 2. Treatment by ambulance staff, medical support and pattern of diagnoses].

In this investigation, the results from a spot test investigation comprising 3182 emergency ambulance services (AU) from three geographical regions with different degrees of urbanization are presented: The Danish capital (Municipality of Copenhagen), a large provincial town (Odense) and a rural district with smaller towns (the County of Ringkøbing). The conditions of the patients were assessed by the ambulance staff: 7-12% of the patients transported had visible haemorrhage, 5-8% were unconscious, 4-7% were cyanotic, 2-3% had seizures and 1-2% had pareses. The serious cases tended to be most frequent in the least urbanized regions. Registration of the therapeutic efforts by the ambulance staff prior to and during transport revealed that 15-33% of the patients did not receive any treatment. The commonest forms of treatment consisted of oxygen treatment (13-18%), treatment for shock (8-12%), Nato position (4-16%) and stopping of haemorrhage (7-12%). No differences were observed between the three geographic regions except that fewer patients in the capital received treatment. In cases of emergency ambulance services employing signals, medical support was available in 22% of the cases in Copenhagen, mainly by means of medically staffed ambulances. In the County of Ringkøbing, doctors, usually the doctor-on-call, participated in 27% of these services while medical support was only available in 2% of the cases in Odense. Registration of the diagnoses by the hospitals which received the patients revealed that the commonest group of diagnoses were injuries (36-44%) and cardiovascular disease (14-21%).(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulances↗

PubMed1998

[Seroepidemiology of Toxoplasma gondii infection among Atayal aborigines and local animals in Nan-ao district, Ilan county and Jen-ai district, Nan-tou county, Taiwan].

In this study, latex agglutination test (LAT) was used to detect sera anti-toxoplasma antibodies of Atayal aborigines and local animals in Nan-ao district, Ilan county and Jen-ai district, Nan-tou county as a measure of exposure to the Toxoplasma gondii. Out of 422 Atayal aborigines and 64 different animals were tested in Nan-ao district and 82 Atayal children in Jen-ai district were also screened, the positive rates for sera anti-toxoplasma antibodies were 21.8%, 17.2% and 15.9%, respectively. In Nan-ao district, neither were the positive rates significantly different in males (22.1%) and females (21.4%), nor in humans (21.8%) and dogs (19.6%) (P > 0.05). The seroprevalence in adults (28.3%) was significantly higher than that in children (18.7%) (P < 0.05), and the highest seropositive rate (38.1%) was in the age group 50-59 years and the lowest (7.7%) was in the age group 1-9 years. In general, the age pattern of prevalence is consistent with increasing duration of exposure to Toxoplasma gondii with age. For animals, the seropositive rate in dogs (19.6%) was also significantly higher than that in wild rats (7.7%) (P < 0.05). No significant difference in seropositive rate of Atayal children was observed between Nan-ao and Jen-ai districts (P > 0.05).

Adolescent↗

PubMed2004

County hospitals and regional medical care in Texas: an analysis of out-of-county costs.

The current system of regional medical service delivery in Texas places large demands on the state's urban public hospitals. To assess the nature and scope of such demands, we examined financial data from five of the state's largest public hospital districts. During fiscal year 2002, these hospitals reported 103,381 encounters with out-of-county patients, resulting in 66 million dollars in unreimbursed costs. Given the current economic outlook, Texas requires a more effective regional model that centralizes tertiary care, disperses primary and secondary care, and preserves key public health goods.

Catchment Area, Health↗

PubMed1992

A collaborative model of a county crisis intervention team: the Lake County experience.

A model is introduced for the classification of crisis intervention and disaster services as being clinic-based, ad hoc, school-oriented, disaster service based and integrative. An example is presented of an integrative-collaborative model that was developed in Lake County, Ohio to cope with situations of suicide, accidental death or natural disaster when they occur in rural areas and small towns. The Community Crisis Intervention Team (CCIT) was developed with characteristics specific to a collaborative model. The distinctive qualities of the CCIT are identified and discussed within the context of a case study of a postvention in a school setting following adolescent suicide.

Community Mental Health Services↗

PubMed1999

[Severe pediatric psychiatric problems in a Danish county. Admitted patients during a 10-year period in the county of Funen].

This retrospective case record describes all the child psychiatric in- and day-patients in one Danish county in the period 1978-1987. A total of 148 patients (18% of all the child psychiatric patients) was treated as in- or day-patient. Sixty-two percent were boys, with a mean age of 8.1 years, the mean-age for girls was 9.0 years. Adversities in the family appear to be great in this population. The families had experienced broken homes (44% of the inpatients vs 29% of the daypatients), parental death (18% vs 9%) and/or parental mental illness (21% vs 15%). The diagnoses and the treatment modalities agree well with investigations from other Nordic countries. Neurosis infantilis (19% vs 9%) and anorexia nervosa (18% vs 0%) are more common among inpatients, whereas adjustment disorder (18% vs 32%) is more common among daypatients. The treatment modalities include parent-guidance, psychotherapy, dyadic relationship and pharmacotherapy. At discharge 18% of the inpatients and 6% of the daypatients were placed in institutions and 12% and 4% respectively in foster families, and respectively 38% and 42% needed to be moved from an ordinary school to a specialized school. There is a need for documentation of the effectiveness of inpatient and daypatient treatment.

Adolescent↗

PubMed1975

Variola minor in Braganca Paulista County, 1956. Flow of the epidemic through the schools of the county.

The characteristics of the 10 elementary, teachers, business and high schools operated in the city capital of the Braganca Paulista County, state of São Paulo, Brazil, during the 1956 epidemic of variola minor (alastrim) are presented. Also shown are the numbers of students with variola and of students without variola but with homemates with variola, by grade and school. Of the total 131 cases recorded among students, 128 occurred in the 4 elementary schools. Of the latter cases, 101 occurred among the students of the JG School and the JT School. The distribution of these cases by age, sex, previous immunity status, school grade and clinical severity of the disease (typed according to Dixon's classification) were remarkably similar in these two schools. Only the ratio of students introducing the disease into their households to students having secondary cases in their households suggestively varied, the JT School having more introductory cases. No student with a previous attack of variola showed any clinical manifestation in any school. Only 2 of the total 101 cases from the JG and JT Schools occurred among students with a previous successful vaccination. Moreover, those two cases apparently resulted from within-household contacts rather than from contacts at the school. No student with current variola showed a severe type (Dixon's types 1 to 5). More than half of the cases typed showed the typical, medium-severity type (Dixon's type 6). More than 2/3 of the cases occurred among students aged 6 to 9 years, particularly among those 7- to 9-year old. The number of cases reached a maximum in the first grade and gradually and definitely decreased with increasing grade.

Adolescent↗

PubMed1991

[Cardiovascular screenings in Norwegian counties. Trends in risk pattern during the period 1985-90 among persons aged 40-42 in 4 counties].

In 1985-90, two screenings for cardiovascular disease risk factors were carried out with an interval of three years in four Norwegian counties. All residents aged 40-42 were invited to both screening rounds, and certain subgroups from the first round were re-invited to the second round. Compared with the score attained by the first generation, the total mean risk score for myocardial infarction achieved by the second generation was 19% lower in males, and 15.5% lower in females. The main cause of this reduction was lower serum cholesterol level. Based on results from the subgroups, the estimated mean risk score for the total male cohort from the first round had decreased by 10% at the rescreening three years later. It is concluded that the results indicate a continued, and perhaps accelerated, decrease in coronary heart disease mortality, as new generations populate the age groups where this disease is more prevalent. The screenings were part of a prevention programme, and it is reasonable to assume that the efforts by the primary health care services contributed to the improvement.

Adult↗

PubMed1980