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PubMed1998

Bacteraemic pneumococcal infections in Southern Sweden 1981-96: trends in incidence, mortality, age-distribution, serogroups and penicillin-resistance.

In a survey of pneumococcal blood isolates from patients in Southern Sweden, 560 isolates were found between 1981 and 1996. Between these years, the incidence of pneumococcal bacteraemia increased from 5.2 to 15.2/100,000/y. The eight most common serogroups/types (14, 7, 9, 6, 23, 3, 4 and 19) accounted for > 75% of the isolates, and 96.4% of the isolates were of serogroups/types represented in the present vaccine. A male preponderance (1.17:1) was noted, and the men were younger than the women (mean 57 vs 63 y of age; p < 0.05). The overall case-fatality rate during the period was 19%. Seven isolates with reduced susceptibility to penicillin were noted, all from 1991 to 1996. The increasing incidence of pneumococcal bacteraemia could not be explained by any of the following factors; age or sex of the patients, changes in prevailing serogroups/types, variations in vaccine use, emergence of penicillin-resistance, more liberal indications for blood cultures or improved culture methods.

Adolescent↗

PubMed1998

Influence of age and gender on gastroesophageal reflux in symptomatic patients.

Studies have reported that normal males have significantly more physiologic gastroesophageal reflux (GER) than women but little difference in reflux parameters is seen between younger and older normal individuals. The aims of this study were to investigate the influence of age and gender on GER in symptomatic patients. We reviewed 353 24-h pH studies performed in patients with reflux symptoms. The following parameters were assessed: % time pH < 4 of total, upright and supine periods; total reflux episodes; total reflux episodes > 5 min; longest reflux episode. These parameters were analyzed according to age and gender using non-parametric tests. The median age was 47 years and this was used as the cutoff between younger and older patients. Also, an elderly group (age > or = 65) was analyzed. Age did not influence % time pH < 4 for total, upright and supine periods. However, older symptomatic patients had longer reflux episodes. As with normal subjects, male patients had significantly (P < 0.05) more reflux than females, comparing median values for the percentage times pH < 4: total 4.7 vs 2.7%; upright 5.2 vs 3.3%; supine 1.2 vs 0.4%; total reflux episodes 63 vs 45; episodes > 5 min (2 vs 0) and longest reflux episode 9 vs 5 min. Therefore, different cutoff values may be necessary for males and females in diagnosing abnormal reflux.

Acid-Base Imbalance↗

PubMed1995

A biologically based explanation for mortality crossover in human populations.

We consider the impact of a genetically predetermined maximum life span (or upper bound on life span of a species) on patterns of human mortality. In particular, we consider the implication of a predetermined maximum life span on two distinct population subgroups: one group advantaged, the other group disadvantaged. We show that the existence of a genetically predetermined maximum life span imposes the condition that the two subgroup mortality rates must cross. We further observe that proportional mortality must be associated with divergent mortality differences over the life course. We illustrate these arguments via some simulated examples.

Adolescent↗

PubMed1998

Iodine deficiency disorders among school children in upper Egypt: an epidemiologic study.

Iodine deficiency disorders (IDD) are the world's single most significant cause of preventable brain damage and mental retardation. Data regarding IDD in upper Egypt are scarce and even lacking. The aim of the present work was to study the prevalence of IDD and some potential risk factors in upper Egypt. Using a two-stage cluster sampling technique, 6750 school children aged 8-10 years were screened for IDD through clinical examination of the thyroid gland and determination of urinary iodine, from three governorates in upper Egypt, namely Al-Minya (population of 3.3 million), Assyut (population of 2.9 million), and Suhag (population of 3.1 million). Iodine was determined in samples of soil and drinking water. Overall, the prevalence rate of goitre was 34.6 per cent. The median urinary iodine level for children with goitre was 5.04 micrograms/dl compared to 14.81 micrograms/dl among children free of goitre. Multiple logistic regression analysis showed that certain groups of school children were much more likely to develop goitre. They included females (OR = 3.07, 95 per cent CI = 2.78-3.39), children in households where drinking water had an iodine content of less than 0.5 microgram/100 ml (OR = 3.44, 95 per cent CI = 3.09-3.89), and children living in places where soil content of iodine was less than 0.2 microgram/100 g (OR = 2.67, 95 per cent CI = 2.30-3.10). We conclude that IDD is a severe public health problem in upper Egypt. The present situation in upper Egypt necessitates an urgent intervention programme.

Chi-Square Distribution↗

PubMed1995

Prevalence of dental fluorosis in Sudanese children from two villages with 0.25 and 2.56 ppm fluoride in the drinking water.

Dental fluorosis is endemic in Eastern Africa and a high prevalence has been found even in low-fluoride (approximately 0.5 ppm) areas. Substantial seasonal changes in the fluoride content of water have also been reported. The aim of the present study was to ascertain, through one year, the fluoride concentration in water from two underground reservoirs in Sudan, in Treit el Biga (TeB) and Abu Groon (AG), and to assess dental fluorosis in children aged 7-16 years who had been lifelong residents. The water in one of the reservoirs (TeB) was shown to have a low, very stable fluoride concentration (0.25 ppm SD 0.04) whereas the other (AG) had a tenfold higher, and slightly varying, fluoride concentration (2.56 ppm SD 0.26). Dental fluorosis was recorded on maxillary central incisors according to Dean's index. In TeB 91% of the children showed signs of dental fluorosis whereas in AG all children had fluorotic teeth. The Community Fluorosis Index in TeB and AG was 1.40 and 2.44, respectively. There was a significantly higher degree of fluorosis in boys than in girls in the low-fluoride area. In TeB, older boys tended to have more fluorosis than younger boys; the difference, however, was not statistically significant. No significant sex or age differences in fluorosis were found in AG. In both villages great inter-individual variations in dental fluorosis were recorded. The prevalence and severity of dental fluorosis in TeB was higher than that previously reported in areas with similar fluoride concentrations in the drinking water.

Adolescent↗

PubMed1996

Sex differential for suicide among Austrian age cohorts.

The suicide mortality data in Austria were studied over a period of four decades of continuous reporting. The data were studied for age, period and cohort effects. For the period 1951 to 1990 suicides among eight birth cohorts, born between 1932 and 1975, show a marked sex differential in time trends. Up to 1985, the rates increase in a constant manner for males in all age groups, in contrast to females. Results obtained using the Poisson regression models demonstrate a 35% (incidence rate ratio (IRR), 1.35%; 95% CI, 1.27-1.45) increased risk for male cohorts born later compared with those born earlier. The risk for later-born females was not increased (IRR, 1.03; 95% CI, 0.91-1.17). Explanations such as improved living conditions for Austrian women remain tentative, however, as age, period and cohort effects cannot be separated as independent variables in the suicide mortality data available in Austria.

Adolescent↗

PubMed1998

Immigration, moving house and psychiatric admissions.

This study was designed to elucidate psychiatric admission rates for native Swedes and foreign-born individuals during the period 1991-1994, when Sweden had a great influx of refugees. During the same period, and even earlier, psychiatric in-patient care had been reduced. Tests of differences between Swedes and foreign-born individuals in first psychiatric admission rates were performed using Poisson regressions, and the risk of a readmission was assessed using a proportional hazard model. Foreign-born individuals and native Swedes, both males and females, showed a similar admission pattern with regard to the number of admissions. Foreign-born males under 55 years of age and foreign-born females under 35 years of age had significantly higher admission rates than native Swedes. In total, native Swedes, both males and females, were hospitalized for a significantly longer period than the foreign-born subjects. About 43% of the patients were readmitted. The risk of a readmission was significantly increased among those with a high rate of internal migration. The high admission rates for young foreign-born individuals might be explained by a high incidence of mental illness owing to the trauma of being violently forced to migrate, acculturation difficulties, or unsatisfactory social circumstances such as high unemployment. The shorter hospitalization time could be due to undertreatment or less serious mental illness.

Adult↗

PubMed1997

HIV-associated oral lesions: prevalence in Zambia.

OBJECTIVES: To describe the prevalence of HIV-associated oral lesions in known HIV+ subjects in Zambia and assess the predictive value of these lesions to identify individuals with CD4 cell counts less than 200 x 10(6) L-1. SETTING: St Francis Hospital, situated in the rural Katete District, Eastern Province, Zambia. SUBJECTS: 107 newly diagnosed heterosexual HIV positive individuals included 42% males and 58% females (mean age 34.5, range 16-62). METHODS: Following a medical history and detailed oral examination, blood and whole saliva were collected in each subject. RESULTS: A total of 47.7% from this sample had an AIDS diagnosis. The mean CD4 count was 252.2 cells mm-3 (s.d. +/- 160.5, range 44-810); 40.2% of the study group demonstrated oral lesions associated with HIV seropositivity. Candidiasis was most commonly seen (25% prevalence). In this population erythematous candidiasis was the only oral lesion significantly associated with CD4 counts of less than 200 x 10(6) L-1 (P < 0.05, Two-tailed Fisher's Exact Test). CONCLUSION: In resource poor countries a thorough oral examination may suggest HIV infection and predict disease progression. Health care professional education regarding the orofacial manifestations of HIV infection needs urgent reinforcement in these areas.

AIDS-Related Opportunistic Infections↗

PubMed1998

Relation between attempted suicide and suicide rates among young people in Europe.

STUDY OBJECTIVE: To determine if there are associations between rates of suicide and attempted suicide in 15-24 year olds in different countries in Europe. DESIGN: Attempted suicide rates were based on data collected in centres in Europe between 1989 and 1992 as part of the WHO/EURO Multicentre Study of Parasuicide. Comparison was made with both national suicide rates and local suicide rates for the areas in which the attempted suicide monitoring centres are based. SETTING: 15 centres in 13 European countries. PATIENTS: Young people aged 15-24 years who had taken overdoses or deliberately injured themselves and been identified in health care facilities. MAIN RESULTS: There were positive correlations (Spearman rank order) between rates of attempted suicide and suicide rates in both sexes. The correlations only reached statistical significance for male subjects: regional suicide rates, r = 0.65, p < 0.02; national suicide rates, r = 0.55, p < 0.02. CONCLUSIONS: Rates of attempted suicide and suicide in the young covary. The recent increase in attempted suicide rates in young male subjects in several European countries could herald a further increase in suicide rates.

Adolescent↗

PubMed1998

The epidemiology of hospital-referred head injury in northern Norway.

This retrospective population-based survey describes the epidemiology of head injury in a defined population in Northern Norway. It includes all 247 patients with head injury referred to the University Hospital of Tromsø, Norway, during 1993. Head injury was defined as physical damage to the brain or skull caused by external force. The annual incidence rate of hospital-referred head injury was 229/100,000 population with a male preponderance of 1.7:1.0. The cause was a fall in 62%, road traffic accident in 21% and assault in 7% of the cases. The observed incidence rate is low despite the use of wide inclusion criteria, probably due to a decrease in road traffic accidents. A further decrease in the number of head injuries in our region may be achieved by preventing falls.

Accidental Falls↗

PubMed1997

Outcome after stroke rehabilitation in Hong Kong.

OBJECTIVE: To determine the outcome of patients discharged to the community after stroke rehabilitation. METHODS: One hundred and eighty-five consecutive patients discharged after stroke rehabilitation were enrolled for follow-up 12 months after discharge from a hospital in Hong Kong. A telephone interview to determine disability and place of residence was conducted. Disability was assessed by the Barthel Index and ratings of activities of daily living and mobility on a 4-point scale. RESULTS: One hundred and thirty-one patients or their carers were contacted (70.1%). This comprised 19 patients (10.3%) who died and 112 patients or their carers (60.5%) who were interviewed. Fifty-four patients (29.2%) were lost to follow-up. Comparison of the patients contacted and those lost to follow-up did not detect membership bias. Median Barthel Index of the surviving patients who were contacted rose from 90.0 (interquartile range 78.75-100.0) at discharge to 100.0 (interquartile range 85.0-100.0) at 12 months. Ratings of activities of daily living and mobility were maintained, with significant improvement in toileting. After rehabilitation 77.3% of the patients were discharged home and there was no significant change in residence at 12 months. Elderly patients (> or = 70 years old) had higher rates of institutionalization after hospital discharge and more disability although they achieved similar gains in Barthel Index and had similar lengths of hospital stay compared to younger patients. CONCLUSIONS: These results suggest that stroke patients were able to maintain their gains achieved during inpatient rehabilitation up to one year after discharge from hospital.

Activities of Daily Living↗

PubMed1998

Relationship between etiology and phenomenologic profile in delirium.

This study describes the symptom profile of 46 patients with delirium seen as consecutive referrals to a consultation-liaison psychiatry service. The relationship between symptoms rated on the Delirium Rating Scale (DRS) and delirium subtypes defined according to three putative etiologic groups are described. The relationship between etiologic groups and motoric subtype of the delirium episode is also described. Drug-related cases had the highest total DRS score and higher scores than the anticholinergic group for perceptual changes, delusions, psychomotor disturbance, and mood lability. Drug-related cases had higher scores than both the anticholinergic and infectious/electrolyte group for changes in sleep-wake cycle and fluctuation of symptoms. Those from the anticholinergic etiologic group were more likely to fit the hypoactive motoric subtype. Although our findings are tentative, etiologic categories may present with different symptom profiles, which may be associated with differing treatment responsiveness and course.

Adult↗

PubMed1998

Mortality of adults with developmental disabilities living in California institutions and community care, 1985-1994.

We compared risk factor-adjusted mortality for California adults with developmental disabilities based on 22,576 adults receiving services in California, 1985-1994. Mortality rates were adjusted for factors such as age and level of functioning. Risk factor-adjusted mortality was 72% higher in community care than in institutions. The mortality pattern over the years 1993-1994, which had not previously been studied, was comparable to that of 1985-1992. The substantially increased risk in community care suggests that community settings may be less effective in preventing mortality in this population.

Adult↗

PubMedDate not supplied

[Comparative study of patients with tuberculosis with and without HIV infection in the Federal District].

The main aim of this paper is to study the degree of association between the variables: HIV positive and negative tuberculosis patients, in relation to the location and extension of tuberculosis lesion and also to observe whether there is or not an agreement in distribution of tuberculosis disease between male and female groups, infected or not by HIV, according to their age. Seventy-eight tuberculosis/HIV positive and 2950 tuberculosis patients without HIV between 1985 and 1992 have been analyzed. The data have been collected directly from the files kept at Hemocentro and Instituto de Saude do Distrito Federal, Brasilia-DF Brazil. Statistical analysis using the X-squared and Kolmogorov Smirnov's tests have been applied. It has been observed a significant increase in the cases of pulmonary cavity and not cavity moderate tuberculosis among the tuberculosis/HIV positive patients when compared with the ones only infected with tuberculosis. In the age group below 40 years old, the male presented a higher incidence of cases when compared with the ones without HIV. In the age group below 34 years old, women showed a significative increase of the disease, when compared to men in the same age group.

AIDS-Related Opportunistic Infections↗

PubMed1995

Alcohol consumption among adolescents and young adults: the Bogalusa Heart Study, 1981 to 1991.

This report describes the alcohol consumption of adolescents and young adults who participated in the Bogalusa Heart Study, 1981 to 1991. Data were collected in three cross-sectional surveys of school-age children (11 to 19 years) and three surveys of young adults (18 to 32 years). White males had the highest proportion of drinkers and Black females had the lowest. By the end of the decade, adult White and Black male drinkers were about equal. Most individuals drank once or twice a week, but daily drinkers had the highest weekly alcohol intake. An association between alcohol and high-density lipoprotein cholesterol was found only in the latest survey and probably reflects the aging of the cohort.

Adolescent↗

PubMed1997

Burnout in orthopaedic physical therapists.

Few studies exist about burnout in physical therapists. No research is available on burnout in orthopaedic therapists. The purpose of this study was to determine if burnout exists in this group and if a relationship exists between burnout scores and selected variables. Members of the Orthopaedic Section of the American Physical Therapy Association from the east north central region of the United States were sent a survey consisting of demographic questions and the Maslach Burnout Inventory. The return rate was 38.7%. Burnout levels were low to moderate depending on the grouping used to examine the data. All of the variables examined (eg., years as a physical therapist, number of patients seen per day) showed very low correlations with subscale scores. Further research is needed to identify those at most risk for burnout and to find effective strategies for its prevention.

Adult↗

PubMed1996

Activities of daily living studied longitudinally between 70 and 76 years of age.

Functional performance, i.e. personal and instrumental activities of daily living (P-ADL, I-ADL), was studied in a population of 70-year-old persons followed to the age of 76, and with an intervention period included between the ages of 70 and 73. At age 70 (n = 617), 83% were independent, 13% were dependent in I-ADL and 4% dependent in I+P-ADL. Among the independent subjects, the 6-year outcome in mortality was 13%. Dependence at 70 predicted mortality as well as institutionalization, and the risk was higher for those dependent in P+I-ADL than for persons dependent in I-ADL only. Of participant survivors the incidence of disability was 30% (8% between 70 and 73, 26% between 73 and 76 years of age) and was dominated by dependence in I-ADLs. The intervention did not lead to less dependence in ADL at age 76. Gender differences were found at age 76 in cooking, bathing and dressing, males being more dependent in such activities. At 70, 73 and 76 years of age, assistance given by relatives dominated.

Activities of Daily Living↗

PubMed1996

An estimation of the functional disability burden in elderly Chinese age 70 years and over.

A cross-sectional survey of functional status among elderly Hong Kong Chinese aged 70 years and over was carried out to estimate the current burden of disability. Two thousand and thirty-two subjects (999 men, 1033 women) were recruited by random sampling of the old age and disability allowance schemes covering over 90% of the elderly population, stratified by sex and 5-year age groups. Functional ability was administered using the Barthel Index. The duration of disability, if any, was also noted. The prevalence of disability for different activities of daily living varied from 0.8% to 26% (lowest for feeding and highest for climbing stairs and bathing). The prevalence was higher for women than men, and higher in the older age group for both sexes. Men in the 80+ age group had shorter duration of disability compared with those in the 70-79 age group, and compared with women. Using disability years (estimated number of elderly with disability in the population x median duration of disability) as an estimate of disability burden, the number ranges from approximately 19,000 (inability to feed) to 100,000 (inability to climb stairs). This estimate may be useful in the planning of service provisions for the formal and informal care sector.

Activities of Daily Living↗