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PubMed2004

ENA's Delphi study on national research priorities for emergency nurses in the United States.

INTRODUCTION: This study identified and prioritized research questions with greatest value to emergency nurses and of highest importance for health care consumers. METHODS: Three hundred twenty emergency nursing leaders were invited to participate in 3 rounds of mailed surveys aimed at developing consensus. During round I, 147 nurses submitted 456 research problems. These problems were synthesized into 154 researchable questions, encompassing 17 themes. The round II questionnaire listed these questions in random order. Respondents used a 7-point Likert scale to rate each question's value for practicing nurses and importance for health care consumers. One hundred one nurses rated 106 questions >5.0. The round III questionnaire was individualized to provide each respondent's round II score and each item's median group score. Reflecting on these data, subjects again rated the 106 questions. RESULTS: Seventy-nine nurses rated 16 questions 6.0 or greater for value for practicing nurses; 3 questions were rated 6.0 or greater for importance to consumers. Optimum staff to patient ratios, effects of mandatory overtime, holding admitted patients, and ED overcrowding, as well as effective strategies for educating and ensuring competence of nurses, were highest priority research problems for practicing nurses. Pain relief, impact of and methods of decreasing holding/lengthy ED stay, and effective strategies for patient teaching were judged most important for consumers. DISCUSSION: Nurses' concerns with staff shortages and overcrowding of emergency departments and their effects on patients are paramount. Pain management and patient education were chief clinical issues requiring research. The mission of ENA is "to provide visionary leadership for emergency nursing and emergency care." This mission encompasses a number of values, including the following: "The discipline of emergency nursing includes a defined and evolving body of knowledge based on research."(1) In 1998, the ENA appointed vision councils to develop futuristic ideas to advance ENA's mission. The Research Vision Council proposed that ENA develop a center for emergency nursing research to provide leadership and focus for scientific approaches to the many issues that concern emergency nurses and their patients. The Board of Directors supported this idea by formulating a work group to develop the National Institute for Emergency Nursing Research. In 1999, the work group proposed that a study be conducted to determine national priorities for emergency nursing research. This article reports on the methods and results of a Delphi study conducted for that purpose.

Adult↗

PubMed2004

Canine ecology and socioeconomic factors associated with dogs unvaccinated against rabies in a Mexican city across the US-Mexico border.

A cross-sectional study was conducted to identify ecologic and socioeconomic factors associated with dogs unvaccinated against rabies in Mexicali, the capital city of Baja California, Mexico (located across the US-Mexico border). A total of 1100 households were selected by random sampling from a list of all 180,000 households. A questionnaire was filled in during a personal interview with the household head or another adult person to gather information of epidemiological interest (such as canine ecology, social and economic factors that might influence owners' decision to allow their dog to be vaccinated). There were 910 dogs identified. The human-to-dog ratio was 4.3:1. The male-to-female dog ratio was 1.5:1. Out of 791 dogs > or = 3 months old, 577 (73%) were classified as vaccinated against rabies. Most dogs (95%) were not spayed. Neighborhood dogs had 25 times higher risk of nonvaccination compared to dogs owned by a family. Dogs 3-11 months old had three times higher risk of nonvaccination compared to dogs > or = 1 year old. Dogs that were obtained as a gift, born at home or found had two times higher risk of nonvaccination compared to dogs that were reportedly purchased. Crossbred dogs had 1.5 times higher risk of nonvaccination compared to purebred dogs. The canine-ecology structure is similar to that in regions were rabies is endemic.

Animals↗

PubMed2004

The efficacy of smoking cessation strategies in people with chronic obstructive pulmonary disease: results from a systematic review.

Smoking cessation is the most effective way to reduce the risk of developing chronic obstructive pulmonary disease (COPD). It prevents or delays the development of airflow limitation and also reduces its progression. The objective of this study was to systematically review the effects of interventions for smoking cessation in people with COPD. Comprehensive searches of electronic and internet databases were carried out from 1966 to March 2002, using the Cochrane Airways Group search strategy. The reference lists of all selected randomized trials and relevant reviews were inspected for additional published reports and citations of unpublished research. We evaluated the efficacy of behavioural interventions (e.g. counselling), pharmacotherapy (nicotine replacement therapy and non-nicotine therapy such as bupropion), and combinations of both. The main clinical outcome measure was prolonged abstinence after at least 6 months, confirmed by a biochemical test. Five trials comprising 6491 patients with COPD were included. Results of the Lung Health Study show that, by using an intensive behavioural (relapse prevention) programme combined with nicotine replacement therapy, prolonged abstinence rates are not only significantly higher compared with no intervention, but the difference in efficacy was sustained for over 5 years. A 12-week treatment course with bupropion sustained release combined with individual counselling, however, did not result in significantly higher prolonged abstinence rates after 12 months. Present evidence suggests that the most effective intervention for prolonged smoking cessation in patients with COPD is the combination of nicotine replacement therapy, coupled with an intensive, prolonged relapse prevention programme.

Behavior Therapy↗

PubMed2005

Prevention and health promotion in clinical practice: the views of general practitioners in Europe.

BACKGROUND: Disease prevention and health promotion are important tasks in the daily practice of all general practitioners (GPs). The objective of this study was to explore the knowledge and attitudes of European GPs in implementing evidence-based health promotion and disease prevention recommendations in primary care, to describe GPs' perceived barriers to implementing these recommendations and to assess how GPs' own health behaviors affect their work with their patients. METHODS: A postal multinational survey was carried out from June to December 2000 in a random sample of GPs listed from national colleges of each country. RESULTS: Eleven European countries participated in the study, giving a total of 2082 GPs. Although GPs believe they should advise preventive and health promotion activities, in practice, they are less likely to do so. About 56.02% of the GPs answered that carrying-out prevention and health promotion activities are difficult. The two most important barriers reported were heavy workload/lack of time and no reimbursement. Associations between personal health behaviour and attitudes to health promotion or activities in prevention were found. GPs who smoked felt less effective in helping patients to reduce tobacco consumption than non-smoking GPs (39.34% versus 48.18%, P < 0.01). GPs who exercised felt that they were more effective in helping patients to practice regular physical exercise than sedentary GPs (59.14% versus 49.70%, P < 0.01). CONCLUSIONS: Significant gaps between GP's knowledge and practices persist in the use of evidence-based recommendations for health promotion and disease prevention in primary care.

Alcohol Drinking↗

PubMed2006

Reducing minors' access to tobacco: eight years' experience in Hawaii.

OBJECTIVE: This paper reports the findings of annual Synar inspections to assess compliance with federal and state legislation to limit minors' access to tobacco products in Hawaii. We also report on factors associated with selling tobacco to minors for the most recent year of inspections (2003). METHODS: Annual, random, unannounced inspections were conducted by minors (ages 14-17 years) over an 8-year period (1996-2003). Stores were randomly selected from a list of stores that sell tobacco products in Hawaii. RESULTS: There was a significant decrease in the percent of successful purchases made over the period from 1996 (44.5%) to 2003 (6.2%). Based on multivariate analyses, only two variables were associated with whether a successful purchase was made in 2003: whether the minor's identification or age was requested. CONCLUSION: Findings suggest that surveillance, education, and enforcement efforts in Hawaii have been successful at making substantial reductions in noncompliance rates. Even with the current low rate of sales to minors, failing to request the minor's identification or age was associated with making a successful purchase, while characteristics of the minor and retail environment were not.

Adolescent↗

PubMed1999

Dietary intake and body mass index of adults in 2 Ojibwe communities.

OBJECTIVE: To describe and compare dietary intake and prevalence of overweight in a sample of adults in 2 Ojibwe communities in Mille Lacs, Minn, and Lac Courte Oreilles, Wis. DESIGN: Cross-sectional survey based on interviews that included a 24-hour recall, food frequency questionnaire, and a sociocultural questionnaire. SUBJECTS/SETTING: One hundred four adult Band (tribe) members were selected randomly from current housing lists; pregnant and lactating women were excluded. STATISTICAL ANALYSES PERFORMED: Nonparametric Wilcoxon rank sum tests were used to determine differences in absolute nutrient intakes where normality could not be assumed. Two-tailed t tests were conducted to test for differences between nutrient densities. A significance level of alpha = .05 was used; procedurewise adjustments were made using the Bonferroni method when adjusting for multiple comparisons. RESULTS: The importance of the traditional food system was evident: at least 50% of respondents engaged in hunting and fishing practices. Prevalence of overweight was 47%. Mean nutrient intakes were below the Recommended Dietary Allowance for women for vitamin A, folate, calcium, iron, and zinc and for men for vitamin A and calcium, despite energy intakes that met the Recommended Dietary Allowance. Nutrient densities were lower than those in the third National Health and Nutrition Examination Survey for women for carbohydrate, vitamin C, folate, calcium, and dietary fiber and for men for folate and dietary fiber. Fat contributed 37% (for men) and 40% (for women) of energy intake. APPLICATIONS/CONCLUSIONS: Areas of focus for culturally relevant education programs (eg, promotion of traditional foods that provide nutrients of low intake status and low-fat traditional food preparation methods) and research needs are suggested to reduce risks for nutrition-related chronic disease among Native Americans.

Adult↗

PubMedDate not supplied

Supraventricular tachycardia after coronary artery bypass grafting surgery and fluid and electrolyte variables.

OBJECTIVE: To explore the relationship between fluid and electrolyte variables and the development of supraventricular tachycardia (SVT) after coronary artery bypass grafting (CABG) surgery. DESIGN: Retrospective chart review. Random selection from a list obtained from the medical records department and with use of the International Classification of Diseases code to identify patients undergoing their initial CABG. SETTING: Medical records department of a southeastern 600-bed urban referral hospital with a large cardiovascular surgical program. PATIENTS: Forty patients experiencing SVT and 40 patients not experiencing SVT during their stay in an intensive care unit after CABG. OUTCOME MEASURES: Fluid and electrolyte variables and the development of SVT in the intensive care unit after CABG. VARIABLES: Data collected included preoperative demographic variables such as age and gender; previous history of SVT, congestive heart failure, cardiac arrest, previous surgery, diabetes, hypertension, valve disease, tobacco use, obesity; preoperative and postoperative medications; postoperative laboratory values of potassium, calcium, and magnesium; intravenous intake; hourly urine output; and chest tube drainage. RESULTS: Demographic variables revealed that patients with SVT were older (p = 0.001) and had a higher incidence of preoperative SVT (p = 0.04). Although groups did not differ by numbers of patients with high or low potassium, calcium, or magnesium, patients receiving additional intravenous potassium by bolus after surgery had a higher incidence of SVT (p = 0.02). Patients who lost blood via the chest tube at a rate greater than 100 ml per hour for at least 1 hour after surgery had a higher incidence of SVT (p = 0.02). Patients with a urine output greater than 300 ml per hour for longer than 9 hours had an increased incidence of SVT (p = 0.02). In the patients experiencing SVT, 62% had it occur 24 to 48 hours after surgery. CONCLUSIONS: These data suggest that shifts in fluid and electrolytes may be important characteristics of patients in whom SVT will develop, which could lead to better identification and nursing management of SVT and improve hemodynamic status, patient recovery, and cost after CABG.

Coronary Artery Bypass↗

PubMed2000

What American surgeons read: a survey of a thousand Fellows of the American College of Surgeons.

PURPOSE: The modern American surgeon is immersed in an ever-deepening sea of printed and electronic information. Although publishers know how many books and journals they sell, and journals can quote their calculated impact factor, no information exists whatsoever about what surgeons read. Which surgical journals are "popular," and how does it compare with their impact factor (IF)? Our objective was to assess the sources of information and reading habits of American surgeons and to compare the "popularity" of journals with their IFs.A questionnaire was mailed to 1000 American surgeons, randomly selected from a list provided by the American College of Surgeons.A total of 418 surgeons responded, and 371 responses could be analyzed (37%). The leading sources of medical information were medical literature (93%), professional meetings (88%), and CME courses (69%). The average time per surgeon/month dedicated to medical literature was 14 hours (range, 1 to 120). Peer-reviewed journals were read by 95%, textbooks by 68%, and update series by 60% of the respondents. The three most popular surgical journals were Annals of Surgery (IF, 5.40), selected by 60%; Journal of the American College of Surgery (IF, 1.87), selected by 48%; and Archives of Surgery (IF, 2.53), selected by 36%. The most popular subspecialty journals were Cancer (IF, 3.66), selected by 31%; Critical Care Medicine (IF, 3.74), selected by 17%; and Gastroenterology (IF, 10.33), selected by 12%. The New England Journal of Medicine (IF, 28.66), selected by 67%, and the Journal of the American Medical Association (IF, 9.55), selected by 66%, were the most popular general medical journals, followed by Mayo Clinic Proceedings (IF, 1.98), selected by 16%. Among the "leaders" on the IF list for international, British medical and surgical journals were Lancet (IF, 11.79), selected by 5%, and British Journal of Surgery (IF, 2.38), selected by 0.5% of the respondents.Those American surgeons responding consider published literature as their chief source of information, especially peer-reviewed journals. Overall, they ignore non-United States publications and select the journals they read without considering its IF.

Journal Article↗

PubMed1998

Survey of rheumatic heart disease in school children of Kinshasa town.

STUDY OBJECTIVE: To determine the prevalence of rheumatic heart disease and study the association of this disease to factor such as personal host and environment. DESIGN: A cross sectional survey was carried out by a specially trained medical team. SETTING: The study involved high risk school children aged 5-16 years from Binza-Kinshasa urban area and adjoining slums in semi-urban area of Kinshasa town. METHODS: A total of 4848 children randomly selected on the list of semi-urban and urban schools and representing 10% of the schools population were included in the survey with clinical echocardiographic examinations. RESULTS: Of the 4848 children screened, prevalence of rheumatic heart disease was 14.03/1000. The prevalence was significantly greater in slums schools (22.2/1000) than in urban school (4/1000). In slums area, the mitral valve was the valve most commonly affected by rheumatic heart disease. Risk factors such as birth in rainy season (RR=2.2), low birth weight (RR=1.81), low socioeconomic status (RR=2.68), malnutrition 8 persons/household (RR=4.10) and migrant status (RR=4.79) predicted significantly rheumatic heart disease occurrence in children living in the semi-urban area (slums). Only birth in rainy season (RR=3.24) predicted significantly rheumatic heart disease onset in children having residence in the urban area. CONCLUSIONS: Rheumatic heart disease runs a more severe course in Kinshasa, because appropriate medical care, sanitary conditions, primary and secondary prophylaxis are not available. Echocardiograpy is necessary to identify cases of rheumatic heart disease.

Adolescent↗

PubMed1997

Law enforcement agencies and out-of-hospital emergency care.

STUDY OBJECTIVE: We sought to assess the involvement of law enforcement agencies in out-of-hospital emergency medical care and their attitudes toward expanded roles in emergency medical services (EMS) systems. METHODS: We mailed a 20-question survey to 800 police chiefs and sheriffs randomly selected from a list of all law enforcement agencies in the United States. The questions focused on the characteristics of each law enforcement agency, its current level of involvement in providing out-of-hospital emergency medical care, and the characteristics of its associated community and local EMS system. The survey concluded with four statements to assess officer attitudes toward an expanded role in EMS-related activities. We used the chi 2 or Fisher exact test to analyze differences in proportions. The alpha-error rate was set at .05. RESULTS: Seventeen surveys were returned as undeliverable. Of the remaining 783 surveys, we received 602 responses (77%). Five hundred forty-nine (70.1%) of the respondents were the primary law enforcement agencies in their communities; they make up the final sample. The median number of officers per agency was 12 (range, 1 to 2,623), and the median population served was 6,936 (range, 150 to 1,500,000). Responses indicated that 442 (80.7%) agencies responded to one or more specific types of medical emergencies and 263 (50.3%) provided some level of patient care. Law enforcement officers frequently arrived at the scene of medical emergencies before EMS personnel (81.5%), with a roll-time interval of less than 8 minutes (87.2%). Only 14 agencies (2.6%) used automatic external defibrillators. Fifty-three percent agreed with the statement that EMS-related activities would interfere with their law enforcement duties. However, more than 60% of respondents agreed that law enforcement agencies should be involved in providing emergency medical services for life-threatening emergencies, that their officers would be willing to undertake extra medical training and that EMS-related activities would improve their public images. CONCLUSION: Many law enforcement agencies are involved to some extent in providing out-of-hospital emergency medical care, and most of the agencies we surveyed would support additional medical training and new or expanded roles for themselves in EMS systems.

Attitude↗

PubMed2002

Prevalence and treatment of menopausal symptoms among breast cancer survivors.

Women diagnosed with breast cancer often experience early menopause secondary to treatment effects, yet physicians may be reluctant to prescribe hormone replacement therapy (HRT) because of the potential increased risk of recurrence. To assess the burden of menopausal symptoms, HRT use, and alternative treatments in recent breast cancer survivors, a population-based, case-control study was conducted among breast cancer survivors and age-matched controls. Wisconsin women 18-69 years old with a new diagnosis of breast cancer 8-11 months prior to interview (n = 110) and control subjects randomly selected from population lists (n = 73) responded to a standardized telephone questionnaire that elicited information on menopausal symptoms, estrogen and alternative therapies (prescription medications, vitamins, herbal preparations, soy products, acupuncture, chiropractic) used to alleviate symptoms. We used multivariate logistic regression to obtain odds ratios and 95% confidence intervals (CI) for symptoms of menopause, use of estrogen, and use of alternative therapies. Breast cancer survivors were 5.3 (95% CI 2.7-10.2) times more likely to experience symptoms, 25 (95% CI 8.3-100) times less likely to use estrogen, and 7.4 (95% CI 2.5-21.9) times more likely to use alternatives than controls. Soy, vitamin E, and herbal remedies were the most common alternative therapies reported by participants; use was greater in cases compared to controls. Most soy users reported increasing soy products specifically to reduce the chances of a diagnosis of recurrent breast cancer. Among cases, tamoxifen users (n = 62) reported a higher prevalence of symptoms and a higher prevalence of alternative treatments. This is the first population-based survey of menopausal symptoms and treatments that compares breast cancer cases with disease-free controls. Cases are both more likely to experience menopausal symptoms and less likely to use HRT than controls. Instead, cases treat menopausal symptoms with vitamin E and soy products, even though the safety and efficacy of these therapies are unproven. The increased use of soy products in this population has not been previously documented.

Adolescent↗

PubMed1997

Musculoskeletal pain in cardiac ultrasonographers: results of a random survey.

Myalgias and arthralgias are common among workers whose jobs require repetitive isometric maneuvers or malalignment of body position. However, few systematic studies have been performed to evaluate the frequency of these complaints among cardiac ultrasonographers. Therefore the purpose of this study was to determine the prevalence of musculoskeletal pain (MSP) among ultrasonographers and to identify risk factors related to their occurrence. Two hundred twenty ultrasonographers randomly chosen from a list of more than 1600 active members of the American Society of Echocardiography were mailed surveys consisting of 22 questions. Included were questions regarding height, age, years of experience, frequency and type of physical exercise, and job-related parameters such as a number of scans per day, scanning from right or left side of bed, number of hours, bed type, type of equipment, and manual or self-propelled machines. Respondents were asked whether they had had back, neck, or shoulder pain related to their profession and to describe treatment rendered and its effectiveness. One hundred thirteen (51%) of 220 ultrasonographers responded to the survey. Ninety (80%) of 113 respondents reported new pain that was not present before they began scanning, with 42 of this group (46%) requiring either physiotherapy (n = 17) or medication (n = 23). Treatment was believed to be helpful in 63% of cases. Factors found to have a positive relationship to MSP included ultrasonographer height less than 63 inches, performing 100 or more scans per month, average scan time of 25 minutes or more per patient, and use of manually propelled machines (each p < 0.05). Factors found to have no relationship to MSP included age, type of equipment, right or left scan position, physical conditioning, bed type, and time between patients. Musculoskeletal pain is prevalent among cardiac ultrasonographers, and may have specific work-related factors for its occurrence.

Adult↗

PubMed2002

Effects of alcohol consumption on the risk of colorectal cancer among men by anatomical subsite (Canada).

OBJECTIVE: To estimate the effects of alcohol consumption on the risk of colorectal cancer according to anatomical subsite. METHODS: Between 1979 and 1985 a population-based case-control study of cancer at multiple sites was carried out in Montreal. This analysis was restricted to the 585 cases with adenocarcinoma of the large bowel, aged 35-70 years, who underwent face-to-face interviews. Controls (n = 500) were selected either from electoral lists or by random-digit dialing and were frequency-matched to the cases on age. Polytomous logistic regression was used to estimate the risk of cancer of the proximal colon, distal colon, and rectum in relation to the consumption of alcoholic beverages. RESULTS: Daily consumption of alcohol of any type was associated with increased risks of cancer of the distal colon [odds ratio (OR)= 2.3; 95% confidence interval (CI) 1.4-3.7] and the rectum (OR = 1.6; 95% Cl 1.0-2.6), but not with an increased risk of cancer of the proximal colon (OR = 1.0; 95% CI: 0.6-1.7). When type of beverage was considered, beer showed strong associations with cancer at all three subsites (ORs among the heaviest drinkers ranging from 1.8 to 2.4), spirits showed weaker associations with cancer at all three subsites (ORs ranging from 1.4 to 1.6), and wine showed null associations. CONCLUSIONS: The results are consistent with the hypothesis that consumption of alcoholic beverages increases the risk of colorectal cancer. The evidence is strongest for effects on the distal colon and rectum, and, among the three types of beverage, it most strongly implicates beer.

Adult↗

PubMed2001

Profiling lady luck: an empirical study of gambling and problem gambling amongst female club members.

This paper helps to address a deficiency of gender-specific research into gambling. It focuses on gambling participation, gaming machine play, and problem gambling amongst 1,257 female respondents to a telephone survey of 3,000 members selected randomly from the membership lists of six of the largest clubs in Sydney, Australia. Using predominantly non-parametric tests, results identify a range of behaviors that characterize the gambling activities of female club members when compared to their male counterparts. Testing four hypotheses revealed that, when compared to male club members, the females had a higher preference for bingo, lotto, lotteries, pools, and gaming machines; they gambled less frequently on off-course and on-course betting, casino table games and hotel gaming machines, but more frequently on bingo; they were more likely to display patterns of gaming machine play that maximize playing time; and they experienced problem gambling at levels comparable to males. Further research questions arising from the study's findings are discussed.

Adult↗

PubMed1991

Does organization improve priming?

In five experiments, the effects of organization on implicit memory or priming tests were compared with its effects on the explicit memory tests of free and cued recall. Organization was manipulated by varying list structure (blocked vs. random presentation of categorized items) and by instructions. The results showed that organization had parallel effects on the category-production priming test and free- and cued-recall tests; performance was enhanced by organization on both types of tests. It was also demonstrated that the effect of organization on priming was limited to the category-production test and was not obtained with the word-identification priming test. These results suggest that performance on implicit and explicit memory tests is similarly affected by experimental manipulations when both types of tests rely on conceptually driven processing. In addition, performance on two implicit tests is dissociated when one test relies on conceptually driven processing and the other on data-driven processing.

Adult↗

PubMed2005

Farm Family Exposure Study: methods and recruitment practices for a biomonitoring study of pesticide exposure.

PURPOSE: The Farm Family Exposure Study was initiated to characterize pesticide exposure to farm family members around the time of one pesticide application in a manner that will facilitate exposure assessment in epidemiologic studies of pesticides. METHODS: A sample of farm families with children was recruited by randomly selecting farmers from lists of licensed pesticide applicators in Minnesota and South Carolina. Eligible families were selected from among those who planned to apply one of three chemicals, glyphosate, 2,4-D, or chlorpyrifos, as part of their normal operations. The applicator, spouse, and all children in the family ages 4-17 years were included in the study. The applicator and spouse completed self-administered questionnaires addressing demographics, farming practices and potential exposures to them and their children. Field observers documented the application, recorded application practices, equipment, potential exposures, and the presence of children or spouses in the immediate vicinity of pesticide activities. All study participants were asked to collect each urine void for 5 days, 1 day before through 3 days after the application. Pesticides were measured in 24-h composite urine samples with a one part per billion limit of detection. RESULTS: Of 11,164 applicators screened, 994 families met the inclusion criteria. Of these, 95 families were enrolled. Enrollees were similar in most characteristics to their peers who were not participants in the study. In total, there were 106 applications, 10 of which involved more than one chemical. This resulted in urinary data for 48 farmers and spouses and their 79 children for glyphosate, 34 farmers and spouses and their 50 children for chlorpyrifos, and 34 farmers and spouses and their 53 children for 2,4-D. Compliance with the 24-h urine collection was particularly good for the adult participants. There were more missing samples for children than for adults, but overall compliance was high. CONCLUSION: The Farm Family Exposure Study should provide insights about pesticide exposure under real world conditions and thereby facilitate improved exposure assessment in epidemiologic studies of agricultural populations.

Adolescent↗

PubMed2003

Trends and social factors in blood pressure control in Scottish MONICA surveys 1986-1995: the rule of halves revisited.

Time trends and social factors in detection, treatment and control of hypertension in the community were examined in four independent Scottish MONICA cross-sectional surveys in 1986, 1989, 1992 and 1995. Residents aged 25-64 years were recruited randomly from general practice lists in north Glasgow, Scotland with stratification by sex and 10-year age groups. A total of 1262 participated in the first survey, 1397 in the second, 1516 in the third and 1836 in the fourth. Differences and trends in proportions of hypertension undetected, detected but untreated, treated but uncontrolled and controlled across the four surveys were tested by chi(2), and the associations of the poor control of hypertension with social factors were estimated by multivariate logistic regression model to derive odds ratios. Using the cut point of >/=160/95 mmHg, proportion of hypertension undetected across the four surveys was 56.3, 44.6, 32.0 and 38.2%, and of treated controlled hypertension was 15.2, 26.4, 32.0 and 32.8% (both trends P<0.001). Multivariate analysis showed that poor control of hypertension was not related to social deprivation, but significantly related to being male, young, of low body mass index and heavy alcohol drinking. Undetected hypertension was significantly related to full-time employment, and untreated hypertension to high social class and possibly education level. These findings suggest that in this part of Scotland the management of hypertension has improved, so the 'rule of halves' no longer applies. Control of blood pressure is not positively associated with social deprivation, but people at a high risk of poor control of hypertension should be targeted.

Adult↗

PubMed2000

Analysis of risk factors for nosocomial sepsis in surgical patients.

BACKGROUND: This study aimed to identify patients at high risk for developing sepsis following surgery according to criteria determined by the American College of Chest Physicians and the Society of Critical Care Medicine Consensus Conference on sepsis. METHODS: A prospective case-control study was performed in surgical patients in a tertiary care centre over 1 year. Patients were identified by a daily prospective surveillance. Controls were selected randomly from the daily list of surgical inpatients. Data were collected prospectively. Crude and adjusted odds ratios (ORs) and their 95 per cent confidence intervals were computed using logistic regression analysis. RESULTS: During follow-up, 99 cases and 99 controls were identified. The main risk factors for sepsis found in the multivariate analysis were coma within 48 h before sepsis (OR 13.5, 95 per cent confidence interval 3.6-50.8), low serum albumin level at admission (OR 15.8, 5.4-46.4), two or more intrinsic co-morbidities (OR 11.8, 2.8-49.4) and parenteral nutrition (OR 5.1, 1.5-17.1). Emergency surgery (OR 3.0, 1.4-6.4), abdominal surgery (OR 2.6, 1.0-6.8) and number of surgical interventions (OR 2.5, 1. 1-6.1) were the variables related to surgery that significantly increased the risk of sepsis. Both the study on the Efficacy of Nosocomial Infection Control (SENIC) and the National Nosocomial Infections Surveillance indices showed a statistically significant trend with sepsis. CONCLUSION: Patient-related factors appear to represent the greatest risk for developing postoperative nosocomial sepsis, rather than factors associated with the surgery.

Case-Control Studies↗