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At least 91 records · Page 5Linked to original sources
PubMed1994

Estimates of the extent of morbidity and mortality due to occupational diseases in Canada.

OBJECTIVE: To estimate the extent of occupational disease morbidity and mortality in Canada by comparing and contrasting four different data sources. DATA SOURCES: 1) Canadian National Workers' Compensation Boards Statistics, 2) U.S. Bureau of Labor Statistics adjusted to Canadian Workforce, 3) California Physician's First Reports adjusted to the Canadian Workforce, and 4) proportionate model of overall disease incidence obtained through literature review. MAIN FINDINGS: Each data source was limited in its ability to provide a true estimate of the extent of morbidity and mortality due to occupational disease in Canada. Collectively, an estimate of between 77,900 and 112,000 new cases of occupational diseases and 2,381 to 6,010 occupational disease deaths were obtained. CONCLUSIONS: Occupational diseases are a significant and under-estimated cause of morbidity and mortality in Canada.

Canada↗
PubMed1993

Development of a statewide trauma registry using multiple linked sources of data.

In order to develop a cost-effective method of injury surveillance and trauma system evaluation in a rural state, computer programs were written linking records from two major hospital trauma registries, a statewide trauma tracking study, hospital discharge abstracts, death certificates, and ambulance run reports. A general-purpose database management system, programming language, and operating system were used. Data from 1991 appeared to be successfully linked using only indirect identifying information. Familiarity with local geography and the idiosyncracies of each data source were helpful in programming for effective matching of records. For each individual case identified in this way, data from all available sources were then merged and imported into a standard database format. This inexpensive, population-based approach, maintaining flexibility for end-users with some database training, may be adaptable for other regions. There is a need for further improvement and simplification of the record-linkage process for this and similar purposes.

Computer Communication Networks↗
PubMed1991

Potential health effects of greenhouse effect and ozone layer depletion in Australia.

OBJECTIVE: To identify potential health effects of the greenhouse effect and ozone layer depletion in Australia. DATA SOURCES: Data were derived from a number of sources: (i) published articles accessed from relevant databases in the disciplines of health, public health and climatology over the past 20 years; (ii) published conference proceedings, review monographs and government reports covering the topic; (iii) a survey of experts in public health and climatology/geography (150 individuals were surveyed in the first phase with a 63% response rate); and (iv) a consensus conference in which 22 invited experts reviewed the results of the literature review and survey and a second conference in which 18 senior members of the health bureaucracy and public health profession considered the implications of the findings. STUDY SELECTION: Over 200 published articles or monographs were reviewed. Criteria for selection were whether the papers contributed information to the objectives of the review. DATA EXTRACTION: Because of the nature of the problem under investigation, predictions based on reasonable scientific assumptions were the major content of the review rather than conclusions based on scientific research. DATA SYNTHESIS: The major predicted health effects of long-term climatic change in Australia are skin and eye damage from increased ultraviolet radiation exposure, increased incidence of some respiratory diseases, vector-borne and water-borne diseases, and the social and physical effects of natural hazards and social and economic restructuring. The most vulnerable groups include the aged, the very young, the chronically ill, those living in poorly designed neighbourhoods and those working in outdoor occupations or heavy industry. CONCLUSIONS: The potential effects on health of long-term climatic change cover the broad spectrum of public health concerns. Detailed predictions of likely problems in specific geographic areas are not yet possible, but progressive development of such predictive capability is a high priority. Doctors will have an increasingly important role in monitoring local health status and participating in disease prevention and surveillance programmes.

Animals↗
PubMed1995

Longitudinal patterns of medical service use and costs among people with AIDS.

OBJECTIVE: This study examines the effect of race, HIV transmission group, and decedent status on the use and cost of inpatient and outpatient care among people with AIDS. DATA SOURCES: Data come from 914 people with AIDS who were receiving services in nine cities across the United States in 1990-1991 and who indicated that a hospital clinic was their usual source of care. Review of hospital medical and billing records provided data on use and costs of medical services over an 18-month period. Vital status was determined from hospital records and death certificates. STUDY DESIGN: Data from each respondent were aggregated into three-month intervals, beginning with the last quarter of data and working backward. Regression analyses using random-effect models and generalized estimating equations were conducted to assess temporal patterns of inpatient and outpatient use and costs. PRINCIPAL FINDINGS: Inpatient utilization and costs were higher for decedents than for nondecedents. However, differences between decedents and nondecedents varied as a function of race. Nonwhites had more inpatient use and higher costs than whites, but lower outpatient use, and these differences were greater among decedents. Inpatient nights and costs rose sharply in the six months prior to death. Outpatient use and costs did not display as strong a temporal trend. CONCLUSIONS: Much of the cost of treating HIV infection is concentrated in the period immediately preceding death. The intensity of service use in the terminal period should be considered when developing estimates of annual costs of care and when designing programs to provide community-based treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Inhaled respiratory medications and the use of chlorofluorocarbons (CFCs). Thoracic Society of Australia and New Zealand.

OBJECTIVE: To assess the use of chlorofluorocarbons (CFCs) in metered-dose aerosols against the background of community concerns regarding the adverse environmental effects of CFCs. DATA SOURCES: Data on the constituents of currently available metered-dose aerosols were supplied by the manufacturers, and details of chemistry and safety were obtained from monographs and papers published in the medical literature. STUDY SELECTION: Five papers, published in the early 1970s when metered-dose aerosols first became popular, were reviewed for safety data on CFCs. Several chapters in monographs were searched for data on the nature and function of CFCs in metered-dose aerosols, and five papers were the source of information on alternatives to CFCs as vehicles for the delivery of inhaled respiratory drugs. DATA SYNTHESIS: The medical use of CFCs accounts for only 1.5% of the total production in Australia, the majority being used for refrigeration, air-conditioning and other commercial or industrial purposes. The physicochemical properties of CFCs are such that they function as a suitable storage medium for active drugs within the canister and as an ideal vehicle for drug delivery. Approximately 20 s after inhalation of a clinically recommended dose of a bronchodilator metered-dose aerosol, CFCs are detectable in the blood, but the concentrations decline rapidly (half-life less than 40 s). Although CFCs have been shown to sensitise the myocardium to the arrhythmogenic effects of catecholamines in experimental animals, the requisite concentrations can only be achieved by patients if they inhale from a canister on every breath for approximately 20 successive breaths. CONCLUSIONS: CFCs used in metered-dose aerosols are an effective storage medium and a convenient vehicle for drug delivery. They are non-toxic--unless amounts far in excess of the clinically recommended doses are used, when arrhythmogenic effects may occur. The medical use of CFCs has minimal environmental impact compared with their industrial and commercial use. Dry powder delivery systems offer an alternative approach, and future research will yield nonozone-depleting CFCs suitable for replacing those in current metered-dose aerosols.

Administration, Inhalation↗
PubMed1995

The poisoned patient with altered consciousness. Controversies in the use of a 'coma cocktail'.

OBJECTIVE: In the assessment and management of the potentially poisoned patient with altered consciousness, the most consequential and controversial interventions occur during the first 5 minutes of care. In this review article, the risks and benefits of standard diagnostic and therapeutic interventions are presented to guide clinicians through this critical period of decision making. DATA SOURCES: Data for discussion were obtained from a search of English-language publications referenced on MEDLINE for the years 1966 to 1994. Older literature was included when pertinent. Search terms included poisoning, overdose, toxicity, naloxone, glucose, thiamine, and flumazenil. STUDY SELECTION: Only large trials were used for determinations of diagnostic utility and efficacy. Small trials, case series, and case reports were reviewed extensively for adverse effects. DATA EXTRACTION AND SYNTHESIS: Trials were reviewed for overall methodology, inclusion and exclusion criteria, sources of bias, and outcome. CONCLUSION: Analysis favors empirical administration of hypertonic dextrose and thiamine hydrochloride to patients with altered consciousness. Although rapid reagent test strips can be used to guide this therapy, they are not infallible, and they fail to recognize clinical hypoglycemia that may occur without numerical hypoglycemia. Administration of naloxone hydrochloride should be reserved for patients with signs and symptoms of opioid intoxication. Flumazenil is best left for reversal of therapeutic conscious sedation and rare select cases of benzodiazepine overdose.

Consciousness↗
PubMed1993

Estimating the population prevalence of injection drug use and infection with human immunodeficiency virus among injection drug users in Glasgow, Scotland.

Although data on the prevalence of injection drug use are an essential prerequisite for estimating the number of individuals infected with the human immunodeficiency virus (HIV), there have been few attempts to utilize statistical methods of population estimation based on multiple data sources. Data on 3,670 cases (2,866 individuals) were obtained from the HIV test register, drug treatment agencies, police records, and needle and syringe exchanges in Glasgow, Scotland, in 1990. Log-linear analysis was used to model the number of individuals in each of the sources. The model incorporating dependency among the three health care agencies (HIV test, drug treatment, and needle exchange) and independence of the police sample fitted the data well, with a residual chi 2 value of 2.9 (6 df). The expected value of the missing cell corresponding to absence from all four samples was 5,628, yielding an overall estimate of 8,494 injectors (95% confidence interval (CI) 7,491-9,721), for a prevalence rate of 1.35% for people aged 15-55 years in Glasgow during 1990. The high ratio of known to unknown injectors (1:2) resulted from the extensive coverage of known injectors and the relatively high level of overlap between the combined health care agency sample and the police sample. While further analysis demonstrated that the probability of appearing in the four samples varied by age and sex, heterogeneity in the population did not affect the choice of model or substantially alter the estimates for the total number of unknown injectors. A concurrent study of a community-wide sample of 503 injectors resulted in an HIV prevalence rate of 1.1% (95% CI 0.4-2.5%). The results of these studies were combined to produce a further estimate of 93 HIV-infected current injectors in Glasgow (95% CI 33-214).

Adolescent↗
PubMed1994

Multiple organ failure syndrome in the 1990s. Systemic inflammatory response and organ dysfunction.

OBJECTIVE--This review of the systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) provides an overview of a common but complex problem found in critically ill patients. It emphasizes definitions, common clinical patterns, metabolic responses, and pathophysiological changes. A brief discussion of treatment concepts is also included. DATA SOURCES--Data for this review were gathered from peer-reviewed journals, review articles by experts in SIRS/MODS, and selections from reference volumes written on SIRS/MODS. STUDY SELECTION--Reference selections were chosen on the basis of quality of research. Peer-reviewed journals were given primary consideration. Those review articles cited were felt to be essential to any discussion of SIRS/MODS. DATA EXTRACTION--Where possible, randomized, controlled, prospective studies were reviewed and conclusions used in this overview of SIRS/MODS. CONCLUSION--Our ability to care for critically ill patients has led to a new problem, SIRS and eventually MODS, which may become progressive organ failure and death. Unfortunately, these conditions are extremely frequent and carry high mortality rates. Increased oxygen consumption demands highlight the physiological response. The typical metabolic responses are characterized by hyperglycemia and accelerated protein catabolism. Unrecognized perfusion deficits, an uncontrolled septic focus, a persistent source of inflammation, or injured tissue is commonly present with SIRS/MODS and should be corrected. Restoration of oxygen transport and metabolic support are also important components of treatment. The cause of SIRS/MODS is complex and not fully understood, but multiple mediators and stimulated macrophages likely are important components and areas where treatment may well be focused.

Critical Illness↗