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[Incidence of cerebral vascular accident].

The incidence of the patient who has got cerebral vascular stroke in the internment of the medical services of the district hospitals (level 1) is, in general, and in other Portuguese hospitals, very large and takes great part of the resources, physical space, team's time of caring/treatment and costs per service. This kind of stroke happens in an advanced aged group with polimorf and chronical pathologic situation, concerning a serious prognostic. A retrospective and statistical study was done in the service of medicine from all internments cases in five years, (1990-1994) in the Hospital Candido Figueiredo, Tondela. This study concentrates this incidence in age, sex, death-rate, haemorragic and ischemia CVS and cerebral haemorrage but separately. 647 cases were studied from the existent registration in this hospital. In our casuistry, the ischemia CVS was present in 91.8% but compared to the total amount of internments it was 10.44% in average. It was in the female sex that we notice a higher frequency and the prognostic was more serious and the death-rate incidence was also higher in this sex. The ischaemial CVS's death-rate was in average 29.83%. This kind of patient demand (from a logistic point of view) a large number off beds, the interdisciplinary support of an internist, a neurologist, a neuro-surgeon, a neuroradiologist, a psychiatrist, a physiologist, a geriatrist, a phsychologist, a social assistant, specialized nurses in physical rehabilitation.

Female↗
PubMed1997

[Validity of the attendance pressure indicator in a primary care area].

OBJECTIVE: To measure the validity of the attendance pressure indicator in the Primary Care clinics at a Health Centre. DESIGN: An observational, crossover study. SETTING: Primary Care Area 3, Madrid. PATIENTS AND OTHER PARTICIPANTS: Stratified sampling by professional group and systematic sampling out of a total of 296 Primary Care team professionals in the area were performed. The size of the sample was 100: 40 general practitioners, 15 paediatricians and 45 nurses. Information on the attendance pressure indicator was gathered directly from the Health Centres and compared with that sent to Area 3's Information System (3-IS) by the professionals themselves. MEASUREMENTS AND MAIN RESULTS: The attendance pressure indicator showed the following ICC for Area 3: 0.86 (LL > or = 0.79) in general medicine, 0.79 (LL > or = 0.69) in paediatrics and 0.95 (LL > or = 0.93) in nursing. The over-notification found was: 1.35 users per day (p < 0.05) in general medicine, 1.47 (p < 0.05) in paediatrics and 0.47 in nursing. CONCLUSIONS: The measurement method of the attendance pressure indicator in Madrid's Primary Care Area 3 is valid for general medicine, paediatrics and nursing. A light, but statistically significant, over-notification to 3-IS was observed in general medicine and paediatrics, but this does not affect the validity of the indicator.

Adult↗
PubMed1990

Does psychiatric care by family practitioners reduce the cost of general medical care?

This is the first "impact" type of economic study of psychiatric/counseling services from general practitioners. The paper analyzes a province-wide database that collates statistical data from all inpatient and outpatient psychiatric services as well as from private physicians. This paper asks whether psychiatric services from family physicians also reduce the overall costs of medical care. This research supports the general research findings that medical costs are lower after psychiatrists' care. ECT patients show a marked reduction in their medical costs. Patients with psychotherapy/counseling from family physicians did not show statistically significant reductions in overall medical costs. We need new classifications for the kinds of mental disorders seen in primary care settings.

Electroconvulsive Therapy↗
PubMed1999

Does hospital at home for palliative care facilitate death at home? Randomised controlled trial.

OBJECTIVE: To evaluate the impact on place of death of a hospital at home service for palliative care. DESIGN: Pragmatic randomised controlled trial. SETTING: Former Cambridge health district. PARTICIPANTS: 229 patients referred to the hospital at home service; 43 randomised to control group (standard care), 186 randomised to hospital at home. INTERVENTION: Hospital at home versus standard care. MAIN OUTCOME MEASURES: Place of death. RESULTS: Twenty five (58%) control patients died at home compared with 124 (67%) patients allocated to hospital at home. This difference was not significant; intention to treat analysis did not show that hospital at home increased the number of deaths at home. Seventy three patients randomised to hospital at home were not admitted to the service. Patients admitted to hospital at home were significantly more likely to die at home (88/113; 78%) than control patients. It is not possible to determine whether this was due to hospital at home itself or other characteristics of the patients admitted to the service. The study attained less statistical power than initially planned. CONCLUSION: In a locality with good provision of standard community care we could not show that hospital at home allowed more patients to die at home, although neither does the study refute this. Problems relating to recruitment, attrition, and the vulnerability of the patient group make randomised controlled trials in palliative care difficult. While these difficulties have to be recognised they are not insurmountable with the appropriate resourcing and setting.

Death↗
PubMed1999

Mental health service utilization by African Americans and Whites: the Baltimore Epidemiologic Catchment Area Follow-Up.

OBJECTIVE: To compare mental health service utilization and its associated factors between African Americans and whites in the 1980s and 1990s. DESIGN: Household-based longitudinal study with baseline interviews in 1981 and follow-up interviews from 1993 to 1996. SETTING: The Baltimore Epidemiologic Catchment Area (ECA) Follow-Up. SUBJECTS: Subjects included 1,662 adults (590 African Americans and 1,072 whites). MAIN OUTCOME VARIABLE: Use of mental health services, defined as talking to any health professional about emotional or nervous problems or alcohol or drug-related problems within the 6 months preceding each interview. RESULTS: In 1981, crude rates of mental health service use in general medical (GM) settings and specialty mental health settings were similar for African Americans and whites (11.7%). However, after adjustment for predisposing, need, and enabling factors, individuals receiving mental health services were less likely to be African American. Mental health service use increased by 6.5% over follow-up, and African Americans were no longer less likely to report receiving any mental health services in the 1990s. African Americans were more likely than whites to report discussing mental health problems in GM settings without having seen a mental health specialist. They were less likely than whites to report use of specialty mental health services, but this finding was not statistically significant, possibly because of low rates of specialty mental health use by both race groups. Psychiatric distress was the strongest predictor of mental health service use. Attitudes positively associated with use of mental health services were more prevalent among African Americans than whites. CONCLUSIONS: Mental health service use increased in the past decade, with the greatest increase among African Americans in GM settings. Although it is possible that the racial disparity in use of specialty mental health services remains, the GM setting may offer a safety net for some mental health concerns of African Americans.

Adult↗
PubMed1979

[Cytogenetic and hormonal studies of persons occupationally irradiated with ionizing radiation].

Cytogenetic investigations were carried out on 23 subjects and hormonal -- on 18 of them, working in the sphere of ionizing radiation at medical institutions. After the quantitative processing of the results from the cytogenetic investigations, statistically significant differences were established to exist in cell obtaining with aberations, chromozome and chromatide fragments as compared with the spontaneous frequency of healthy subjects. Statistically significant differences were observed also in the group with length of service over 10 years as regards the dicentrics obtaining as well. With the follow-up of hormone concentrations in blood plasma a statistical decrease was found in the level of sex hormones -- testosterone in males and progesterone in females, accompanied by increased level of FSH, suggesting a primarily damage of gonads (testis and ovaries). Plasma cortisol level is statistically significant increased in all subjects examined whereas aldosterone level is normal in subjects with a length of service to 10 years and statistically significant decrease with a length of service over 10 years.

Adult↗