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PubMed1993

Trends in morbidity and mortality from peptic ulcer disease: Tayside versus Scotland.

Recent studies have shown that the prophylactic use of H2-receptor antagonists reduces both ulcer recurrence and the risk of ulcer complications. Despite these results, epidemiological studies have failed to show any evidence of an effect of gastric anti-secretory drugs on complicated ulcer disease in the community. Since 1979, it has been the policy of the gastroenterology department at Ninewells Hospital in Tayside to recommend long-term, continuous therapy with H2-receptor antagonists for patients with peptic ulcer; in contrast, prophylactic therapy is less commonly used in the rest of Scotland. The difference in the management of peptic ulcer between Tayside and Scotland presented an opportunity to study the population effects of the widespread use of continuous H2-receptor antagonists on the morbidity and mortality from ulcer disease. This study compared the trends in hospital admissions, gastric surgery, haemorrhage, perforation and mortality from ulcer disease using data supplied by the Information and Statistics Division of the Common Services Agency, Scottish Health Service, Edinburgh. During the 1980s, hospital admissions for peptic ulcer declined significantly in Tayside, whereas in Scotland there was no obvious downward trend. Gastric surgery for ulcer disease declined throughout Scotland although the fall was significantly steeper in Tayside than in the rest of Scotland. For the population in general, the rate of perforation decreased faster in Tayside than in the rest of Scotland, although the difference was not significant. The rate of admissions for ulcer haemorrhage declined substantially in Tayside whereas there was little change in Scotland as a whole. The decrease in mortality from ulcer disease in all groups except younger females was more marked in Tayside than in Scotland, although the differences were not significant. The magnitude of the differences between Tayside and Scotland, and in particular the consistency of these results across a broad range of indicators of ulcer disease, suggests that the policy of prescribing long-term, continuous therapy with H2-receptor antagonists has reduced both uncomplicated and complicated peptic ulcer in the community in Tayside.

Adult↗

PubMed2005

Predicting vascular risk in Type 1 diabetes: stratification in a hospital based population in Scotland.

AIMS: To estimate the absolute cardiovascular risk of patients with Type 1 diabetes attending hospital diabetes clinics in Scotland and to develop a method for identifying those at highest risk, thus enabling therapy to be targeted. METHODS: Baseline information was collected for 2136 patients with Type 1 diabetes using the Royal College of Physicians of Edinburgh Diabetes Register. These records were then linked to diagnoses of macrovascular disease in databases of the Information Statistics Division of the Common Services Agency. RESULTS: During six to nine years of follow up 110 patients (5%) developed macrovascular disease. There were significant associations between baseline age (P < 0.00001), blood pressure (P < 0.00001), albuminuria (P < 0.0002), HbA1c (P < 0.001), cholesterol (P < 0.00001) and smoking status (P < 0.00001) with the development of macrovascular disease. A scoring system for future macrovascular risk was developed from a multivariate analysis of this data. CONCLUSIONS: The data confirm the high vascular risk of patients with Type 1 diabetes. The relationship with age is such that those patients above 50 years require only one additional risk factor to reach such a high vascular risk that intervention is indicated. Using these data many patients between the age of 40 and 49 years are also likely to be identified to be at high risk.

Adult↗

PubMed1992

Oral cancer in Scotland: changing incidence and mortality.

OBJECTIVES: To determine the incidence of oral cancer in Scotland between 1960 and 1989 and oral cancer mortality from 1911 to 1989. SETTING: Data were obtained on oral cancer incidence from the information and statistics division of the Common Services Agency of the Scottish Health Service and mortality data from the office of the registrar general for Scotland. RESULTS: Mortality from intraoral cancers in Scotland substantially declined throughout this century until the mid-1970s. This trend, however, was then reversed, and fourfold increases in incidence were observed in younger age groups after 1960. Death rates in these younger age groups increased to levels previously recorded in the 1940s. These increases seemed to be cohort based and may therefore continue into the future. CONCLUSIONS: Reasons for increasing rates among younger age groups are speculative and rely on combining knowledge about risk factors and available ecological data. Though increases in incidence at younger ages do not result in a large change in the number of cases diagnosed, possible similar increases continuing into older ages, when oral cancer is more common, will correspond to a much larger increase in the actual number of cases. Given that such a large attributable risk is associated with tobacco and alcohol, however, these increases may be preventable.

Adolescent↗

PubMed1993

Utility of Scottish morbidity and mortality data for epidemiological studies of motor neuron disease.

OBJECTIVES: To determine the accuracy of (1) hospital discharge data and (2) death certificates, coded as motor neuron disease (MND). DESIGN: Comparison of data from The Scottish Motor Neuron Disease Register (SMNDR) with routinely collected Scottish Hospital In-Patient Statistics (SHIPS) and death certificate coding. SETTING: Scotland UK. PATIENTS: 1) 379 adults (> 15 years) discharged for the first time from a Scottish hospital in 1989-90 and (2) 281 deaths in the same period assigned to the International Classification of Diseases (ICD)-9, category 335 (MND). MAIN OUTCOME MEASURES: The sensitivity and positive predictive value of a diagnosis of MND as retrieved by (1) the Information and Statistics Division of the Common Services Agency for the Scottish Health Service for morbidity data and (2) the Registrar General's office for mortality data, using the SMNDR as the 'gold standard'. RESULTS: (1) Thirty per cent of adult patients identified as having MND by SHIPS did not have this disease and 23% of patients with MND did not appear on SHIPS. The sensitivity of a diagnosis of MND, as retrieved by SHIPS, was 84% and the positive predictive value was 70% overall. Miscoding of patients with pseudobulbar palsy caused by cerebrovascular disease was the major source of false positive error. The incidence of adult onset sporadic MND was over estimated by SHIPS by a factor of 1.6. (2) Mortality data were more accurate, with a false negative rate of 6% and a positive predictive value of 90%. CONCLUSIONS: Coded hospital discharge data are an inaccurate record of a diagnosis of MND and cannot, in their present form, be used as a reliable measure of disease incidence in Scotland. Greater care is required in the preparation of discharge summaries and coding if these data are to be useful for health care planning and epidemiological research. SHIPS is, however, an important source of information to achieve a complete sample of patients with MND. There is also a problematic false positive rate for mortality data but this source more closely approximates true incidence.

Adolescent↗

PubMed1993

A local review of domiciliary consultations.

This report examines the trends and patterns of domiciliary consultations within Lothian Health Board area. Lothian Health Board is the second largest health board in Scotland. It is a teaching board with a mixed urban and rural population of 750,000. This is a retrospective study of data on domiciliary consultations from the Information and Statistic Division of the Common Services agency for the years 1986 to 1991. Comparison of total figures nationally and locally and an examination of numbers of visits among specialties within the health board area. Between 1986 and 1991 the total number of domiciliary consultations in Scotland dropped by 27%. During the same period the average rate for three of the four Scottish teaching boards fell by 32% while for Lothian it fell by 20%. Average teaching board figures dropped consistently each year but Lothian figures showed more fluctuation, in particular, a drop of 20% between 1990 and 1991. The large drop in domiciliary visits was reflected in two of the three main specialties for the same period.

Health Services Research↗

PubMed2000

A randomized field trial in Oakland, California.

This study evaluates the impact of a civil remedy program (Beat Health) on drug and disorder problems under experimental field trial conditions. Using calls for service data, the authors find statistically significant differences between the control and experimental groups, when drug problem calls prior to the start of the intervention were compared to drug calls during a 12-month follow-up period. The Beat Health sites, especially the residential sites, improved relative to the control sites. By contrast, the control treatment (patrol response) led to significant increases in drug problems, particularly at the commercial properties included in this study. The authors also examined the spatial influences of the Beat Health and patrol responses in catchment areas surrounding each of the 100 study sites. The results show some improvement in the experimental residential sites. The authors found, however, a possible displacement of drug problems in and around both the commercial experimental and control sites. They show that the displacement effect is most notable in the commercial control sites.

California↗

PubMed2002

Economic costs of post-natal depression in a high-risk British cohort.

BACKGROUND: Post-natal depression is a common condition that can result in distress for the mother and deleterious effects on the development of the infant. AIMS: To estimate the economic costs of post-natal depression in a geographically defined cohort of women at high risk of developing the condition. METHOD: Unit costs were applied to estimates of health and social care resource use made by 206 women recruited from antenatal clinics and their infants. Net costs per mother-infant dyad over the first 18 months post-partum were estimated. RESULTS: Mean mother-infant dyad costs were estimated at pound 2419.00 for women with post-natal depression and pound 2026.90 for women without post-natal depression, a mean cost difference of pound 392.10 (P=0.17). The mean cost differences between women with and without post-natal depression reached statistical significance for community care services (P=0.01), but not for other categories of service. Economic costs were higher for women with extended experiences of the condition. CONCLUSIONS: The results of this study should be used to facilitate the effective planning of services by different agencies.

Adult↗

PubMed1997

Deaths resulting from animal attacks in the United States.

The objective of this study was to elucidate the etiology and frequency of deaths in the United States from encounters with animals. The number of deaths from venomous and nonvenomous animals is reported annually to the US Department of Health and Human Services and published in Vital Statistics of the United States. This study is a survey of all animal-related fatalities listed as E-codes 905-906 reported in the Vital Statistics of the United States from 1979 through 1990. Data were extracted uniformly from the annual reports and analyzed using descriptive statistics. From 1979 through 1990, there were 1882 animal-related deaths in the United States. Venomous animals caused 718 deaths; nonvenomous animals caused 1164 deaths. Most deaths occurred among white males. The home site was the location of injury for the majority of deaths. The majority of venomous animal-related deaths were from hymenoptera; "other specified animal" caused the majority of nonvenomous deaths. An annual average of 157 deaths from animal attacks occurred in the United States between 1979 and 1990. Both fatal and nonfatal animal-related injuries are under-recognized public health hazards. Health care providers should educate their patients on exercising caution around animals, seeking medical care after an animal injury, carrying epinephrine kits if they have a history of systemic reactions to insect stings, and wearing helmets and other protective equipment when riding or working around large animals.

Black or African American↗

PubMed2004

Stress perception and social indicators for low back, shoulder and joint pains in Japan: national surveys in 1995 and 2001.

This study aims to clarify the effects of stress perception and related social indicators on three major musculoskeletal symptoms: low back, shoulder, and joint pains in a Japanese population. Twenty health-related variables (stress perception and 19 social indicators) and the three symptoms were obtained from the following Japanese national surveys: the Comprehensive Survey of Living Condition of the People on Health and Welfare, the System of Social and Demographic Statistics of Japan, and the Statistical Report on Health Administration Services. The results were compared among 46 Japanese prefectures in 1995 and 2001. By factor analysis, the 19 indicators were classified into three factors of urbanization, aging and life-regularity, and individualization. The prevalence of stress perception was significantly correlated to the 8 indicators of urbanization factor. Although simple correlation analysis revealed a significant relationship of stress perception only to shoulder pain (in both years) and low back pain (in 2001), the results of multiple regression analysis showed that stress perception and some urbanization factors were significantly associated with all the three symptoms in both years exclusive of joint pain in 1995. Taking the effects of urbanization into consideration, stress perception seems to be closely related to the complaints of musculoskeletal symptoms in Japan.

Arthralgia↗

PubMed1998

The National Breast and Cervical Cancer Early Detection Program: report on the first 4 years of mammography provided to medically underserved women.

OBJECTIVE: We describe results from 284,503 mammographic examinations and associated diagnostic workups provided to medically underserved women in an ongoing nationwide breast cancer early detection program. MATERIALS AND METHODS: We report the results of mammographic examinations and diagnostic workups on 230,143 medically underserved women 40 years old or older who underwent at least one mammographic examination from July 1991 through June 1995. Mammograms were obtained in hundreds of mammography and clinical facilities throughout the United States, including community health centers, health department clinics, private practitioners' offices, university based facilities, and mobile mammography units. Our analysis included rates of mammograms with abnormal findings (reported according to the categories of the American College of Radiology Breast Imaging Reporting and Data System), breast cancer detection rates, numbers of diagnostic procedures performed, stage and size distribution of breast cancers, and positive predictive value of mammograms and biopsies with abnormal findings--all presented according to screening round and 10-year age intervals. RESULTS: Mammograms with abnormal findings constituted 5% of mammograms in the first round and 4% in subsequent rounds, both proportions declining by approximately one third from the youngest (40-49 years) to the oldest (70 years and older) age group. Breast cancer detection rates per 1000 mammographic examinations were 5.1 for the first round and 2.0 for subsequent rounds; from the youngest to the oldest age group, the first-round rates doubled and the subsequent-round rates tripled. Early-stage cancers accounted for 54% of first-round cancers and 81% of subsequent-round cancers. Percentage of invasive cancers at least 2 cm in size declined from 51% in the first round to 33% in subsequent rounds: however, we found little change in the proportion of lesions smaller than 1 cm. Positive predictive values declined from 9.5 cancers per 100 mammograms with abnormal findings in the first round to 5.6 cancers per 100 mammograms with abnormal findings in the subsequent rounds. CONCLUSION: A large nationwide breast cancer early detection program conducted through hundreds of diverse facilities has provided results that, although not a statistically representative sample of mammography services, are probably the best available characterization of the current state of breast cancer screening practices as they actually occur in the 1990s in the United States. These results should be useful to clinicians, researchers, and public health personnel in counseling patients, planning new studies, and improving efforts to control breast cancer.

Adult↗

PubMed1983

Sex differences in psychiatric morbidity: an analysis of Victorian data.

This study examined relevant Victorian data in the light of overseas findings on sex differences in psychopathology and utilisation of psychiatric treatment resources. Data sources included community health surveys and treatment statistics from the State psychiatric services, general hospitals and general practitioners. It was revealed that more Victorian women than men reported and were treated for psychiatric problems, and that women were most often diagnosed as depressed and otherwise neurotic, whereas men more often had alcohol and personality disorders. Married women had higher rates of mental illness than married men, whereas single and divorced men had higher rates of psychiatric morbidity than their female counterparts. Occupational status was related to men's, but not women's mental health. Various explanations for the findings are discussed, with some stress on the possible contribution of the sex role socialisation and cultural expectations of men and women.

Alcoholism↗

PubMed1984

A medical record and information system for primary health care in Iceland. The Egilsstadir Project.

In Iceland a problem oriented medical record system for primary health care has been developed. A contact-form is used to record data on all contacts between the inhabitants in a district and the health center. A minicomputer is used for retrieval and analysis. One rural health center using this system has been successful in recording a basic set of data on all contacts taking place since 1976 and linking these data to the national register data for the population in the district. Most health centers in Iceland are now adopting this system, because it seems to be: A valuable aid in the treatment of patients, which improves the quality of the treatment. A useful source of information of the health of the population, which among other things makes possible the identification of those at special risk. A good instrument for research and teaching. A useful source of statistics on the primary care services.

Humans↗

PubMed1982

Privacy ACt 1974; report of a new system of records 09-90-0089. Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services. Notification of new system of records--National Long-Term Care Survey.

In accordance with 5 U.S.C. 552a(e)(4), wer are issuing public notice of our intent to establish a new system of records: National Long-Term Care Survey, HHS/OS/ASPE, 09-90-0089. We also are proposing to include routine uses of the system in accordance with 5 U.S.C. 552(a)(11). A sample of approximately 50,000 persons, drawn from Medicare administrative records, will be administered a short interview to determine if they have limitations in the personal care and instrumental (shopping, housework, etc.) skills which are necessary for independent living. Those who are limited--approximately 6,000--will be administered a second interview in which data will be obtained on their demographic, health, and economic characteristics, functional status, and utilization and costs of services. As part of this interview, respondents will be asked the names of family and friends who give them care. A sample of 2,000 of these caregivers will be administered an interview to determine the kinds and amount of care they give and their attitudes toward caregiving. The Caregivers Survey will be conducted by the National Opinion Research Center (NORC); all the other interviewing will be conducted by the Bureau of the Census, which will transmit to NORC the names and addresses of caregivers. All data will be used by the Department of Health and Human Services and/or their agents for statistical analysis. The same size has been determined by standard sample design techniques to be the minimum that will allow the required analysis.

Activities of Daily Living↗

PubMed1996

[Poliomyelitis in Madagascar (1988-1996): current situation in the World Health eradication program by the year 2000].

The number of acute flaccid paralysis (AFP) cases reported to World Health Organization (WHO) decreased from 1988 (48 cases) to 1996 (8 cases), but the real endemic situation of poliomyelitis is unknown. Cases are under or misreported. Very often, notifications are delayed; virological investigations of the etiology could not be performed as well as the environment studies and the immunization ripostes. In 1996, only one AFP case was confirmed by isolation of wild poliovirus. The immunization coverage in children under one by OPV (3 doses) was 73.0% in 1996 from the statistics of the Public Health Services but only 54.7% from randomized studies. The eradication of poliomyelitis by the year 2000 has engaged Madagascar in the disease prevention by improving the immunization coverage within the Expanded Immunization Programme in association with the Organization of National Immunization Days in October and November 1997. Likewise, the Virological Unit of the Pasteur Institute was recognized as the National WHO Reference Centre for Polio.

Adolescent↗

PubMedDate not supplied

Attitudes toward the shortened dental arch concept among Swedish general dental practitioners.

PURPOSE: The purpose of this investigation was to obtain the opinions and assess the attitudes of Swedish general dental practitioners in private practice versus a public health care setting regarding management of patients with a shortened dental arch (SDA). MATERIALS AND METHODS: A questionnaire containing different statements regarding the SDA concept was sent to a random sample of 189 clinicians. Differences between male and female practitioners and between private practitioners (PPs) and those employed by the Public Dental Health Service (PDHS) were tested for statistical significance by the Student t test. RESULTS: The response rate was 54% (102 clinicians). Among the respondents, 62% were men and 38% were women. Fifty-six percent were PPs and 44% were employed by the PDHS. The results showed small differences in attitudes between various groups of practitioners but large individual variations. In general, Swedish general practitioners had a positive attitude toward the SDA concept with respect to oral function and oral comfort. They recognized few risks with a dentition lacking molar support, although female clinicians were more risk conscious. PPs expressed fewer advantages in using the SDA concept than PDHS practitioners with respect to the reduced risk for overtreatment, better patient economy, and the ability for older patients to keep their teeth. CONCLUSION: The results from this questionnaire study indicate that, overall, Swedish general practitioners have an affirmative opinion toward the SDA concept.

Attitude of Health Personnel↗

PubMed1991

[Therapeutic use of fresh plasma and "virus-safe" plasma].

The use of plasma and factor concentrates for the treatment of coagulation disorders is well established, but many questions remain. The indications for fresh frozen plasma are still not clearly established and excessive use is rampant. The safety of all blood products has not yet been firmly established. Peer review of transfusion practice in a hospital can be achieved by a Hospital Transfusion Committee. The review and analysis of the statistical reports of the transfusion service and strategies for enhancing quality of patient care will be presented.

Algorithms↗

PubMedDate not supplied

Home blood pressure monitoring for mild hypertensives.

A clinical trial of 204 untreated patients with mild hypertension was conducted to assess the effect of home blood pressure monitoring on blood pressure level, pharmacologic treatment, reduction of risk factors, and use of health services. After 1 year, no statistically significant differences were found between the treatment and control groups. The findings indicate that, while home blood pressure monitoring may be useful, it has no measurable short-term impact on these aspects of blood pressure management for patients with mild hypertension.

Blood Pressure Determination↗

PubMed1991

A local area network for medical research; planning, realization and experience.

This report focuses on the planning and realization of an interdisciplinary local area network (LAN) for medical research at the University of Heidelberg. After a detailed requirements analysis, several networks were evaluated by means of a test installation, and a cost-performance analysis was carried out. At present, the LAN connects 45 (IBM-compatible) PCs, several heterogeneous mainframes (IBM, DEC and Siemens) and provides access to the public X.25 network and to wide-area networks for research (EARN, BITNET). The network supports application software that is frequently needed in medical research (word processing, statistics, graphics, literature databases and services, etc.). Compliance with existing "official" (e.g., IEEE 802.3) and "de facto" standards (e.g., PostScript) was considered to be extremely important for the selection of both hardware and software. Customized programs were developed to improve access control, user interface and on-line help. Wide acceptance of the LAN was achieved through extensive education and maintenance facilities, e.g., teaching courses, customized manuals and a hotline service. Since requirements of clinical routine differ substantially from medical research needs, two separate networks (with a gateway in between) are proposed as a solution to optimally satisfy the users' demands.

Costs and Cost Analysis↗