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Biomedical subjects

R Wilkins

Publications and source records attributed to R Wilkins.

At least 55 records · Page 3Linked to original sources
PubMed1991

An analysis of frequencies of surgical procedures in Canada.

This paper reports preliminary and selected results of an analysis of the frequencies of 36 common surgical procedures in hospitals across Canada during the period April 1985 to March 1987. Age-sex-specific and age-sex-standardized procedure rates were calculated for each procedure for each of 245 Census Divisions (CDs) across Canada, as well as for 338 smaller urban areas (FSAs) within the province of Ontario. Special attention was given to adjusting the rates for differing population sizes of the geographical regions. Procedure rates were computed based on the residence of the patient, not on the location of the hospital. Graphical techniques, analysis of variance, and other statistical techniques were used to identify unusually high or low procedure rates and to determine effects due to differences in age, sex, and geographical region. The relationship of procedure rate to the socio-economic level of a region (as measured by the proportion of low-income individuals in the region) was analyzed.

Canada↗
PubMed1991

Birth outcomes and infant mortality by income in urban Canada, 1986.

For 1986, 219,470 live births were reported for residents of Canada's 25 Census Metropolitan Areas (CMAs). For each of these births, street address information as shown on the birth registration was used to code the census tract where the mother lived. Data by census tract were obtained for 1,650 infant deaths in 1986, and from the 1986 census for the population of 4,727,770 women aged 10-49 in 1986. Births, infant deaths and census population data (adjusted for undercount) were then used to calculate rates of infant mortality, low birth weight (LBW), very low birth weight (VLBW), prematurity, small for gestational age (SGA), and total fertility. The results are presented by neighborhood income quintile group (based on percentage of low income), and by the mother's age, parity (number of live births), marital status and country of birth, as well as by CMA.

Adolescent↗
PubMed1989

HIV screening and counseling for intravenous drug abuse patients. Staff and patient attitudes.

At least one third of patients enrolled in a methadone maintenance treatment program are willing to comply voluntarily with screening for and counseling about human immunodeficiency virus (HIV). A questionnaire about knowledge, attitudes, and behavior concerning acquired immunodeficiency syndrome was answered anonymously by 79% (46) of the clinical staff and 67% (868) of the enrolled patients. On their own initiative, 21% of the patients had already received voluntary anonymous HIV screening and brief counseling, seldom discussing the result with the staff. Approximately 90% of the staff and a majority of the patients (72%) thought a voluntary HIV screening program should be offered to all patients. Almost all staff (98%), but only 50% of the patients, felt the HIV test results should be known to physicians, nurses, and counselors at the clinic. Few staff members (15%) believed that patients had changed their sex behavior; more (48%) felt that needle sharing was reduced. Patients believed methadone patients in general had changed their sex behavior (49.2%) and reduced needle sharing (62%) to prevent becoming infected. Patients reported statistically significant reductions both in number of sex partners and in personal needle sharing during the past year.

Adult↗
PubMed1989

Changes in mortality by income in urban Canada from 1971 to 1986.

The reduction of socio-economic inequities in health is now an explicit objective of health policy in Canada. This study examines changes in mortality by income in urban Canada from 1971 to 1986 in terms of both relative and absolute differences between income groups. Street address information as shown on death certificates was used to code census tract of usual place of residence for deaths occurring to residents of Canada's Census Metropolitan Areas (CMAs) in 1971 and 1986. After exclusion of residents of health care institutions, 73,995 deaths were included in the study for 1971, and 88,129 for 1986. These deaths were analyzed by income quintile (based on census tract incidence of low income), age, sex, and cause of death. In 1971, the difference in life expectancy at birth between the highest and lowest income quintiles was 6.3 years for men and 2.8 years for women. By 1986, these differences had decreased to 5.6 years for men and 1.8 years for women. However, relative mortality (lowest compared to highest income quintile) at most ages changed only slightly over the 15 years. Relative infant mortality, for example, was 1.97 in 1971 and 1.82 in 1986. In 1986, 21% of total potential years of life lost (PYLL) prior to age 75 could be attributed to differences in quintile death rates compared to rates for the highest income quintile. Approximately 45% of this "excess" PYLL was for persons under 45 years of age. In 1971, the comparable figure was 67%. In 1986, the major causes of death contributing to income inequalities in mortality were: circulatory diseases, accounting for 25% of excess PYLL related to quintile differences; accidents, poisonings and violence, accounting for about 17%; and neoplasms, accounting for 15%. Respiratory diseases, ill-defined conditions, metabolic diseases and perinatal conditions each contributed 6-7% of excess PYLL. From 1971 to 1986, in terms of age-standardized morality rates (ASMRs) for all ages, certain causes of death showed increased mortality together with greater inequality by income, especially for males: these causes included lung cancer, suicide, metabolic diseases other than diabetes, and ill-defined conditions. Other causes of death showed either little change or less inequality by income but higher ASMRs: these included breast cancer, colon and rectal cancer, arterial diseases, alcoholism, mental disorders, and diseases of the nervous system.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1987

Hallucinations in children and teenagers admitted to Bethlem Royal Hospital in the nineteenth century and their possible relevance to the incidence of schizophrenia.

The case notes of 1069 children and teenagers admitted to Bethlem Royal Hospital, ("Bedlam"), in the nineteenth century were analysed with particular reference to the frequencies and types of hallucinations. There was a significant increase (P less than 0.001) in the frequencies of auditory and visual hallucination from 1830 to the end of the century. The presence of auditory hallucinations of people, when they occurred in males, significantly worsened the prognosis (P less than 0.025) compared to females. The findings are considered with special reference to the incidence and aetiology of schizophrenia in the last century.

Adolescent↗
PubMed1987

Cardiogenic shock in right ventricular infarction managed with a combined thermodilution and pacing pulmonary artery flotation catheter.

When cardiogenic shock complicates right ventricular infarction it is widely appreciated that rational therapy can only be achieved by use of plasma volume expansion and inotropic agents guided by invasive monitoring (Cohn et al., 1974). In these cases, there is a high incidence of symptomatic heart block and serious atrial and ventricular dysrhythmias (Cohn, 1979). Thus, venous access may be required for monitoring, pacing, infusion of fluid, and vasoactive or antiarrhythmic drugs. A case of right ventricular infarction complicated by cardiogenic shock, heart block, multiple arrhythmias and severe hypoxaemic respiratory failure is described. Technical problems in venous access were encountered and overcome by the use of a single multi-purpose catheter for haemodynamic monitoring, infusion of drugs and fluids and passage of a pacing wire. We believe that this is the first description of the use of such a catheter in the United Kingdom, although the use of a multi-purpose pulmonary artery flotation catheter with fixed pacing electrodes has been described before (Zaidan & Freniere, 1983).

Aged↗
PubMed1987

Changes in the healthfulness of life of the elderly population: an empirical approach.

This paper presents an empirical approach to measuring the healthfulness of life of the elderly population. It discusses information related to trends in disability-free and quality-adjusted life expectancy in the context of the current debate concerning prospects for a possible future compression of morbidity. Trends in each of the components underlying health expectancy are examined: survivorship and remaining life expectancy in each state of health, rates of institutionalization, as well as incidence of disability and prevalence of activity restriction in the household population. The effects on health expectancy of changes in these components are noted.

Aged↗
PubMed1985

A comparison of elective mutism and emotional disorders in children.

The case notes of 24 children diagnosed as elective mutes were compared with those of 24 matched controls with diagnosed emotional disorders. One-third of the elective mutes (but none of the controls) had experienced delayed development of speech or difficulties in articulation. All the elective mutes lived in two-parent families, but marital discord was noted in half the families in both groups. Compared with the controls, the mute children were more often described as 'anxious', 'depressed' and 'manipulative', and their mothers were characterised as 'over-protective', and tending to 'spoil' their children. Three unusual cases, of mutism at home, are described in detail. It is proposed that elective mutism is associated with particular personal and family characteristics and represents a condition different from any recognised emotional disorder.

Adolescent↗
PubMed1984

Giant lymph node hyperplasia (Castleman's disease) of the mesentery. Observations on the associated anemia.

A mesenteric mass, histologically characterized as giant lymph node hyperplasia was found in an 18-yr-old man with at least 11 yr of growth retardation and anemia. The anemia was characterized by iron deficiency from selective malabsorption of iron, and by features of the anemia of chronic disorders. In contrast with a previous report, no inhibitor of erythropoietin was found and there was no abnormality of erythropoietin secretion. Resection of the mass was followed by rapid correction of the anemia and catch-up growth. The mass had histologic features of the hyaline vascular and plasma cell types of Castleman's disease with multinucleate giant cells probably of macrophage origin. Immunologic studies of the mass showed that the B lymphocytes were polyclonal and the T lymphocyte helper/suppressor cell ratio was normal, suggesting that giant lymph node hyperplasia is a local inflammatory reaction.

Adolescent↗
PubMed1983

The accuracy of the plain abdominal radiograph in assessing colonic faecal contamination.

A prospective study of 333 out-patients assessed the accuracy of determining colonic cleansing from the plain abdominal radiograph. The results indicate that the amount of colon contaminated with faeces was significantly underestimated and the difference in efficacy between the best and worst preparation regimens could not be detected from the plain film. Nevertheless, plain films have been used in comparative studies of preparation regimens for barium enema. It is suggested that results so obtained are misleading and that comparisons are best made on barium films alone.

Barium Sulfate↗
PubMed1983

Health expectancy in Canada, late 1970s: demographic, regional, and social dimensions.

Based on estimates of activity restriction from the Canada Health Survey, institutional data on long-term care, and survival data from vital statistics, we have calculated an index of health expectancy (life expectancy in each state of health), and a summary of these indices which we have called quality-adjusted life expectancy. At birth, expected years of long-term institutionalization were 0.8 for men and 1.5 for women. Expected years of activity restriction not involving long-term institutionalization were 10.8 for men and 14.0 for women; 3.0 of the expected years of activity restriction for men and 1.3 of these years for women were in the most severe category of restriction (unable to do major activity). For both sexes together, quality-adjusted life expectancy was 1.4 years greater in Ontario and the Prairies than in the Atlantic region, 3.2 years greater in Canada's three largest cities than in rural areas and small towns, and 7.7 years greater among persons from high-income families than among persons from low-income families.

Activities of Daily Living↗