The risks and benefits of episiotomy: a review.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to S B Thacker.
Explore the source record for details and available documents.
Excess deaths due to pneumonia and influenza and excess deaths for all causes were estimated using a time-series analysis for each of the eight influenza epidemics in the United States that occurred between 1967-1978. The effects of different analytic methods and different methods of structuring data are compared. Future directions for estimating the impact of influenza on mortality include a combination of regression techniques and multiple time-series analyses of surveillance data.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Proposed in this paper is a new method of forecasting the expected number of pneumonia and influenza deaths based on a time series analysis of the historical mortality data. Currently, the method for forecasting the expected pneumonia and influenza deaths used by the Center for Disease Control is based on regression analysis. These forecasts are used to estimate the excess deaths attributable to pneumonia and influenza. Careful comparative analysis demonstrates that the proposed method provides a more accurate forecast of pneumonia and influenza mortality than the existing method.
In this paper, the percentage of all deaths that are related to pneumonia and influenza (P & I ratio) is evaluated as an indicator of influenza activity and as a method to quantify the impact of influenza on mortality. Analysis of data from 1962-1979 indicates that the P & I ratio is an accurate indicator of influenza activity, as confirmed by independent systems of morbidity and laboratory surveillance. A rule using the P & I ratio for detecting an outbreak of an influenza epidemic was evaluated. It was found to be much more specific than a rule based on the regression model, but did not provide more timely detection of outbreaks of influenza during the past 17 years. The use of the P & I ratio in the autoregressive integrated moving average (ARIMA) model of forecasting provided the most accurate prediction of the expected pneumonia and influenza mortality.
Asymptomatic infection with either Entamoeba histolytica or Giardia lamblia was found in 60 per cent of the residents in an institution for the mentally retarded one year after eradication of these parasites. The residents were then segregated into infected and noninfected groups and drug therapy was again successfully undertaken. The two groups remained separated except during periods of play. A one-year follow-up showed that both study and control groups were equally infected. The failure of segregation was confounded by patient age and infection with nonpathogenic parasites.
During a severe drought Port-au-Prince, Haiti, lost hydroelectric power for 10 weeks. This led to water shortages in areas of the city dependent on water supplied from electrically driven pumps. In a study of the impact of water restriction on disease, 400 families were randomly selected from two urban areas differentially affected by the water shortage. Disease in children was found to be related to quantity of water used, socioeconomic status, employment of head of household, and family size. The methods used in this study are recommended for the investigation of the relationship between water quantity and health.
Explore the source record for details and available documents.
A passive disease report card (DRC) surveillance system failed to detect an epidemic of diarrheal disease caused by a newly identified drug-resistant strain of Shigella sonnei. The DRC system inaccurately described both the population at risk and the geographic location of cases. Specific limitations of the DRC system, including problems of underreporting and ascertainment bias, were complicated by the absence of timely data analysis and feedback to providers.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The purpose of this study is to describe quantitatively the primary health care system of a defined population. The ambulatory care services of private practices and institutions in Durham County, North Carolina were sampled four times during 1975-1976 to determine the relative contributions to primary care made by specified types of practice and sources of care. All the institutions and 96 per cent of practicing physicians participated. Utilization of primary care services was analyzed by race, sex, age and health insurance status. One striking finding is the predominant role in the delivery of primary care played by the private specialists practicing in the community in contrast to the relatively small role of the university teaching hospital. Another important finding is the low proportion of blacks and Medicaid patients served by these community physicians. Thirdly, removal of legal and financial barriers has made little impact as yet on the patterns of health care delivery established before the institution of mandatory integration of health services. Since these findings have broad implications for health care delivery, this study warrants replication in other settings.
Explore the source record for details and available documents.
Asymptomatic infection with either Entameba histolytica or Giardia lamblia was found in 61 per cent of the residents of a dormitory in an institution for the mentally retarded; two other dormitories had rates of 20 per cent and 22 per cent. Drug therapy was successfully undertaken in all three dormitories, and environmental improvements were introduced in the heavily infected dormitory. A one-year follow-up showed a reduction in parasitic disease in two dormitories but, in the most heavily infected dormitory, infection had returned to pretreatment levels.
Explore the source record for details and available documents.
Electronic fetal monitoring (EFM) is an example of a medical technology that has been widely accepted since its introduction in the mid-1960s. However, review of the literature does not provide convincing evidence of EFM efficacy, and four recent, controlled, clinical trails show little if any benefit in terms of preventing death or long-term disability of the baby. Public and private policies have largely acted to encourage use of EFM, and none have acted to slow or prevent its spread. This need for mechanisms to assure the timely evaluation of new medical technologies before they are accepted as a medical practice has led to a new medical devices program in the Food and Drug Administration, consensus development groups at the National Institutes of Health, and congressional legislation to establish a new National Center for Health Care Technology.
Sixty-nine laboratory-documented cases of Legionnaires' disease occurred in Vermont between 1 May and 31 December 1977. Clinical manifestations were similar to those in the 1976 Philadelphia epidemic. Case-control studies suggested that Legionnaires' disease patients were more likely to present with headache or diarrhea than were patients with pneumonia of presumed nonbacterial cause. The case-fatality ratio for patients treated with erythromycin was 4%, compared with 17% in patients not treated with erythromycin. Thirteen patients had been hospitalized throughout the 10 days preceding onset of illness, equaling the maximal known incubation period. This suggests either acquisition or reactivation of infection in the hospital. However, even during the week of peak disease activity, cases occurred in patients with no recent hospital contact. The only community factor possibly associated with acquisition was home air conditioning. This prevalence of seroreactivity to the Legionnaires' disease bacterium in various community populations was as high as 26%, suggesting a possible endemic area.