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At least 271 records · Page 15Linked to original sources
PubMed2004

What caused the decline in breast cancer mortality in the United Kingdom?

BACKGROUND: The marked improvement in breast cancer mortality in the United Kingdom (UK) has attracted worldwide interest. To understand the details of this phenomenon the morbidity and mortality rates of breast cancer in the UK during the past 30 years were analyzed. METHODS: The official publications and statistical data were available and downloaded at the official UK Web sites of the National Health Service, National Statistics and Cancer Research Organization. Parts of the data were obtained directly from the National Cancer Intelligence Centre of UK. RESULTS: After the beginning of breast screening the morbidity of the subject age group soared up to the level of an age group that was 10 years older. Noninvasive carcinoma was often discovered in the subject age group after the beginning of breast screening and constituted 8.3%of all cases. The mortality rates, however, began to decrease before the start of screening and fell clearly even in age groups other than that of the study group and particularly in elderly women. CONCLUSIONS: Not only the prevalence of breast screening but also the increase of early stage cancer in all age groups have probably resulted from improvements in diagnostic technology and heightened social interest and awareness. In addition, the development of adjuvant endocrine therapy must have influenced the evident improvement in mortality of breast cancer in the UK.

Adult↗
PubMed1997

Posttraumatic stress disorder in U.S. Army Vietnam veterans who served in the Persian Gulf War.

We reviewed U.S. Army medical boards (136 cases) held between October 1990 and July 1994 for posttraumatic stress disorder (PTSD) that involved participation in the Persian Gulf War of 1990 to 1991. Thirty-five percent of these soldiers (34 cases) had also served in Vietnam. Their records were compared with the records of 102 other soldiers also medically retired for PTSD who served in the Persian Gulf War but did not serve in Vietnam. Approximately one-half of the Vietnam group developed PTSD symptoms in anticipation of deployment to the Persian Gulf. Those soldiers with prior Vietnam service had statistically significant odds ratios for PTSD (between about 5 and 24) compared with soldiers without Vietnam service. These findings indicate that for some persons with prior war experience, the threat of another war is sufficient to exacerbate symptoms or provoke a new episode of PTSD and this risk is substantially greater than that for soldiers without such experience.

Acute Disease↗
PubMed2003

Dangerous to your health: the role of chronic drug use in serious injuries and trauma.

OBJECTIVES: This study estimated the differential risks of serious injury or trauma for a community-based sample of chronic drug users (CDUs; n = 926) and a matched group of nondrug users (NDUs; n = 553). The study also estimated whether CDUs and NDUs differed in their utilization of health care services for serious injury or trauma. MATERIALS AND METHODS: Data were collected in 1996 and 1997 through community outreach activities in Miami-Dade County, Florida. The analysis estimated the effects of drug use on (1) any lifetime serious injury or trauma, (2) any serious injury or trauma during the past 12 months, and (3) utilization of health care services for serious injury or trauma. All analyses were gender specific and the models were also estimated with a measure of problematic alcohol use in addition to CDU. To examine the potential endogeneity of drug use, various specification tests were conducted. RESULTS: For females, CDUs experienced significantly more serious injury, trauma, or both (both lifetime and past year) than nonusers. Drug use status was not a significant predictor of serious injury or trauma (lifetime and past year) for males. Regardless of gender, conditional on experiencing any serious injury or trauma during the past year, CDUs and NDUs did not differ in their utilization of health care services. Various statistical tests determined that CDU was exogenous in all specifications and the findings were largely unchanged when problematic alcohol use was included in the models. CONCLUSIONS: The elevated risk for serious injury or trauma for female CDUs renders these persons vulnerable to severe medical problems. Specific training in substance abuse issues may be necessary if health care providers are to identify, engage, knowledgeably serve, and refer CDUs for appropriate services.

Adult↗
PubMed2004

[Could we trust clinical statistics from data banks of the National Health Service (NHS)?].

Can we accept the statistics provided by the Ministry of Health, which uses large computerized databases? Through MEDECHO, the Ministry provides to hospital managers, reports cards on different interventions. These reports compare different hospitals performances. Surgeons involved in the process hesitate to accept this information. Using the results of the performance of cholecystectomy provided by this system (Gr: A), we compared the same cohort (1 April-31 December 1996 = 346 cholecystectomies) but using specific criteria determined as relevant to our surgeons (Gr: B). The rate of complication gives a crude aftermath and no attempt was used to adjust for severity. The MEDECHO data are adjusted for severity. The global rate of complications is similar Gr: A 11%, Gr: B 12%. Major complication rate for pulmonary embolism, hemorrhage and biliary duct trauma are identical. The rate of surgical site infection is higher in Gr: B (5% vs. 2%). The patients are seen in the outpatient clinic and these observations are not included by the analytical system unless the patient has been readmitted. For our hospital, the MEDECHO data are valid and reliable even though they underestimated the wound infection rate. These results could be explained by an appropriate interpretation of the code system by the archivist and by the surgeons' precision to complete the summary sheet of hospitalization. We can conclude that these data can be used as a means to evaluate the quality of outcome of a surgical service.

Canada↗
PubMed2007

Predictors of referral to the North Carolina Child Service Coordination Program among infants with orofacial clefts.

OBJECTIVE: North Carolina has several programs that identify high-risk women and children for needed services, including the Child Service Coordination Program (CSCP). This study determines CSCP referral rates among infants with orofacial clefts (OFCs) and predictors of CSCP referral. We hypothesized receiving Medicaid and maternity care coordination (MCC) services increases the likelihood of CSCP referral. DESIGN AND SETTING: For births between 1999 and 2002, data were matched from North Carolina Vital Statistics, Health Services Information System (MCC and CSCP data), and North Carolina Birth Defects Monitoring Program. Multivariate analysis was used to determine crude and adjusted odds ratios for sociodemographic variables to predict CSCP referral. PARTICIPANTS: A total of 644 mothers of live-born infants with OFCs in North Carolina were identified. RESULTS: About 45% of infants with OFCs were referred to the CSCP. Infants of mothers who were at least 30 years of age and mothers who had more than a high school education were significantly less likely to be referred to the CSCP. Compared with infants with OFCs whose mothers did not receive Medicaid, mothers who received Medicaid were 1.9 times more likely to be referred to the CSCP, and mothers who received Medicaid and MCC services were 2.3 times more likely. CONCLUSIONS: Receipt of Medicaid and MCC services and receipt of Medicaid alone were positively associated with CSCP referral. Future studies should examine the effects of the duration of MCC services and factors related to the timeliness of CSCP referral.

Adult↗
PubMed1987

Perspectives on medical school library services in Turkey.

This paper gives a brief overview of medical education in Turkey and shows the impact of established social, educational, and economic patterns upon current medical library services. Current statistical information is given on the twenty-two medical school libraries in Turkey. Principal problems and chief accomplishments with library services are highlighted and discussed.

Libraries, Medical↗
PubMed2000

Service provision patterns by main diagnoses and characteristics of patients.

Service provision patterns may be influenced not only by clinical oral health status leading to a diagnosis and treatment plan, but also by other variables such as patient characteristics. The main aim of this study was to investigate whether associations between services provided and patient factors would persist after controlling for the main presenting diagnosis or condition. A random sample of dentists surveyed in 1993-94 provided a response rate of 74%. Private general practitioners recorded service provision data from logs of 1-2 typical days of practice. Caries (26.5%) was the most prevalent diagnosis, followed by recall/maintenance care (19.0%), pulpal/periapical infection (10.9%), and failed restorations (10.4%). Diagnoses were associated with variation in the percentage of patients receiving services in main areas of service, and also with insurance status, sex and age distributions of patients, and type of visit (chi-square; P< 0.05). Logistic regressions of receipt of services indicated statistically significant associations with patient characteristics and diagnosis categories. Controlling for diagnosis, uninsured patients and those visiting for emergencies had less favourable service patterns (e.g., higher odds of extractions, but lower odds of preventive and crown and bridge services) compared to patients who had dental insurance or visited for check-ups or other non-emergency dental problems. The influence of these factors on services provided has implications of public health importance in terms of appropriateness of care and social inequality.

Adolescent↗
PubMedDate not supplied

Maternal mortality in rural Bangladesh: the Jamalpur District.

During the 12-month period from September 1982 to August 1983, 9,317 live births and 58 maternal deaths were recorded in Melanda and Islampur upazilas in the Jamalpur district of rural Bangladesh, giving a maternal mortality rate of 62.3 per 10,000 live births. Maternal mortality was positively related to maternal age and parity, with the mortality risk rising very sharply beyond age 35 years, and beyond parity four among women aged 25-34 years in particular. The most common causes of maternal death were eclampsia (20.7 percent), septic abortion (20.7 percent), postpartum sepsis (10.3 percent), obstructed labor (10.3 percent), and antepartum and postpartum hemorrhage (10.3 percent). These findings indicate that family planning, by decreasing the likelihood of pregnancy after age 35 and parity four, can help reduce the proportion of women at risk of maternal mortality.

Adolescent↗