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PubMed1992

Short-term hospital care for psychiatric illness among seniors.

This study focuses on recent changes in hospital use by seniors (aged 65 or over) who have been treated as inpatients in general and psychiatric hospitals for less than one year with functional psychoses and clinical disorders. The data analyzed are hospital separations for the age groups 65 to 74, 75 to 84, and 85 and over, for the period 1980-89. The data are derived from hospital morbidity statistics submitted annually to Statistics Canada by the provincial ministries of health. Age-specific separation rates for the age groups 75 to 84, and 85 and over increased during 1980-89. However, for the age group 65-74, the rates were fairly stable and in some instances decreased. These increases in short-term hospitalization of the seniors 75 and over are evidence of the appreciation of their treatability and of the improved recognition of these disorders in this age group. Adverse reactions to prescription drugs resulting in psychiatric symptoms may also be a factor in the increasing hospitalization rates. The largest increases in age-specific rates and bed days were for the age group 85 and over. For this age group, the separation rates were higher for men than women. In this age group in 1986, a higher proportion of women than men lived in institutions. For seniors living outside institutions, a larger percentage of men than women lived alone. This situation likely promotes more social isolation for men than women, and may be an important factor in the higher hospitalization rates among men.

Adolescent↗
PubMed1992

The effect of participatory school health programme on the control of malaria.

Two hundred primary level school children, aged between 7 and 18 years took part in a comparative pilot study of the effect of participatory school health education in Kisumu, Western Kenya in 1988. An experimental cohort of 100 pupils had participatory health education versus a passive control of another 100. An initial KAP survey revealed comparable sociological variables as well as morbidity statistics. No significant change occurred on the knowledge of the disease between the groups after 3 months. However, positive change in attitude here determined by positive antimalarial practices, was observed more frequently in the experimental group than in the control group. Efforts to environmental manipulation increased by 69% vs 1%, while parasite rates decreased by 32% vs an increase of 5%, respectively. Similarly there was a decrease in absenteeism of 25% vs an increase of 5% between the groups. Clinical malaria was reported less frequently in the experimental group than the control (26% against 8%). In conclusion, this pilot study suggests that participatory approach in effective health education to school children should be investigated further to determine its potential in the intersectoral malaria control strategy.

Adolescent↗
PubMed1991

The literature and perspectives on muscle relaxants for rapid sequence induction.

Since the advent of surgical anesthesia, one of the single greatest challenges to providers and researchers has been to develop, test, and promote drugs and techniques to facilitate rapid intubation and security of the airway to diminish risk of regurgitation and gastric aspiration. This article provides a comprehensive, historical perspective of such efforts, including the efficacy of various techniques and muscle relaxant drugs that have been used to further the ideal situation in which airway control would obviate the all-too-common morbidity statistics of gastric aspiration. Special emphasis is given to the review of succinylcholine and vecuronium relative to their roles in rapid sequence induction.

Anesthesia, Inhalation↗
PubMed1991

Peptic ulcers: mortality and hospitalization.

This study analyzes data on peptic ulcer disease based on deaths for 1951-1988 and hospital separations for 1969-1988. The source of the data are mortality and morbidity statistics provided to Statistics Canada by the provinces. The age-standardized mortality rates (ASMR) for peptic ulcer disease decreased from 1951 to 1988 by 69.4% for men (8.5 to 2.6 per 100,000 population), and 31.8% for women (2.2 to 1.5). Separation rates from hospitals during 1969-1988 for peptic ulcer disease also decreased by 59.8% for men (242.7 to 97.6 per 100,000 population) and 35.6% for women (103.2 to 66.5). Age-specific rates for both mortality and hospital separations increased with age. Epidemiological studies indicate that the incidence of peptic ulcer disease is declining in the general population. The downward trends in mortality and hospitalization rates for peptic ulcer disease reflect this change in incidence, but additional factors probably contribute as well to this decline. Male rates for both mortality and hospital separations were much higher than female rates at the beginning of the study period; but toward the end, the gap between the sexes narrowed considerably, mainly because the male rates declined substantially while the female rates decline moderately. The slower decline in the rates for women may be related to such factors as the increasing labour force participation among women and the slower decline in the population of female smokers.

Adult↗
PubMed1991

Autopsy: clinicopathological concordance and imaging techniques.

We have assessed clinical and post-mortem diagnostic agreement, comparing two one-year periods 10 years apart (1976 and 1986), in order to evaluate the contribution of noninvasive imaging techniques to diagnostic accuracy. Excluding stillbirths, perinatal deaths and forensic cases, a total of 434 hospital autopsies were analysed retrospectively, 190 from 1976 and 244 from 1986. The overall percentage of major disagreement between clinicians and pathologists was 55% for autopsies carried out in 1976 and 34% for those in 1986. In the majority of these, the clinicians located the immediate cause of death outside the organ system identified by the pathologist. For major conditions not classified as the immediate cause of death, the concordance rates were 62% in 1976 and 75% in 1986; this significant improvement between the two periods suggests that the new modalities in widespread use in 1986 may have increased clinical diagnostic accuracy with respect to these conditions. We conclude that (i) the rate of verification at autopsy of the clinically suspected cause of death remains unacceptably low; (ii) the autopsy is indispensable as an instrument of quality control and for generating mortality and morbidity statistics; and (iii) the introduction of new diagnostic modalities seems not to have improved the accuracy of clinical diagnosis of the immediate cause of death but may significantly have improved the detection of other major diseases.

Aged↗
PubMed1979

[Long-term clinical supervision of direct pulp capping (performed by the students of the School of Dentistry, Geneva)].

Of 123 teeth treated by direct pulp capping 110 could be rechecked clinically and radiographically after periods of 1 1/2 to 7 years, 4 on the average. In 25 cases a change in endodontic treatment has been recorded on the files: In 18 cases biopulpectomy was performed for symptomatic (pain) reasons considered as failure of the capping treatment; in 5 cases biopulpectomy was indicated for periodontal and prosthetic reasons (not considered as failure); in 5 cases of the 110 rechecked necrosis and periapical involvement was diagnosed. The rate of failure thus was 22 cases or 17%. This relatively high ratio of unfavorable results (Tab. VII) is in part due to lack of operative skill of the students while progressing tooth morbidity statistically established in the Genevan population also was taken into account. Advancing tooth ages according to graph figure 6 in accordance with other recent surveys were found to constitute no impediment for direct pulp capping. The success of this endodontic treatment is best ascertained by observing a strict selection of the case and the observance of an exacting operative procedure, namely: - Only accidentally exposed pulps without symptoms of previous spontaneous pain (Category I) are liable to successful conservation by direct pulp capping using calcium hydroxide. Previously painful pulps (Category II) according to Table VIII are either indirectly capped using corticosteroids particularly in young teeth or after exposure subject to coronal or radicular pulpotomy (Category III). Rigorous aseptical procedure and lasting hermetical sealing of the calcium hydroxide pulp dressing are additional prerequisites for success.

Adolescent↗
PubMed1979

[An epidemiologic approach to psychoses].

This study is an epidemiological approach of psychoses based on morbidity statistics from french psyschiatric hospitals for the years 1968, 1971 and 1975. It compares some of the most interesting census and first admission data for the following categories: manic-depressive psychoses, chronic schizophrenia and paranoid states on the one hand, neurotic conditions, personality disorders and non-psychotic depressions on the other. Major trends are analysed. Two of them seem particularly interesting: 1) the decreasing number of cases classified as manic-depressive psychoses; 2) the diminishing proportion of females in most instances. Some explanatory hypotheses are suggested.

Adult↗
PubMed1978

Autocategorization: a new technique for statistical comparisons of medical diagnoses.

Autocategorization is a new technique appropriate for studies involving relative frequencies of illness diagnoses using the International Classification of Diseases. It is ideally suited for emergency department illness patterns. The technique uses the standard chi-square statistical test, but is novel in objectively determining the aggregation of diseases into categories for analysis. The numbers of observed occurrences of the various diseases are used. without applying any a priori judgements, to decide whether a disease should be analyzed alone, or aggregated with others. This technique, because it is based on the ICDA code, will permit comparisons between various studies while retaining the statistical validity of the individual studies.

Computers↗
PubMed1979

General right censoring and its impact on the analysis of survival data.

This paper concerns general right censoring and some of the difficulties it creates in the analysis of survival data. A general formulation of censored-survival processes leads to the partition of all models into those based on noninformative and informative censoring. Nearly all statistical methods for censored data assume that censoring is noninformative. Topics considered within this class include: the relationships between three models for noninformative censoring, the use of likelihood methods for inferences about the distribution of survival time, the effects of censoring on the K-sample problem, and the effects of censoring on model testing. Also considered are several topics which relate to informative censoring models. These include: problems of nonidentifiability that can be encountered when attempting to assess a set of data for the type of censoring in effect, the consequences of falsely assuming that censoring is noninformative, and classes of informative censoring models.

Clinical Trials as Topic↗
PubMed1979

Detecting systematic errors in multi-clinic observational data.

In multi-clinic studies it is hard to maintain a uniformly high quality of measurement and coding. Systematic errors almost always occur, in spite of the best of intentions and the most rigid protocols. It is the statistician's responsibility to plan for the detection of these errors, as well as to try to avoid them and not be misled by them. The practice of examining the univariate and multivariate sample frequency distributions of the variables under study, with an eye open for anything that looks puzzling, can be very helpful in detecting and trying to correct systematic errors that would bias the analysis. Examples are given from a 21-clinic study on pregnancy and child development.

Humans↗