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At least 469 records · Page 26Linked to original sources
PubMed2003

Prostate cancer--testing, incidence, surgery and mortality.

OBJECTIVES: This article examines recent use of the prostate-specific antigen (PSA) test and presents trends in prostate cancer incidence, surgery and mortality. DATA SOURCES: Data are from the 2000/01 Canadian Community Health Survey, the National Cancer Incidence Reporting System and the Canadian Cancer Registry, the Hospital Morbidity Database, and the Canadian Mortality Database. ANALYTICAL TECHNIQUES: Descriptive data on PSA testing among men aged 40 or older were produced. Age-standardized prostate cancer incidence, surgery and mortality rates were calculated. Significant changes in linear trends were detected with joinpoint analysis. Provincial differences in incidence and mortality rates were tested using a one-way analysis of variance (ANOVA). MAIN RESULTS: In 2000/01, 43% of Canadian men aged 40 or older reported having had a PSA test. Prostate cancer incidence rates rose in the early 1990s, but have since fallen. Prostate cancer mortality rates have decreased among men aged 60 or older, but show little change among younger men. While interprovincial differences in rates of PSA testing were significant, differences in incidence and mortality rates were not pronounced.

Adult↗
PubMed1992

The clinical application of the interferons: a review. NSW Therapeutic Assessment Group.

OBJECTIVES: To review the clinical information on the use of alpha, beta and gamma interferons and to classify the use of alpha interferons in Australia according to approved indications, indications for which there is good supporting evidence and indications where therapy is under investigation; and to estimate the cost of therapy with alpha interferons in New South Wales in 1991. DATA SOURCES: Data were obtained from computerised literature searches. DATA EXTRACTION: A position paper was drafted on behalf of the NSW Therapeutic Assessment Group (NSWTAG). This was circulated to clinicians identified as having a particular interest in the use of the interferons in major NSW teaching hospitals, for comment and amendment where necessary. CONCLUSIONS: Two forms of alpha interferon, interferon alfa-2b and interferon alfa-2a have been approved for use in Australia, interferon alfa-2b for use in the management of hairy cell leukaemia and condylomata acuminata and interferon alfa-2a for use in the management of hairy cell leukaemia and human immunodeficiency virus (HIV) related Kaposi's sarcoma. Applications have been lodged for the use of interferon alfa-2b in HIV related Kaposi's sarcoma, cutaneous basal cell carcinoma and hepatitis B and C and for the use of interferon alfa-2a in the management of hepatitis B, cutaneous T-cell lymphoma and metastatic renal cancer. Interferon alfa-n1 is not available in Australia except for use in a clinical trial in patients who are HIV seropositive. The use of the alpha interferons is currently under investigation in a wide variety of other diseases, with the likelihood that other indications will soon be established. However, the alpha interferons are generally not regarded as first line agents. Beta and gamma interferons have been studied less intensively than the alpha interferons, but it is likely that selected applications for their use will also be defined with the passage of time.

Australia↗
PubMed1992

Thrombolytic therapy of acute myocardial infarction. Keeping the unfulfilled promises.

OBJECTIVE: To assess the use of thrombolytic therapy for acute myocardial infarction, evaluating whether inclusion and exclusion criteria should be altered as well as the public health implications of any such alterations. DATA SOURCES: Data obtained were from English-language articles on the use of thrombolytic therapy in acute myocardial infarction. Articles that reported on inclusion and exclusion criteria as well as specific complications of this therapy were specifically sought. The review included articles under the terms thrombolytic therapy and acute myocardial infarction in the National Library of Medicine's MEDLINE database. STUDY SELECTION: Studies selected for detailed review were those reporting specifics about inclusion and exclusion criteria and efficacy. Data extraction guidelines for assessing data quality included study size, patient population, detail of patient information acquired, and consecutive patient enrollment. DATA SYNTHESIS: Thrombolytic therapy can provide substantial decrements of morbidity and mortality of acute myocardial infarction in the subset of patients who receive this therapy, but is underused in the United States. Advanced age per se should not be an exclusion criterion. Improvements can be made in electrocardiographic diagnosis of acute myocardial infarction. Many of the clinical conditions initially excluded from thrombolytic consideration, such as hypertension or having received cardiopulmonary resuscitation, are only relative contraindications. The benefit/risk ratio in treatment of these patients is often acceptable. Several well-documented points of delay from onset of symptoms to treatment can be minimized, and accelerated therapy can result in a reduction in mortality rates. CONCLUSION: Significant public health benefits will result from greater use of thrombolytic therapy in acute myocardial infarction.

Contraindications↗
PubMed2004

Pathogenesis and treatment of hepatitis C virus-related liver diseases.

BACKGROUND: Few comprehensive reviews on the pathogenesis of hepatitis C virus (HCV)-related liver diseases have been presented to the present. This article was to review the pathogenesis and treatment of HCV-related liver diseases. DATA SOURCES: Data presented here are mostly taken from Japanese studies. RESULTS: HCV infection is characterized by persistent inflammation of the liver and frequent development of hepatocellular carcinoma (HCC) in most cases. These characteristic evidences could be explained by immunological alterations and oxidative stress in the hepatocyte caused by HCV infection. Interferon (IFN) treatment is carried out, at present, not only for the elimination of infected HCV for the treatment of chronic liver diseases, but also for both the prevention of HCC and the treatment of advanced HCC with chemotherapy. The treatment for oxidative stress is also important for non-responders to IFN. CONCLUSION: It is important to understand the pathogenesis of HCV-related liver diseases for a successful treatment.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2004

Stress, health and the benefit of social support.

OBJECTIVES: This article describes stress exposure among Canadians aged 18 or older and analyzes short- and long-term associations with psychological distress and chronic conditions. The buffering role of emotional support is also explored. DATA SOURCES: Data are from the household cross-sectional (1994/95) and longitudinal (1994/95 to 2000/01) components of Statistics Canada's National Population Health Survey. Supplemental data are from the 2000/01 Canadian Community Health Survey. ANALYTICAL TECHNIQUES: Exposure rates to stress were calculated by sex, age group and socio-economic characteristics. Multivariate analyses were used to examine associations between stress and mental and physical health in 1994/95, and between stress and changes in health by 2000/01, controlling for other possible confounders. MAIN RESULTS: Women reported more stress than did men. For both sexes, stress levels were higher among the less educated, less affluent, and previously married. The level of psychological distress in 1994/95 and the prevalence of chronic conditions were related to stress, as were increases in distress over the next six years and the likelihood of having been diagnosed with chronic conditions.

Adolescent↗
PubMed2004

Incident arthritis in relation to excess weight.

OBJECTIVES: This article reports incidence rates of arthritis, based on data for people aged 40 or older who were followed over six years. The association between excess weight and arthritis, controlled for possible confounders, is also studied. DATA SOURCES: Data are from the household components of cycle 1.1 of Statistics Canada's Canadian Community Health Survey (2000/01) and from the first four cycles of the National Population Health Survey (1994/95 to 2000/01). ANALYTICAL TECHNIQUES: The prevalence of arthritis in 2000/01 was estimated using cross-sectional data; 1994/95-to-2000/01 incidence density is based on longitudinal data. Logistic regression was used to study the association between excess weight and arthritis (respondent-reported, doctor-diagnosed), while controlling for age, household income, smoking, number of physician consultations, strenuous daily activity, and other factors. MAIN RESULTS: In 2000/01, 19% of men and 31% of women aged 40 or older reported having been diagnosed with arthritis. Incidence rates of arthritis were 31 and 48 cases per 1,000 person-years for men and women, respectively. For both sexes, the odds ratio for obesity (based on self-reported height and weight) in association with subsequent arthritis was significantly elevated, at 1.6.

Adult↗
PubMed2004

Misoprostol in labour induction of term pregnancy: a meta-analysis.

OBJECTIVE: To evaluate the efficacy and safety of misoprostol in term labour induction. DATA SOURCES: Data from published English and Chinese literatures about misoprostol in term labour induction were identified from Medline and CBMdisk (using the search terms "misoprostol" and "labour induction") before 2001; hand searches of reference lists of original studies and reviews (including meta-analyses) and contact with investigators in this field before 2001. STUDY SELECTION: Studies were included if they had data on misoprostol and labour induction. Altogether 623 articles were found and 124 were admitted, including 19,287 cases. DATA EXTRACTION: Data were collected on efficacy and incidence of side-effects of misoprostol and oxytocin. Data were checked for consistency within the published articles and converted into a standard format for incorporation into a central database. DATA SYNTHESIS: The average successful induction rate, rates of caesarean section; incidence of tachysystole, hypertonus of uterus and precipitous labour, and rates of meconium stained amniotic fluid between the misoprostol and oxytocin groups were significantly different (P < 0.05). There were no significant differences between the two groups concerning the average interval from the administration of misoprostol and oxytocin to the onset of labour, duration of the total stage of labour, incidence rate of foetal distress, neonatal asphyxia (1-minute Apgar score < and= 7), postpartum haemorrhage or amount of blood loss in postpartum. CONCLUSIONS: Misoprostol is a superior agent over oxytocin on the induction of term labour, but its application might increase the risk of precipitous labour, abnormal uterine contractions or meconium stained amniotic fluid. Therefore, the dosages and regimens of the agent need further investigation.

Female↗
PubMed2002

Hip and knee replacement.

OBJECTIVES: This article examines trends in hip and knee replacement surgery between 1981/82 and 1998/99, focussing on procedures involving seniors. It also presents 1998/99 data on readmissions within 30 days. DATA SOURCES: Data on hip and knee replacement are from the Hospital Morbidity Database for 1981/82 through 1998/99. The Person-oriented Information Database is used to examine readmissions in 1998/99. Supplementary data on arthritis are from the 1998/99 National Population Health Survey. ANALYTICAL TECHNIQUES: Hospitalization rates were calculated by dividing the number of hip and knee surgery separations by the population estimates for the relevant age/sex group and multiplying by 100,000. Population estimates for 1998 were used to calculate age-adjusted hospitalization rates. MAIN RESULTS: Between 1981/82 and 1998/99, the numbers and rates of hip and knee replacement increased substantially, while length of stay for both procedures declined. By 1998/99, knee replacements outnumbered those for hip. Both procedures had relatively low in-hospital mortality and post-surgery complication rates.

Aged↗
PubMed2001

Five-year relative survival from prostate, breast, colorectal and lung cancer.

OBJECTIVES: This article presents five-year relative survival rates for prostate, breast, colorectal and lung cancer diagnosed in 1992. Provincial variations are also examined. DATA SOURCES: Data are from the Canadian Cancer Registry, the National Cancer Incidence Reporting System, the Canadian Mortality Data Base, and life tables. ANALYTICAL TECHNIQUES: Analysis was conducted using the maximum likelihood method of Estève. Provincial rates were standardized to the age distribution of patients diagnosed with the specific cancer. Statistical tests were conducted to determine if the site-specific age-standardized provincial relative survival rates should be regarded as heterogeneous. (National estimates exclude Québec.) MAIN RESULTS: Five-year relative survival rates for ages 15 to 99 were highest for prostate cancer (88%) and lowest for lung cancer (17%, women; 14%, men). Relative survival rates for prostate, breast and male lung cancer differ among provinces. There was little inter-provincial variation in relative survival rates for colorectal cancer.

Adolescent↗
PubMed2001

Hysterectomy, 1981/82 to 1996/97.

OBJECTIVES: This article examines national and provincial trends in hysterectomies from 1981/82 to 1996/97 among women aged 35 or older. DATA SOURCES: Data for 1981/82 to 1994/95 were obtained from the Hospital Morbidity File maintained by Statistics Canada; for 1995/96 and 1996/97, from the Canadian Institute for Health Information. Supplementary data are from the 1998/99 National Population Health Survey. ANALYTICAL TECHNIQUES: Descriptive analyses present hospitalization rates for hysterectomy, the percentage performed vaginally, and average length of stay. A hierarchy of indications was used to establish the main reason for hysterectomy. Confidence intervals were calculated to determine significant changes over time and between provinces and the national level. MAIN RESULTS: From 1981/82 to 1996/97, the hysterectomy rate declined; the proportion performed vaginally increased; and average length of stay for a hysterectomy decreased. These trends generally characterized each province, although there were substantial provincial differences in rates, procedures, and average length of stay.

Adult↗
PubMed2004

Leading cancers--changes in five-year relative survival.

OBJECTIVES: Changes in five-year relative survival ratios for prostate, breast, colorectal and lung cancer cases are examined. Ratios for cases diagnosed in the 1985-1987 period are compared with those for 1992-1994. Incidence and mortality rates between 1985 and 1999 are compared with changes in relative survival. DATA SOURCES: Data are from the Canadian Cancer Registry, the National Cancer Incidence Reporting System, the Canadian Mortality Data Base, and life tables. ANALYTICAL TECHNIQUES: Analysis was conducted using the maximum likelihood method of Esteve. Age-standardized ratios for a given cancer were calculated by weighting age-specific ratios to the age distribution of patients diagnosed with that cancer. Statistical tests were used to compare corresponding age-specific and age-standardized ratios across the two periods. National estimates exclude Québec and New Brunswick. MAIN RESULTS: Between the 1985-1987 period and the 1992-1994 period, increases in five-year age-standardized relative survival ratios were dramatic for prostate cancer, large for breast cancer, and somewhat smaller for colorectal cancer. There was little absolute change in the ratios for lung cancer.

Adolescent↗
PubMed2004

Proxy reporting of health information.

OBJECTIVES: This article documents the extent of proxy reporting in Statistics Canada's National Population Health Survey (NPHS) and explores associations between reporting status and the prevalence and incidence of selected health problems. DATA SOURCES: Data are from the household cross-sectional (1994/95, 1996/97 and 1998/99) and longitudinal (1994/95 to 2000/01) components of the NPHS. Supplemental data are from the 2000/01 Canadian Community Health Survey. ANALYTICAL TECHNIQUES: Estimates of health conditions from the two cross-sectional files that are produced for each NPHS cycle were compared. The file with the lower proxy reporting rate was expected to yield higher prevalence rates. Multivariate analyses of the longitudinal data were used to examine associations between changes in reporting status and the incidence of the selected conditions. MAIN RESULTS: Compared with the 1998/89 General file, in which proxy reporting was more common, the 1998/99 Health file yields higher estimates of certain health conditions. Declines in proxy reporting rates over time are generally associated with greater increases in estimates. Analyses based on the longitudinal file suggest that the incidence of some conditions may also be subject to a proxy effect.

Adolescent↗
PubMed2004

Infection after cholecystectomy, hysterectomy or appendectomy.

OBJECTIVES: This article uses patient-linked data to focus on hospitalization with post-operative infection following cholecystectomy, hysterectomy or appendectomy. The average number of hospital days and the costs of readmission are also estimated. DATA SOURCE: Data for surgeries in fiscal years 1997/98, 1998/99 and 1999/00 are from the Health Person-Oriented Information Database. ANALYTICAL TECHNIQUES: Bivariate tabulations were used to estimate the percentage of patients hospitalized with post-operative infection after cholecystectomy, hysterectomy or appendectomy between 1997/98 and 1999/00. Logistic regression was used to explore associations between infection and patient characteristics, readmission, and peri-operative mortality, while controlling for surgical characteristics. MAIN RESULTS: Hospitalization with post-operative infection was relatively rare, occurring in 1.4% of cholecystectomy, 2.0% of hysterectomy, and 3.8% of appendectomy patients. The associated costs of readmission for post-operative infection for the three surgeries were estimated at 5.4 to 6.3 million dollars annually. Old age, being male, surgical complexity and approach, and diabetes were associated with hospitalization involving a post-operative infection.

Adult↗
PubMed2004

Inflammatory bowel disease--hospitalization.

OBJECTIVES: This analysis examines trends in hospitalization for Crohn's disease and ulcerative colitis, the two main forms of inflammatory bowel disease (IBD). DATA SOURCES: Data are from the Hospital Morbidity Database for 1983/84 to 2000/01, and from the Health Person-Oriented Information Database for 1994/95 to 2000/01. ANALYTICAL TECHNIQUES: Sex- and age-specific rates were calculated for separations attributed to Crohn's disease and ulcerative colitis. Rates and hospital days were also calculated for hospitalizations in which IBD was among the first five diagnostic codes on a patient's discharge abstract. The frequency of rehospitalization was examined. MAIN RESULTS: From the early 1980s to the mid-1990s, annual rates of hospitalization for Crohn's disease and ulcerative colitis rose slightly, but have since levelled off. Hospitalization rates for both conditions are highest among people in their twenties. The average length of stay for patients with either disease fell from about 2 weeks in 1983/84 to 9 or 10 days in 2000/01. More than a quarter of patients hospitalized for Crohn's disease and over 20% of those with ulcerative colitis were readmitted within the same year.

Adolescent↗
PubMedDate not supplied

Accuracy of familial reporting of a child's medical history in a dental clinic setting.

PURPOSE: Accurate reporting of medical history information is essential to provide safe and successful dental treatment to children. The purpose of this study was to evaluate the accuracy of health histories reported by parents/guardians of pediatric patients presenting for dental treatment by comparing them to the histories provided in the child's medical chart. METHODS: Data collection from the dental record was performed using the medical history questionnaire from the child's first visit as the data source. Data collected focused on knowledge of the child's medical conditions, current medications, allergies, immunization status, and need for prophylactic antibiotics. Corresponding data were collected from the child's medical chart. Statistical analysis included kappa analysis and calculation of sensitivity, specificity, and failure-to-report rates. RESULTS: The study group consisted of 226 children (99 girls, 127 boys), with a mean age of 10.35 years. The patients were divided into 2 groups based on their medical status (healthy vs medically compromised). For the medically compromised children, parents had high sensitivity reporting rates (>75% sensitivity) for only 2 out of the 9 medical categories. For both groups, <50% of the medicine, allergy, and need for prophylaxis categories had sensitivity rates above 75%. Failure-to-report rates of 40% to 60% were common, with some as high as 80%. Weighted failure-to-report rates were consistently higher for medically compromised children compared to healthy children. CONCLUSIONS: Parents/guardians of children presenting for dental treatment are not always able to accurately report vital medical history information. Therefore, pediatric dentists need to more closely examine the dental health questionnaire and make every attempt to obtain accurate information to provide appropriate care for each patient.

Child↗
PubMed1992

Can we alter survival in patients with congestive heart failure?

OBJECTIVE: To assess the efficacy of pharmacologic therapy in improving survival in patients with congestive heart failure (CHF) in the context of recent investigational studies having mortality as an end point. DATA SOURCES: Data were obtained from English-language articles that reported both randomized and retrospective studies assessing the efficacy of pharmacologic therapy in the treatment of patients with CHF. The review included articles indexed under the terms congestive heart failure and drug therapy in the National Library of Medicine's MEDLINE database. STUDY SELECTION: Studies selected for detailed review were those having mortality as a primary or secondary end point. DATA EXTRACTION: Guidelines for assessing data quality and validity included study size, double-blind and randomized design, the number of end points, the sensitivity and specificity of objective measurements, and the validity of the statistical analysis. DATA SYNTHESIS: Review of the existing literature demonstrates that pharmacologic agents that improve resting hemodynamics or exercise duration in patients with CHF may not necessarily prolong survival. However, recent studies demonstrate that angiotensin-converting enzyme inhibitors prolong survival in patients with symptomatic CHF, while at the same time improving exercise capacity and left ventricular performance. Although less well tolerated, the combination of hydralazine hydrochloride and isosorbide dinitrate therapy also improves survival, but to a lesser degree. New agents show promise, but definitive assessment requires the results of large, randomized and double-blind studies having mortality as an end point. CONCLUSIONS: Mortality is an important end point in assessing the efficacy of drugs for the treatment of CHF.

Anti-Arrhythmia Agents↗
PubMed2004

Bipolar I disorder, social support and work.

OBJECTIVES: This article reports the estimated lifetime prevalence of bipolar I disorder in the household population and describes characteristics of people of working age (25 to 64) affected by this disorder. The relationship between social support and employment status is examined in people with the disorder. DATA SOURCE: Data are from the 2002 Canadian Community Health Survey: Mental Health and Well-being. ANALYTICAL TECHNIQUES: Weighted frequencies and cross-tabulations were used to estimate the prevalence of bipolar I disorder. Multiple logistic regression modeling was used to examine four dimensions of social support in relation to having a job, in people with bipolar I disorder. MAIN RESULTS: An estimated 444,000 (2.6%) people aged 25 to 64 had lifetime bipolar I disorder. Alcohol dependence, asthma, migraine, obesity and panic disorder were far more prevalent among these people, compared with the general population. People with bipolar I disorder who reported readily accessible tangible support had higher odds of being employed, compared with those with less available tangible support.

Adolescent↗
PubMed2004

Panic disorder and coping.

OBJECTIVES: This article presents prevalence estimates of panic disorder in the household population aged 15 or older Associations between panic disorder and measures of physical and mental health, work status and coping behaviour are examined. DATA SOURCE: Data are from the 2002 Canadian Community Health Survey: Mental Health and Well-being. ANALYTICAL TECHNIQUES: 2002 prevalence rates are presented for people with a history of panic disorder. Characteristics associated with current and past panic disorder are examined. Multiple logistic regression models are used to examine work status and coping behaviour, and chronic physical and other mental health problems. MAIN RESULTS: In 2002, an estimated 1.5% of the population had current panic disorder, and 2.1%, a past history. Average age of onset was 25. People with current panic disorder were less likely to work and more likely to be permanently unable to work, compared with those who had never had the condition. Negative coping behaviours, including alcohol or drug use and smoking, were more common among those with panic disorder.

Adaptation, Psychological↗