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PubMed1996

The Scottish tonsillectomy audit. The Audit Sub-Committee of the Scottish Otolaryngological Society.

Regional specialist societies offer a valuable mechanism for the conduct of medical audit. The experience of the audit sub-committee of The Scottish Otolaryngological Society in conducting an audit on laryngeal cancer encouraged us to undertake a larger audit of tonsillectomy practice in Scotland. Although the number of tonsillectomies performed has declined over the last 10 years, they still account for about 20 per cent of all operations performed by otolaryngologists and as such are a major consumer of resources (Personal communication-Directorate of Information Services, Information and Statistics Division. NHS in Scotland, Management Executive, Edinburgh). The Scottish tonsillectomy audit was devised to define current practice, review indications for surgery and recommend such modifications in practice as may be necessary to optimise patient care and the use of resources. Funding was obtained from the Clinical Resource and Audit Group (CRAG) of the Scottish Home and Health Department. Data on current practice was collected during the period February 1992 to January 1993. Proformas were completed by medical, administrative and secretarial staff in all participating hospitals, collected by an audit secretary and passed to the relevant data collection centre. Data was then entered into a specially designed database before being forwarded to the audit co-ordinator based in Dundee for collation. Six and 12 months following surgery, all inpatients were sent a questionnaire to obtain data on the efficacy of the operation. Data were obtained from a total of 9,773 patients. Two thousand and seventy-nine of these were seen as both outpatients and inpatients, 4,309 were outpatients only and 3,385 were inpatients only. Four thousand, one hundred and one patients returned at least one follow-up questionnaire. The topics audited included source and reason for referral, indications for surgery, grade of staff involved, type of surgery and length of stay in hospital. In agreement with previous studies (H.M.S.O., 1989), differences were found in the rates of tonsillectomy performed in different Health Boards. Although the highest referral and operation rates were found in the Highland region, referral and operation rates did not correlate in all other areas. Recurrent tonsillitis was the most frequent principal reason for the decision to operate although there were differences between Health Boards for other indications including obstructive symptoms. Most patients had symptoms for two to three years although some patients had been affected for 40 years prior to being listed for tonsillectomy. Some are ENT services were consultant-based while others involved more junior staff. The grade of staff involved did not appear to affect the decision made at the Outpatient Department (OPD) or the outcome of the operation. Ninety-eight per cent of patients who returned the questionnaire were glad that the operation had been performed. Recommendations regarding changes in tonsillectomy practice are given.

Adolescent↗
PubMed2001

Psychiatric symptoms, functional impairment, and receptivity toward mental health treatment among obstetrical patients.

OBJECTIVE: To examine psychiatric symptomatology and associated functional impairment among pregnant women; and to examine the obstetrical patient's receptivity to discussion of and intervention regarding emotional distress. METHODS: Fifty-seven patients 16 weeks or less pregnant presenting for routine obstetrical appointments at a faculty practice at a major medical center participated in this study. Each completed a self-administered assessment packet regarding psychopathology, functional impairment and service utilization attitudes. Statistical analyses were performed using chi-square and Mann-Whitney tests. RESULTS: Seventeen subjects (29.8 percent) screened positive for at least one anxiety disorder. Fourteen of those subjects also screened positive for depression. Those with positive screens for either anxiety and/or depression had significantly higher levels of functional impairment. Only five (29.4 percent) of the 17 subjects with positive screens reported having discussed an emotional issue with their Ob/Gyn, although 14 (82.4 percent) said that they would be willing to do so. All subjects (100 percent) reported that they would see a mental health professional if their Ob/Gyn referred them. CONCLUSION: Routine screens for mental disorders in early pregnancy appear to be a useful adjunct in an obstetrical setting. Although most had never discussed their emotional concerns with their Ob/Gyn, a substantial proportion of our study sample reported psychiatric symptomatology and significant levels of functional impairment that had not been recognized by their Ob/Gyn. All of the patients in our study sample reported a willingness to see a mental health professional if their Ob/Gyn referred them. Further studies investigating the benefits of antenatal diagnosis and treatment of psychiatric disorders are warranted.

Adult↗
PubMed2002

[Prevalence and factors associated with self-medication: the Bambuí health survey].

OBJECTIVE: A population-based study was carried out in the municipality of Bambuí, Brazil (population: approx. 15,000 inhabitants), to determine the prevalence of self-medication and its associated factors. METHODS: A random sample of 1,221 residents aged >18 years was selected. Of these, 796 reported use of medications in the last 90 days and were selected for this study (775 participated). Data was collected through home interviews. Study variables were divided in 3 groups: social and economic, health status and health service use indicators. Statistical analysis was performed using Pearson's Qui-square test, and odds ratios adjusted by multinomial logistic regression. RESULTS: Of the total, 419 (54.0%) reported use of only prescribed medications, 133 (17.2%) took prescribed and over-the-counter medications, and 223 (28.8%) took only over-the-counter medications in the last 90 days. After adjusting for confounders, the following variables presented significant associations with exclusive use of self-medication: female sex (OR=0.6; IC95%=0.4 - 0.9); age (OR=0.4; IC95%=0.3 - 0.6 for 40-59 years old and OR=0.2; IC95%=0.1 - 0.5 for >60 years); >5 residents in the household (OR=2.1; 1.1 - 4.0); number of visits to a doctor in the previous 12 months (OR=0.2; IC95%=0.1 - 0.4 and OR=0.1; IC95%=0.0-0.1 for 1 visit and >2 visits, respectively); report of consulting a pharmacist in the previous 12 months (OR=1.9; IC95%=1.1 - 3.3); and reports of financial expenses with medications during this period (OR=0.5; IC95%=0.3 - 0.8). CONCLUSIONS: The study results show that the prevalence of self-medication in the studied community was similar to that observed in developed countries. These results also suggest that self-medication works in place of the formal health attention in this community.

Adolescent↗
PubMed1983

Comparison of use of dental services by finnish immigrants and Swedes using national health statistics.

Dental statistics and treatment information collected by the National Social Insurance Board (NSIB) since the Dental Insurance Scheme was introduced in Sweden in 1974, give a unique opportunity to study the use of dental services by the adult population. Earlier studies showed that adult Finnish immigrants utilized dental services less, and had a greater need of dental care, than the Swedish population. The possible confounding effects of age and social class were not, however, controlled. The aim of this study was to compare use of dental services and dental treatment performed in matched groups of Finnish immigrants and Swedes using central statistics. All Finnish citizens between 17 and 64 yr old born on the 20th of any month and living in the county of Stockholm in 1975, altogether 1378 persons, were selected from the population register. For each Finn a Swedish "social twin" was selected with respect to age, sex and occupation. Information about use of dental services and treatment performed during 1975 was collected from the patient register at the NSIB. The study showed that Finnish immigrants in 1975 visited a dentist less often than the corresponding Swedish group. Those Finnish immigrants who received treatment had had more comprehensive and more expensive care than the Swedish comparison group. The study shows that there were significant differences in use of dental services by and treatment performed on Finnish immigrants and Swedes even when differences in demographic and socioeconomic distribution were controlled.

Adolescent↗
PubMed1990

A simulation model for evaluating a set of emergency vehicle base locations: development, validation, and usage.

This paper describes our experiences in developing a simulation model for evaluating a set of emergency response vehicle base locations. The project was undertaken jointly by the University of Arizona and the Tucson Fire Department. The issues of model development, data collection, model validation, and experimentation are discussed. The critical nature of the problem and the clients' lack of experience with mathematical models, made model validation the major step in gaining user acceptance. We show that looking solely at standard performance statistics such as the calls successfully serviced, may lead to the acceptance of an invalid model. We also show that the high level of detail used in many simulation models for evaluating base locations is unnecessary in the current case. An analysis evaluating two alternative sets of locations for the Tucson system is discussed.

Ambulances↗
PubMed1999

Automated entry of nosocomial infection surveillance data: use of an optical scanning system.

Surveillance of nosocomial infections is the foundation of any infection control programme. One of the main obstacles to surveillance is the speed and accuracy of data collection and entry. To overcome this bottleneck, we instituted automated data capture and processing in a number of point-prevalence and continuous nosocomial infection surveillance programmes. The system incorporated a document scanner, form design and processing software (Formic for Windows version 2) and statistical analysis software SPSS (Statistical Products and Service Solutions). After designing the surveillance questionnaire, it was completed by putting an X or a numeral in the the appropriate boxes. Information was collected by the infection control nurse and/or by members of clinical staff depending on the type of surveillance being undertaken. Once the form was completed it was returned and scanned using a document scanner with automatic feed. The software read and evaluated the data on each page. Data from 16741 A4 sides of surveillance questionnaires were automatically processed in a total time of 37.3 hours. This system was found to have a 99.98% accuracy rate and it was estimated to be 22 times quicker than manual entry of data. Infection control teams who are required to carry out surveillance activities should consider automatic data-entry systems. The versatility of such systems makes it possible to achieve extensive surveillance with limited resources.

Cross Infection↗
PubMed1997

Impact of declining reimbursement and rising hospital costs on the feasibility of total hip arthroplasty.

Total hip arthroplasty, although a very successful clinical treatment, remains an expensive procedure in an era of constrained health care resources. Hospitalization cost, charge, and reimbursement data were compared between all patients who underwent elective, primary, unilateral total hip arthroplasty in 1988 and 1993 at the UCLA Medical Center. Although length of hospitalization decreased by 36%, increases both in unit supply costs and in the intensity of hospital services prevented a statistically significant reduction in total hospitalization cost. Reimbursement declined by 27% after calculating inflation with the Consumer Price Index for Medical Care. Further, the margin by which reimbursement exceeded cost decreased from 66% in 1988 to 8% in 1993. These trends constitute a serious threat to the financial feasibility of total hip arthroplasty.

Aged↗
PubMed2000

[Adolescents and ambulatory care: results from a national survey of young people 15 to 20 years of age in Switzerland].

UNLABELLED: In industrialized countries, statistics on health services exhibit a low level of health care use by adolescents, despite the fact that their needs have been widely described. OBJECTIVES: To assess ambulatory health care use by 15-20-year-old teenagers in Switzerland. METHOD: Nine thousand, two hundred and sixty-eight adolescents responded to the self-administered questionnaire distributed in secondary schools and vocational classes for the Swiss Adolescent Health Survey. Questions about visits to general practitioners, specialists and gynecologists, reasons for visit, the availability of a regular health care provider and a confidential health care resource were analysed. RESULTS: Within the previous 12 months, 87.6% of the girls and 75.3% of the boys reported having seen a physician. General practitioners were visited more frequently than specialists. The contact with a specialist was the only one to be related to socio-demographic variables: a lower proportion of reported visits to a specialist was related to apprenticeship, low educational status of parents or rural living area. Thirty-nine percent of the girls reported having seen a gynecologist during the previous 12 months. Two adolescents out of three reported having a personal doctor, and one out of two declared being aware of a confidential health care resource. Girls reported a larger number of reasons for visits than boys: chronic conditions, fatigue, headache and depressive symptoms were the most often cited in a list of ten reasons. Among the subjects who declared a health concern (sleep disturbances, eating disorders, depressive symptoms, smoking or alcohol-related problems) and a need for help, less than 10% declared having seen a health care provider for this reason, even if more than 70% reported contact with a physician within the last 12 months. CONCLUSION: These results show that most adolescents, especially girls, reported recent use of medical services, but did not discuss their health concerns with the doctor. Training should be improved to give better knowledge and counseling skills to health professionals, in order to allow them to address adolescents' health needs.

Adolescent↗
PubMed2002

Influence of aboriginal and socioeconomic status on birth outcome and maternal morbidity.

OBJECTIVE: To assess the association of Aboriginal and socioeconomic status with birth outcome and maternal morbidity in Alberta. METHODS: A retrospective cohort study using Alberta health service and vital statistics data from 1997 to 2000. Aboriginal women registered with the Department of Indian and Northern Development (DIAND) were linked to a personal health number. Low socioeconomic status was defined as either receiving subsidization for the Alberta Health Care Insurance premium or receiving welfare. RESULTS: Women registered with DIAND and women receiving subsidy or welfare were younger, more often unmarried, smoked more, consumed more alcohol, and abused more illicit drugs than other women in Alberta during the time period studied. Fewer women registered with DIAND and women receiving subsidy or welfare had physician prenatal visits, attended prenatal classes, had forceps or vacuum deliveries, and more of these women frequently had gestation ages less than 37 weeks. Women registered with DIAND had more deliveries in smaller, non-metropolitan facilities; and more of these women delivered outside their region of residence; more had longer lengths of hospital stay; more mothers and neonates were re-admitted to hospital within 28 days of discharge after delivery; fewer delivered small for gestational age neonates; fewer delivered neonates with birth weight less than 2500 g, but more delivered neonates with birth weight greater than 4000 g. There were fewer Caesarean sections in women registered with DIAND (OR = 0.84, 95% CI 0.76-0.93) and in women receiving subsidy or welfare (OR = 0.88, 95% CI 0.82-0.93). CONCLUSION: Women receiving subsidy or welfare and women registered with DIAND had many demographic similarities and generally had worse maternal and neonatal outcomes than other women in Alberta. Medical system interaction may be different for these two groups of women than it is for other women in Alberta.

Adolescent↗
PubMed2002

Evaluating and rejecting true mediation models: a cautionary note.

This research note describes an overlooked problem in understanding whether a given variable in a model truly acts as a mediator between some exogenous variable(s) and some final dependent factor. Demonstrations of mediation and the rules for identifying have relied on simple 3-variable models with an explicit direct effects alternative model as the competing explanation. Incorporating a 4th variable demonstrates that it is quite simple to reject mediation when a true form of mediation exists. In the presence of an unobserved relation, correlated error, between mediator variable and outcome variable, the 3-variable model will consistently show direct effects when, in fact, there is no direct effect of the exogenous variable. Applying well-established rules to test for mediation in this circumstance cannot distinguish a model in which pure mediation is rejected from a model in which true mediation is correct. This poses a fundamental problem for the typical assessment of mediation offered by the Baron and Kenny procedures.

Adolescent↗
PubMed2002

Referral for secondary restorative dental care in rural and urban areas of Scotland: findings from the Highlands Et Islands Teledentistry Project.

OBJECTIVES: To compare the reported level of use of secondary care services for restorative dental care in rural and urban areas of Scotland. DESIGN: Postal questionnaire survey SUBJECTS AND METHODS: Postal questionnaire sent to all dentists in the Highland region, the island regions in Scotland and Dumfries Et Galloway (n = 150) and an equal number were sampled from the remainder of Scotland stratified by health board area. Non-respondents were sent 2 reminders after which 62% of the sample had responded. RESULTS: Most dentists (85%) who practised in what they considered were urban areas of Scotland said they felt that they had good access to a secondary referral service. Whereas most of those who practised in what they considered were rural areas either said they had no access to such a service (26%) or that access was difficult (53%), only 3% of those in urban areas said they had no access to a secondary restorative consultative service compared with 14% of dentists practising in rural areas of mainland Scotland and 54% of those practising on Scottish islands. CONCLUSIONS: The survey suggests the people of the Scottish islands and some of the remoter parts of the Scottish mainland would be among those who might benefit from improvement in access to a restorative dentistry consultant service.

Adult↗
PubMed1991

Continuing education in the GDS. An England survey.

The Department of Health's Management Consultancy Unit Survey of Postgraduate Dental Training in the General Dental Service surveyed a statistically valid sample of general dental practitioners (GDPs) in England to determine the rate of attendance at formal training courses, to look at the needs and expectations of practitioners and to identify factors influencing non-attendance. The results indicate that 79% of GDPs attended some form of training during 1989. Seventy-one per cent of the non-attenders who received Section 63 video programmes watched all the videos they received. Non-attendance rates were highest in those aged under 30 or over 50 years. Ninety-three per cent of practitioners felt their needs were met to an acceptable level and 52% rated their needs very well met or well met.

Adult↗
PubMed2002

Antibiotic prescription rates vary markedly between 13 European countries.

There is a lack of data on antibiotic utilization in most European countries. In this study, information about the number of antibiotic prescriptions was obtained for Austria, Belgium, Finland, France, Germany, Greece, Italy, The Netherlands, Portugal, Spain and the UK from the Institute for Medical Statistics Health Global Services in the UK. For Denmark and Sweden the information was obtained from the Danish Medicines Agency (Laegemiddelstyrelsen) and the National Corporation of Swedish Pharmacies (Apoteket AB), respectively. Between 1994 and 1997 the number of prescriptions per 1,000 inhabitants increased in France and Greece whilst Portugal, Spain and Sweden reported a decrease. In 1997, Greece (1,350), Spain (1,320) and Belgium (1,070) had the highest numbers of antibiotic prescriptions per 1,000 inhabitants in the Anatomical Therapeutic Chemical classification system for drugs group J01 while The Netherlands (390), Sweden (460) and Austria (480) had the lowest. The most common antibiotic drug was extended-spectrum penicillin in 6/13 countries, macrolides in Austria, Finland, Germany and Italy, phenoxymethylpenicillin in Denmark and Sweden and cephalosporins in Greece. The variation in the number of antibiotic prescriptions per 1,000 inhabitants between the 13 European countries was substantial in terms of both total use and use of different antibiotics.

Anti-Bacterial Agents↗
PubMedDate not supplied

Trends in the incidence and transmission patterns of trichinosis in humans in the United States: comparisons of the periods 1975-1981 and 1982-1986.

Since 1947, the U.S. Public Health Service has recorded statistics on reported cases of trichinosis in humans. More complete clinical and epidemiologic data on cases became available after 1965, when trichinosis was officially made a notifiable disease. The numbers of reported cases declined markedly from an average of approximately 400, with 10-15 deaths reported each year in the late 1940s, to 57 per year, with three deaths in the 5 years 1982-1986. Although annual incidence was highest in sparsely populated Alaska, the highest numbers of cases are reported from the northeastern United States. Food sources of this infection vary in different geographic regions. The decline in annual incidence during the past 12 years appears to be accounted for largely by a decline in the number of cases attributed to commercially purchased pork, although pork products continue to be the major source of infections in humans. The number of cases due to ingestion of wild animal meat have remained relatively constant. Activities at the national and state level that have improved the prospects for control and prevention of trichinosis in commercial products are discussed.

Animals↗
PubMed1998

Changes in the risk of schizophrenia in Scotland: is there an environmental factor?

Various studies have suggested that there may be an environmental factor in schizophrenia acting before or at birth but with delayed effects. Evidence that the risk of developing schizophrenia varies randomly with the year of birth would help confirm the existence of such a factor. Data from the Scottish Health Service Information and Statistics Division, comprising all first admissions for ICD-9 schizophrenia in the years 1963-91, were used to estimate the lifetime risk of developing schizophrenia for each year of birth from 1900 to 1969. In the period after 1928 the lifetime risk steadily declined. The rate of decline was greater in females. The random fluctuations in the risks in females did not change systematically, but there was a significant decline in the variability of these fluctuations in males. These random fluctuations suggest a possible role for randomly varying environmental influences around the time of birth. Our findings suggest a possible diminution in the role of such environmental influences in schizophrenia among males in Scotland in the years 1929 to 1969.

Adolescent↗
PubMed1996

Ventricular outflow tract reconstructions with cryopreserved cardiac valve homografts. A single surgeon's 10-year experience.

OBJECTIVE: From January 1, 1985 through December 31, 1994, one surgeon implanted cryopreserved valved homografts into 149 patients--65 since December 1988. This latter series (II) was accomplished in a single hospital, facilitating patient follow-up with biannual echocardiograms. Analysis of these 65 patients is the primary focus of this report; the indications and early surgical results for the two parts of the series (I and II) are compared to assess the evolution of a single surgeon's use of homografts in a mixed pediatric and adult practice. METHODS: Fifty-one variables for each patient (series II) were entered into a computerized database and analyzed (multivariate and univariate) using SPSS 6.1 software (Statistical Products and Service Solutions, Chicago, IL). Cox proportional hazard model was used to identify the independent contribution of each variable for patient mortality and homograft failure. Cumulative survival estimates were made using Kaplan-Meier analysis. Homograft failure was defined as requirement for replacement or death. In series I, there were 41 left ventricular outflow tract (LVOT) reconstructions (31 adult) and 43 right ventricular outflow tract (RVOT) reconstructions (42 pediatric). In series II, there were 55 RVOT reconstructions (52 pediatric) and 10 LVOT reconstructions (7 adult). RESULTS: There were no technical surgical failures. Total surgical mortality rate was 6% (5/84) in series I (3 LVOT, 2 RVOT) and 15% (10/65) in series II (2 LVOT, 8 RVOT) (I vs. II NS; p = 0.11, two-tailed Fisher exact test). By the Cox analysis, only age < 2 years (p < 0.03) and cross-clamp time > 120 minutes (p < 0.05) were significant predictors for death. Age-based survival curves were compared in a sequential bivariate analyses (log rank test) and age < 2 years again was a significant predictor of decreased patient survival (p < 0.006). Actuarial freedom from patient death or reoperation for homograft failure was 82% +/- 7% at 1000 days and 77% +/- 10% at 2000 days. Three patients required re-replacement for homograft failure (5.4%); one of these patients died. The only significant predictor of homograft failure was postoperative endocarditis (p < 0.05). Homograft performance was evaluated by an extensive echocardiography protocol: in surviving patients and homografts, three valved conduits were judged to have severely impaired performance (stenosis or regurgitation), awaiting surgical replacement for a putative total homograft-related structural failures rate of 11% at 5 1/2 years. CONCLUSIONS: Comparisons of series I and II shows, in one surgeon's practice, an evolution away from use of cryopreserved homografts for LVOT reconstructions except when needed for destructive bacterial endocarditis or complex congenital anatomy. Homograft efficacy and durability were similar in RVOT and LVOT positions, with 78.5% of patients surviving at 5 1/2 years; in surviving patients, 89% of homografts have continued to function well. Homografts are not immune to prosthetic bacterial endocarditis, and its occurrence is associated with accelerated deterioration. Cryopreserved homograft valves are an imperfect but satisfactory biological material for specific ventricular outflow reconstructions.

Adolescent↗