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PubMed2001

Unequal cluster sizes for trials in English and Welsh general practice: implications for sample size calculations.

Cluster randomized trials are often used in primary care settings. In the U.K., general practices are usually the unit of allocation. The effect of variability in practice list size on sample size calculations is demonstrated using the General Medical Services Statistics for England and Wales, 1997. Summary statistics and tables are given to help design such trials assuming that a fixed proportion of patients are to be recruited from each cluster. Three different weightings of the cluster means are compared: uniform, cluster size and minimum variance weights. Minimum variance weights are shown to be superior to uniform, particularly when clusters are small, and to cluster size weights, particularly when clusters are large. Where there are large numbers of participants per cluster and cluster size weights are used, the power actually falls as more patients are recruited to large clusters. When minimum variance weights are used the increase in the design effect due to variation in list size is small, regardless of the size of intracluster correlation coefficient or the number of participants per cluster, provided there is no loss of randomized units. When the expected number of participants per practice is low a greater loss in power comes from practices which fail to recruit patients. A method to estimate the likely effect and allow for it is presented.

Accidental Falls↗
PubMed1993

Childhood thermal injuries in New Zealand resulting in death and hospitalization.

Thermal injury is a significant contributor to the overall problem of injury among children. Children are at greater risk of hospitalization due to thermal injury than any other age group, and their fatality rate is second only to those over 60 years of age. This study provides an overview of thermal injury in New Zealand children, age 0-14 years, resulting in death or hospitalization. Eighty-one thermal fatalities were identified from Health Statistical Services (HSS), Department of Health, data accessed for the 10-year period from 1978 to 1987. The records of the Coroners' Court, held by the Justice Department, were also accessed in order to gather additional information about the circumstances of fatal injury in each case. Thermal injury hospital admissions (n = 634) were identified from HSS data for the year 1988. Children were more likely to die in house fires than any other thermal injury event. Most house fires were started by smoking paraphernalia or electrical appliances. Two-thirds of the childhood thermal injury hospitalizations were due to contact with hot water, the most commonly identified source being a hot beverage. Thermal injury rates for New Zealand children are higher than reported overseas. Prevention strategies that have proven effective elsewhere are discussed with recommendations for New Zealand.

Adolescent↗
PubMed2003

Randomized trial of suture versus electrosurgical bipolar vessel sealing in vaginal hysterectomy.

OBJECTIVE: To compare blood loss and procedure time of vaginal hysterectomy using an electrosurgical bipolar vessel sealer versus using sutures. METHODS: Sixty patients scheduled for vaginal hysterectomy in a single surgical practice were randomized to either electrosurgical bipolar vessel sealer or sutures as the hemostasis technique. Procedure time was defined as time from initial mucosal injection to closure of the vaginal cuff with satisfactory hemostasis. Blood loss was estimated by the anesthesia service. Statistical methodology included the Student t and Wilcoxon rank-sum tests, and all comparisons were two tailed, with P <.05 considered significant. RESULTS: Use of an electrosurgical bipolar vessel sealer resulted in shorter procedure times: The mean procedure time in the electrosurgical bipolar vessel sealer arm was 39.1 minutes (range 22-93) versus 53.6 minutes (range 37-160) for the suture arm (P =.003). Mean estimated blood loss was also statistically less with electrosurgical bipolar vessel sealer: 68.9 mL (range 20-200) versus 126.7 mL (range 25-600) for the suture arm (P =.005). Complication rate and length of stay did not differ by hemostasis technique. Seventy-eight percent of all cases were outpatient. CONCLUSION: Electrosurgical bipolar vessel sealer is an effective alternative to sutures in vaginal hysterectomy, resulting in significantly reduced operative time and blood loss.

Adult↗
PubMed1997

Design and implementation of the United States National Animal Health Monitoring System 1994-95 Cattle on Feed Evaluation, and an evaluation of the impact of response biases.

The 1994-95 Cattle on Feed Evaluation was a cooperative project (sponsored by the United States Department of Agriculture) involving Washington State University, state agricultural departments, and several agencies of the United States Department of Agriculture). The project focused on cattle-on-feed operations in 13 states that accounted for over 85% of the United States cattle on feed inventory. Participants were selected from National Agricultural Statistics Service list frames. Questionnaires were administered by telephone to operations with a one-time capacity of fewer than 1000 cattle; larger operations were visited twice to administer questionnaires. The participation rate for the first phase of the study was 56.7%. Ninety-one percent of eligible operations completed the second phase of the study. Data summarized from this national study can be used to profile management practices on cattle-feeding operations in the United States. Differences between participants and non-participants did not appear to be great. However, one does need to be mindful of the fact that a small percentage of the producers accounted for the vast majority of feedlot cattle marketed when interpreting the results.

Animal Feed↗
PubMed1998

The availability of state-level data on interstate cattle movements in the United States.

Knowledge about the patterns of animal movement--particularly feeder-cattle movement--within the USA is necessary in order to anticipate how diseases might be spread geographically. This study was conducted to explore the availability of interstate-level movement data which might be used to develop a more coherent national picture of interstate feeder-cattle movement. State Statistical Offices of the National Agricultural Statistics Service, 1996 (NASS) and Departments of Agriculture in all 50 states were contacted to determine the type of information collected regarding the import and export of feeder cattle. Eighteen of the 50 states contacted recorded updated import and export information by using certificates of veterinary inspection and (occasionally) entry permits for verification. The 18 states were: Alabama, Colorado, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Maryland, Massachusetts, Minnesota, New Jersey, Pennsylvania, Texas, West Virginia, Wisconsin, and Wyoming. Profiles of import and export data from Kansas, Texas, Colorado and Iowa (the primary receivers of 51% of total 1995 imports) were developed. These four states received at least 50% of their cattle imports from < 9 different states. As a result, approximately half of the nation's import movement can be explained by a total of 13 states and Mexico (excluding duplicates). Also, > 50% of the exports from Kansas, Texas, Colorado, and Iowa go to < or = 3 states. This import and export information confirms conclusions of others that cattle tend to move toward the center of the USA. However, if more states kept comprehensive, up-to-date records of movement information, knowledge about cattle-movement patterns in the USA would be importantly increased. The lack of specific notations on certificates of veterinary inspection can lead only to perceived trends; the present records have limited value in tracking animal movement.

Animal Welfare↗
PubMed2001

Maternal mortality in Greece (1980-1996).

OBJECTIVE: To use data from the National Statistical Service of Greece to examine trends in maternal mortality and risk factors for maternal deaths. STUDY DESIGN: Maternal mortality in Greece has been studied from years 1980 to 1996 in total, by cause of death, by residency (urban/rural) and by maternal age. The maternal mortality ratio (MMR) has been defined as the number of deaths per 100,000 live births. RESULTS: From years 1980 to 1996, there have been 136 maternal deaths (MMR: 7). The number of deaths has significantly decreased during this period and six major causes of death have been identified, resulting in 80% of maternal deaths. A simulation of maternal mortality between urban and rural areas has been achieved during the last decade. Also, maternal mortality rises dramatically with age. CONCLUSIONS: Although overall rates of maternal mortality in Greece have been significantly decreased over the last years, an improved recording of maternal deaths is necessary for identifying preventable factors and developing effective interventions.

Adult↗
PubMed1998

Reassessment of the incubation time in a controlled clinical comparison of the BacT/Alert aerobic FAN bottle and standard anaerobic bottle used aerobically for the detection of bloodstream infections.

This study assessed the minimum incubation time required to detect bloodstream infections during a controlled clinical comparison of the performance characteristics of the BacT/Alert aerobic FAN bottle and the standard anaerobic bottle used aerobically except on a selective basis. Blood was collected from adults with suspected bloodstream infections and inoculated into each bottle, which was monitored in the BacT/Alert Microbial Detection System. The anaerobic bottle was vented before incubation except when cultures were obtained from patients on the colorectal and gynecologic surgical and emergency services. Statistical analysis was limited to those culture sets in which each bottle was inoculated with > or = 8 mL of blood and bacterial growth was considered to be clinically significant. A total of 682 positive cultures from 243 patients satisfied the inclusion criteria. Significantly more isolates of Staphylococcus aureus (p < 0.001), S. epidermidis (p < 0.001), other coagulase-negative staphylococci (p < 0.001), Enterococcus spp. (p = 0.04), Escherichia coli (p = 0.03), all Enterobacteriaceae (p < 0.001), Pseudomonas aeruginosa (p = 0.001), and Candida spp. (p < 0.001) were detected by the aerobic FAN bottle. Significantly more septic episodes due to S. aureus, S. epidermidis, other coagulase-negative staphylococci, Enterobacteriaceae, P. aeruginosa, and Candida spp. were detected by the aerobic FAN bottle. Significantly more bacterial isolates were detected by the aerobic FAN whether or not antibiotics were being administered at the time of blood culture, whereas there were significantly fewer positive cultures in the vented standard anaerobic bottle when patients were receiving antimicrobial therapy than when they were not. All but 5% of positive cultures were detected within three days. Only six of the cultures requiring four or five days of incubation represented true misses, and only one of these six resulted in a change in therapy which, however, did not affect the patent's outcome.

Adult↗
PubMed1992

Incidence of facial fractures resulting in hospitalisation in New Zealand from 1979 to 1988.

The incidence and aetiology of facial fractures resulting in admission to public hospitals in New Zealand in 1987 were investigated retrospectively from data collected by the Health Statistical Services. Data were analysed by the age group, ethnic origin and gender of those affected. During 1987 the overall incidence of facial fractures was 47.9/100,000 of the population. The highest incidence was for Maori males at 152/100,000. A comparison with data for the period 1979 to 1988 showed a decrease for the population as a whole but an increase for those who declared themselves to be Maori. Assault was the most common cause of facial fractures resulting in hospitalisation for both males and females. Sport was the second most common cause of facial fractures with rugby football contributing two-thirds of these. These results indicate where future preventive measures should be targeted.

Adolescent↗
PubMed2000

Increased risk of agricultural injury among African-American farm workers from Alabama and Mississippi.

Research on the epidemiology of agriculture-related injuries has largely ignored African-Americans and farm workers. This cohort study is the first to estimate injury rates and to evaluate prospectively risk factors for agriculture-related injuries and compare them among African-American and Caucasian farmers and African-American farm workers. A total of 1,246 subjects (685 Caucasian owners, 321 African-American owners, and 240 African-American workers) from Alabama and Mississippi were selected from Agricultural Statistics Services databases and other sources and were enrolled between January 1994 and June 1996. Baseline data included detailed demographic, farm and farming, and behavioral information. From January 1994 to April 1998, subjects were contacted biannually to ascertain the occurrence of an agriculture-related injury. Injury rates were 2.9 times (95% confidence interval (CI): 2.0, 4.3) higher for African-American farm workers compared with Caucasian and African-American owners. Part-time farming (relative risk (RR) = 2.0, 95% CI: 1.3, 2.5), prior agricultural injury (RR = 1.5, 95% CI: 1.0, 2.1), and farm machinery in fair/poor condition (RR = 1.8, 95% CI: 1.2, 2.7) were also independently associated with injury rates. The results demonstrate the increased frequency of agricultural injury among farm workers and identify a number of possible ways of reducing them.

Accidents, Occupational↗
PubMed1991

Estimating maternal mortality in Djibouti: an application of the sisterhood method.

In many developing countries even crude estimates of the level of maternal mortality are lacking and the prospects of fulfilling this need using conventional sources of vital registration and health service statistics are not encouraging. The constraint this imposes on the effective planning, management and evaluation of the programmes now being launched to reduce these neglected deaths is self-evident. It is less obvious how the majority of developing countries can be expected to meet the call for reliable estimates of maternal mortality by 1995. The sisterhood method provides a means of obtaining population-based estimates using household surveys for data collection. This paper describes the application of the method in Djibouti in the context of a rapid multi-purpose household survey in difficult field circumstances. In recent years the reduction of the level of maternal mortality in developing countries has become a priority for both national governments and international agencies. Attention has been drawn to the wide range of levels within and between countries and to the huge discrepancies in the lifetime risk of maternal death for women in the developed compared with the developing world. This risk has been estimated to range from 1 in 19 in West Africa to almost 1 in 10,000 in Northern Europe.

Adolescent↗
PubMed1993

Epidemiology of spinal cord injury in New Zealand.

Spinal cord injury (SCI) is a catastrophic and costly result of both intentional and unintentional injury. We present data from the Health Statistics Services files of New Zealand for the year 1988 on the epidemiology of SCI resulting in morbidity. New Zealand has one of the highest rates of SCI in the western world and since 1979 this has been increasing. It occurs most often to young, caucasian men and is typically the result of motor transport crashes. The ethnicity adjusted rates show high rates for Maori males. Children in New Zealand have greater than 4 times the risk of an SCI than American children. The rehabilitation and hospital costs for SCI are among the highest for all injuries. There were a higher number of high cervical injuries than reported in previous series and 92% of SCI were incomplete indicating the high rehabilitation potential of the sample. Some measures are suggested to reduce the incidence of SCI.

Accidents, Traffic↗
PubMed1979

Normal values of transfer factor and transfer coefficients in healthy males and females.

A population study was performed to obtain local normal values of the transfer factor for a respiratory laboratory providing a routine hospital service. Statistical analysis of the results obtained showed similar results to those of previous investigators for the transfer factor and alveolar volume. The transfer factor was found to be dependent on height, age and sex, while the alveolar volume depended only upon height and sex. Unlike previous investigations, however, the present study showed that the transfer coefficient was the same for women as for men and was related solely to age.

Adolescent↗
PubMed1995

A survey of a Canadian on-line substance abuse prevention initiative for adolescents and young adults.

Electronic Zoot is a Canadian youth-oriented, computer bulletin board system based in Edmonton. The system is designed to teach its users about the risks associated with substance use and abuse. More than 600 of Electronic Zoot's users were surveyed to obtain demographic data and information about attitudes. The majority of the users of the system were male. Most users were between 11 and 25 years of age and a disproportionately high number were from rural communities. It was found that peer support was a primary component of this telehealth service. Statistically significant age differences revealed that the system's younger users were more likely than its older users to be influenced by the drug education message of the bulletin board system. In addition, it was noted that on-line surveys are easy to conduct and greatly facilitate the collection of longitudinal telehealth data.

Adolescent↗
PubMed1999

[Quality assurance in intensive care: the situation in Switzerland].

The movement for quality in medicine is starting to take on the dimensions of a crusade. Quite logically it has also reached the intensive care community. Due to their complex multidisciplinary functioning and because of the high costs involved, ICUs are model services reflecting the overall situation in our hospitals. The situation of Swiss intensive care is particularly interesting, because for over 25 years standards for design and staffing of Swiss ICUs have been in effect and were enforced via onsite visits by the Swiss Society of Intensive Care without government involvement. Swiss intensive care thus defined its structures long before the word "accreditation" had even been used in this context. While intensive care in Switzerland is practised in clearly defined, well equipped and adequately staffed units, much less is known about process quality and outcomes of these services. Statistics on admissions, length of stay and length of mechanical ventilation, as well as severity data based on a simple classification system, are collected nationwide and allow some limited insight into the overall process of care. Results of intensive care are not systematically assessed. In response to the constant threat of cost containment, Swiss ICUs should increasingly focus on process quality and results, while maintaining their existing good structures.

Critical Care↗
PubMed1992

Analysis of injury and death from burning upholstered furniture.

AIMS: Upholstered furniture is considered by governments in the United Kingdom, United States of America, Canada and New Zealand to be a potentially hazardous product. Use of polyurethane foam in upholstered furniture in the United Kingdom was banned in 1989 so as to reduce the risk of injuries and deaths from fire. This study assessed the situation in New Zealand. METHODS: Burn related deaths (1977-86) and injuries (1986) from the Health Statistics Services hospitalisation records were examined to identify cases in which upholstered furniture and bedding were implicated and analysed to describe the situation. Coroners files where relevant were examined. Detail on all fires and domestic fires for 1987 obtained from the New Zealand Fire Service were also examined. Characteristics of upholstered furniture available in New Zealand during the 1987 production year were identified through responses to a questionnaire sent to manufacturers, wholesalers and importers of this type of furniture. RESULTS: Examination of burn related deaths in which upholstered furniture and bedding were implicated (28.3% of all burn related deaths) showed the average annual death rate was at least 0.16 per 100,000 population and that the change in rate over ten years was not significant. Bedding and mattresses appeared to be the first textile items to ignite in 25.1% of those deaths occurring in the bedroom and furniture in 7.2% of those in the lounge. At risk groups were males (1.9 per 100,000 compared with 1.3 per 100,000 for females), those over 55 years (males 5.3, females 4.8 per 100,000) and those who may live alone (separated 4.5, single 5.4, divorced 11.4, widowed 13.4 per 100,000). The mix of alcohol consumption, smoking, then falling asleep created a situation of risk. Sufficient information was not always available to identify with certainty that upholstered furniture and/or bedding was the item to first ignite those fires which subsequently caused burn related injuries and deaths. Manufacturers, wholesalers and importers of upholstered furniture in New Zealand reported that of the total units, at least 38.5% had covers of wool/wool rich or leather and other materials which generally do not ignite readily. Polyurethane and polyester hollow-fill were commonly used as fillings. CONCLUSIONS: The death rate attributable to burning of upholstered furniture and bedding was not found to be especially high. Bedding, mattresses and bedroom furniture were reported more frequently than upholstered furniture.

Bedding and Linens↗
PubMed1992

The impact of chronic diseases of lifestyle and their major risk factors on mortality in South Africa.

The purpose of this study was to determine the impact of chronic diseases of lifestyle on the mortality pattern of South Africans and to estimate the number of South Africans affected by major risk factors for these diseases. The proportion of deaths due to chronic diseases of lifestyle was calculated from the deaths reported to the Central Statistical Services. This group of diseases was responsible for 24.5% of deaths of all South Africans and 28.5% of those aged 35-64 years whose deaths were reported in 1988. The major causes of death contributing to these figures were cerebrovascular diseases (7.2% of all deaths and 7.9% of deaths of persons aged 35-64 years) and ischaemic heart disease (8.7% of all deaths and 9.6% of deaths of persons aged 35-64 years). The age-standardised prevalence rates for the major risk factors reported in five cross-sectional studies in different areas and groups are compared. Estimates from the reported prevalence rates, based on the size of the South African population recorded in the 1985 census figures, were calculated for the major risk factors. Overall 4.88 million South Africans smoked, the largest group of smokers being black males (2.6 million). for hypertension 5.5 million South Africans had blood pressures above 140/90 mmHg; again the largest groups were blacks (3.0 million). For hypercholesterolaemia and raised low-density lipoprotein cholesterol levels, 4.8 million and 3.1 million South Africans respectively had an increased risk for ischaemic heart disease, blacks having the lowest levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Incidence of cancer among Pacific Island people in New Zealand.

AIM: to describe the epidemiology of new cancer registrations among Pacific Island people in New Zealand with a view to identifying important cancers for preventive activities. METHODS: new cancer cases registered with the New Zealand Cancer Registry of the Health Statistical Services for the decade 1979-88 were analysed. Cancer cases among Pacific Island people were compared with cancer cases among Maori and the remainder of the New Zealand population (other). RESULTS: while the number of cases reported among Pacific Island people was relatively small (1884), age standardised rates for cancer of all sites were much higher than age standardised rates for Maori and other populations. The age standardised rate (per 100,000 person years) for cancer of all sites among males in all age groups was 400 for Pacific Island, 308.8 for Maori and 295.3 for others. The age standardised rate for cancer of all sites among women in all age groups was 373.3 for Pacific Island women, 324.2 for Maori and 313.4 for other women. Liver cancer was more common among Pacific Island men than could be explained by temporary migration from the Pacific Islands for treatment. The age standardised rate for liver cancer was 28.2 for Pacific Island men, 11.4 for Maori and 1.9 for other men. Cancer of the cervix was the leading site among Pacific Island women as in Maori women, compared with breast cancer among women in the rest of the population. The age standardised rate for cervical cancer was 61.8 for Pacific Island, 69.0 for Maori and 59.3 for other women. CONCLUSION: in the decade 1979-88 there was an excess number of new registrations for some cancers described among Pacific Island people compared with Maori and other ethnic groups. Temporary migration from the Pacific Islands for treatment may explain some of the excess cases.

Adolescent↗
PubMed1987

[Characteristics of work-loss in diseases of the peripheral nervous system].

Diseases of the peripheral nervous system (PNS) rank fourth among all causes of temporal loss of working ability and first in the structure of neurological morbidity causing temporal disability. Statistical service based on the principles of the International Classification of Diseases, Injuries and Causes of Death does not provide the neurologic service with data about loss of the working time due to PNS diseases. In the comprehensive work on the improvement of neurologic care of patients with PNS diseases conducted in Byelorussia an important place has been recently given to the systematic monitoring of the temporal disability rate which decreased by 28.3% over a period of 3 years (1983-1985).

Delivery of Health Care↗