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There is a need to evaluate cancer services and provide a baseline on current treatment success and organization. This study shows that this process may be severely hindered by case note destruction or inaccessibility and incomplete information. This is an ongoing problem that needs to be addressed now.
This study presents a review of the trend in the Danish abortion rate, with a view to prevention campaigns and introduction of electronic registration of abortions through the National Patient Registry. The number of induced abortions has been decreasing steadily since 1975; abortion on demand up to the end of 12th gestational week has been permitted by law in Denmark since 1973. The lowest number ever was registered in 1994 and 1995, corresponding to a rate of 13.7 per 1,000 women aged 15-49 years. The number per 1,000 liveborn decreased from 277 in 1993 to 253 in 1994. The relative number of abortions was highest among women aged 20-29 years, and in the capital area. Since 1993 the health authorities have strengthened campaigns to reduce the number of unplanned pregnancies, primarily focusing on younger women and with special programs in the capital area. The reduction for these groups could point to a success of the prevention campaigns, although the rates of terminated pregnancies might be influenced by many other factors.
To assess the feasibility of using hospital records for occupational disease surveillance and to evaluate the quality of the industry/occupation (I/O) information available in these records, the computer file of all discharge diagnoses from a large health maintenance organization during 1985 was reviewed. The frequencies of discharge diagnoses previously listed as Sentinel Health Events (Occupational), or SHE (O), were calculated and three possible SHE(O) diagnoses--lung cancer, bladder cancer, and toxic hepatitis--were selected for further review. Outpatient charts of patients discharged for each diagnosis were abstracted with regard to I/O information and the discharged patients were interviewed by telephone to obtain a lifetime occupational history. The accuracy of the I/O information obtained from the hospital chart was compared to that obtained by patient interview by number of digits matched on standard classification codes. The frequencies of matches for occupation and industry were greater for "usual" than for "last" categories with both cancer diagnoses, but were similar for "usual" and "last" categories with toxic hepatitis. To assess the proportion of each possible SHE(O) diagnosis that was related to workplace exposures, the I/O information obtained by interview was rated in a blinded fashion by an experienced occupational medicine physician. The highest probability ratings for work-relatedness were noted for lung cancer, primarily due to asbestos exposure. The results of this study suggest that hospital records can be used to identify possible SHE(O); if adequate I/O information is available, then work-relatedness can be assessed. However, the accuracy of I/O obtained from hospital charts is relatively low. The efficient and accurate collection of I/O information from hospital records will require the use of a simple, easily coded instrument to be routinely administered on admission.
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BACKGROUND: Understanding the mediating role of health care in mitigating social, economic and occupational role disability is a complex task. METHODS: No single method of research will be successful in addressing all elements of this NORA research priority area. In this paper, we argue that research methods are needed which have the following components: (1) the detailed measurement of therapeutic intervention and the impacts of this intervention on clinical and functional health status using study designs which rule out competing explanations, (2) a longitudinal follow-up component which measures social, economic, and occupational role function following the conclusion of therapy, and (3) a commitment to execute studies across multiple settings to observe the variations in health care and in social and occupational role function that arise as a result of differences in labor market factors and employer and government policies. CONCLUSIONS: More comprehensive portraits of the longitudinal trajectory of individual workers, social, economic and occupational role function following an occupational injury or illness will have significance for a large number of policy sectors.
The NHANES I Epidemiologic Followup Study contains several sources of information that can be used to define case status. Incidence rates and relative risks associated with selected, documented risk factors for heart disease were estimated using nine different case definitions. Despite wide variation in the estimates of incidence, the characteristics of the cases were remarkably similar as were the risks associated with heart disease incidence. The main difference occurred when cases were defined on the basis of death certificate information. Cases defined this way are more severe and models based on this definition result in relative risks of greater magnitude.
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The hypothesis that parental hormone levels around the time of conception partially control offspring sex ratios-though here taken to be true in substance-will need a great deal of work to specify with any accuracy. We do not know with any certainty which hormones are involved, nor how they are implicated. Answers to these two questions are only likely to emerge after prolonged experimental work. And it is fair to say that that work has not yet started. I assume that experimental workers will not embark on such a project until it is perfectly clear that there is a watertight case that mammalian parental hormone levels somehow influence offspring sex ratios. The present note indicates where further (human) evidence for that case will be found. In regard to human beings, much of the required information is held by clinics and registries not primarily concerned with reproductive biology. This point is illustrated here in regard to toxicology, teratology, radiation medicine, neurology, psychiatry, oncology, dermatology, rheumatology, occupational medicine and sports medicine as well as obstetrics and gynaecology. Tests (based on the hypothesis) are offered for intrauterine endocrine causes of malformations, and for pre- and post-natal endocrine causes of disease.
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