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PubMed2002

[Tuberculosis in the Zaragoza province. Estimation by means of the capture-recapture method].

INTRODUCTION: Tuberculosis (TB) is an underreported condition to the Communicable Diseases Control System (CDCS). The objective of this work was to estimate the actual incidence of tuberculosis and the epidemiological characteristics of the diseases in the Zaragoza province. MATERIAL AND METHODS: Retrospective study in which the capture-recapture method was used to estimate the number of tuberculosis cases, by using the microbiology laboratories and the CDSC as data sources. The socio-demographic and clinical characteristics of diagnosed patients throughout three years in this province were analyzed. RESULTS: The mean annual incidence rate of TB was 22.02 per 100,000 inhabitants according to microbiological data, and 48.5 per 100,000 according to the capture-recapture method. A total of 569 patients were studied, and 400 of them were males (70.3%). The mean age was 43.2 years, and the 25-34 year-old group had the highest number of cases (27.9%). Twenty-three percent of cases were co-infected with HIV, and 77.4% were parenteral drug abusers, and 4.4% immigrants. CONCLUSIONS: The capture-recapture method has demonstrated to be useful to know the relevance of TB in our setting. The actual incidence of tuberculosis was higher than that pointed out by the CDCS. Relevant differences were observed regarding incidence rates by age and sex groups. HIV infection and immigration do not appear to explain the frequency of this disease in our setting.

Adolescent↗
PubMed2006

Human factors in pediatric anesthesia incidents.

BACKGROUND: Anesthesia and the operating theater environment is a complex system involving man-machine and human-human interactions. Although we strive for an error free system, we are humans and errors and mistakes will occur. The aim of this study was to investigate the human factors behind events and incidents in pediatric anesthesia at our institution. METHODS: This study consisted of a retrospective review and analysis of all contemporaneously reported anesthetic incidents between April 1, 2002 and March 31, 2004 at Birmingham Children's Hospital. Where there were anesthetic human factors involved in the event these were classified. RESULTS: There were 668 incidents reported, giving a rate of 2.4% of the 28 023 anesthetics recorded. Airway and respiratory incidents were the most common representing 52.2% of all incidents. A total of 284 anesthetic human factors could be identified and classified. Of these the most common were errors in judgment 43%, failure to check 17.8%, technical failures of skill 9.2%, inexperience 7.7%, inattention/distraction 5.6% and communication issues 5.6%. CONCLUSIONS: In our institution anesthetic human factors occur in 42.5% of in-theater incidents in pediatric anesthesia. Knowledge of these is necessary so that changes can be made in practice both by individuals and departments of anesthesia, to make anesthesia as safe as possible.

Anesthesia↗
PubMed1987

Sudden infant death syndrome in Sweden in 1973-1977 and 1979.

The aim of the investigation has been to describe Sudden Infant Death Syndrome, SIDS, in Sweden, its background, true incidence and epidemiological characteristics, and finally to offer possibilities of prophylaxis. The method used has entailed a retrospective survey of all 1,873 post-perinatal (1-51 weeks) deaths from six birth cohorts in 1973-1977 and 1979. Through comprehensive documentation, 334 deaths have been isolated as SIDS. The result was an incidence of 0.54/1000 live births. Internationally, this incidence is low, but the study could establish that SIDS increased during 1973-1977 and 1979 in Sweden. The epidemiological characteristics shown by the study agree to an extent with American and British investigations, but reported Swedish incidence is lower. An assessment of the total post-perinatal mortality has also been made to demonstrate that there is no communication between SIDS with a uniform diagnosis and other causes of death. Analysis has been binary: in relation to factors in society, and on an individual basis. Geographical or social bases did not affect incidence of SIDS in Sweden, which is remarkable when comparing these findings with other reports on the subject. In regards to individuals, the analysis has been based upon the place where the infant died. Deaths in the infant's own bed showed a clear rise on Saturdays, but the incidence here remained constant over the period studied. Deaths in bed with one/two adults showed epidemiological findings which indicated disadvantageous family and social factors in many cases; this group increased from year to year. Deaths outdoors were common in winter; a certain increase towards the end of the week as well as from year to year was indicated. No social strain was shown. Deaths during car rides clearly increased from year to year, but showed no particular socio-familial profile nor weekday variation. Findings analyzing location of death have indicated that the different places have their own epidemiological characteristics distribution. Analyses of this sort are scarce. There were no certain indications of SIDS occurring more often in socially disadvantageous circumstances: 4/5 of the SIDS families had no social strain. The study has also included medico-historical notes, e.g. 'over-laying' and a description of epidemiological/pathological and forensic aspects of sudden infant death from Stockholm during the 1840s. SIDS means that neither anamnesis nor a thorough autopsy can explain the death. SIDS may be considered a dysfunction syndrome, in which endogenous and exogenous factors act together and silently lead to death.(ABSTRACT TRUNCATED AT 400 WORDS)

Female↗
PubMed1998

Should pediatric echocardiography be performed in adult laboratories?

OBJECTIVES: Current health care management has resulted in a change in referral patterns. The present study was undertaken to define the efficacy and value of pediatric echocardiography performed and interpreted in adult laboratories. METHODS: We reviewed the findings in 100 consecutive pediatric patients 1 month to 18 years of age referred for possible heart disease and evaluated previously by echocardiography performed in an adult laboratory. Technical adequacy and interpretation of the echocardiogram at the outside facility was correlated with our final diagnosis. RESULTS: Of the studies, 32 (32%) were performed in hospital laboratories, and 68 (68%) in physician offices. A total of 52 (52%) of the 100 patients arrived with an outside diagnosis in agreement with our final diagnosis. Technical difficulties were reported in 14 (14%) studies by the original laboratory; we felt that 32 (32%) studies were inadequate. Interpretation or communication between the outside echocardiography laboratory, primary care physicians, and patients' family was erroneous in 32 (32%) cases. Repeat echocardiography was necessary in 38 (38%) patients (6 because of planned surgery). If initial referral had been to our own institution, 25 to 30 patients would not have undergone echocardiography. CONCLUSIONS: Slightly more than half of echocardiography studies performed in pediatric patients in adult laboratories were technically adequate and interpreted correctly with proper physician-family communication. Many patients require repeat studies on further referral. A significant number would be spared echocardiography if they were sent to a pediatric cardiology center initially.

Adolescent↗
PubMed2005

Reliability of the Social Phobia and Anxiety Inventory (SPAI) Portuguese version in a heterogeneous sample of Brazilian university students.

OBJECTIVE: To evaluate internal consistency and temporal stability trough test re-test reliability of the Portuguese version of the Social Phobia and Anxiety Inventory (SPAI) in a heterogeneous Brazilian sample. METHODS: After informed consent, the translated and adapted version of the SPAI Portuguese was tested and re-tested at a 14-day interval in a sample of 225 university students, both genders, from 4 different undergraduate courses. After double data entry, statistical analysis included Cronbach's alphas, Pearson and intra-class correlation coefficients. RESULTS: The studied sample consisted of 213 students from 4 sub-samples: 95 law students, 31 social communication students, 54 civil engineering students and 33 dental medicine students. The mean age was 23 (+/-6) years and 110 (51.6%) were female. The Cronbach' alpha was 0.96, no difference for both genders. The differential (total) score of the SPAI Portuguese showed Pearson coefficient 0.83 (95% CI 0.78-0.87) and Intra-class coefficient 0.83 (95% CI 0.78-0.86). There was no statistical difference in Pearson coefficients between genders (p = 0.121) and the 4 sub-samples (p = 0.258). CONCLUSION: The results do not ensure validity, however, the SPAI Portuguese version presented a good content homogeneity with satisfactory level of internal consistency. The temporal stability evaluated was substantial. The results showed that the Portuguese SPAI presents perfectly acceptable reliability for both genders and suggest that it can be used in Brazilian populations.

Adolescent↗
PubMed1994

[Analysis of utilization of information in the journal Medicina Clinica].

BACKGROUND: Scientific communication knowledge is specifically based in the analysis of the bibliographic references inside the publications. Pattern and laws determining the information consumption in the items of the journal Medicina Clinica are investigated in the present study as its own aim. METHODS: An analysis was performed on the 13,286 references downloaded from 618 papers published by the journal in 1990. With dBASE IV was generated a database for the management of the information; data was distributed in several tables through criteria of age, documentary types, countries, journals and Bradford zones. RESULTS: The analysed references belong to 1,241 different journals, 110 from Spain. Being two thirds of the total sum, the publications from United States and United Kingdom have received more citations than those from Spain. The publications from european countries, like France, Germany and Italy, are scarcely present. Bradford core is constituted by the journals Medicina Clinica and The Lancet. CONCLUSIONS: The analysis of the bibliographic references available from the articles in this journal is able to produce knowledge on the information consumption by the practitioners; its usefulness as a complementary utility to the Indice de Citas e Indicadores Bibliométricos de Revistas Españolas de Medicina Interna y sus especialidades 1990 must be considered.

Databases, Bibliographic↗
PubMed1994

Relationship of advance directives to physician-patient communication.

BACKGROUND: Although advance medical directives, such as living wills and durable powers of attorney for health care, are by themselves imperfect instruments for expressing patients' treatment preferences, a possible benefit of these documents is that they will enhance patient-physician communication, especially when end-of-life treatment decisions have to be made. METHOD: Structured interviews were completed for 115 seriously ill cancer patients and 22 of their physicians. The questions dealt with various aspects of advance directives, including communications between the two parties regarding general and specific treatment wishes. Responses were compared in 37 physician-patient pairs for patients who had executed advance directives and in 31 physician-patient pairs for patients who had not executed advance directives. RESULTS: Physicians were frequently unaware of their patients' advance directives. Although patients with advance directives were marginally more likely than patients without advance directives to report discussions about end-of-life treatment decisions, only 34 (30%) out of the total of 115 patients claimed that they had any discussion of treatment decisions with their physicians. Such discussions tended to be about general life attitudes and feelings rather than specific treatments, such as use of artificial nutrition or ventilation. CONCLUSION: Despite public enthusiasm for the use of advance directives and great efforts to promote them, we found little evidence that these documents are associated with enhanced communication between patients and physicians about end-of-life treatment decisions.

Advance Directives↗
PubMed2005

Infertility: a label of choice in the case of sexually dysfunctional couples.

OBJECTIVES: In Indian society infertility and sexual dysfunction are stigmatized characteristics. The aim of the study was to explore which label couples who have both complaints, prefer to describe their situation, and whether gender differ occur in this preference. METHODS: A total of 40 couples - all clients of the reproductive health clinic of the King Edward Memorial Hospital in Pune because of problems with infertility and sexual dysfunction - participated in this study. Data were collected by means of interviews. RESULTS: The findings show that sexual activity decreased as the number of childless years increased. However, the interspouse-relationship gets stronger and more supportive. The couples never revealed their sexual dysfunction to others. When the husband was sexually dysfunctional, the couples preferred to label their situation as 'infertility' in order to avoid stigma. CONCLUSION: Issues that are related to sexual dysfunction, sexual behavior, inter-spouse relationship and communication are important aspects into the reality of an infertile couple's life. PRACTICE IMPLICATION: In planning the treatment clinicians should give more attention to the specific cultural context of these aspects.

Adaptation, Psychological↗
PubMed2005

Medical advance care planning for persons with serious mental illness.

OBJECTIVE: This study examined preferences regarding medical advance care planning among persons with serious mental illness, specifically, experience, beliefs, values, and concerns about health care proxies and end-of-life issues. METHODS: A structured interview, the Health Care Preferences Questionnaire, was administered to a convenience sample of 150 adults with serious mental illness who were receiving community-based services from the Massachusetts Department of Mental Health. Clinical information and demographic data were also collected. RESULTS: A total of 142 participants completed the questionnaire. Although more than one-quarter had thought about their medical treatment preferences in the event that they became seriously medically ill, very few had discussed these preferences. A majority of respondents (72 percent) believed that someone should be designated to make medical health care decisions for a person who is too sick to make or communicate these decisions him- or herself. Common end-of-life concerns included financial and emotional burdens on family, pain and suffering, interpersonal issues such as saying "goodbye," spiritual issues, and funeral arrangements. Participants were most uneasy about the prolonging or stopping of life support by proxy decision makers. A total of 104 respondents (69 percent) expressed interest in formally selecting a health care proxy. CONCLUSIONS: Although persons with serious and persistent mental illness have little experience with medical advance care planning, they show substantial interest in it. Furthermore, they are able to consider and communicate their preferences. This study supports the feasibility, acceptability, and utility of a standardized approach to medical advance care planning with this population.

Acute Disease↗
PubMed2002

The families evaluation on management, care and disclosure for terminal stage cancer patients.

BACKGROUND: Quality of life is an important concept which is subjective and personal; what is an acceptable quality of life to one may be 'worse than death' to another. The objective of this study was to develop and validate a questionnaire to assess relatives' perceptions and attitudes towards their terminal stage cancer patients' management (information disclosure, treatment choice, hospitalization and support-communication and care) including aspects regarding end-of-life and quality-of-life decisions. METHODS: The final study consisted of 146 relatives of advanced terminal stage cancer patients receiving palliation, attending a Pain Relief and Palliative Care Unit. The questionnaire incorporated 6 multi-item and 7 single-item scales, and was developed following a systematic review of measures appropriate for use in palliative care settings. RESULTS: Following analysis of the 25-item scale, the questionnaire has been validated as a shortened 21-item scale consisting of 5 multi-item and 5 single-item scales. Factor analysis was based upon information disclosure, hospitalization, and support-communication demonstrating Cronbach's alpha coefficients of 0.66, 0.5 and 0.70 respectively. Average item totals and inter-item scale correlations were between 0.62-0.70, with convergent validity correlations between 0.60-0.86. The questionnaire was well accepted by all subjects with an 8-10 minute completion time. CONCLUSION: The shortened 21-item self-assessment questionnaire may provide acceptable and valid assessment of caregiver(s)/Greek cancer patients' relatives perceptions on palliative care.

Journal Article↗
PubMed2005

[Surgical management of ischemic mitral regurgitation].

OBJECTIVE: To summarize the experience in surgical technique and clinical results of treating ischemic mitral regurgitation (IMR). METHODS: From April 1998 to September 2004 fifty-three IMR patients, 8 with mild-moderate IMR, 24 with moderate IMR, and 21 with severe IMR, underwent coronary artery bypass grafting (CABG) combined with mitral valvuloplasty (MVP, n = 33) or mitral valve replacement (MVR, n = 20). The procedures of MVP included commissural annuloplasty in 14 cases, posterior ring annuloplasty in 18, and "double-orifice" technique in 1 case. In the cases undergoing MVR, mechanical valves were implanted in 18 patients and biological prosthesis was used in 2. Forty-two patients were followed up by outpatient department visit, telephone, or letter communication for 29 months. RESULTS: The total operative mortality was 15.09% (8/53) with the causes of death of heart failure in 4 cases, arrhythmia in 2 and multiple organ dysfunction syndrome in 2. Two cases of late death were recorded. Thirty-seven survivors showed the NYHA functional class I-II, and 3 survivors showed the class III. Ultrasonic cardiography showed no or only trace mitral regurgitation (MR) in 17 cases undergoing MVP, mild MR in 6, and moderate MR in 3, all with the left ventricle size decreased significantly. There was 1 case of perivalvular leak in the MVR group. Statistical analysis showed that preoperative left ventricle ejection fraction and cardiac function were independent risk factors of operation, but operation protocol was not. CONCLUSION: While performing CABG, moderate to severe IMR with pathological changes of mitral valve must be corrected by revascularization and mitral correction. The choice of protocol depends on the mitral pathology and experience of the surgeon. MVP and MVR have the similar effect on IMR.

Adult↗
PubMed2006

Stress and undetected hyperglycemia in southern Indian coastal population affected by tsunami.

AIM: Natural calamities are known to result in higher stress conditions and also result in adverse health outcomes including development of non-communicable diseases. The impact of tsunami on mental stress and prevalence of hyperglycemic conditions was assessed in a population affected by the calamity in coastal populations of southern India. METHODS: Two populations similar in demography and physical characteristics, but, one affected by tsunami were selected for a comparative study. Subjects aged 20 years or above were randomly selected (control population n = 1176; tsunami population n = 1184). Details of stress were assessed using Harvard trauma questionnaire and scores were assigned. Glucose tolerance was assessed using 2h capillary blood glucose (75gms glucose load) and diagnosis was made using WHO criteria. RESULTS: Stress score was significantly higher in tsunami population. Although the total prevalence of diabetes was similar (control - 10.0 %; tsunami population - 10.5 %) prevalence of undetected diabetes (5.7 % vs. 3.8 %; Z = 9.54, P < 0.001) and impaired glucose tolerance (9.8 % vs. 8.3 %; Z = 12.83, P < 0.001) higher in the tsunami area. Stress score was higher in women and in the young in the tsunami area. CONCLUSION: Population affected by tsunami was under high stress and also showed a high prevalence of undetected diabetes and impaired glucose tolerance.

Adult↗
PubMed1979

[Total orbitoplasty].

In injuries, removal of tumours and infections of the orbit the exenteration of the orbit may become necessary, sometimes even with sacrificing the eyelids. After healing of the orbital disorder the task of the orbitoplasty consists in rebuilding an orbit fit for a prosthesis; when the eyelids have to be reconstructed too, we speak of a total orbitoplasty. Further difficulties arise for the plastic surgeon, when the disorders or/and their treatment are followed by an open communication with the nasal hole and its paranasal sinuses. Mennig has called this complicated form of orbital reconstruction as total orbitoplasty of rhinosurgical type; its additional task is to close the open communications of the nasal hole and its paranasal sinuses with the orbit. Two selected clinical examples of total orbitoplasty demonstrate the procedure in such cases. The first case shows a total orbitoplasty with reconstruction of the eyelids after an injury to the right half of the face caused by high-tension current. The second case illustrates the rhinosurgical type of total orbitoplasty (Mennig), with closure of the fistulas between the orbit and the nasal cavity and paranasal sinuses as an additional reconstruction task.

Adult↗
PubMed1995

The effects of malnutrition on child mortality in developing countries.

Conventional methods of classifying causes of death suggest that about 70% of the deaths of children (aged 0-4 years) worldwide are due to diarrhoeal illness, acute respiratory infection, malaria, and immunizable diseases. The role of malnutrition in child mortality is not revealed by these conventional methods, despite the long-standing recognition of the synergism between malnutrition and infectious diseases. This paper describes a recently-developed epidemiological method to estimate the percentage of child deaths (aged 6-59 months) which could be attributed to the potentiating effects of malnutrition in infectious disease. The results from 53 developing countries with nationally representative data on child weight-for-age indicate that 56% of child deaths were attributable to malnutrition's potentiating effects, and 83% of these were attributable to mild-to-moderate as opposed to severe malnutrition. For individual countries, malnutrition's total potentiating effects on mortality ranged from 13% to 66%, with at least three-quarters of this arising from mild-to-moderate malnutrition in each case. These results show that malnutrition has a far more powerful impact on child mortality than is generally appreciated, and suggest that strategies involving only the screening and treatment of the severely malnourished will do little to address this impact. The methodology provided in this paper makes it possible to estimate the effects of malnutrition on child mortality in any population for which prevalence data exist.

Child Nutrition Disorders↗
PubMed2005

Linking land cover and water quality in New York City's water supply watersheds.

The Catskill/Delaware reservoirs supply 90% of New York City's drinking water. The City has implemented a series of watershed protection measures, including land acquisition, aimed at preserving water quality in the Catskill/Delaware watersheds. The objective of this study was to examine how relationships between landscape and surface water measurements change between years. Thirty-two drainage areas delineated from surface water sample points (total nitrogen, total phosphorus, and fecal coliform bacteria concentrations) were used in step-wise regression analyses to test landscape and surface-water quality relationships. Two measurements of land use, percent agriculture and percent urban development, were positively related to water quality and consistently present in all regression models. Together these two land uses explained 25 to 75% of the regression model variation. However, the contribution of agriculture to water quality condition showed a decreasing trend with time as overall agricultural land cover decreased. Results from this study demonstrate that relationships between land cover and surface water concentrations of total nitrogen, total phosphorus, and fecal coliform bacteria counts over a large area can be evaluated using a relatively simple geographic information system method. Land managers may find this method useful for targeting resources in relation to a particular water quality concern, focusing best management efforts, and maximizing benefits to water quality with minimal costs.

Agriculture↗
PubMedDate not supplied

Impact of direct mail as a method to recruit smoking mothers into a "quit and win" contest.

In the early 1980s the concept of a Quit and Win (Q&W) contest was developed in the Minnesota Heart Health Program (MHHP) as a population-based smoking cessation strategy. The Q&W model has since spread and been applied in many countries around the world. Different communication strategies have been applied for recruiting participants for Q&W. In the Q&W contest in 1995 in Stockholm County, Sweden, direct mail was used as the main recruitment strategy among daily smoking mothers with children aged 0-6 years. Two additional strategies were employed to recruit participants, that is, ads in a local newspaper and personal communication. The target group was estimated to be approximately 4,300 women. In total 5.5% of the target group was recruited, and of those, 4.3% were recruited by direct mail. After 12 months, 14.3% of the women were sustained smoke-free, and the corresponding percentage for those women who were recruited by direct mail was 15.5%. In comparison with several other Q&W contests employing other strategies, the direct-mail technique seems not only to have been successful in recruiting participants, but also in aiding remained sustained smoke-free women after 12 months. To optimize recruitment for Q&W contests, a combination of recruiting strategies should be applied.

Adult↗
PubMed2006

The effect of performance feedback on wound infection rate in abdominal hysterectomy.

BACKGROUND: In many hospitals, infection of the surgical wound is the most common nosocomial infection. Its presence implies patient morbidity, a mortality risk, and an increase in procedure costs because of prolonged hospitalization. OBJECTIVES: Our objective was to ascertain the effect of an infection control program, using performance feedback, on wound infection (WI) rate in abdominal hysterectomy. METHODS: All patients undergoing abdominal hysterectomy in our center (Hospital A. Marcide, Ferrol, Spain) between 1999 and 2004 were prospectively followed up to determine the WI rate. A complete set of parameters, including age, underlying illnesses, cancer, diabetes mellitus, immunosuppressive therapy, albumin, American Society of Anesthesiologists preoperative assessment score (ASA) risk, days in hospital presurgery, date of surgery, hygiene and perioperative antimicrobial prophylaxis, type of surgical operation, duration of surgery, surgeon, and WI, were collected in each case. After data collection for 1999 concluded, we communicated surgical WI rates to surgeons every year. A logistic regression analysis was performed to compare WI rates with those observed in 1999. RESULTS: A total of 980 females was enrolled in the prospective surveillance: mean age, 50.7 +/- 10.7 years. Cases included 25.8% cancer, 4.9% diabetes, 0.5% immunosuppressive therapy, 26.6% ASA 1, 58.4% ASA 2, 13.9% ASA 3. In 9 patients, emergency surgery was performed and, in 971 patients, surgery was scheduled: Total abdominal hysterectomy, 878; subtotal abdominal hysterectomy, 65; Wertheim-Meigs, 37. The factors associated with WI were albumin (OR, 0.97; 95% CI: 0.94-0.99) and antimicrobial prophylaxis (OR, 0.08; 95% CI: 0.02-0.32). The mean values for albumin and the number of patients with antimicrobial prophylaxis fluctuated from year to year. The WI rate improved from 10.7% (95% CI: 5.8-15.6) in 1999 to 6% (-43.9%) in 2004. CONCLUSION: Performance feedback of surgical wound infection rates to individual surgeons reduces these rates.

Adult↗
PubMed1976

Geriatrics in relation to the social and behavioural sciences.

Social and behavioural gerontology is the scientific study of how men and women adapt to their environment as they grow older. It is a multidisciplinary area, comprising subjects each of which asserts an existence in its own right, as a scientific enterprise, apart from other subjects in the area, and apart from geriatrics. Social and behavioural gerontology, however, forms part of the total context within which geriatrics gets its meaning and value. Geriatrics, in turn, affects these other adjacent disciplines. Social and behavioural gerontology could help in a general way by putting geriatrics into this wide perspective and thus demonstrating the wider issues that might otherwise be neglected in the busy round of geriatric care. Social and behavioural gerontology could also help in numerous particular ways such as: the collection of normative data; improved conceptual analysis; better methods of observation, experimentation, measurement and data analysis; the integration of social and behavioural case-work with clinical geriatrics for both treatment and training purposes; improved techniques of social and behavioural assessment; improvements in communication; better social attitldes; increased self-help and understanding of the role of the elderly in society; more effective consumer behaviour; and more effective social policies incorporating long-range, broad-spectrum preventive measures.

Aged↗