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PubMed2001

Mental health problems as a cause of long-term sick leave in the Norwegian workforce.

AIMS: There has been a growing concern about the proportion and socioeconomic consequences of work incapacity due to mental health problems. The aim of the present study was to describe the incidence and duration of different categories of mental health problems with at least two weeks of compensated absence from work in the general working population in Norway. METHODS: Cases were identified from files of the national medical insurance system, covering 90% of all employees, while census data were used for the denominators. Based on the International Classification of Primary Care, a total of 101,512 individuals with one or more long-term sick leaves (>2 weeks) due to psychological problems were identified in 1997 and 1998. RESULTS: Employees absent for psychological problems accounted for 16.8% of all incidences and 31.5% of all refunded sick days. The average one-year incidence was 2.47%, and was significantly higher for women (3.53%) than for men (1.66%). The incidence increased with increasing age, and more so for women than for men. The median duration of absence for all claimants was 79 days. Approximately 25% were back to work after one month, 52% after three months, while 8.5% had not returned to work after 12 months and were transferred to other forms of compensation. The length of sick leave varied considerably with diagnostic category, age, and gender. CONCLUSION: Mental health problems constitute a major health problem in the Norwegian workforce today. There is an urgent need for more knowledge about the effectiveness of interventions.

Adolescent↗
PubMed2002

Emergency department overcrowding in Florida, New York, and Texas.

BACKGROUND: This study was done to determine the incidence, causes, and effects of overcrowding in emergency departments (EDs) in Florida, New York, and Texas. METHODS: Surveys were mailed to a random sample of EDs in Florida, New York, and Texas. Questions included census, area population, frequency and causes of overcrowding, and impact. Causes of overcrowding were ranked on a 5-point scale. RESULTS: A total of 300 surveys were sent, and 210 (70%) were returned. Overcrowding was reported in 194 EDs (92%): New York (90%), Florida, (92%), and Texas (95%). Causes of ED overcrowding included hospital bed shortage, high medical acuity of patients, increasing patient volume, too few examination spaces, and shortage of RN staff. Overcrowding resulted in death, permanent disability, additional procedures, and increased length of hospitalization. CONCLUSION: In this survey of EDs, overcrowding was pervasive. Many factors contribute to ED overcrowding. Poor medical outcomes may occur because of overcrowding.

Crowding↗
PubMed1992

Suicide and fatal antidepressant poisoning.

OBJECTIVE: To compare the fatal toxicities of antidepressant drugs in England, Scotland and Wales 1985-1989. METHODS: Epidemiological retrospective study using Department of Health prescription data and mortality data from the Office of Population Censuses and Surveys, and the Registrar General for Scotland, for the years 1974-1989. The fatal toxicity index (FTI) of groups of drugs and individual drugs was compared with the FTI for all antidepressant drugs for the years 1985-1989. RESULTS: Of 3,604 single antidepressant deaths between 1975 and 1989, the majority (70.95%) were from amitriptyline or dothiepin. The mean FTI for all drugs for the years 1985-1989 was 35.6; the FTIs for dothiepin, amitriptyline, nortriptyline and tranylcypromine were significantly higher than the mean of all, while those for clomipramine, lofepramine, fluvoxamine, trimipramine, maprotiline, trazodone, mianserin, protriptyline, isocarboxazid and phenelzine were lower. The FTI for the older tricyclic drugs was higher at 43.03 (p < 0.001). The FTI for the monoamine oxidase inhibitors, of 27.03 (p = 0.045), and for all drugs introduced after 1973, of 5.32 (p < 0.001), were each significantly lower than the mean of all drugs. CONCLUSIONS: Overdose deaths from antidepressants have not decreased over the last 15 years. A trend away from prescribing drugs with a higher fatal toxicity index in favour of those with a lower index, would reduce the number of deaths from antidepressant poisoning.

Acute Disease↗
PubMed2005

[Occupational mortality in Italy during 1992, assessed through record-linkage between pension records and death certificates].

BACKGROUND: The creation of a surveillance system of occupational mortality in Italy is limited by the low quality of information on occupation in death certificates, since the information is often incomplete or lacking and because only the occupation at the time of death is registered. OBJECTIVE: To evaluate the possible use of INPS (National Institute of Social Security) records for the purpose of surveillance of occupational mortality, in terms of feasibility of setting up a system and of validity of the results obtained. METHODS: Death records of 218,510 subjects aged 18-74, deceased in the 12 months following the 1991 census, were obtained from ISTAT (Central Statistics Institute). These were combined through record-linkage with the INPS social security archives, which contain the employment records by economic sector going back to 1974, in order to assign these deaths the sector in which they had worked the longest. Mortality by specific causes was evaluated by industry by means of a proportional mortality analysis stratified by sex and occupational status, and adjusted for age, education, marital status, geographical area of birth, drawing a disability pension, employment status at the time of death and work instability. RESULTS: Record-linkage allowed attribution of the longest held job to 70% of the deaths recorded. Results are presented and discussed only on mortality in men due to asbestosis and silicosis, and causes of death with a substantial proportion attributable to occupation: chronic obstructive pulmonary disease (COPD); cancers of the bladder, nasal cavity, larynx, lung and pleura; leukaemia and lymphoma; accidental causes. Among the economic sectors with a significant excess mortality, the following are well documented in the literature: mortality due to COPD in the coal and peat-bog sectors; due to leukaemia among farmers; due to sino-nasal tumours in wood-working and furniture production; due to cancer of the larynx, lung, and pleura in occupations where there was probable exposure to asbestos (fishing and maritime transport, non-metal mining, building industry, and naval, train and aircraft construction); due to silicosis in industries with potential exposure to crystalline silica; due to accidental causes in the building industry and farming. Other mortality excesses and deficits, especially those due to bladder and lympho-haemopoietic cancers, appear to be only partly consistent with those described by other authors. DISCUSSION: The feasibility of developing a surveillance system of occupational mortality based on the INPS source was found to be good, and, at least among males, for 75% of the deceased subjects historical information existed concerning the economic sectors registered in the INPS records. The results obtained would appear to indicate that the system is capable of highlighting risk excesses due to widespread exposure in the industries examined, regarding diseases for which there is a strong association with exposure. On the other hand, due to the inherent limits of the study's design (lack of a complete work history and of precise information on the jobs held) its use is not recommended in the surveillance of diseases with a low proportion attributable to a risk factor, or with wide exposure variability in a given sector among the various jobs.

Adult↗
PubMed2006

Otago rural hospitals study: what do utilisation rates tell us about the performance of New Zealand rural hospitals?

AIM: To provide a description of the role and function of Otago Province's three main rural hospitals, utilising analysis of hospital discharge data for the period July 2001 to June 2002. METHODS: Calculation of hospitalisation rates based on analysis of information contained in the National Minimum Dataset (Hospital Events); Census data from Statistics New Zealand; and local knowledge of hospital utilisation by geographical district. RESULTS: A comparison between the rural Otago population and New Zealand (as a whole) show age-standardised hospitalisation rates of 19,847 vs 19,930 per 100,000, and a mean length of hospital stay of 4.5 days vs 6.8 days respectively. Patients aged over 75 years account for 49% of the work of rural Otago hospitals calculated by total bed days; 9% of patients account for 28% of the total discharges. CONCLUSIONS: Results show that Otago's rural hospitals (when compared to the New Zealand average) provide an efficient and appropriate service for their communities when judged by hospitalisation rates, mean length of stay, and patient groups cared for. There are serious difficulties encountered in using the National Minimum Dataset to analyse the workload of a rural hospital. An agreed methodology to overcome these difficulties is needed as they have significant implications for service planning and resource allocation for rural hospitals in New Zealand.

Adolescent↗
PubMed1991

[Choice of contraception in relation to sexual activity among younger women in Nuuk/Godthåb (Grönland) and in Nykøbing Falster (Danmark). A population-based cross-sectional study among 1,247 women].

Contraceptive habits in relation to sexual activity were investigated in a population-based cross-sectional investigation. A total of 661 women from Nykøbing Falster and 586 women from Nuuk/Godthåb in Greenland participated. The women, who were in the age group 20-39 years, were selected at random from the census and all underwent a personal interview. Both in Godthåb and in Nykøbing Falster a "non-barrier" method of contraception was the commonest method employed, regardless of the number of sexual partners. In Godthåb, the majority had thus employed IUDs and in Nykøbing Falster, oral contraception was the method most employed. In Godthåb, 9-22% had employed condoms on one or other occasion and the prevalence of this was found to increase with the number of sexual contacts. In Nykøbing Falster 57-63% had employed condoms but no significant variation was observed between various categories of numbers of partners in this area. From the point of view of prevention of sexually transmitted disease, it is striking that among women with greater than or equal to 20 sexual partners, approximately 79% and approximately 40% in Godthåb and Nykøbing Falster, respectively, had never employed condoms or diaphragms. In future, it will be important to investigate the patterns of sexual behaviour in various cultures and their development during the course of time in order to advise a population on the basis of the norms found in the culture concerned.

Adult↗
PubMedDate not supplied

Prevalence of contraceptive use: trends and issues.

This article discusses the sources of data for estimates of contraceptive use, including their reliability and validity. Data from sample surveys and from censuses are presented by countries from the 1960s to the present time. Tables on proportions of users by method of contraception for various time periods are included. The relationship between contraceptive use and level of fertility is also shown. Contraceptive use has increased rapidly in much of Asia and Latin America, but much less so in Arab countries and sub-Saharan Africa. Worldwide, about 400 million of the 800-850 million married couples of reproductive age practice contraception; of these, about 340 million use a modern method. Sterilization is the most widely practiced method of contraception in the world, with tubal ligations far outnumbering vasectomies.

Contraception↗
PubMed1994

Changing asthma mortality.

BACKGROUND: Rates of death from asthma in the United States have increased progressively since 1978. OBJECTIVE: To identify recent trends in asthma mortality. METHODS: The National Center for Health Statistics supplied asthma mortality data (ICD 493), and the Bureau of the Census supplied population data that permitted calculation and graphing of mortality data by age group, race, sex, and region and calculation and tabulation of mortality rates by state. The Departments of Health and Vital Statistics of Australia, Canada, Great Britain, and New Zealand provided data that permitted calculation and graphing of rates of death from asthma (ICD 493) in those countries. RESULTS: Rates of death from asthma in the United States increased from 0.8 per 100,000 in 1977 and 1978 to 2.0 in 1989, fell to 1.9 in 1990 and then increased again to 2.0 in 1991. Rates have been much higher for blacks than whites; age-adjusted rates for blacks increased from 1.5 in 1977 and 1978 to 3.5 in 1991; those for whites, from 0.5 in 1977 to 1.2 in 1991. Rates of death from asthma have increased with age and across time have increased in almost all age groups. The greatest proportional increase has occurred at 10 to 14 years of age with rates of 0.1 in 1979, 0.5 in 1987, and 0.4 in 1991. Rates of death at 5 through 34 years of age have increased for both blacks and whites in all regions of the country. Increases in rates of death from asthma have also occurred in other countries, but rates have been falling in New Zealand since the peak of 8.1 in 1980 and in Australia since the peak of 5.7 in 1989. CONCLUSIONS: The recent plateau in increases in rates of death from asthma in the United States may suggest effectiveness of improved management of asthma that may have followed increased awareness of the importance of optimal management.

Adolescent↗
PubMed1993

[Mortality trends in ischemic heart disease in São Paulo State: 1970-1989].

PURPOSE: Description of proportional mortality and deaths rates by coronary heart disease (CHD) in adult population (20 years of age or older) of São Paulo State, Brazil. METHODS: The deaths were obtained from the statistical official bureau. The population data were based in the Federal Census (1970, 1980 and 1991). All trends whose the slope was significantly greater than zero had a calculation of the decline per year. RESULTS: Proportional mortality for CHD decreased for males(M) (-13.83%) and increased for females(F) (+1.93%). CHD in all cardiovascular diseases showed increase in both sexes: +5.70% M and +13.74% F. CHD adjusted-age death rates declined 1.16% M per year and 1.52% F per year among 1970 and 1989. during 1970-79 a non-significant decline was observed. The ages whose decline was more important were those 60-years-old of age or older. The male/female sex ratio increased during the observed years (67% in 1970 to 77%) due to the change in the 60-69 age (76% in 1970 to 101% in 1989). CONCLUSION: The fall of the CHD deaths rates may be due to decline of heart attacks, to change in risk factors prevalence, mainly smoking, and to medical care.

Adult↗
PubMed1997

Meningococcal disease in England and Wales: 1995.

The number of laboratory confirmed cases of meningococcal infection in England and Wales rose in 1995 for the first time since 1990. Culture confirmed cases rose to 1459, an increase of 29% over the 1994 total, due largely to increased disease activity in the last quarter of 1995. Cases diagnosed by non-culture methods totalled 431, giving a total of 1890 laboratory confirmed cases. Notifications reported to the Office of Population Censuses and Surveys also increased to a similar extent. Northern regions generally had higher rates of disease activity and greater increases in rates. Meningococcal disease caused by serogroup C strains accounted for the main increase in culture confirmed cases and made up 32% of the total in 1995. Disease caused by C2a strains showed a particularly large increase. A change in the age distribution was noted with a greater proportion of patients in older age groups. Among group B isolates, B4 P1.4 strains continued to be identified most commonly.

Age Distribution↗
PubMedDate not supplied

[Predominance of urban suicides over rural suicides in Spain].

INTRODUCTION: The different occurrence of Suicide depending on the rural/urban environment, as well as the interaction of this variable with others such as sex and age has given rise to a large quantity of investigations over the world. It was necessary to carry out in Spain an updated study of these characteristics. OBJECTIVE AND METHODS: Our purpose is to work with the raw data referred to suicide in the two last Spanish Census years. 4,619 records of suicide are requested and obtained from the Spanish National Statistics Institute registered in the years 1981 and 1991. Adjusted rates by rural/urban environment, sex and age are established and compared to each other. RESULTS AND CONCLUSIONS: Suicide rate in Spain is always higher in the cities that in the country, no matter be sex or the age group. However, there appears to be no continuous relationship between Suicide and the environment variable, since the large cities seem to confer a certain prevention. On the other hand, the feminine urban suicidal behaviour is becoming quantitatively more and more similar to those of men.

Adolescent↗
PubMed1998

Twenty-year trends in the Ohio generalist physician workforce.

BACKGROUND: Many factors contribute to the variations seen in physician workforce projections, including assumptions about attrition, new physician entry, and geographic requirements. Our study offers data for bench-marking future research into this complex issue. METHOD: At 5-year intervals starting in 1975, data were collected for each Ohio county by local physician census takers. RESULTS: Total Ohio family physician rates per population did not increase appreciably during the 20-year period. A decrease in the number of allopathic family physicians was balanced by an increase in the number of osteopathic family physicians, many of whom were graduates of the state's first osteopathic medical school, which graduated its first class in 1980. Rates of general internists and general pediatricians increased. In 1975, the percentage of physicians older than 59 years was higher for family physicians than for general internists and general pediatricians. By 1995, this disparity in age distribution had greatly decreased. Rural family physician rates per 100,000 population decreased, and urban rates increased, while both urban and rural rates increased for general internists and general pediatricians. CONCLUSIONS: Variations in accounting for clinical time used for non-generalist clinical and nonclinical activities may explain a large part of the difference between generalist head count and full-time equivalency (FTE) study results; together these activities can be said to make up a "fourth compartment" contributing to improper specialty designation. The decrease in the percentage of family physicians older than 59 years indicates that the future supply of practicing family physicians is not in jeopardy. The rural family physician workforce is decreasing, while the general internist and general pediatrician rural workforce is increasing, but the total rural workforce is still well below the urban workforce. Neither component of the rural workforce appears to have stabilized.

Adult↗
PubMed1985

Development of a cost-efficient psychogeriatrics service.

Various cost-efficient and space-efficient methods were used to expand outpatient services to the elderly at a teaching hospital's psychiatry clinic over a 2-year period. During this time the active treatment census of elderly patients more than doubled, to 185 patients. Only one enrolled patient required psychiatric hospitalization, and none required nursing home placement in the 2 years. Except for the geriatrics service director, no new paid staff and no extra space were required to form the service. The authors review the methods that seemed most beneficial to the service.

Aged↗
PubMed1979

A new evaluation of United States census data on the extreme aged.

Population and mortality data for the extreme aged have generally been considered subject to a large degree of error, particularly for nonwhites. In this study, estimates of the United States population 85 years of age and over in 1960 are devised through a procedure known as the "method of extinct generations," which permits the reconstruction of "extinct" population cohorts from a series of annual death statistics. Estimates of the total population by single year of age and of sex-color groups by five-year age groups are compared with the 1960 census. With some exceptions, the data for whites show remarkable correspondence; the tally for nonwhites developed from death records falls considerably short of the census count, indicating a greater overstatement of age in the latter source.

Age Factors↗
PubMed2004

The effect of rate denominator source on US fatal occupational injury rate estimates.

BACKGROUND: The Current Population Survey (CPS) is often used as a source of denominator information for analyses of US fatal occupational injury rates. However, given the relatively small sample size of the CPS, analyses that examine the cross-classification of occupation or industry with demographic or geographic characteristics will often produce highly imprecise rate estimates. The Decennial Census of Population provides an alternative source for rate denominator information. We investigate the comparability of fatal injury rates derived using these two sources of rate denominator information. METHODS: Information on fatal occupational injuries that occurred between January 1, 1983 and December 31, 1994 was obtained from the National Traumatic Occupational Fatality surveillance system. Annual estimates of employment by occupation, industry, age, and sex were derived from the CPS, and by linear interpolation and extrapolation from the 1980 and 1990 Census of Population. Fatal injury rates derived using these denominator data were compared. RESULTS: Fatal injury rates calculated using Census-based denominator data were within 10% of rates calculated using CPS data for all major occupation groups except farming/forestry/fishing, for which the fatal injury rate calculated using Census-based denominator data was 24.69/100,000 worker-years and the rate calculated using CPS data was 19.97/100,000 worker-years. The choice of denominator data source had minimal influence on estimates of trends over calendar time in the fatal injury rates for most major occupation and industry groups. CONCLUSIONS: The Census offers a reasonable source for deriving fatal injury rate denominator data in situations where the CPS does not provide sufficiently precise data, although the Census may underestimate the population-at-risk in some industries as a consequence of seasonal variation in employment.

Accidents, Occupational↗