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PubMed2000

When should hypertension be treated? The different perspectives of Canadian family physicians and patients.

BACKGROUND: Hypertension guidelines from different organizations often specify different treatment thresholds, and none explicitly state how these thresholds were chosen. This study was undertaken to determine the treatment thresholds of family physicians and hypertensive patients for mild, uncomplicated essential hypertension. A subject's treatment threshold can be determined by eliciting the minimum reduction in cardiovascular risk that he or she feels outweighs the inconvenience, costs and side effects of antihypertensive therapy (the minimal clinically important difference [MCID]). METHODS: The study subjects consisted of a random sample of family physicians and a consecutive sample of hypertensive patients without overt cardiovascular disease from Ottawa and Edmonton. To determine participants' MCIDs, we used a survey employing hypothetical scenarios (each depicting a different baseline cardiovascular risk) and a probability trade-off tool. RESULTS: Of 94 family physicians and 146 patients approached for the study, 72 and 74 participated respectively. There was marked variability in the MCIDs of both groups. In general, patients were less likely to want antihypertensive therapy than physicians, particularly when baseline cardiovascular risks were low: 49% v. 64% (p = 0.06), 68% v. 92% (p < 0.001) and 86% v. 100% (p = 0.001) for 5-year cardiovascular risks of 2%, 5% and 10% respectively. Moreover, patients expressed larger MCIDs (i.e., wanted greater benefits before accepting therapy) than physicians. However, a subgroup of patients (15% to 26%, depending on the scenario) wanted treatment even if there was no anticipated benefit. Multivariate analysis showed that no sociodemographic factors strongly predicted the MCIDs of either group. INTERPRETATION: Guidelines that set treatment thresholds on the basis of physician or expert opinion may not accurately reflect the preferences of hypertensive patients. There is a need for patient decision aids and attention to patient preferences when initiation of antihypertensive therapy is considered for the prevention of cardiovascular disease. Further research is needed to define treatment thresholds for other chronic conditions and in other groups.

Adult↗
PubMed1975

California's experience with non-adversary divorce.

California's Family Law Act of 1969, effective January 1, 1970, instituted non-adversary proceedings for divorce, suggested a more equal division of community property and reduced the minimum waiting time for a final divorce decree. A rapid increase in the number of divorces granted in California followed. Analysis revealed that the 1969 Law did not lead to any real increase in marital dissolution among Californians or produce any significant changes in the characteristics of the population filing for divorce. What was seen were certain modifications in behavior on the part of divorcing persons to take advantage of the Law's new provisions.

California↗
PubMed2001

Domain analysis and modeling to improve comparability of health statistics.

Health statistics is an essential element to improve the ability of managers of health institutions, healthcare researchers, policy makers, and health professionals to formulate appropriate course of reactions and to make decisions based on evidence. To ensure adequate health statistics, standards are of critical importance. A study on healthcare statistics domain analysis is underway in an effort to improve usability and comparability of health statistics. The ongoing study focuses on structuring the domain knowledge and making the knowledge explicit with a data element dictionary being the core. Supplemental to the dictionary are a domain term list, a terminology dictionary, and a data model to help organize the concepts constituting the health statistics domain.

Demography↗
PubMed1975

An improved life table method.

A life table estimates probabilities of surviving and of dying as well as death rates, as these would apply in a stationary population with the same underlying continuous mortality curve as the observed population. We have derived approximations to the probability of surviving that require no iteration, do not depend on graduation or interpolation, and appear to give as precise results as interpolated or iterated tables. On the side of theroy we show that methods due to T.N.E. Greville and to Reed and Merrell are special cases of our formula (3). The new approach is extended to cause-deleted tables and to multiple decrement.

Humans↗
PubMed2002

The clinical effectiveness of a novel power toothbrush and its impact on oral health.

This review details the invention and clinical testing of a new power toothbrush designed to provide a low cost, effective toothbrush, which has a combination of a round oscillating head in conjunction with fixed bristles. The data demonstrate this power toothbrush (Crest SpinBrush) is an effective cleaning toothbrush with respect to plaque removal. Four independent 4-period crossover studies, where subjects used each brush twice, have demonstrated that brushing with this power toothbrush results in 10-40% greater plaque removal relative to a series of control manual toothbrushes. Separate research has confirmed that adults and children tend to brush longer, 35.8% and 38.3% respectively, when using this power toothbrush relative to manual toothbrushes. In addition, it has been shown to be superior to a battery-powered toothbrush (Colgate ActiBrush) in two independent studies and has demonstrated comparable efficacy to a leading powered toothbrush (Oral-B Ultra Plaque Remover). In parallel, this power toothbrush has also been shown to be safe relative to manual and power toothbrushes.

Adult↗
PubMed1987

The method of expected number of deaths, 1786-1886-1986.

"The method of expected number of deaths is an integral part of standardization of vital rates, which is one of the oldest statistical techniques. The expected number of deaths was calculated in 18th century actuarial mathematics...but the method seems to have been forgotten, and was reinvented in connection with 19th century studies of geographical and occupational variations of mortality.... It is noted that standardization of rates is intimately connected to the study of relative mortality, and a short description of very recent developments in the methodology of that area is included." (SUMMARY IN FRE)

Demography↗