British Hyperbaric Association carbon monoxide database, 1993-96.
(33/9064)
OBJECTIVES: To study the referral pattern of patients, poisoned with carbon monoxide and subsequently transferred to British hyperbaric oxygen facilities, from April 1993 until March 1996 inclusive. METHODS: A standard dataset was used by hyperbaric facilities within the British Hyperbaric Association. The data on each patient were sent in confidence to the Hyperbaric Unit at Whipps Cross Hospital for analysis. The epidemiology of poisoning and the population studied were analysed. Times of removal from exposure, referral to a hyperbaric facility, arrival at the hyperbaric facility, and start of treatment were recorded. Data on the outcome of the episode were documented in one of the contributing facilities. RESULTS: 575 patients exposed to carbon monoxide were reported as being referred to British hyperbaric facilities in the three years, the busiest facilities being in London and Peterborough. The proportions of accidental and non-accidental exposures were 1:1.05. Of the accidental exposures, central heating faults were responsible in 71.5% of cases (n = 206). Smoke inhalation from fires was responsible for a further 13.5% (n = 39). The mean delay to arrival in a hyperbaric oxygen facility was 9 hours and 15 minutes after removal from exposure. Recovery after treatment was sometimes incomplete. CONCLUSIONS: The reported pattern of referral was regionally weighted towards the south east of England. Smoke inhalation victims were often not referred for hyperbaric oxygen treatment. The delay to treatment was multifactorial; and the mean delay was well in excess of six hours. There is room for improvement in the consistency and speed of referral. Treatment schedules require standardisation. A central advice and referral service would be helpful. (+info)
Older people's use of ambulance services: a population based analysis.
(34/9064)
OBJECTIVE: To investigate the use of emergency and non-urgent ambulance transport services by people aged 65 years and over. SETTING: The study was undertaken in Queensland where the Queensland Ambulance Services (QAS) is the sole provider of emergency pre-hospital and non-urgent ambulance services for the entire state. METHODS: The age and sex of 351,000 emergency and non-urgent cases treated and transported by the QAS from July 1995 to June 1996 were analysed. RESULTS: People aged 65 years and over who comprise 12% of the population utilise approximately one third of the emergency and two thirds of the non-urgent ambulance resources provided in Queensland. While the absolute number of occasions of service for females for emergency services is higher than for males, when the data are stratified for age and sex, males have higher rates of emergency ambulance service utilisation than females across every age group, and particularly in older age groups. Gender differences are also found for non-urgent ambulance usage. The absolute number of occasions of service for older females aged 65 and over using non-urgent ambulance transport is high, but utilisation patterns on stratified data reveal similar gender usage patterns across most age groupings, except at the older age groupings where male usage greatly exceeds female usage. CONCLUSIONS: As the aged are disproportionately high users of ambulance services, it will become increasingly important for ambulance services to plan for the projected increase in the aged population. Emergency pre-hospital care is one of the few health services along the continuum of care where male usage patterns are higher than those of females. More information needs to be obtained on the age and presenting characteristics of those people who are multiple users of the ambulance service. Such information will assist service planners. (+info)
The prevalence and health burden of self-reported diabetes in older Mexican Americans: findings from the Hispanic established populations for epidemiologic studies of the elderly.
(35/9064)
OBJECTIVES: The prevalence and health burden of self-reported adult-onset diabetes mellitus were examined in older Mexican Americans. METHODS: Data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly were used to assess the prevalence of self-reported diabetes and its association with other chronic conditions, disability, sensory impairments, health behaviors, and health service use in 3050 community-dwelling Mexican Americans 65 years and older. RESULTS: The prevalence of self-reported diabetes in this sample was 22%, and there were high rates of obesity, diabetes-related complications, and diabetic medication use. Myocardial infarction, stroke, hypertension, angina, and cancer were significantly more common in diabetics than in nondiabetics, as were high levels of depressive symptoms, low perceived health status, disability, incontinence, vision impairment, and health service use. Many of the rate differences found in this sample of older Mexican Americans were higher than those reported among other groups of older adults. CONCLUSIONS: Our findings indicate that the prevalence and health burden of diabetes are greater in older Mexican Americans than in older non-Hispanic Whites and African Americans, particularly among elderly men. (+info)
Updating UK estimates of age, sex and period specific cumulative constant tar cigarette consumption per adult.
(36/9064)
BACKGROUND: In 1993 we presented age and sex specific estimates of cumulative constant tar cigarette consumption (CCTCC) per adult for five year periods to 1986-90. These were derived from annual surveys conducted for the Tobacco Manufacturers' Association (TMA) since 1946, extrapolated back to 1891 for men and to 1921 for women and corrected for the decline in average (machine smoked) tar levels. We now provide estimates for 1991-5. METHODS: TMA surveys having ceased, 1991-5 estimates of manufactured cigarette consumption per adult (MCA) were derived from the General Household Survey (GHS) and corrected for the continuing decline in tar. These estimates were divided by 0.75 (men) and 0.80 (women), based on a comparison of GHS and TMA data for 1971-90, to allow accumulation with the TMA derived estimates prior to 1991. RESULTS: For both sexes the GHS/TMA ratio of MCA varied little by age or five year period, justifying the use of the correction factors when adjusting GHS estimates for 1991-95. TMA estimates were higher than GHS estimates as only TMA sales-corrected their data for understatement of smoking and the surveys differed in questions on handrolled cigarette smoking. The 1991-95 data confirm the continuing decline in CCTCC at all ages in men. Women show a less steep decline for ages 30-64 and an increase for ages 65-84. CONCLUSION: The GHS data can validly be used to update the CCTCC estimates. Some reservations about the use of CCTCC are discussed. (+info)
Prevalence of exercise induced bronchospasm in Kenyan school children: an urban-rural comparison.
(37/9064)
BACKGROUND: Higher rates of exercise induced bronchospasm (EIB) have been reported for urban than for rural African schoolchildren. The change from a traditional to a westernized lifestyle has been implicated. This study was undertaken to examine the impact of various features of urban living on the prevalence of EIB in Kenyan school children. METHODS: A total of 1226 children aged 8-17 years attending grade 4 at five randomly selected schools in Nairobi (urban) and five in Muranga district (rural) underwent an exercise challenge test. A respiratory health and home environment questionnaire was also administered to parents/guardians. This report is limited to 1071 children aged < or = 12 years. Prevalence rates of EIB for the two areas were compared and the differences analysed to model the respective contributions of personal characteristics, host and environmental factors implicated in childhood asthma. RESULTS: A fall in forced expiratory volume in one second (FEV1) after exercise of > or = 10% occurred in 22.9% of urban children and 13.2% of rural children (OR 1.96, 95% CI 1.41 to 2.71). The OR decreased to 1.65 (95% CI 1.10 to 2.47) after accounting for age, sex, and host factors (a family history of asthma and breast feeding for less than six months), and to 1.21 (95% CI 0.69 to 2.11) after further adjustment for environmental factors (parental education, use of biomass fuel and kerosene for cooking, and exposure to motor vehicle fumes). CONCLUSIONS: The EIB rates in this study are higher than any other reported for African children, even using more rigorous criteria for EIB. The study findings support a view which is gaining increasing credence that the increase in prevalence of childhood asthma associated with urbanisation is the consequence of various harmful environmental exposures acting on increasingly susceptible populations. (+info)
Environmental correlates of impaired lung function in non-smokers with severe alpha 1-antitrypsin deficiency (PiZZ).
(38/9064)
BACKGROUND: Active smoking is the most important risk factor for pulmonary emphysema in subjects with severe alpha 1-antitrypsin (AAT) deficiency. The aim of this study was to analyse the effects of environmental risk factors other than active smoking on lung function and on respiratory symptoms in non-smoking PiZZ individuals. METHODS: Lifetime exposure to passive smoking, domiciliary use of a kerosene (paraffin) heater or gas cooker, and all occupations since leaving school were reported by 205 non-smoking PiZZ individuals (95 men and 110 women) included in the Swedish AAT deficiency register. Lung function test results and histories of respiratory symptoms (chronic bronchitis, recurrent wheezing, and exertional dyspnoea) were elicited from the AAT register records. RESULTS: After adjustment for age, agricultural employment and domiciliary kerosene heater usage, but not gas cooker usage or passive smoking, were both associated with significantly decreased lung function. Multiple linear regression analysis showed age, sex, kerosene heater usage, and agricultural employment to be independent determinants of lung function impairment. Age and passive smoking for 10 years or more, both at home and at the work place, were associated with the presence of chronic bronchitis. Age and agricultural employment for > or = 10 years were associated with recurrent wheezing and exertional dyspnoea. CONCLUSIONS: Domiciliary kerosene heater usage and an agricultural occupation therefore appear to be environmental factors associated with decreased lung function in non-smoking PiZZ individuals, and passive smoking is associated with an increased frequency of chronic bronchitis, but not with impaired lung function. (+info)
Immunoglobulin A, G, and M responses to L1 and L2 capsids of human papillomavirus types 6, 11, 16, 18, and 33 L1 after newly acquired infection.
(39/9064)
OBJECTIVES: We performed a study to establish the pattern of serological reactivity for immunoglobulins (Ig), to capsids of human papilloma virus (HPV) after new HPV infection in two groups of subjects. METHODS: The pattern of serological reactivity after acquisition of infection with HPV was investigated by measuring IgA, IgM, and IgG antibodies to capsids containing L1 and L2 proteins of HPV types 6, 11, 16, 18, and 33 in longitudinal studies of groups with different patterns of sexual activity. Individuals who tested negative for HPV DNA by the polymerase chain reaction at enrolment, but who became HPV DNA positive during follow up, were examined for antibodies to HPV capsids by enzyme linked immunosorbent assay. One group consisted of 15 young girls (with eight controls who remained HPV DNA negative) who were becoming sexually active and the other comprised 12 male (with five controls) and 35 female (with seven controls) heterosexual attenders of a sexually transmitted disease clinic who had had multiple sexual partners. RESULTS: The sexually inexperienced girls showed IgA and IgG responses, but seldom an IgM response to infection with HPV types 6/11, 16, and 18. No consistent pattern of serological reactivity was apparent for the heterosexuals with multiple partners. The lack of association between current HPV DNA positivity and detectable antibodies in these individuals was possibly related to the duration of infection or to prior exposure to HPV. For the latter group serological reactivity to HPV capsids was significantly greater in women than in men (p = 0.001, p = 0.003, and p = 0.024, for IgG to HPV 6, 11, and 16, respectively). CONCLUSION: The sex difference in antibody response detected in previous studies with assays based on peptide antigens was thus corroborated in the present study with capsid based serological assays. This sex difference might reflect a difference in sexual activity and prior exposure to HPV between men and women in this particular group. (+info)
Unwelcome customers? The epidemiology of removal from general practitioner lists in Sheffield.
(40/9064)
BACKGROUND: The 1990 contract and the 1991 fundholding scheme encouraged speculation that general practitioners (GPs) may remove patients from their lists for financial reasons. Despite assertions that patient removals are increasing, little evidence exists on the number or trends in removals. AIM: To describe the epidemiology of removals by time, place, and person, and to determine whether removals have increased in recent years. METHOD: Descriptive analysis of routine data relating to all removals of Sheffield residents from GP lists during 1991-1996. RESULTS: Removal from a doctor's list was a rare event (2.4 per 1000 patients per year) that did not become more common over the period examined. Removal rates varied by age, sex, and practice, with relatively high rates among children, young women, and the over-75s. There was a significant tendency for higher removal rates in more deprived parts of the city. CONCLUSION: Removal rates have not increased in Sheffield. The reasons for the variation in rates by age, sex, and practice are unknown. The higher rates noted in the under-fives and young women are consistent with the possibility that the 1990 target payment scheme may have increased removal rates in these age groups. (+info)