Estimates of complications of medical care in the adult US population.
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BACKGROUND: Total US population estimates of complications of medical care have relied on extrapolations of state-specific estimates. Generalizability is suspect because findings are limited by geographical location or time. We describe the relationship between the annual prevalence of complications of medical care (CM) and socio-demographic characteristics in the adult US population. METHODS: We used data from the National Health Interview Surveys, annual nationwide surveys of the resident, civilian, noninstitutionalized population of the United States. The main outcome of interest was self-reported conditions from CMs (ICD-9 996-999) and activity limitations that arise from such events. Univariate estimates and multivariably adjusted models accounting for selected socio-demographic characteristics and health status were derived. RESULTS: A total of 618,167 reports of conditions from 313,438 subjects 18 years and older from 1987 to 1994 were examined. In 1987, 830,386 adults reported complications of medical care, increasing by about 40% to 1,174,089 adults in 1994. Based on an extrapolation to the US adult population, rates increased by 25% from 558 to 678 per 100,000 during the same period. One-third reported onset a year prior to the interview; two-thirds visited a doctor six months prior; half experienced limitation in major activities; a quarter reported limitation in personal care activities. In the two weeks preceding the interview, complications of medical care caused an average of 1.72 days of restricted activity, 0.79 days spent in bed, and 0.58 days of work lost. Race modified the age-specific risk of these complications. CONCLUSIONS: Complications of medical care impose heavier morbidity than previously considered with some indication that socio-demographic variables modify the risk for injuries. (+info)
A population based time series analysis of asthma hospitalisations in Ontario, Canada: 1988 to 2000.
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BACKGROUND: Asthma is a common yet incompletely understood health problem associated with a high morbidity burden. A wide variety of seasonally variable environmental stimuli such as viruses and air pollution are believed to influence asthma morbidity. This study set out to examine the seasonal patterns of asthma hospitalisations in relation to age and gender for the province of Ontario over a period of 12 years. METHODS: A retrospective, population-based study design was used to assess temporal patterns in hospitalisations for asthma from April 1, 1988 to March 31, 2000. Approximately 14 million residents of Ontario eligible for universal healthcare coverage during this time were included for analysis. Time series analyses were conducted on monthly aggregations of hospitalisations. RESULTS: There is strong evidence of an autumn peak and summer trough seasonal pattern occurring every year over the 12-year period (Fisher-Kappa (FK) = 23.93, p > 0.01; Bartlett Kolmogorov Smirnov (BKS) = 0.459, p < 0.01). This pattern was observed in both sexes. However, young males (0-4 years) were hospitalised at two to three times the rate of females of the same age. Rates were much lower in the older age groups. A downward trend in asthma hospitalisations was observed in the total population over the twelve-year period (beta = -0.980, p < 0.01). CONCLUSIONS: A clear and consistent seasonal pattern was observed in this study for asthma hospitalisations. These findings have important implications for the development of effective management and prevention strategies. (+info)
Reliability and cultural applicability of the Greek version of the International Personality Disorders Examination.
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BACKGROUND: The International Personality Disorders Examination (IPDE) constitutes the proposal of the WHO for the reliable diagnosis of personality disorders (PD). The IPDE assesses pathological personality and is compatible both with DSM-IV and ICD-10 diagnosis. However it is important to test the reliability and cultural applicability of different IPDE translations. METHODS: Thirty-one patients (12 male and 19 female) aged 35.25 +/- 11.08 years, took part in the study. Three examiners applied the interview (23 interviews of two and 8 interviews of 3 examiners, that is 47 pairs of interviews and 70 single interviews). The phi coefficient was used to test categorical diagnosis agreement and the Pearson Product Moment correlation coefficient to test agreement concerning the number of criteria met. RESULTS: Translation and back-translation did not reveal specific problems. Results suggested that reliability of the Greek translation is good. However, socio-cultural factors (family coherence, work environment etc) could affect the application of some of the IPDE items in Greece. The diagnosis of any PD was highly reliable with phi >0.92. However, diagnosis of non-specific PD was not reliable at all (phi close to 0) suggesting that this is a true residual category. Diagnosis of specific PDs were highly reliable with the exception of schizoid PD. Diagnosis of antisocial and Borderline PDs were perfectly reliable with phi equal to 1.00. CONCLUSIONS: The Greek translation of the IPDE is a reliable instrument for the assessment of personality disorder but cultural variation may limit its applicability in international comparisons. (+info)
A comparison of hospital readmission rates between two general physicians with different outpatient review practices.
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BACKGROUND: There has been a relentless increase in emergency medical admissions in the UK over recent years. Many of these patients suffer with chronic conditions requiring continuing medical attention. We wished to determine whether conventional outpatient clinic follow up after discharge has any impact on the rate of readmission to hospital. METHODS: Two consultant general physicians with the same patient case-mix but markedly different outpatient follow-up practice were chosen. Of 1203 patients discharged, one consultant saw twice as many patients in the follow-up clinic than the other (Dr A 9.8% v Dr B 19.6%). The readmission rate in the twelve months following discharge was compared in a retrospective analysis of hospital activity data. Due to the specialisation of the admitting system, patients mainly had cardiovascular or cerebrovascular disease or had taken an overdose. Few had respiratory or infectious diseases. Outpatient follow-up was focussed on patients with cardiac disease. RESULTS: Risk of readmission increased significantly with age and length of stay of the original episode and was less for digestive system and musculo-skeletal disorders. 28.7% of patients discharged by Dr A and 31.5 % of those discharged by Dr B were readmitted at least once. Relative readmission risk was not significantly different between the consultants and there was no difference in the length of stay of readmissions. CONCLUSIONS: Increasing the proportion of patients with this age- and case-mix who are followed up in a hospital general medical outpatient clinic is unlikely to reduce the demand for acute hospital beds. (+info)
An epidemiological study of respiratory syncytial virus associated hospitalizations in Denmark.
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Respiratory syncytial virus (RSV) is the most common viral pathogen that causes lower respiratory tract infections in infants. Studies have implicated severe RSV infections early in life as a risk factor for subsequent development of reactive airway disease. We are conducting a study to validate RSV-associated diagnoses in the Danish National Patient Registry, to assess whether the incidence of severe RSV infection is increasing in Denmark, to identify predisposing and protective factors for RSV-associated hospitalization in Denmark, and to examine the association of severe RSV infection with reactive airway disease. The influence of various biological, social and environmental factors on hospitalization for RSV infection will be studied through several population-based registers, including the Danish National Birth Cohort: 'Better health for mothers and children'. The RSV hospitalization cases will be compared with control individuals selected within the same population groups on a case-control or a cohort basis in order to produce estimates of age-adjusted and sex-adjusted relative risks (odds ratio and relative risk) for hospitalization associated with various risk factors. Using register linkage and unique registration of exposures collected through interviews and blood samples from the Danish National Birth Cohort, we will be able to resolve the issues referred to above in a very large sample of Danish children. (+info)
Hospitalizations among employees in the Danish hotel and restaurant industry.
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BACKGROUND: The aim of the present study was to provide a broad picture of the morbidity among employees in the Danish hotel and restaurant industry. METHODS: Cohorts of all 20-59-year-old employees in the Danish hotel and restaurant industry in the years 1981, 1986, 1991 and 1994 were formed to calculate age-standardized hospitalization ratios (SHR) and time trends (1981-1997) for many different diagnoses. RESULTS: Both for women and men, significantly higher SHRs were found for infectious and parasitic diseases, neoplasms, diseases in the nervous system and sense organs, diseases of the circulatory system, diseases of the respiratory system, diseases of the digestive system and diseases of the musculoskeletal system among employees in hotels and restaurants than in the digestive system and diseases of the musculoskeletal system among employees in hotels and restaurants than in the working population at large. Furthermore, among women a significantly elevated risk was found for injuries in the lower extremities, injuries in the upper extremities and head injuries, and among men a high risk was found for head injuries and a low risk for ruptures in ligaments and muscles. The trend assessments did not detect any significant changes in SHRs over time. CONCLUSION: Employment in the Danish hotel and restaurant industry is associated with an elevated hospitalization risk due to many diseases, which may be related to occupation and lifestyle. In line with the official policy of reducing inequality in health, focus should be placed on the health problems in this group. (+info)
Alcohol-attributable and alcohol-preventable mortality in Italy. A balance in 1983 and 1996.
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BACKGROUND: Since the mid-1970s, a striking reduction in alcohol consumption has been observed in Italy and other developed countries. Alcohol-related mortality in Italy has been estimated for 1983 and 1996. METHODS: Alcohol-attributable and alcohol-preventable deaths were estimated by: i) data on prevalence of drinkers from two Italian surveys; ii) the parameters of meta-regression models investigating the relationship between alcohol intake and the risk of several conditions positively and negatively related to alcohol; and iii) the number of deaths from 21 alcohol-related conditions. RESULTS: About 68,000 and 42,000 deaths were attributed to alcohol consumption in 1983 and in 1996 respectively, mostly from hemorrhagic stroke, liver cirrhosis, cancer, and injuries. About 6,600 deaths from coronary heart disease were prevented by alcohol. Light intake (25 g/day or less) caused about 30% of deaths attributable to any consumption in women. In men, about one-half of the deaths were attributable to the highest category of intake (100 g/day or more), while a lower proportion of deaths was attributed to light intake (almost 7%). In 1996 the number of the deaths caused and those prevented by light intake was approximately the same (5,400 and 5,200 respectively) and did not significantly differ. CONCLUSION: The estimated number of deaths attributable to alcohol consumption in Italy still far exceeds the number prevented for both women and men. Despite the cardiac protective effect, alcohol consumption remains a major public health problem in Italy. Both population and high risk strategies in preventing alcohol-related problems should be implemented. (+info)
The March 2002 update of the electronic version of ICPC-2. A step forward to the use of ICD-10 as a nomenclature and a terminology for ICPC-2.
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The electronic version of the second edition of the International Classification of Primary Care, ICPC-2-E, available on the website of Family Practice since 2000, needed an update of the mapping with ICD-10 as a nomenclature and, consequently, of some of its criteria. This is now being made available, together with the full four-digit conversion structure between the two systems, in an electronic form, allowing the use of the alphabetical index of ICD-10 in several languages to be used as a terminology for ICPC-2. In this contribution, we discuss the considerations for preparing this new mapping structure, and its potential use in future electronic patient records in family practice. (+info)