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The relation between education, prevalence of 17 chronic diseases or groups of diseases, and pattern of health care utilisation was evaluated from data from the 1983 Italian National Health Survey, based on 58 462 individuals aged 25 or over randomly selected within strata of geographical area, size of place of residence, and size of household, in order to be representative of the whole Italian population. Most of the diseases considered, including diabetes, hypertension, myocardial infarction and other heart disease, haemorrhoids or varices, chronic respiratory disease, anaemias, gastroduodenal ulcer, cholelithiasis and liver cirrhosis, kidney and urological diseases, arthritis, and psychiatric and neurological disturbances, were consistently less prevalent among more educated individuals. The age and sex adjusted risk estimates for individuals educated in high school or university compared with those with only a primary school education or less ranged between 0.21 for liver cirrhosis and 0.80 for anaemias. The sole exception was allergy, which was more prevalent among the more educated individuals (relative risk = 1.42). General practitioner visits and hospital admissions were reported less frequently by the more educated individuals, but specialist consultations of potential preventive value were less frequent among the less well educated. The results were similar when occupation was utilised as an indicator of social class. Thus, the findings of this national survey provide confirmation and quantitative assessment of considerable differences in health and health service utilisation according to indicators of social class.
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PMID:Education, prevalence of disease, and frequency of health care utilisation. The 1983 Italian National Health Survey. 365 37

Among 500 patients of a rural general practice, 4,4% proved to be oropharyngeal carriers of Pseudomonas aeruginosa as shown by examination of mouth rinse fluid through enrichment in malachite-green-broth followed by isolation on Pseudosel-Agar at 42 degrees C. Most positive samples were found in persons 54-63 years old. There were no significant sex differences. The isolation of Ps. aeruginosa showed no relation to visible inflammatory processes in the oral cavity, to dentures, diabetes mellitus, chronic respiratory disease, former antibiotic treatment or smoking habits. The age distribution of the carriers cannot be explained.
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PMID:[Pseudomonas aeruginosa in the oral cavity: occurrence and age distribution of adult germ carriers]. 392 14

The aim of the study was to assess the early results of abdominal aortic aneurysm resection in relation to cardiac and other operative risk factors, assess the magnitude of the procedure, and evaluate longer-term postoperative rehabilitation; 176 patients (mean age 67,1 years) were assessed, of whom 160 (90,9%) had operations. Using the multifactorial index of cardiac risk in non-cardiac surgical procedures (Goldman) the majority fell into the low-risk category (groups I and II). Other risk factors evaluated were respiratory disease, renal insufficiency, hypertension and diabetes. The majority of these patients had creatinine clearance rates of less than 50% of the theoretical normal rate for age. Of 7 postoperative deaths (operative mortality rate 4,4%) 4 followed myocardial infarction, and all the latter patients fell into cardiac risk grade III. The other risk factors did not significantly influence the mortality or complication rates. The highest complication rate occurred in patients who underwent aortic bifurcation graft placement and the lowest in patients who underwent simple infrarenal tube grafting. Of 153 survivors, 10 have been lost to follow-up and 141 have returned to full activity. In conclusion, the cardiac risk index used is a valuable predictor of operative risk. If the patient survives surgery, excellent longer-term rehabilitation can be expected.
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PMID:Abdominal aortic aneurysm resection--operative risk and long-term results. 400 73

A historical prospective mortality study was conducted on 3579 white male workers employed between 1935 and 1976 with potential exposures to brominated compounds including 1,2-dibromo-3-chloropropane (DBCP), Tris (2,3-dibromopropyl) phosphate, polybrominated biphenyls (PBB), various organic and inorganic bromides, and DDT. The vital status as of 31 December 1976 was determined for 3384 (95%) of these workers: 2806 (79%) were still living and 578 (16%) had died. Death certificates were obtained for 541 deaths (94% of all deaths). The mortality experience of the entire cohort and several subcohorts was compared with that of United States white men adjusted for age and calendar time. The comparison statistic was the commonly used standardised mortality ratio (SMR). Historical industrial hygiene data were not available, and the workers were classified by their work areas or departments in order to estimate their potential exposures. Overall mortality for the entire cohort and several subgroups was significantly lower than expected. For the entire cohort, significant mortality deficits were observed in diseases of the circulatory system, non-malignant respiratory disease, and diseases of the digestive system. On the other hand, mortality from diabetes mellitus was significantly raised for the cohort. No significant overall or cause-specific mortality excess was detected among employees potentially exposed to either TRIS or DDT. A significant mortality excess due to diseases of the circulatory system was observed among workers potentially exposed to DBCP. Mortality from testicular cancer was significantly higher than expected among those potentially exposed to other organic bromides. The common potential exposure of those who had died of testicular cancer was methyl bromide. Owing to the lack of accurate historical exposure information and the fact that many workers were potentially exposed to a multitude of chemicals, it is difficult to draw definitive statements on the causations of the observed mortality excesses.
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PMID:Mortality of workers potentially exposed to organic and inorganic brominated chemicals, DBCP, TRIS, PBB, and DDT. 631

An intensive care program was offered to all insulin-dependent, pregnant diabetic women who presented to The New York Hospital Obstetrical Clinic in their eighth week or less of gestation. The patients were hospitalized for 1 wk to normalize their blood glucose and to teach the technique of self-monitored glucose determination, diet and exchange lists, and the method to titrate insulin according to the blood glucose determination. The mean blood glucose for the first 10 patients accepted to the program was 169 mg/dl at the start of the program with a mean hemoglobin A1c of 9.4% for the group (normal < 5.5%) and glucosuria up to 50 g/24 h. After discharge, mean glucose was 91 mg/dl, and urinary glucose excretion was 1.4 g/24 h. HbA1c fell into the normal range 5 wk after normoglycemia was achieved (3.4%) (nl < 5.5%). Normoglycemia was maintained as outpatients until 3 wk before delivery when the patients were readmitted for tests of fetal well-being. Mean weight gain for the mothers was 12.2 kg. Mean glucose at delivery was 87 mg/dl and HbA1c was 3%. Hormonal profiles (hCG, hPRL, estrogens, progesterone, hPL) normalized after normoglycemia was achieved and remained normal until delivery. Mean gestational age at time of delivery was 38.8 wk with a mean infant birth weight of 2988 g. No infant manifested hypoglycemia, hypocalcemia, erythremia, or respiratory disease. The use of self-monitored blood glucose allows for optimal care of the insulin-dependent, pregnant diabetic woman while she remains at home with her family.
Diabetes Care
PMID:Management of the pregnant, insulin-dependent diabetic woman. 699 70

Cystic fibrosis is an autosomal recessive disorder which affects one in 2500 live births. It is a multisystem disease and has a variety of presentations. The major clinical features affect the gastrointestinal and respiratory tracts. Severe respiratory disease, diabetes and gastroesophageal reflux are common features of concern to anaesthetists. Improved care of young patients has allowed many to survive into adulthood. Lung transplantation has significantly improved the outlook for many patients. At Alfred Hospital, 74 patients with cystic fibrosis underwent 149 procedures from January 1978 to January 1994, with a mortality of 0.6% (95% CI 0.4%-0.8%). This retrospective cohort study describes the anaesthetic management and perioperative care of these patients. Most of the anaesthetics were for procedures related to cystic fibrosis but 12% were for unrelated conditions. Cystic fibrosis related procedures include diagnostic, venous access, enteral feeding procedures, treatment of complications of cystic fibrosis and lung transplantation. Despite extremely poor respiratory function, these patients can be managed with acceptably low postoperative mortality (1%). Pre- and postoperative care must be directed towards optimal clearance of viscous respiratory secretions. Procedures need to be planned so that optimal care can be given by each member of the team caring for cystic fibrosis patients.
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PMID:Anaesthesia for adults with cystic fibrosis. 757 20

The purpose of this study was to identify factors from simple past medical history which could alert surgeons to patients at increased risk of postoperative complications. Five hundred and fourteen patients undergoing elective surgery were studied prospectively. Factors evaluated included the patients' age, gender, race and the presence in the past medical history of coronary artery disease, congestive heart failure, cardiac dysrhythmias, respiratory disease, endocrine disease, peripheral atherosclerosis, renal disease, neuropsychiatric disease, hypertension, diabetes mellitus, prior major surgery and prior or active malignancy. All complications were recorded. The data were analysed by univariate and multivariate statistical methods. Gender, race and age were not associated with any complications. Coronary artery disease, respiratory disease, atherosclerotic peripheral vascular disease, neuropsychiatric disease, malignancy, the absence of prior major surgery, hypertension and diabetes mellitus were associated with specific postoperative complications by univariate analysis. Malignancy, diabetes mellitus, peripheral atherosclerosis, coronary artery disease, neuropsychiatric disease, renal disease and respiratory disease were independent predictors of complications as determined by multivariate analysis. Of interest is the phenomenon that the risk of postoperative complications when a combination of risk factors was present was greater than what would be predicted by the cumulative risk of these factors. This study helps identify those patients which by simple history may be at increased risk of postoperative complications and may require aggressive preoperative evaluation.
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PMID:The effects of age, gender, race and concomitant disease on postoperative complications. 769 33

The most serious infection after coronary artery bypass grafting (CABG) is mediastinitis following deep sternal wound infection. Antibiotic prophylaxis for at least 48 hours has been recommended. In this trial 551 consecutive patients were randomized to receive ceftriaxone in a single dose or cefuroxime thrice daily until the end of the second postoperative day. The overall infection rate was 7.7% in the ceftriaxone and 8.3% in the cefuroxime group, and the incidence of deep sternal infection was 2.9% in both groups. Significant risk factors for such infection were chronic respiratory disease (p < 0.001) and diabetes (p < 0.01). The antibiotic prophylaxis had no harmful effects on the colonic flora in either group. Acquisition and delivery costs for the prophylactic agents were three times higher in the cefuroxime than in the ceftriaxone group. Both antibiotics are concluded to be equally safe and effective. Single-dose ceftriaxone prophylaxis is as effective as cefuroxime given for 48 hours postoperatively. Single-dose ceftriaxone is also simple to use.
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PMID:Ceftriaxone vs cefuroxime for infection prophylaxis in coronary bypass surgery. 779 59

In a prospective longitudinal study over 21 months the performance of general practitioners and the disease status of their patients was measured during the formulation and implementation of guidelines on follow-up care. Data on 15 general practitioners and on 613 patients with hypertension, 95 with diabetes mellitus, 66 with chronic ischemic heart disease, 115 with chronic respiratory disease, and 17 with osteoarthritis were used for analysis. Performance measures were defined and for each disease a disease status indicator was used. The possibly modifying effect of compliance of the general practitioner, and of patient compliance with the guidelines was taken into account. The general practitioners formulated consensus guidelines on follow-up care and implemented these guidelines in their practices. The implementation was supported by peer review. The performance of general practitioners tended to conform more with the guidelines during the study period, especially with regards to actions that should be performed routinely. There were no major changes in the disease status indicators. Compliant hypertensive patients had a normotensive status more frequently than non-compliant patients. Diabetic patients were more likely to be normoglycaemic when they received care according to guidelines. None of the differences were statistically significant over time.
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PMID:Implementing guidelines in general practice. Evaluation of process and outcome of care in chronic diseases. 779 62

The "Health Transition" describes the medical consequences which accompany the demographic transition and development. In many Asian countries, as the infectious diseases of infancy decline, such as diarrhea, acute respiratory disease, measles and malaria, so too, do infant mortality rates. As a consequence of falling infant mortality rates and declines in fertility, the age pyramid has become more rectangular. No longer is nearly half of the population under the age of 15 years. Diseases of adults are beginning to become predominant: trauma, heart disease, cancer, stroke and diabetes. Life expectancy has increased along with costs of the health care system. As a fraction of per capita gross domestic product, health care is beginning to become a major national expense. It is ironic that the one vector-borne infectious disease likely to bridge the health transition in tropical countries is dengue. As evidenced by the experience of Singapore and Taiwan, modern housing and commercial development provide more, rather than fewer breeding places for Aedes aegypti. Greater affluence often means less compliance with mosquito control programs. Meanwhile, the dengue viruses, heeding some unknown genetic imperative, cause ever more severe disease. Modern Asian societies must count dengue as a real and enduring threat. To prevent costly hospitalizations and a sense of social disorder, effective measures must be adopted to achieve a significant reduction of Aedes aegypti populations. Sustained dengue control requires source reduction which, in turn depends upon imaginative leadership, skilled man power, legislative authority, an authentic national research program and intersectoral cooperation. A leadership role beckons for new actors in the control of Aedes aegypti: large municipalities, environmental agencies and the private sector.
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PMID:Dengue in the health transition. 784 46


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