2451
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Anderson IM, Nutt DJ, Deakin JF. Evidence-based guidelines for treating depressive disorders with antidepressants: a revision of the 1993 British Association for Psychopharmacology guidelines. British Association for Psychopharmacology. J Psychopharmacol 2000; 14:3-20. [PMID: 10757248 DOI: 10.1177/026988110001400101] [Citation(s) in RCA: 271] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A revision of the British Association for Psychopharmacology guidelines for treating depressive disorders with antidepressants was undertaken in order to specify the scope and target of the guidelines and to update the recommendations based explicitly on the available evidence. A consensus meeting, involving experts in depressive disorders and their treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from participants and interested parties. A literature review is given which identifies the quality of evidence followed by recommendations, the strength of which are based on the level of evidence. The guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing, management when initial treatment fails, continuation treatment, maintenance treatment to prevent recurrence and stopping treatment.
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Affiliation(s)
- I M Anderson
- University of Manchester Department of Psychiatry, University of Manchester, UK.
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2452
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Abstract
Atherosclerosis is an inflammatory disease which displays features of immune activation both locally and systemically. In the present review, we discuss the evidence for immune activation in human disease and experimental models, and survey candidate antigens associated with atherosclerosis. Studies of atherosclerosis in genetic models of immunodeficiency are analysed, as well as immunomodulating therapies and immunization protocols. Based on recent research, it is concluded that immunomodulation represents an interesting approach to the development of new prevention and treatment methods for atherosclerosis.
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Affiliation(s)
- A Nicoletti
- INSERM U430, Hôpital Broussais, Paris, France and the Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
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2453
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Mak KH, Effron MB, Moliterno DJ. Platelet glycoprotein IIb/IIIa receptor antagonists and their use in elderly patients. Drugs Aging 2000; 16:179-87. [PMID: 10803858 DOI: 10.2165/00002512-200016030-00003] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
With increasing age of the general population, cardiovascular diseases are becoming a greater health burden. Coronary artery disease remains a major cause of morbidity and mortality worldwide. Among the various pathophysiological processes, platelets play a pre-eminent role. With the identification of the glycoprotein (GP) IIb/IIIa receptor as the final common pathway for platelet aggregation, potent antiplatelet agents have been developed. These GP IIb/IIIa antagonists have been shown to be effective in improving outcomes among patients undergoing percutaneous coronary interventions and for the treatment of acute coronary syndromes. By pooling the results of several large-scale trials, these benefits have been found to extend to the elderly population. Among 7860 patients undergoing percutaneous coronary intervention, the occurrence of death or myocardial infarction at 30 days was reduced from 10.0 to 5.9% (odds ratio 0.56; 95% confidence level, 0.37 to 0.83) with abciximab compared with placebo, in those >70 years of age. Importantly, this benefit was achieved without an increase in major bleeding complications. Similarly favourable trends were also observed among elderly patients treated with tirofiban or eptifibatide for acute coronary syndromes. As such, GP IIb/IIIa antagonists are effective in preventing ischaemic complications and can be safely administered to elderly patients.
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Affiliation(s)
- K H Mak
- Department of Cardiology at the National Heart Centre, Tan Tock Seng Hospital, Singapore
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2454
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Saradamma RD, Higginbotham N, Nichter M. Social factors influencing the acquisition of antibiotics without prescription in Kerala State, south India. Soc Sci Med 2000; 50:891-903. [PMID: 10695985 DOI: 10.1016/s0277-9536(99)00380-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We investigated the magnitude of self-medication with antibiotics in a peri-urban area of Southern Kerala State, India and factors influencing this practice. First, a random sample of 400 households was surveyed in one primary health centre area near Trivandrum. We found 69.3% (95% CI = 64.8-73.8) of households had at least one person using a pharmaceutical product during the two-week recall period; antibiotics formed almost 11% of the medicines consumed. Next, pharmacy based interview and observation data were collected from 405 antibiotic purchasers sampled from 11 out of the 12 private pharmacies in the area. Seventy-three of these 405 customers purchased antibiotics without a prescription (18%; 95% CI = 14.3-21.7). By combining the household survey and pharmacy observations, we estimate that almost half of 1% (0.41%; 95% CI = 0.24-1.16) of the population, or four people per 1000, is engaged in self-medication using antibiotics in Kerala in any two-week period. Our data show that people least likely to follow this practice are from higher income families, having more education and higher status occupations and receiving the benefits of medical insurance. Conversely, logistic regression analysis indicated that risk of buying antibiotics without a script was associated with education at secondary level or below, the perception that it is expensive to consult a doctor and low satisfaction with medical practitioners. Keralites' self-medication patterns are interpreted broadly using social, cultural, historical and economic perspectives. Solutions to the problem of antibiotic misuse are suggested, proceeding on several fronts: among practitioners, suppliers and marketeers of medicines, and among the population of pharmaceutical consumers themselves.
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Affiliation(s)
- R D Saradamma
- Clinical Epidemiology Unit, Medical College, Trivandrum, Kerala, India
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2455
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Abstract
Physical activity may play an important role in the management of mild-to-moderate mental health diseases, especially depression and anxiety. Although people with depression tend to be less physically active than non-depressed individuals, increased aerobic exercise or strength training has been shown to reduce depressive symptoms significantly. However, habitual physical activity has not been shown to prevent the onset of depression. Anxiety symptoms and panic disorder also improve with regular exercise, and beneficial effects appear to equal meditation or relaxation. In general, acute anxiety responds better to exercise than chronic anxiety. Studies of older adults and adolescents with depression or anxiety have been limited, but physical activity appears beneficial to these populations as well. Excessive physical activity may lead to overtraining and generate psychological symptoms that mimic depression. Several differing psychological and physiological mechanisms have been proposed to explain the effect of physical activity on mental health disorders. Well controlled studies are needed to clarify the mental health benefits of exercise among various populations and to address directly processes underlying the benefits of exercise on mental health.
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Affiliation(s)
- S A Paluska
- Rex Sports Medicine Institute, Cary, North Carolina, USA.
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2456
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Abstract
Rotaviruses are the most important cause of pediatric gastroenteritis worldwide. In August 1998, a new rotavirus vaccine was licensed for general use in the United States. However, 14 months later, the vaccine was withdrawn from the market because of serious gastrointestinal side effects. This paper discusses the need for a rotavirus vaccine, the development of the first rotavirus vaccine, and the safety issues that led to the recall of that vaccine.
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Affiliation(s)
- SE Coffin
- Division of Immunologic and Infectious Diseases, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA.
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2457
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Dinh-Zarr T, DiGuiseppi C, Heitman E, Roberts I. Interventions for preventing injuries in problem drinkers. Cochrane Database Syst Rev 2000:CD001857. [PMID: 10796829 DOI: 10.1002/14651858.cd001857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To assess the effect of interventions for problem drinking on subsequent injury risk. SEARCH STRATEGY Data Sources.- Twelve computerized databases: MEDLINE (1966-8/96), EMBASE (1982-1/97), Cochrane Controlled Trials Register (1997, issue #1), PSYCHINFO (1967-1/97), CINAHL (1982-10/96), ERIC (1966-12/96), Dissertation Abstracts International (1861-11/96), IBSS (1961-1/97), ISTP (1982-1/97) and three specialized transportation databases, using terms for problem drinking combined with terms for controlled trials; bibliographies of relevant trials; and contact with authors and government agencies. SELECTION CRITERIA Data Selection.- Randomized controlled trials of interventions among particiapnts with problem drinking, which are intended to reduce alcohol consumption or to prevent injuries or their antecedents, and which measured injury-related outcomes. Of 7014 studies identified, 19 (0. 3%) met the inclusion criteria. DATA COLLECTION AND ANALYSIS Data Extraction.- Two authors extracted data on participants, interventions, follow-up, allocation concealment, and outcomes, and independently rated allocation concealment quality. MAIN RESULTS Data Synthesis.- In completed trials, interventions for problem drinking were associated with reduced suicide attempts, domestic violence, falls, drinking-related injuries, and injury hospitalizations and deaths, with reductions ranging from 27-65%. Several interventions among convicted drunk drivers reduced motor vehicle crashes and injuries. Because few trials were sufficiently large to assess effects on injuries, individual effect estimates were imprecise. We did not combine the results quantitatively because the interventions, patient populations, and outcomes were so diverse. REVIEWER'S CONCLUSIONS Conclusion.- Interventions for problem drinking may reduce injuries and their antecedents. Because injuries account for much of the morbidity and mortality from problem drinking, further studies are warranted to evaluate the effect of treating problem drinking on injuries.
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Affiliation(s)
- T Dinh-Zarr
- Management and Policy Sciences (MAPS), University of Texas School of Public Health, 1200 Herman Pressler, RAS-901, Houston, Texas 77030, USA.
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2458
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Abstract
The incidence of chronic obstructive pulmonary disease (COPD) is increasing throughout the world. Much less is known about the pathogenesis of COPD than that of asthma and there is little response to current therapy. Most patients with COPD have acquired their lung disease through smoking cigarettes, and the major step in management is to minimise further damage by stopping this habit. A number of therapies are being developed for the treatment of COPD; including new bronchodilators such as tiotropium bromide, agents to block inflammation induced by neutrophils and macrophages, as well as strategies to combat proteases and oxidants. The long-term goal is to provide therapy that retards the accelerated loss of lung function occurring in COPD. Development of novel therapies for COPD requires reliable Phase II decision making before entering large scale Phase III studies. The patient with COPD is often overlooked compared to their asthmatic counterpart, who benefit from an urgent need to identify novel targets and better therapy.
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Affiliation(s)
- M J Leckie
- National Heart and Lung Institute, Royal Brompton Clinical Studies Unit, Imperial College, London, UK
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2459
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2460
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Hollinghurst S, Bevan G, Bowie C. Estimating the "avoidable" burden of disease by Disability Adjusted Life Years (DALYs). Health Care Manag Sci 2000; 3:9-21. [PMID: 10996972 DOI: 10.1023/a:1019016702081] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The World Bank's Global Burden of Disease Study pioneered the use of Disability Adjusted Life Years (DALYs). In this paper we distinguish between the total and the "avoidable" burden of disease. We identify different ways of measuring DALYs: incidence-based DALYs are appropriate where the means of reducing the burden of disease is by prevention; prevalence-based DALYs are appropriate when a disease cannot be prevented but effective treatment is available. The methods of estimating each are explained and we describe how we have applied these methods to seven causes of death and disability in the South and West Region. We discuss the relevance of this work for monitoring the health of populations and deciding how best to use scarce resources to improve health.
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Affiliation(s)
- S Hollinghurst
- LSE Health, London School of Economics and Political Science, UK.
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2461
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Dandona R, Dandona L, Naduvilath TJ, McCarty CA, Rao GN. Utilisation of eyecare services in an urban population in southern India: the Andhra Pradesh eye disease study. Br J Ophthalmol 2000; 84:22-7. [PMID: 10611094 PMCID: PMC1723225 DOI: 10.1136/bjo.84.1.22] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To assess utilisation of eyecare services by people with visual impairment <6/18 or equivalent visual field loss in the better eye in the urban population of Hyderabad in southern India. METHODS 2522 subjects of all ages, representative of the population of Hyderabad city, underwent a detailed interview and dilated examination as part of the population based Andhra Pradesh eye disease study. Subjects more than 15 years of age were interviewed regarding the use of eyecare services. RESULTS Of 250 subjects with presenting distance visual acuity <6/18 or equivalent visual field loss in the better eye, information on utilisation of eyecare services was available for 229 (91.6%). Of these 229 subjects, 44 (19%) had visual acuity <6/60 or equivalent visual field loss in the better eye, and 202 (88.2%) had noticed decrease in vision over the past 5 years. Multivariate analysis showed that this decrease in vision was noticed significantly less by subjects with refractive error as the cause of visual impairment (odds ratio 0.34, 95% confidence interval 0.12-0.93). Of the 229 subjects who were visually impaired, 108 (59%) did not seek treatment. Multivariate analysis revealed that the odds for seeking treatment were significantly lower for Hindus than Muslims (odds ratio 0.53, 95% confidence interval 0.28-0.98). The reasons for not seeking treatment could be classified as personal (49.5%), economic (30.8%), and social (19.6%). CONCLUSION A large proportion of subjects with visual impairment in this urban population in India did not seek treatment even after noticing decrease in vision. Projecting these data to the 155 million urban population >15 years of age in India, there may be 4.9 million (95% confidence interval 4.3-5.5 million) people in urban India who are not seeking treatment for their visual impairment even after noticing decrease in vision. These data suggest that efforts have to be made to better understand the reasons for this phenomenon so that optimal utilisation of the available eyecare services in urban India can be planned.
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Affiliation(s)
- R Dandona
- Public Health Ophthalmology Service, LV Prasad Eye Institute, Hyderabad, India
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2462
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2463
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2464
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2465
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Abstract
On the verge of the new millennium, hypertension remains an area of significant unmet medical need. Although progress has been made in the awareness, treatment, and control of hypertension during the last half of the 20th century, recent trends suggest that progress has stalled. Unfavorable trends in awareness and control have been noted by researchers at the Mayo Clinic, in a community that is socioeconomically prosperous with easy access to primary and tertiary medical care. Evidence suggests that a renewed focus on systolic blood pressure and on efforts to maintain compliance will result in better outcomes in populations at risk. Hiatt and Goldman have presented the case for "making medicine more scientific"--that is, understanding how the application of medical care advances can best be applied to benefit population health status. This is the challenge that hypertension control presents in world populations. Aging societies make this challenge an urgent concern.
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Affiliation(s)
- J D Jackson
- Executive Director Outcomes Research, Bristol-Myers Squibb, PO Box 4000, J-34-09, Princeton, NJ 08543-4000, USA
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2466
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Sata M, Yoshitake K, Utsunomiya H, Hatada K, Ohtsuka T, Sugasaki H, Nakane Y. Factors affecting disability in patients attending the internal medicine departments of general hospitals. Psychiatry Clin Neurosci 1999; 53:611-20. [PMID: 10687740 DOI: 10.1046/j.1440-1819.1999.00615.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study was to investigate the effect of sociodemographic factors, physical factors and mental factors on the physical and social disability of patients attending outpatient clinics of general hospitals. Physical and psychiatric morbidity in 1580 consecutive patients attending the internal medicine department of general hospitals was assessed using a stratified two-stage sampling design method. Of the total, 336 patients completed the second stage interview composed of Primary Care Version of Composite International Diagnostic Interview and Groningen Social Disability Schedule to assess sociodemographic, physical and mental factors. In this study, restricted activity days, disability days and Brief Disability Questionnaire were used for the assessment of physical disability, and Groningen Social Disability Schedule was used for social disability. Sociodemographic, physical and mental factors were all related to disability. Among sociodemographic factors, unemployment was associated with physical disability and social disability mildly. Among physical factors, the severity of physical disease was not associated with disability and medically explained somatic symptoms were associated with disability. Furthermore, the mental factor was more strongly associated with physical and social disability. It could be said that the mental factor is more strongly associated with physical and social disability than sociodemographic or physical factors. In addition, even mild mental symptoms not leading to ICD-10 mental disorders affected disability. From the viewpoint of the patients' burden, it is important to assess the mental symptoms as well as physical status in outpatient clinics of internal medicine or primary care.
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Affiliation(s)
- M Sata
- Department of Neuropsychiatry, Nagasaki University School of Medicine, Nishisonogi-gun, Japan
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2467
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Berger K, Ajani UA, Kase CS, Gaziano JM, Buring JE, Glynn RJ, Hennekens CH. Light-to-moderate alcohol consumption and the risk of stroke among U.S. male physicians. N Engl J Med 1999; 341:1557-64. [PMID: 10564684 DOI: 10.1056/nejm199911183412101] [Citation(s) in RCA: 199] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Several studies have shown U- or J-shaped relations between alcohol consumption and the risk of stroke. We evaluated the effect of light-to-moderate alcohol intake on the risk of stroke, with separate analyses of ischemic stroke and hemorrhagic stroke. METHODS Our analyses were based on a prospective cohort study of 22,071 male physicians, 40 to 84 years old, who were participating in the Physicians' Health Study. At base line, the participants reported that they had no history of stroke, transient ischemic attack, or myocardial infarction and were free of cancer. Alcohol intake, reported by 21,870 participants at base line, ranged from none or almost none to two or more drinks per day. RESULTS During an average of 12.2 years of follow-up, 679 strokes were reported. As compared with participants who had less than one drink per week, those who drank more had a reduced overall risk of stroke (relative risk, 0.79; 95 percent confidence interval, 0.66 to 0.94) and a reduced risk of ischemic stroke (relative risk, 0.77; 95 percent confidence interval, 0.63 to 0.94). There was no statistically significant association between alcohol consumption and hemorrhagic stroke. The overall relative risks of stroke for the men who had one drink per week, two to four drinks per week, five or six drinks per week, or one or more drinks per day were 0.78 (95 percent confidence interval, 0.59 to 1.04), 0.75 (95 percent confidence interval, 0.58 to 0.96), 0.83 (95 percent confidence interval, 0.62 to 1.11), and 0.80 (95 percent confidence interval, 0.64 to 0.99), respectively, in an analysis in which we controlled for major risk factors for stroke. CONCLUSIONS Light-to-moderate alcohol consumption reduced the overall risk of stroke and the risk of ischemic stroke in men. The benefit is apparent with as little as one drink per week. Greater consumption, up to one drink per day, does not increase the observed benefit.
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Affiliation(s)
- K Berger
- Department of Medicine, Brigham and Women's Hospital, Boston, MA 02215, USA
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2468
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Johnston TG, Kelly CB, Stevenson MR, Cooper SJ. Plasma norepinephrine and prediction of outcome in major depressive disorder. Biol Psychiatry 1999; 46:1253-8. [PMID: 10560030 DOI: 10.1016/s0006-3223(99)00134-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Several epidemiologic and clinical factors have been shown to predict long term outcome in major depressive disorder (MDD). The value of biological predictors has not been extensively studied. This study examined whether plasma norepinephrine may be useful in predicting outcome in MDD. METHODS Forty patients were followed up 8 years after an index major depressive episode. Three outcome variables were assessed: time to first recurrence (the primary outcome measure), the Lee and Murray criteria and the Depression Outcome Scale (DOS). The results were examined against plasma norepinephrine value, at the index episode, using survival analysis and linear regression. RESULTS High plasma norepinephrine at the index episode was positively and significantly associated with time to first recurrence for patients with nonpsychotic MDD (n = 31, chi 2 = 8.38, on 1 df, p < .01). Similarly, plasma norepinephrine was significantly associated with good global outcome, both using Lee and Murray criteria (n = 34, adjusted R2 = .24, p < .01) and DOS criteria (n = 31, adjusted R2 = .17, p < .01) for this group of patients. In contrast, plasma norepinephrine was not significantly related to outcome for MDD with psychotic features. CONCLUSIONS Plasma norepinephrine at index episode seems to be a predictor of outcome in MDD.
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Affiliation(s)
- T G Johnston
- Department of Mental Health, Queen's University of Belfast, UK
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2469
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Affiliation(s)
- A Nicoletti
- INSERM U430, Hôpital Broussais, Paris, France.
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2470
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Wongsrichanalai C, Chuanak N, Tulyayon S, Thanoosingha N, Laoboonchai A, Thimasarn K, Brewer TG, Heppner DG. Comparison of a rapid field immunochromatographic test to expert microscopy for the detection of Plasmodium falciparum asexual parasitemia in Thailand. Acta Trop 1999; 73:263-73. [PMID: 10546844 DOI: 10.1016/s0001-706x(99)00040-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We assessed a rapid, Plasmodium falciparum histidine rich protein 2 (PfHRP2)-based immunochromatographic test (ICT Malaria Pf Test), for detection of asexual P. falciparum parasitemia in 551 subjects in three groups: (1) symptomatic patients self-referring for diagnosis, (2) villagers in a screening survey, and (3) patients recently treated for P. falciparum malaria. Expert light microscopy was the reference standard. ICT test performance was similar for diagnostic and screening modes. Four findings emerged: (1) test sensitivity correlated directly with parasite density, (2) test band intensity correlated directly with parasite density, (3) persistent test positivity after parasite clearance precludes its use for monitoring early therapeutic responses, and (4) a false negative test at 18,000 parasites/microl is unexplained. We conclude that a strong positive ICT test is highly predictive of falciparum asexual parasitemia for the diagnosis of new cases of falciparum malaria in Thailand, but a negative test result is inadequate to exclude parasitemia < 300/microl, and in some instances, even a higher parasitemia.
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Affiliation(s)
- C Wongsrichanalai
- Department of Immunology & Medicine, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
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2471
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Abstract
A large number of viruses can be found in the human intestine. Some (bacteriophages) infect the bacteria present as normal flora and others use the gut as a portal of entry. This review examines the virology, pathogenesis, immunology, epidemiology, clinical features, treatment and prevention of the viral enteropathogens. Rotavirus is undoubtedly the most important, causing an estimated 800,000 deaths each year, especially in developing countries. Recently, an oral live quadrivalent rhesus rotavirus vaccine has been licensed for use in the USA. It has great potential but there are a number of hurdles to be overcome before it can be given to infants in developing countries. Molecular techniques are revolutionizing our understanding of rotavirus pathogenesis, and the tremendous diversity of Caliciviridae and Astroviridae, as well as producing new diagnostic techniques and vaccines.
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Affiliation(s)
- C A Hart
- Department of Medical Microbiology and Genitourinary Medicine, University of Liverpool, PO Box 147, Liverpool L69 3GA, UK.
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2472
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Rubenstein LV, Jackson-Triche M, Unützer J, Miranda J, Minnium K, Pearson ML, Wells KB. Evidence-based care for depression in managed primary care practices. Health Aff (Millwood) 1999; 18:89-105. [PMID: 10495595 DOI: 10.1377/hlthaff.18.5.89] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This paper evaluates whether externally designed, evidence-based interventions for improving care for depression can be locally implemented in managed care organizations. The interventions were carried out as part of a randomized trial involving forty-six practices within six diverse, nonacademic managed care plans. Based on evaluation of adherence to the intervention protocol, we determined that local practice leaders are able to implement predesigned interventions for improving depression care. Adherence rates for most key intervention activities were above 70 percent, and many were near 100 percent. Three intervention activities fell short of the goal of 70 percent implementation and should be targets for future improvement.
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2473
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Marchioli R. Antioxidant vitamins and prevention of cardiovascular disease: laboratory, epidemiological and clinical trial data. Pharmacol Res 1999; 40:227-38. [PMID: 10479466 DOI: 10.1006/phrs.1999.0480] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Naturally occurring antioxidants like vitamin E, beta-carotene, and vitamin C can inhibit the oxidative modification of low-density lipoproteins. This action could positively influence the atherosclerotic process and, as a consequence, the progression of coronary heart disease. A wealth of experimental studies provide a sound biological rationale for the mechanisms of action of antioxidants, whereas epidemiological studies strongly sustain the 'antioxidant hypothesis'. To data, however, clinical trials with beta-carotene supplements have been disappointing and their use as a preventive intervention for cancer and coronary heart disease should be discouraged. Only scant data from clinical trials are available for vitamin C. As for vitamin E, discrepant results have been obtained by the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study with a low-dose vitamin E supplementation (50 mg daily) and the Cambridge Heart Antioxidant Study (400-800 mg daily). Currently ongoing are several large-scale clinical trials that will help in clarifying the role of vitamin E in the prevention of atherosclerotic coronary disease.
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Affiliation(s)
- R Marchioli
- Laboratory of Clinical Epidemiology of Cardiovascular Disease, Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, Via Nazionale, Santa Maria, Imbaro (Chieti), 66030, Italy
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2474
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Parikh CR, Karnad DR. Quality, cost, and outcome of intensive care in a public hospital in Bombay, India. Crit Care Med 1999; 27:1754-9. [PMID: 10507594 DOI: 10.1097/00003246-199909000-00009] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To study the quality, cost, and benefits of intensive care in a public hospital in Bombay, India. DESIGN Prospective collection of data. SETTING Seventeen-bed medical-neurology-neurosurgery intensive care unit (ICU) of a municipal teaching hospital. PATIENTS A total of 993 consecutive ICU patients during a 16-month period. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The 993 patients aged 36.5 +/- 16 yrs (mean +/- SD) had a day-1 Acute Physiology and Chronic Health Evaluation (APACHE) II score of 14.9 +/- 9.6 (mean +/- SD), with a predicted mortality of 21.7%; the observed mortality was 36.2% (standardized mortality ratio = 1.67). The day-1 Therapeutic Intervention Scoring System (TISS) points were 17.7 +/- 6.2 (mean +/- SD), and total TISS points per patient were 87.6 +/- 110 (mean +/- SD). Nurse-to-patient ratio in the ICU was 3:17 and the average workload per nurse was 64.2 TISS points. The average length of stay was 5.5 days (SD = 7.1 days). The overall cost of treating 993 patients was, in Indian rupees (Rs), Rs 107,79,209 (U.S. $307,997), and cost per patient per day was Rs 1,973 (U.S. $57). The cost per survivor was Rs 17,029 (U.S. $487) and cost per TISS point was Rs 90.14 (U.S. $2.57). The low cost per TISS point was attributable to the reuse of disposable equipment and lower cost of drugs and salaries for medical and paramedical staff. CONCLUSIONS Intensive care in India is cheaper than in the West; however, mortality is 1.67 times that for patients with similar APACHE II scores in ICUs in the United States. This finding may be attributable to the lesser intensity of care per patient (lower day-1 TISS points), lower nurse-to-patient ratio because of shortage of trained personnel and budgetary constraints, and higher workload per nurse (64.2 TISS points per nurse, compared with 40 points per nurse in the West). In addition, the APACHE II scores may underestimate mortality for Indian patients because of differences in case mix, higher lead time between onset of admission and treatment before ICU admission, and possible inappropriateness of age points derived from American patients for Indian subjects because of a higher burden of diseases at lower ages in Indian patients.
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Affiliation(s)
- C R Parikh
- Department of Nephrology, University of Colorado Health Science Center, Denver CO, USA
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2475
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McAlearney AS, Schweikhart SB, Pathak DS. Quality-adjusted life-years and other health indices: a comparative analysis. Clin Ther 1999; 21:1605-29; discussion 1604. [PMID: 10509854 DOI: 10.1016/s0149-2918(00)80015-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article provides a descriptive overview of both unadjusted and adjusted health indices that are being applied in the current health-services research literature. We describe, give examples, and discuss a variety of the better-known health indices. Summary tables that compare health indices across dimensions, such as level of analysis, weighting methodology, preference measurement, and longevity measurement, are also included. Our goal is to provide information about similarities among and differences between health indices and enhance understanding of comparative health-outcome measurement. An extensive list of references is included to guide the reader toward additional discussions of metrics and methodologies. Given the multitude of health indices reported in the literature, this descriptive and comparative overview provides a framework for understanding these metrics in the context of health-outcomes research.
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Affiliation(s)
- A S McAlearney
- Graduate Program in Health Services Management and Policy, and Center for Health Outcomes, Policy and Evaluation Studies, The Ohio State University, Columbus 43210-1234, USA
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2476
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McQuaid JR, Stein MB, Laffaye C, McCahill ME. Depression in a primary care clinic: the prevalence and impact of an unrecognized disorder. J Affect Disord 1999; 55:1-10. [PMID: 10512600 DOI: 10.1016/s0165-0327(98)00191-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study assesses depression among primary care patients, the relationship between depression and functioning, and how frequently depressed individuals receive mental health treatment. METHODS Two hundred and thirteen participants completed a diagnostic interview and measures of functional impairment and service utilization. RESULTS Sixty-two clinic patients were depressed, and depressed individuals experienced significant functional impairment even after controlling for comorbid anxiety disorders and medical problems. However, less than 40% of depressed individuals were receiving treatment for depression. Severity of impairment was related to likelihood of receiving mental health services. LIMITATIONS Several factors to consider when evaluating this study are the cross-sectional design, use of self-report data, and lack of random sampling. CONCLUSIONS These results show that depression has a unique and significant impact on the functioning of primary care patients, and emphasize the need for identification of depressive disorders in primary care.
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2477
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Abstract
BACKGROUND Global and regional estimates show that non-communicable diseases in old age are rising in importance relative to other causes of ill health as populations age, and as progress continues against communicable diseases among infants and children. However, these estimates, which cover population groups at all income levels, do not accurately reflect conditions that prevail among the poor. We estimated the burden of disease among the 20% of the global population living in countries with the lowest per capita incomes, compared with the 20% of the world's people living in the richest countries. METHODS Estimates for the global poorest and richest 20% were prepared for 1990 for deaths and disability-adjusted life years (DALYs), by a procedure used in a prominent recent study of the global disease burden. Projected mortality rates in the year 2020 were established for the world's poorest and richest 20% under various assumptions about the future rate of decline in communicable and non-communicable diseases. FINDINGS In 1990, communicable diseases caused 59% of death and disability among the world's poorest 20%. Among the world's richest 20%, on the other hand, non-communicable diseases caused 85% of death and disability. A raised baseline rate of communicable disease decline between 1990 and 2020 would increase life-expectancy among the world's poorest 20% around ten times as much as it would the richest 20% (4.1 vs 0.4 years). However, the poorest 20% would gain only around a quarter to a third as much as the richest 20% from a similar increase in non-communicable diseases (1.4 vs 5.3 years). As a result, a faster decline in communicable diseases would decease the poor-rich gap in 2020, but under an accelerated rate of overall decline in non-communicable diseases, the poor-rich gap would widen. INTERPRETATION Our estimates are crude, but despite their limitations, they give a more accurate picture of changes in attributable mortality among the world's poor than do the global averages in current use.
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Affiliation(s)
- D R Gwatkin
- International Health Policy Program and The World Bank, Washington, DC 20433, USA
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2478
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Davies L, Angus RM, Calverley PM. Oral corticosteroids in patients admitted to hospital with exacerbations of chronic obstructive pulmonary disease: a prospective randomised controlled trial. Lancet 1999; 354:456-60. [PMID: 10465169 DOI: 10.1016/s0140-6736(98)11326-0] [Citation(s) in RCA: 308] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The role of oral corticosteroids in treating patients with exacerbations of chronic obstructive pulmonary disease (COPD) remains contentious. We assessed in a prospective, randomised, double-blind, placebo-controlled trial the effects of oral corticosteroid therapy in patients with exacerbations of COPD requiring hospital admission. METHODS We recruited patients with non-acidotic exacerbations of COPD who were randomly assigned oral prednisolone 30 mg once daily (n=29) or identical placebo (n=27) for 14 days, in addition to standard treatment with nebulised bronchodilators, antibiotics, and oxygen. We did spirometry and recorded symptom scores daily in inpatients. Time to discharge and withdrawals were noted in each group. We recalled patients at 6 weeks to repeat spirometry and collect data on subsequent exacerbations and treatment. Hospital stay was analysed by intention to treat and forced expiratory volume in 1 s (FEV1) according to protocol. FINDINGS FEV1 after bronchodilation increased more rapidly and to a greater extent in the corticosteroid-treated group: percentage predicted FEV1 after bronchodilation rose from 25.7% (95% CI 21.0-30.4) to 32.2% (27.3-27.1) in the placebo group (p<0.0001) compared with 28.2% (23.5-32.9) to 41.5% (35.8-47.2) in the corticosteroid-treated group (p<0.0001). Up to day 5 of hospital stay, FEV1 after bronchodilation increased by 90 mL daily (50.8-129.2) and by 30 mL daily (10.4-49.6) in the placebo group (p=0.039). Hospital stays were shorter in the corticosteroid-treated group. Groups did not differ at 6-week follow-up. INTERPRETATION These data provide evidence to support the current practice of prescribing low-dose oral corticosteroids to all patients with non-acidotic exacerbations of COPD requiring hospital admission.
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Affiliation(s)
- L Davies
- Aintree Chest Centre and Department of Medicine, University Hospital Aintree, University of Liverpool, UK
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2479
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Herran A, Vazquez-Barquero JL. Recognition and treatment of mental disorders in primary health care. Ann Saudi Med 1999; 19:383-4. [PMID: 17277551 DOI: 10.5144/0256-4947.1999.383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Herran
- Clinical and Social Psychiatry Research Unit, Department of Psychiatry, University Hospital "Marques de Valdecilla", Santander, Spain
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2480
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Odero W, Zwi AB. An evaluation of sensitivity and specificity of blood alcohol concentrations obtained by a breathalyser survey in a casualty department in Kenya. ACCIDENT; ANALYSIS AND PREVENTION 1999; 31:341-345. [PMID: 10384227 DOI: 10.1016/s0001-4575(98)00063-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Whereas breathalysers have been shown to provide blood alcohol concentration (BAC) measurements comparable to those obtained by gas chromatography, such evidence has not been reported in low and middle income countries where measures for preventing alcohol-related injuries are virtually non-existent. Before promoting any method of blood alcohol evaluation, as a routine procedure for monitoring the association of alcohol with different types of injuries in Kenya, we sought to assess the reliability and validity of blood alcohol results obtained by a breathalyser, using gas chromatography analysis values as the reference, in a sample of 179 trauma-affected adults presenting to casualty departments. No differences in proportions of subjects with high levels of blood alcohol (equal to or greater than 50 mg%) were detected by breath and blood test procedures (58.7 vs 60.3%). Breathalyser readings yielded high levels of sensitivity and specificity (97.2 and 100%, respectively) with optimal positive and negative predictive values (100 and 95.9%, respectively) at higher BACs (> or = 50 mg%). The study thus reaffirms that breathalyser tests are of value in detecting high blood alcohol levels and can be used to rapidly identify intoxicated subjects. The procedure is easy to perform and can be used for monitoring the association between blood alcohol level and driving in low-income developing countries.
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Affiliation(s)
- W Odero
- Department of Epidemiology and Preventive Medicine, Faculty of Health Sciences, Moi University, Eldoret, Kenya
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2481
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Caligiuri G, Levy B, Pernow J, Thorén P, Hansson GK. Myocardial infarction mediated by endothelin receptor signaling in hypercholesterolemic mice. Proc Natl Acad Sci U S A 1999; 96:6920-4. [PMID: 10359814 PMCID: PMC22017 DOI: 10.1073/pnas.96.12.6920] [Citation(s) in RCA: 150] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Myocardial infarction is linked to atherosclerosis, yet the sequence leading from silent coronary atherosclerosis to acute myocardial infarction has remained unclear. Here we show that hypercholesterolemic apolipoprotein E-/- low density lipoprotein receptor-/- mice develop not only coronary atherosclerosis but also myocardial infarction. Exposure of mice to mental stress or hypoxia led to acute ischemia, which, in a large proportion of the mice, was followed by electrocardiographic changes, leakage of troponin T, and loss of dehydrogenase from the myocardium, all indicative of acute myocardial infarction. Apoptotic death of cardiomyocytes was followed by inflammation and fibrosis in the heart. All these pathological changes could be prevented by a blocker of the endothelin type A receptor. Thus, stress elicits myocardial infarction through endothelin receptor signaling in coronary atherosclerosis caused by hypercholesterolemia.
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Affiliation(s)
- G Caligiuri
- Center for Molecular Medicine, Department of Medicine, Karolinska Institutet, SE-17176 Stockholm, Sweden
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2482
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Plitponkarnpim A, Andersson R, Jansson B, Svanström L. Unintentional injury mortality in children: a priority for middle income countries in the advanced stage of epidemiological transition. Inj Prev 1999; 5:98-103. [PMID: 10385827 PMCID: PMC1730504 DOI: 10.1136/ip.5.2.98] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine the relationship between the magnitude, and the relative importance of unintentional child injury mortality with socioeconomic development, and to conceptualise the dynamic changes in injury mortality within the framework of epidemiological transition. DESIGN Ecological cross sectional study using data on 51 countries. MAIN OUTCOME MEASURES The relationship between total mortality rates, unintentional injury mortality rates, and percentage in children 1-14 years of age with gross national product (GNP) per capita. RESULTS Unintentional injury mortality rates in children were negatively correlated with GNP per capita. However, by categorising the data, we found some areas of non-correlation: in children 5-14 years in low income versus lower middle income countries, and in all age and gender groups in lower high income versus higher high income countries. A high percentage of total deaths due to injuries was clearest in the lower middle income countries in all age and gender groups. CONCLUSIONS The changes in child injury mortality in relation to socioeconomic development could be conceptualised as three stages: a stage of high magnitude; a stage of high priority; and a stage of improvement. Most middle income countries are in the high priority stage where both injury mortality rates and injury percentage of total deaths are high.
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Affiliation(s)
- A Plitponkarnpim
- Karolinska Institute, Department of Public Health Sciences, Stockholm, Sweden.
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2483
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Laurichesse H, Dedman D, Watson JM, Zambon MC. Epidemiological features of parainfluenza virus infections: laboratory surveillance in England and Wales, 1975-1997. Eur J Epidemiol 1999; 15:475-84. [PMID: 10442474 DOI: 10.1023/a:1007511018330] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Hospital laboratory reports of parainfluenza virus (PIV) infections from England and Wales between 1975 and 1997 were analysed with regard to PIV type and seasonality, and in addition, those between 1985 1997 with regard to age, sex and clinical features. Laboratory-based surveillance data highlight striking differences in the seasonality of different PIV types. PIV-3 reports demonstrated a clear annual epidemic cycle, with a peak usually occurring in late spring or summer, whereas peaks of PIV-1 and PIV-2 occurred at one or two year intervals, in the late autumn or early winter. PIV-4 also occurred most frequently in the late autumn or early winter, but a clear epidemic cycle could not be identified. Laboratory surveillance data also provide insight into the age and disease distribution of PIV infection in children and indicate severity of PIV infection in immunosuppressed adults. Of 8221 PIV reports received between 1985-1997, PIV-3 accounted for 70.8%, PIV-1 for 17.2%, PIV-2 for 7.5%, and PIV-4 for 1.1%; 64.1% of reports came from infants under one year, 24.4% from children aged 1-4 years and 7.2% from individuals aged 5 years or older, with an excess of males in all age groups. Bronchiolitis, croup and pneumonia occurred in association with all PIV types. In children under 1 year, PIV-2 infections were more likely to be associated with bronchiolitis than infections with other PIV types. In children under 15 years, croup was more frequently associated with PIV-1 and PIV-2 than with PIV-3 or PIV-4. In 392 (7.2%) of the reported PIV infections between 1989 and 1997 an underlying condition was implicated, which included immunosuppression or chronic cardiac or pulmonary disease. Considerable morbidity is associated with PIV infections in infants and young children and would make the widescale use of a vaccine a valuable public health intervention. Surveillance information is essential to guide the development and use of preventive measures as well as to monitor their effectiveness.
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Affiliation(s)
- H Laurichesse
- Epidemiology Division, Communicable Disease Surveillance Centre, Public Health Laboratory Service, Colindale, London, UK
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2484
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Hultman CM, Sparén P, Takei N, Murray RM, Cnattingius S. Prenatal and perinatal risk factors for schizophrenia, affective psychosis, and reactive psychosis of early onset: case-control study. BMJ (CLINICAL RESEARCH ED.) 1999; 318:421-6. [PMID: 9974454 PMCID: PMC27730 DOI: 10.1136/bmj.318.7181.421] [Citation(s) in RCA: 204] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine prenatal and perinatal risk factors for subsequent development of schizophrenia and affective and reactive psychosis. DESIGN Three population based, case-control studies conducted within a Sweden-wide cohort of all children born during 1973-9. This was done by linking individual data from the Swedish birth register, which represents 99% of all births in Sweden, to the Swedish inpatient register. SUBJECTS Patients listed in inpatient register as having been first admitted to hospital aged 15-21 years with a main diagnosis of schizophrenia (n=167), affective psychosis (n=198), or reactive psychosis (n=292). For each case, five controls were selected. MAIN OUTCOME MEASURES Risks of schizophrenia and affective and reactive psychosis in relation to pregnancy and perinatal characteristics. RESULTS Schizophrenia was positively associated with multiparity (odds ratio 2.0), maternal bleeding during pregnancy (odds ratio 3.5), and birth in late winter (odds ratio 1.4). Affective psychosis was associated with uterine atony (odds ratio 2.2) and late winter birth (odds ratio 1.5). Reactive psychosis was related to multiparity (odds ratio 2.1). An increased risk for schizophrenia was found in boys who were small for their gestational age at birth (odds ratio 3.2), who were number four or more in birth order (odds ratio 3.6), and whose mothers had had bleeding during late pregnancy (odds ratio 4.0). CONCLUSIONS A few specific pregnancy and perinatal factors were associated with the subsequent development of psychotic disorder, particularly schizophrenia, in early adult life. The association of small size for gestational age and bleeding during pregnancy with increased risk of early onset schizophrenia among males could reflect placental insufficiency.
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Affiliation(s)
- C M Hultman
- Department of Neuroscience, Psychiatry, Ullerâker, University of Uppsala, S-750 17 Uppsala 17, Sweden.
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2485
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Rehm J, Bondy S. Alcohol and all-cause mortality: an overview. NOVARTIS FOUNDATION SYMPOSIUM 1999; 216:223-32; discussion 232-6. [PMID: 9949796 DOI: 10.1002/9780470515549.ch14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The relationship between alcohol consumption and all-cause mortality is J-shaped in most industrialized countries. The J-shape is the result of the combination of adverse and beneficial effects of alcohol consumption. Adverse effects include several types of cancer (oropharyngeal, oesophageal, liver, laryngeal and breast cancer), other diseases of the aerodigestive tract, diseases of the heart (alcoholic cardiomyopathy, haemorrhagic stroke, arrhythmia, hypertension), addiction-related mental disorders, and accidents and injuries. Beneficial effects are for ischaemic heart disease and ischaemic stroke. The exact shape of the all-cause mortality curve in a given region depends upon the proportion of the population consuming alcohol at different levels, especially heavy consumption, and on the prevalence of the disorders named above. Thus regions with a relatively low prevalence of ischaemic cardiovascular disease show almost no benefits of consumption, and an all-cause mortality curve which is almost exponential. Females experience a minimum mortality risk at a level of alcohol intake which is lower than that associated with the minimum risk for men. Similarly, an upturn in mortality risk occurs at lower intake levels for women than for men. At present, there is no satisfactory explanation for the observation that the shape of the mortality curve varies with the consumption level of the cohort under study. Heavier-drinking cohorts tend to display their minimum risk at relatively higher levels of alcohol intake than cohorts with lower alcohol consumption.
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Affiliation(s)
- J Rehm
- Addiction Research Foundation, Toronto, Ontario, Canada
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2486
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Abstract
A rotavirus vaccine was recently licensed by the Food and Drug Administration and is likely to be recommended for use in all infants by both the Advisory Committee on Immunization Practices and the American Academy of Pediatrics. If used as recommended, the vaccine is likely to prevent much of the 500,000 physician visits, 50,000 hospitalizations, and 20 to 40 deaths caused by rotavirus infections every year in the United States. An understanding of the biology, immunology, and pathogenesis of rotavirus infection will help to explain the strengths and limitations of the rotavirus vaccine.
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Affiliation(s)
- P A Offit
- Section of Infectious Diseases, Children's Hospital of Philadelphia, PA 19194, USA
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2487
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Abstract
BACKGROUND The lifetime risk of developing coronary heart disease has not been estimated in a general population. We investigated the lifetime risks of initial coronary events at different ages. METHODS We assessed data for 7733 participants in the Framingham Heart Study, who had been examined at least once at age 40-94 years between 1971 and 1975, found to be free of coronary heart disease, and then followed up. We estimated the lifetime risks of coronary heart disease (angina pectoris, coronary insufficiency, myocardial infarction, or death from coronary heart disease) by multiple-decrement life-table methods. FINDINGS The 7733 patients were followed up for a total of 109,948 person-years. Overall, 1157 participants developed coronary heart disease. 1312 died from non-coronary heart disease causes. Lifetime risk of coronary heart disease at age 40 years was 48.6% (95% CI 45.8-51.3) for men and 31.7% (29.2-34.2) for women. At age 70 years, lifetime risk was 34.9% (31.2-38.7) for men and 24.2% (21.4-27.0) for women. After we excluded isolated angina pectoris as an initial event, the lifetime risk of coronary artery disease events at age 40 years was 42.4% for men and 24.9% for women. INTERPRETATION Lifetime risk at age 40 years is one in two for men and one in three for women. Even at age 70 years it is one in three for men and one in four for women. This knowledge may promote efforts in education, screening, and treatment for prevention of coronary heart disease in younger and older patients.
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Affiliation(s)
- D M Lloyd-Jones
- National Heart, Lung, and Blood Institute's Framingham Heart Study, National Institutes of Health, Massachusetts 01702, USA.
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2488
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Newman RD, Grupp-Phelan J, Shay DK, Davis RL. Perinatal risk factors for infant hospitalization with viral gastroenteritis. Pediatrics 1999; 103:E3. [PMID: 9917483 DOI: 10.1542/peds.103.1.e3] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT A tetravalent vaccine against rotavirus, the most commonly identified etiologic agent of viral gastroenteritis (GE), has recently been licensed for use in the United States. OBJECTIVE To evaluate whether specific groups of infants might be at sufficiently high risk to warrant a focused rotavirus vaccine policy, we investigated perinatal risk factors for hospitalization with viral GE and rotavirus in the first year of life. DESIGN Population-based, case-control study. SETTING Washington State linked birth certificate and hospital discharge abstracts from 1987 through 1995. PATIENTS Infants, 1 through 11 months of age, hospitalized for viral GE (N = 1606) were patients in this study. Control subjects were 8084 nonhospitalized infants, frequency-matched to patients on year of birth. PRIMARY OUTCOME MEASURE Maternal and infant characteristics associated with infant hospitalization for viral GE. RESULTS We found a significant association between birth weight and the risk for hospitalization. Very low birth weight infants (<1500 g) were at the highest risk (odds ratio [OR] 2.6; 95% confidence interval [CI]: 1.6,4.1);, low birth weight infants (1500-2499 g), at intermediate risk (OR 1.6; 95% CI: 1.3,2.1); and large infants (>4000 g), at reduced risk (OR 0.8; 95% CI: 0.6,0.9). Other characteristics associated with GE hospitalization were male gender (OR 1.4; 95% CI: 1.3,1.6); maternal smoking (OR 1.2; 95% CI: 1.1,1. 4); unmarried mother (OR 1.2; 95% CI: 1.1,1.4); Medicaid insurance (OR 1.4; 95% CI: 1.3,1.7); and maternal age <20 years (OR 1.2; 95% CI: 1.0,1.5). Infants born October through December were at decreased risk for hospitalization (OR 0.8; 95% CI: 0.7,0.9), as were infants born to Asian mothers (OR 0.5; 95% CI: 0.3,0.7), and infants born to mothers >34 years of age (OR 0.7; 95% CI: 0.6,0.9). Using these factors, the area under a receiver operating characteristic curve was 0.63. Therefore, to achieve a sensitivity of 90% in identifying high-risk infants, specificity would fall to 10%. Subanalyses of children admitted for viral GE during the peak of the Northwest rotavirus season (January to March) and children with confirmed rotavirus infection demonstrated similar risk factors and receiver operating characteristic curves. CONCLUSION We conclude that a focused rotavirus vaccination policy using readily identifiable potential high-risk groups would be unlikely to prevent most infant hospitalizations associated with rotavirus infection. However, the safety of rotavirus vaccine in low birth weight and premature infants must be established, because these children appear to be at greater risk for hospitalization with viral GE and rotavirus.
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Affiliation(s)
- R D Newman
- Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
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2489
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Leeman E. Limitations of epidemiological field data for mental health policy decisions. Int J Psychiatry Clin Pract 1999; 3:155-7. [PMID: 24927200 DOI: 10.3109/13651509909022728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- E Leeman
- Department of Psychiatry, Columbia University, 161 Fort Washington Avenue, New York, NY, 10032, USA, +1 (212) 781-2237, +1 (212) 928-8392
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2490
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Okeke IN, Lamikanra A, Edelman R. Socioeconomic and behavioral factors leading to acquired bacterial resistance to antibiotics in developing countries. Emerg Infect Dis 1999; 5:18-27. [PMID: 10081668 PMCID: PMC2627681 DOI: 10.3201/eid0501.990103] [Citation(s) in RCA: 290] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In developing countries, acquired bacterial resistance to antimicrobial agents is common in isolates from healthy persons and from persons with community-acquired infections. Complex socioeconomic and behavioral factors associated with antibiotic resistance, particularly regarding diarrheal and respiratory pathogens, in developing tropical countries, include misuse of antibiotics by health professionals, unskilled practitioners, and laypersons; poor drug quality; unhygienic conditions accounting for spread of resistant bacteria; and inadequate surveillance.
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Affiliation(s)
- I N Okeke
- Obafemi Awolowo University, Ile-Ife, Nigeria
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2491
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Abstract
BACKGROUND Rotavirus gastroenteritis is an important cause of morbidity and mortality worldwide. OBJECTIVES To review the biology, immunology, and virology of rotavirus infections and describe the efforts towards the construction of vaccines using human and animal rotaviruses. STUDY DESIGN A review of the literature and provision of the author's understanding and speculation of vaccination of infants against rotavirus disease. RESULTS In August 1998 the Food and Drug Administration in the United States approved the licensure of a rotavirus vaccine. Both the Advisory Committee of Immunization Practices and the American Academy of Pediatrics are likely to recommend that the vaccine be given to all children by mouth as a series of three doses at 2, 4, and 6 months of age. The vaccine is made by combining a simian rotavirus strain (RRV) with several human strains representing different rotavirus serotypes. An understanding of the biology, immunology, and virology of rotavirus will help to explain the strengths and limitations of the rotavirus vaccine. CONCLUSION If used as recommended, the rotavirus vaccine should cause a significant decrease in the number of deaths, hospitalizations, and office visits of children infected with rotavirus.
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Affiliation(s)
- P A Offit
- Section of Infectious Diseases, Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, USA.
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2492
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Leistikow BN, Martin DC, Jacobs J, Rocke DM. Smoking as a risk factor for injury death: a meta-analysis of cohort studies. Prev Med 1998; 27:871-8. [PMID: 9922070 DOI: 10.1006/pmed.1998.0374] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Injury and tobacco effects represent one-quarter of the global burden of disease. Understanding the causes of injury and the effects of smoking may help reduce those burdens. Some smokers have high risks of injury. We provide an initial meta-analysis of cohort associations between smoking and fatal injury. METHODS Three authors independently searched MEDLINE, and bibliographies of the pertinent studies found, for cigarette smoker-specific injury death data which allowed estimation of an appropriate relative risk (RR) and 95% confidence interval (CI). Relative risks and dose response were summarized by fixed effects and Poisson modeling, respectively. RESULTS Six studies covering 10 pertinent cohorts were located. Associations between smoking and injury death have been significant after adjustment or, in effect, stratification for age, race, sex, country, and, respectively, alcohol, marriage, education, and body mass; job and time period; job, alcohol, and exercise; etc. Summary dose-response trends were significantly positive (P < 0.00005). Cigarette smoking predicted summary injury death crude RRs of 1.61 (CI 1.44-1.81) vs never smokers and 1.39 (CI 1.25-1.55) vs ex-smokers. CONCLUSIONS Smoking has significant, consistent, dose-response, often strong and independent, prospective associations with injury death, internationally.
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Affiliation(s)
- B N Leistikow
- Department of Epidemiology and Preventive Medicine, University of California, Davis 95616-8638, USA.
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2493
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De Smet PA. Traditional pharmacology and medicine in Africa. Ethnopharmacological themes in sub-Saharan art objects and utensils. JOURNAL OF ETHNOPHARMACOLOGY 1998; 63:1-175. [PMID: 10340784 DOI: 10.1016/s0378-8741(98)00031-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Drawing from the general description that ethnopharmacology studies the human use of crude drugs and poisons in a traditional context, ethnopharmacological themes in native art can be defined as themes visualizing different features of traditional medicines and poisons, such as natural sources, methods of preparation, containers, usage and implements, target diseases and effects. This review documents that native African art objects and utensils are a goldmine of such ethnopharmacological themes by focusing on the following subjects: (a) objects related to the use of medicines (sources as well as tools for their collection, preparation and keeping); (b) objects related to the use of poisons (e.g. for ordeals, hunting and fishing); (c) objects related to the use of psychotropic agents (e.g. alcoholic beverages, kola nuts, smoking and snuffing materials); (d) pathological representations (e.g. treponematoses, leprosy, smallpox, swollen abdomen, scrotal enlargement, goiter and distorted faces); and (e) portrayals of certain types of treatment (e.g. topical instillations, perinatal care, and surgery). To avoid the impression that ethnopharmacology has little else to offer than armchair amusement, an epilogue outlines the medical relevance of this interdisciplinary science for Western and African societies.
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Affiliation(s)
- P A De Smet
- Scientific Institute Dutch Pharmacists, The Hague, The Netherlands.
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2494
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2495
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Davis TM. Adverse effects of antimalarial prophylactic drugs: an important consideration in the risk-benefit equation. Ann Pharmacother 1998; 32:1104-6. [PMID: 9793605 DOI: 10.1345/aph.18239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- T M Davis
- Department of Medicine, University of Western Australia.
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2496
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Affiliation(s)
- J M Robine
- INSERM Démographie et Santé, Val d'Aurelle, Montpellier, France
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2497
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Olesen J, Zberg G, Vestergaard P. Disorders of the brain: costs, recent progress and future possibilities. Eur J Neurol 1998; 5:425-430. [PMID: 10210870 DOI: 10.1046/j.1468-1331.1998.550425.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- J Olesen
- Department of Neurology, Glostrup Hospital, University of Copenhagen, Ndr. Ringvej, DK-2600, Copenhagen Glostrup, Denmark
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2498
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Abstract
There have been many hundreds of studies which have examined the efficacy of different forms of treatment of psychiatric disorders over the past 40 years. This paper presents some background to these studies for statisticians, illustrating and discussing some of the difficult problems which arise in this specialty of medicine. It also demonstrates a major requirement for statisticians to influence both the design and presentation of clinical trials and provides some suggestions about how this may be done.
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Affiliation(s)
- T Johnson
- Medical Research Council Biostatistics Unit, University Forvie Site, Cambridge, UK.
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2499
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Affiliation(s)
- G Andrews
- School of Psychiatry, University of New South Wales at St Vincent's Hospital, Sydney.
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2500
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Andrews G, Sanderson K, Beard J. Burden of disease. Methods of calculating disability from mental disorder. Br J Psychiatry 1998; 173:123-31. [PMID: 9850224 DOI: 10.1192/bjp.173.2.123] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The Global Burden of Disease studies are important because they encompass morbidity as well as mortality. Burden due to morbidity is calculated from incidence, duration and disability. There is a dearth of epidemiological measurements of disability. METHOD Data from a quasi-community sample (n = 1364) were analysed. Diagnoses of mental and physical disorders, and reports of disability, were based on established methods. RESULTS The disabilities reported in mental and physical disorders were comparable. Disability was correlated with comorbidity. The disability in mental disorders was examined by three methods: pure disorders, main problem and regression. It appears that major depression and substance disorder weights were overestimated, and anxiety disorder weights were underestimated in the Global Burden of Disease studies. CONCLUSIONS A method for disentangling the effects of concurrent comorbidity is presented. The size of burden attributed to mental disorders is of potential benefit for funding mental health services, It is important that we get the estimates right.
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Affiliation(s)
- G Andrews
- Clinical Research Unit for Anxiety Disorders, St Vincent's Hospital, Sydney, Australia.
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