Journal of chronic diseases最新文献

{"title":"The therapeutic efficacy of critical care units from two perspectives: A traditional cohort approach vs a new case-control methodology","authors":"Mary E. Charlson ,&nbsp;Frederic L. Sax","doi":"10.1016/0021-9681(87)90094-4","DOIUrl":"10.1016/0021-9681(87)90094-4","url":null,"abstract":"<div><p>The therapeutic efficacy of critical care units—whether they do more good than harm and for whom—has not been established, except for patients who are admitted for life-sustaining interventions, such as mechanical support of ventilation. However, most patients are admitted for observation, and to facilitate intervention if deterioration occurs or complications develop. The objective of this study was to determine whether direct admission to critical care units reduced mortality rates.</p><p>The population under study consisted of all 604 patients admitted to the medical service during a one month period. At the time of admission, the responsible residents rated patients as to how sick and stable they were. These ratings of illness severity and stability have been shown to be the most significant predictors of in-hospital mortality and morbidity, respectively; they were employed to stratify the patients prognostically.</p><p>The first analysis utilized the entire cohort of 604 patients. After patients who would have been ineligible for entry into a trial were removed, direct admission to the unit was associated with a reduced mortality in only one group of patients: the unstable, moderately ill (<em>p</em> &lt; 0.05). “Unstable, severely ill” patients had high mortality rates when admitted to the floor or units, and stable patients (mildly or moderately ill) did equally well when admitted to either location. A further analysis revealed a possible explanation for these findings. Among the unstable, moderately ill patients, the rate of deterioration of pre-existing problems was significantly lower among patients directly admitted to the unit (<em>p</em> &lt; 0.05), whereas the rate of new complications did not differ. Thus, in unstable, moderately ill patients, direct admission to the unit may reduce mortality by preventing deterioration of pre-existing problems.</p><p>The second analysis employed a new method of assessing therapeutic efficacy in which the scientific principles of a randomized trial design are applied to a case-control design. From the original cohort, the 66 fatalities (cases) were matched to 66 survivors (controls): from both groups, patients who would not have been eligible for a randomized trial of admission to critical care units were removed. Patients were then stratified by stability and severity, and the findings were quite similar to those in the cohort study. Direct admission to the unit had a protective effect in only one group of patients: unstable patients who were moderately ill. The concordance of the findings of the new case-control methodology with the trends in the cohort as a whole lends support to the validity of this new methodology for assessment of therapeutic efficacy.</p><p>Direct admission to the unit had a protective effect for patients who are unstable and moderately ill. Since many such patients are currently admitted to the floor, a randomized trial could be done in this group of patients to con","PeriodicalId":15427,"journal":{"name":"Journal of chronic diseases","volume":"40 1","pages":"Pages 31-39"},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/0021-9681(87)90094-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14921731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying profiles of service requirements in a non-institutionalized elderly population","authors":"François Béland","doi":"10.1016/0021-9681(87)90096-8","DOIUrl":"10.1016/0021-9681(87)90096-8","url":null,"abstract":"<div><p>Studies of service requirements for non-institutionalized elderly have tried, more or less successfully, to consider the effects of the elderly environment. Here, the environment of elderly is explicitly introduced in a secondary analysis of a data bank on service requirements of a sample of elderly. The environment of the elderly is described in terms of their housing environment: the resources available and the physical characteristics of the housing. A cluster analysis was done on these variables in order to identify the context in which the service requirements would have to be met. Twelve living arrangement groups were obtained. A cluster analysis of the service requirements was run on each of these living arrangement groups. The profile of services obtained was much the same for each of these groups. Four different profiles were identified. (1) Half of the sampled elderly were classified in the first profile as not requiring any services beyond those already available to middle-aged adults in the community. (2) The group of elderly people (9%) in need of all the services that can be prescribed in the study were also those living in the most congenial social and physical environment, which suggests that they had found a living arrangement which met their level of service needs. (3) One third of the sampled elderly needed help with heavy housework only. (4) Another 6% of the elderly needed help with many activities of daily living, but did not have access to help. The analysis of service requirements should always explicitly consider the resources available to the individual whose needs are assessed.</p></div>","PeriodicalId":15427,"journal":{"name":"Journal of chronic diseases","volume":"40 1","pages":"Pages 51-64"},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/0021-9681(87)90096-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14921733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Simple test of the Multifactorial-Polygenic Model with sex dependent thresholds","authors":"Ruth Ottman","doi":"10.1016/0021-9681(87)90068-3","DOIUrl":"10.1016/0021-9681(87)90068-3","url":null,"abstract":"<div><p>Under the Multifactorial-Polygenic Model, a sex difference in population incidence implies higher risk in relatives of low risk sex probands than in those of high risk sex probands. The relationship between sex ratio in population incidence and expected relative risk (RR) to first-degree relatives of probands of the low risk sex vs the high risk sex under the Multifactorial-Polygenic Model was examined. Five observations were made from this analysis: (1) as the sex ratio increases, the expected RR increases for each combination of incidence and <em>r</em>, the liability correlation between relatives. (2) RRs are higher for low risk sex relatives than for high risk sex relatives at each combination of incidence, <em>r</em>. and sex ratio. (3) the expected RR increases as <em>r</em> increases at each incidence and sex ratio, and (4) variation in population incidence has little effect on RR at a given sex ratio and <em>r</em>, and (5) the expected RRs are small, rarely exceeding two-fold. The quantitative relationship between sex ratio and RR provides the basis for a simple test of the Multifactorial-Polygenic Model when two different sex or severity thresholds can be identified.</p></div>","PeriodicalId":15427,"journal":{"name":"Journal of chronic diseases","volume":"40 2","pages":"Pages 165-170"},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/0021-9681(87)90068-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14934918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients with primary hyperparathyroidism operated on over a 24-year period: Temporal trends of clinical and laboratory findings","authors":"Mats Palmér ,&nbsp;Sverker Ljunghall ,&nbsp;Göran Åkerström ,&nbsp;Hans-Olov Adami ,&nbsp;Reinhold Bergström ,&nbsp;Lars Grimelius ,&nbsp;Claes Rudberg ,&nbsp;Henry Johansson","doi":"10.1016/0021-9681(87)90063-4","DOIUrl":"10.1016/0021-9681(87)90063-4","url":null,"abstract":"<div><p>Temporal trends of clinical and laboratory data of 441 patients operated upon for primary hyperparathyroidism (HPT) during 1956–1979 were analysed retrospectively. There was a marked increase in the number of operations for HPT during that time period, from 32 during 1956–1964 to 326 in 1970–1979. In parallel there was a decrease in the proportion of patients with classical manifestations of HPT such as renal stones or bone disease, the latter being on the whole rarely seen in this population. The increased number of operations was instead largely attributable to the more frequent diagnosis of HPT in patients with vague psychiatric or neuromuscular symptoms or with no clinical manifestations; the majority of these persons were older women, the proportion of operations in women 45 years of age or older, increasing from 56% during 1956–1964 to 71% during 1970–1979.</p><p>The increased number of operations for HPT during the last decades should be mainly the consequence of a greater awareness of the disease.</p></div>","PeriodicalId":15427,"journal":{"name":"Journal of chronic diseases","volume":"40 2","pages":"Pages 121-130"},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/0021-9681(87)90063-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"14937432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response","authors":"Dr Annie J. Sasco","doi":"10.1016/0021-9681(87)90058-0","DOIUrl":"https://doi.org/10.1016/0021-9681(87)90058-0","url":null,"abstract":"","PeriodicalId":15427,"journal":{"name":"Journal of chronic diseases","volume":"40 4","pages":"Page 368"},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/0021-9681(87)90058-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72203219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response","authors":"Richard W. Hornung,&nbsp;Kyle Steenland,&nbsp;Jay Beaumont","doi":"10.1016/0021-9681(87)90056-7","DOIUrl":"https://doi.org/10.1016/0021-9681(87)90056-7","url":null,"abstract":"","PeriodicalId":15427,"journal":{"name":"Journal of chronic diseases","volume":"40 4","pages":"Page 366"},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/0021-9681(87)90056-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72203220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Assessment of psychological morbidity in primary care","authors":"Kenneth B. Wells","doi":"10.1016/S0021-9681(87)80036-X","DOIUrl":"https://doi.org/10.1016/S0021-9681(87)80036-X","url":null,"abstract":"","PeriodicalId":15427,"journal":{"name":"Journal of chronic diseases","volume":"40 ","pages":"81"},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0021-9681(87)80036-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72220250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Patient reports of health status as predictors of physiologic health in chronic disease","authors":"Donald L. Patrick","doi":"10.1016/S0021-9681(87)80030-9","DOIUrl":"https://doi.org/10.1016/S0021-9681(87)80030-9","url":null,"abstract":"","PeriodicalId":15427,"journal":{"name":"Journal of chronic diseases","volume":"40 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0021-9681(87)80030-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72220299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"James Wayne Bush, M.D., M.P.H. 1933–1985","authors":"","doi":"10.1016/S0021-9681(87)80025-5","DOIUrl":"https://doi.org/10.1016/S0021-9681(87)80025-5","url":null,"abstract":"","PeriodicalId":15427,"journal":{"name":"Journal of chronic diseases","volume":"40 ","pages":"Page v"},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S0021-9681(87)80025-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72220308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Midwinter thaw: Parsnips and people","authors":"Richard V. Lee","doi":"10.1016/0021-9681(87)90070-1","DOIUrl":"https://doi.org/10.1016/0021-9681(87)90070-1","url":null,"abstract":"","PeriodicalId":15427,"journal":{"name":"Journal of chronic diseases","volume":"40 2","pages":"179-181"},"PeriodicalIF":0.0,"publicationDate":"1987-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/0021-9681(87)90070-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72220440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}