The relationships of blood pressure, smoking, serum cholesterol and education levels on total and coronary artery disease (CAD) mortality were evaluated in 4576 Quebec men aged 35 to 64 years, free from overt CAD at entry and followed for 12 years. From January 1974 to January 1986, there were 417 deaths, 131 due to CAD. A progressive increase in total and CAD mortality was observed from quintile 3 to 5 for both systolic and diastolic blood pressure. In comparison to quintile 1, the adjusted relative risks of quintiles 4 and 5 for systolic blood pressure were significantly elevated (2 P less than 0.01), being 1.5 and 2.0 for total mortality, and 2.6 and 3.5 for CAD mortality, respectively. The relative risks of quintiles 4 and 5 for diastolic blood pressure were also significantly elevated (2 P less than 0.04), being 1.5 and 1.6 for total mortality and 1.9 and 2.7 for CAD mortality, respectively. In comparison to those who never smoked, the relative risks of smoking one to 20, and 21 and more cigarettes per day, were 2.1 (2 P less than 0.003) and 3.1 (2 P less than 0.0001) for overall mortality, and 2.2 (2 P less than 0.08) and 3.5 (2 P less than 0.002) for CAD mortality. Men who had discontinued smoking at least one year before the study, had a relative risk not different from those who had never smoked. Serum cholesterol and education levels were not significantly associated with total or CAD mortality.(ABSTRACT TRUNCATED AT 250 WORDS)
The authors describe suicide rates in Toronto and Ontario and methods used for suicide in Toronto for 5 years before and after enactment of Canadian gun control legislation in 1978. They also present data from San Diego, Calif., where state laws attempt to limit access to guns by certain psychiatric patients. Both sets of data indicate that gun control legislation may have led to decreased use of guns by suicidal men, but the difference was apparently offset by an increase in suicide by leaping. In the case of men using guns for suicide, these data support a hypothesis of substitution of suicide method.
Comment In: Am J Psychiatry. 1991 Jan;148(1):149-501984701
The authors sent questionnaires to 127 apnea monitoring programs asking whether they had treated patients whose apnea appeared to have been induced by a parent (Munchausen syndrome by proxy-apnea, or MBPA). Fifty-one programs (40%) reported 54 cases of this kind from among their 20,090 monitored patients (0.27%). The authors obtained further information on 32 of these patients, 83% of whom presented with infantile apnea before the third month of life. Although medical problems were documented, including apnea, the clinical condition of these infants was inconsistent with the multiple life-threatening episodes typically reported by parents. Twenty-one of the infants reportedly received cardiopulmonary resuscitation at home, 15 had ambulance calls to the home, and 24 were rehospitalized. Child Protective Service agencies were consulted for 12 patients, 5 of whom were placed in foster homes. Three index infants and five siblings are known to be dead, and one additional infant is severely brain damaged from abuse.
To evaluate the usefulness of International Classification of Diseases external cause-of-injury and poisoning codes (E codes) for public health surveillance of nonfatal injuries, we analyzed E codes from Indian Health Service (IHS) hospital records. E codes for unknown or unspecified causes were used for 25 percent of records. At two hospitals, 63 percent of E codes assigned by independent coders agreed; another 18 percent matched on general cause-of-injury groups. With uniform guidelines and increased training, E coding could provide a valuable, cost-effective method of quantifying and characterizing severe, nonfatal injuries.
Cites: Epidemiol Rev. 1988;10:164-903066626
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We carried out a chart review study to determine the rate of diagnosis of dystocia (abnormal progress) and the use of cesarean section to treat dystocia among 3887 primiparous women who gave birth to a single baby in the vertex presentation at four hospitals in Ottawa-Carleton in 1984. Of the 3740 women who had some labour 1127 (30.1%) were given a diagnosis of dystocia. Cesarean section for dystocia was done during all phases of labour (41% of procedures in the latent phase, 38% in the active phase and 21% in the second stage). The cesarean section rate varied among the hospitals from 11.8% to 19.6%. A total of 75% of the cesarean sections were for dystocia, disproportion or failed induction. The findings suggest that cesarean section is being done for disproportion without a trial of labour beyond the latent phase and for dystocia in the absence of fetal distress. If these practices were modified the cesarean section rate could be reduced from 16% to about 8%, the rate found in some other centres and that observed in Canada in the early 1970s.
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Despite a decrease in the incidence of tuberculosis in Canada over the last decade, the proportion of cases in people not born in Canada has increased. To determine the prevalence of active tuberculosis at the first surveillance clinic visit and the incidence of the disease over a 2-year to 6-year follow-up period, we reviewed the records of all 523 immigrants admitted to Manitoba between 1981 and 1985 who were placed under surveillance. Of the 523, 429 (82%) were seen at least once in the clinic. Among the 429, active tuberculosis was diagnosed at the first visit in 12 (3%) and during the follow-up period in 7 (2%). The relative risk of tuberculosis was 4.5 times higher for immigrants under surveillance than for those not under surveillance. Of the 483 immigrants who were to be seen in Winnipeg 232 (48%) were noncompliant: 94 were not seen at any time, and 138 did not attend for the full follow-up period. Active disease was not reported to have developed in any of the noncompliant subjects. Noncompliers were significantly older than compliers (p less than 0.005), and variations in compliance were noted according to region of origin. Further attempts to improve compliance with surveillance without resorting to punitive measures are indicated.
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