We studied complications after hysterectomy among all women in the Danish population who had a simple hysterectomy in the period 1978-81 based on data obtained from the Danish National Hospital Registry. Among patients, with neither diagnosed cancer nor major co-surgery (n = 23,386), we identified all the complications which occurred during hospital admission from the time of surgery up to six years from that point. Within 30 days of hysterectomy 2.6% of the patients had been diagnosed in hospitals as having complications according to our definition. The corresponding figures at 90 days and two years after the operation were 3.7% and 9.4%. The most frequently observed complications were post operative wound infections and bleeding, each affecting about 2% of all operated women. Logistic regression and Cox regression were used to identify prognostic indicators of readmission with complications. The probability of readmission with complications within six years after hysterectomy was estimated at 8% among low risk patients. The most pronounced increase in risk of readmission with complication occurred among women who had been admitted to psychiatric or somatic hospitals 0-12 months before they had their uterus removed (OR in the range 1.59 to 1.83). We discuss the prevailing difficulties of comparing observational evidence from different clinical settings reported in the literature, and emphasize the importance of developing a coordinated international strategy for non-experimental assessment of medical technology.
OBJECTIVES: Patient-based health status measures have an important role to play in the assessment of health care outcomes. Among these measures, global assessments increasingly have been used, although the understanding of the performance of these indicators and the determinants of patients responses is underdeveloped. In this study, the performance of a single-item global indicator of visual function in cataract patients of four international settings was compared. METHODS: Visual acuity and ocular comorbidity was assessed by patients' ophthalmologist using Snellen-type charts in patients referred for a first cataract surgery in the United States, Manitoba (Canada), Denmark, and Barcelona (Spain). Patients also were interviewed by telephone and asked to report overall trouble with vision on a single-item indicator ("great deal," "moderate," "a little," "none") and to complete the Visual Functioning Index (VF-14), a scale of visual function ranging from 0 (worst function) to 100 (best level of function), along with other questions including the degree the patient was bothered by symptoms as measured by the Cataract Symptom Score (CSS). A total of 1,407 patients completed the clinical examination and the preoperative interview. RESULTS: Distribution of overall trouble with vision varied across the sites, with the proportion of patients reporting a great deal of trouble ranging from 21.7% to 37.9%. In all sites, patients reporting more trouble with vision tended to show a poorer age-adjusted and sex-adjusted visual acuity. The proportion of patients reporting great deal of trouble with vision was higher in the groups with worse visual acuity (P
Fragrances are the first or second most common cause of contact allergy in dermatitis patients.
The aim of this study was to identify risk products for fragrance contact allergy.
The design was a case-control study with a case group of 78 fragrance-mix-positive eczema patients and two control groups, one consisting of 1,279 subjects selected as a random sample of the general population and the other consisting of 806 fragrance-mix-negative eczema patients. The identification of risk products was based on the patients' histories of rash to scented products. Analysis of the associations between first-time rash caused by different specified product categories and fragrance mix sensitivity was performed using logistic regression.
It was found that first-time rash caused by deodorant sprays and/or perfumes were related to fragrance contact allergy in a comparison with both control groups. The risk (odds ratio) of being diagnosed as fragrance allergic was 2.3 to 2.9 greater in cases of a history of first-time rash to deodorant sprays and 3.3 to 3.4 greater in cases of a history of rash to perfumes than if no such history were present. First-time rash to cleansing agents, deodorant sticks, or hand lotions was also statistically significant but only in comparison with one of the control groups.
Safety evaluation of fragrance materials used in perfumes and deodorant sprays should be performed with special attention.