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A 10 year asthma programme in Finland: major change for the better.

https://arctichealth.org/en/permalink/ahliterature168103
Source
Thorax. 2006 Aug;61(8):663-70
Publication Type
Article
Date
Aug-2006
Author
T. Haahtela
L E Tuomisto
A. Pietinalho
T. Klaukka
M. Erhola
M. Kaila
M M Nieminen
E. Kontula
L A Laitinen
Author Affiliation
Skin and Allergy Hospital, Helsinki University Central Hospital, P O Box 160, FIN-00029 HUS, Finland. tari.haahtela@hus.fi
Source
Thorax. 2006 Aug;61(8):663-70
Date
Aug-2006
Language
English
Publication Type
Article
Keywords
Adult
Anti-Asthmatic Agents - therapeutic use
Asthma - economics - epidemiology - therapy
Child
Communication
Cost of Illness
Disabled Persons
Emergency Treatment - statistics & numerical data
Finland - epidemiology
Health Promotion - economics - organization & administration - trends
Hospitalization - statistics & numerical data
Humans
Incidence
Insurance, Disability - economics
Interprofessional Relations
National Health Programs - economics - trends
Pharmaceutical Services - standards
Primary Health Care
Program Evaluation
Smoking - epidemiology
Abstract
A National Asthma Programme was undertaken in Finland from 1994 to 2004 to improve asthma care and prevent an increase in costs. The main goal was to lessen the burden of asthma to individuals and society.
The action programme focused on implementation of new knowledge, especially for primary care. The main premise underpinning the campaign was that asthma is an inflammatory disease and requires anti-inflammatory treatment from the outset. The key for implementation was an effective network of asthma-responsible professionals and development of a post hoc evaluation strategy. In 1997 Finnish pharmacies were included in the Pharmacy Programme and in 2002 a Childhood Asthma mini-Programme was launched.
The incidence of asthma is still increasing, but the burden of asthma has decreased considerably. The number of hospital days has fallen by 54% from 110 000 in 1993 to 51 000 in 2003, 69% in relation to the number of asthmatics (n = 135 363 and 207 757, respectively), with the trend still downwards. In 1993, 7212 patients of working age (9% of 80 133 asthmatics) received a disability pension from the Social Insurance Institution compared with 1741 in 2003 (1.5% of 116 067 asthmatics). The absolute decrease was 76%, and 83% in relation to the number of asthmatics. The increase in the cost of asthma (compensation for disability, drugs, hospital care, and outpatient doctor visits) ended: in 1993 the costs were 218 million euro which had fallen to 213.5 million euro in 2003. Costs per patient per year have decreased 36% (from 1611 euro to 1031 euro).
It is possible to reduce the morbidity of asthma and its impact on individuals as well as on society. Improvements would have taken place without the programme, but not of this magnitude.
Notes
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PubMed ID
16877690 View in PubMed
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Acute care surgery: the impact of an acute care surgery service on assessment, flow, and disposition in the emergency department.

https://arctichealth.org/en/permalink/ahliterature126302
Source
Am J Surg. 2012 May;203(5):578-83
Publication Type
Article
Date
May-2012
Author
Chad G Ball
Anthony R MacLean
Elijah Dixon
May Lynn Quan
Lynn Nicholson
Andrew W Kirkpatrick
Francis R Sutherland
Author Affiliation
Department of Surgery, Foothills Medical Centre, 1403 29 Street NW, Calgary, Alberta, Canada. ball.chad@gmail.com
Source
Am J Surg. 2012 May;203(5):578-83
Date
May-2012
Language
English
Publication Type
Article
Keywords
Adult
Alberta
Critical Care - statistics & numerical data
Emergency Service, Hospital - organization & administration - statistics & numerical data
Emergency Treatment - statistics & numerical data
Humans
Prospective Studies
Abstract
Acute care surgery (ACS) services are becoming increasingly popular.
Assessment, flow, and disposition of adult ACS patients (acute, nontrauma surgical conditions) through the emergency department (ED) in a large health care system (Calgary) were prospectively analyzed.
Among 447 ACS ED consultations over 3 centers (70% admitted to ACS), the median wait time from the consultation request to ACS arrival was 36 minutes, and from ACS arrival to the admission request it was 91 minutes. The total ACS-dependent time was 127 minutes compared with 261 minutes for initial ED activities and 104 minutes for transfer to a hospital ward (P
PubMed ID
22402265 View in PubMed
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Availability and access in modern obstetric care: a retrospective population-based study.

https://arctichealth.org/en/permalink/ahliterature105940
Source
BJOG. 2014 Feb;121(3):290-9
Publication Type
Article
Date
Feb-2014
Author
H M Engjom
N-H Morken
O F Norheim
K. Klungsøyr
Author Affiliation
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Source
BJOG. 2014 Feb;121(3):290-9
Date
Feb-2014
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Cross-Sectional Studies
Delivery, obstetric - statistics & numerical data
Emergency Medical Services - statistics & numerical data
Emergency Treatment - statistics & numerical data
Female
Health Services Accessibility - statistics & numerical data
Humans
Maternal Health Services - statistics & numerical data
Middle Aged
Norway - epidemiology
Pregnancy
Pregnancy Complications - epidemiology
Retrospective Studies
Young Adult
Abstract
To assess the availability of obstetric institutions, the risk of unplanned delivery outside an institution and maternal morbidity in a national setting in which the number of institutions declined from 95 to 51 during 30 years.
Retrospective population-based, three cohorts and two cross-sectional analyses.
Census data, Statistics Norway. The Medical Birth Registry of Norway from 1979 to 2009.
Women (15-49 years), 2000 (n = 1,050,269) and 2010 (n = 1,127,665). Women who delivered during the period 1979-2009 (n = 1,807,714).
Geographic Information Systems software for travel zone calculations. Cross-table and multiple logistic regression analysis of change over time and regional differences. World Health Organization Emergency Obstetric and Newborn Care (EmOC) indicators.
Proportion of women living outside the 1-hour travel zone to obstetric institutions. Risk of unplanned delivery outside obstetric institutions. Maternal morbidity.
The proportion of women living outside the 1-hour zone for all obstetric institutions increased from 7.9% to 8.8% from 2000 to 2010 (relative risk, 1.1; 95% confidence interval, 1.11-1.12), and for emergency obstetric care from 11.0% to 12.1% (relative risk, 1.1; 95% confidence interval, 1.09-1.11). The risk of unplanned delivery outside institutions increased from 0.4% in 1979-83 to 0.7% in 2004-09 (adjusted odds ratio, 2.0; 95% confidence interval, 1.9-2.2). Maternal morbidity increased from 1.7% in 2000 to 2.2% in 2009 (adjusted odds ratio, 1.4; 95% confidence interval, 1.2-1.5) and the regional differences increased.
The availability of and access to obstetric institutions was reduced and we did not observe the expected decrease in maternal morbidity following the centralisation.
PubMed ID
24283373 View in PubMed
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Blood loss after cesarean delivery: a registry-based study in Norway, 1999-2008.

https://arctichealth.org/en/permalink/ahliterature130818
Source
Am J Obstet Gynecol. 2012 Jan;206(1):76.e1-7
Publication Type
Article
Date
Jan-2012
Author
Finn Egil Skjeldestad
Pål Oian
Author Affiliation
Department of Clinical Medicine, University of Tromsø, Norway.
Source
Am J Obstet Gynecol. 2012 Jan;206(1):76.e1-7
Date
Jan-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Blood Loss, Surgical - statistics & numerical data
Case-Control Studies
Cesarean Section - adverse effects
Child
Emergency Treatment - statistics & numerical data
Female
Humans
Middle Aged
Norway - epidemiology
Postpartum Hemorrhage - epidemiology
Pregnancy
Prevalence
Registries - statistics & numerical data
Risk factors
Severity of Illness Index
Young Adult
Abstract
The objective of the study was to assess risk factors for moderate and severe blood loss after cesarean delivery (CD).
All planned (n = 32,716) and emergency (n = 47,942) cesareans, as reported over a 10-year period to the Medical Birth Registry of Norway, were analyzed separately in a case-control design. Women with moderate (500 to =1500 mL) or severe (>1500 mL) blood loss were analyzed with women with blood loss less than 500 mL as controls in SPSS (version 17.0) with ?(2) test and logistic regression.
The prevalence of severe blood loss was consistently higher in emergency (3.2%) than planned CD (1.9%). Planned and emergency CDs share common risk factors for both moderate and severe blood loss, whereas emergency CD carries in addition delivery-related risk factors.
When revising management schemes for CD, anesthetic procedures should be reconsidered as surgical competence in cases with placenta previa, placental abruption, and low hemoglobin.
PubMed ID
21963102 View in PubMed
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Decreasing colectomy rates for ulcerative colitis: a population-based time trend study.

https://arctichealth.org/en/permalink/ahliterature118832
Source
Am J Gastroenterol. 2012 Dec;107(12):1879-87
Publication Type
Article
Date
Dec-2012
Author
Gilaad G Kaplan
Cynthia H Seow
Subrata Ghosh
Natalie Molodecky
Ali Rezaie
Gordon W Moran
Marie-Claude Proulx
James Hubbard
Anthony MacLean
Donald Buie
Remo Panaccione
Author Affiliation
Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta, Canada. ggkaplan@ucalgary.ca
Source
Am J Gastroenterol. 2012 Dec;107(12):1879-87
Date
Dec-2012
Language
English
Publication Type
Article
Keywords
6-Mercaptopurine - therapeutic use
Adult
Aged
Alberta - epidemiology
Azathioprine - therapeutic use
Colectomy - statistics & numerical data - trends
Colitis, Ulcerative - drug therapy - surgery
Drug Prescriptions - statistics & numerical data
Emergency Treatment - statistics & numerical data
Female
Humans
Immunosuppressive Agents - therapeutic use
Linear Models
Logistic Models
Male
Medical Records
Middle Aged
Odds Ratio
Retrospective Studies
Surgical Procedures, Elective - statistics & numerical data
Time Factors
Abstract
Colectomy rates for ulcerative colitis (UC) have been inconsistently reported. We assessed temporal trends of colectomy rates for UC, stratified by emergent vs. elective colectomy indication.
From 1997 to 2009, we identified adults hospitalized for a flare of UC. Medical charts were reviewed. Temporal changes were evaluated using linear regression models to estimate the average annual percent change (AAPC) in surgical rates. Logistic regression analysis compared: (i) UC patients responding to medical management in hospital to those who underwent colectomy; (ii) UC patients who underwent an emergent vs. elective colectomy; and (iii) temporal trends of drug utilization.
From 1997 to 2009, colectomy rates significantly dropped for elective colectomies with an AAPC of -7.4% (95% confidence interval (CI): -10.8%, -3.9%). The rate of emergent colectomies remained stable with an AAPC of -1.4% (95% CI: -4.8%, 2.0%). Azathioprine/6-mercaptopurine prescriptions increased from 1997 to 2009 (odds ratio (OR)=1.15; 95% CI: 1.09-1.22) and infliximab use increased after 2005 (OR=1.68; 95% CI: 1.25-2.26). A 13% per year risk adjusted reduction in the odds of colectomy (OR=0.87; 95% CI: 0.83-0.92) was observed in UC patients responding to medical management compared with those who required colectomy. Emergent colectomy patients had a shorter duration of flare (
PubMed ID
23165448 View in PubMed
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Elective cesarean delivery for term breech.

https://arctichealth.org/en/permalink/ahliterature63535
Source
Obstet Gynecol. 2003 Apr;101(4):690-6
Publication Type
Article
Date
Apr-2003
Author
Lone Krebs
Jens Langhoff-Roos
Author Affiliation
Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. lone.krebs@dadlnet.dk
Source
Obstet Gynecol. 2003 Apr;101(4):690-6
Date
Apr-2003
Language
English
Publication Type
Article
Keywords
Adult
Breech Presentation
Cesarean Section - adverse effects - mortality - statistics & numerical data
Cohort Studies
Delivery, Obstetric - adverse effects - mortality - statistics & numerical data
Denmark - epidemiology
Emergency Treatment - statistics & numerical data
Female
Humans
Obstetric Labor Complications - epidemiology
Parity
Postoperative Complications
Pregnancy
Pregnancy outcome
Puerperal Disorders
Registries
Research Support, Non-U.S. Gov't
Retrospective Studies
Risk factors
Surgical Procedures, Elective - adverse effects - mortality - statistics & numerical data
Abstract
OBJECTIVE: To compare the maternal complications of elective cesarean delivery for breech at term with those after vaginal or emergency cesarean delivery. METHODS: We conducted a population-based, retrospective cohort study of 15441 primiparas who delivered singleton breech at term. Information was obtained from the Danish Medical Birth Register, the Register of Death Causes, and the Denmark Patient Register. RESULTS: Elective cesarean delivery was associated with lower rates of puerperal fever and pelvic infection (relative risk [RR] 0.81; 95% confidence interval [CI] 0.70, 0.92), hemorrhage and anemia (RR 0.91; 95% CI 0.84, 0.97), and operations for wound infection (RR 0.69; 95% CI 0.57, 0.83) than emergency cesarean delivery. There was a higher rate of puerperal fever and pelvic infection (RR 1.20; 95% CI 1.11, 1.25) than for vaginal delivery. Thromboembolic disease occurred in 0.1% of women with cesarean delivery, and anal sphincter rupture occurred in 1.7% of women with vaginal delivery. Elective cesarean delivery was not associated with subsequent ectopic pregnancy, miscarriage, placental complications, uterine rupture, or adverse neonatal outcome. Women with elective cesarean delivery were more often delivered by elective cesarean in their second pregnancy, compared with women delivered vaginally (RR 1.25; 95% CI 1.21, 1.29). Elective cesarean delivery was associated with a lower rate of a subsequent delivery during the study period and a longer mean delivery interval than for vaginal delivery. CONCLUSION: Elective cesarean delivery for term breech carries a low risk of severe maternal complications.
PubMed ID
12681872 View in PubMed
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Endovascular treatment for aortic disease: is a surgical environment necessary?

https://arctichealth.org/en/permalink/ahliterature172316
Source
J Vasc Surg. 2005 Oct;42(4):645-9; discussion 649
Publication Type
Article
Date
Oct-2005
Author
Randy D Moore
Laurencia Villalba
Paul F Petrasek
Gregory Samis
Chad G Ball
Mona Motamedi
Author Affiliation
Division of Vascular Surgery, Peter Lougheed Centre, University of Calgary, Alberta, Canada. RandyD.Moore@CalgaryHealthRegion.ca
Source
J Vasc Surg. 2005 Oct;42(4):645-9; discussion 649
Date
Oct-2005
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Alberta
Aortic Aneurysm, Abdominal - mortality - radiography - surgery
Aortic Aneurysm, Thoracic - mortality - radiography - surgery
Aortography
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - adverse effects - methods
Cohort Studies
Emergency Treatment - statistics & numerical data
Female
Follow-Up Studies
Humans
Male
Middle Aged
Needs Assessment
Operating Rooms - utilization
Prospective Studies
Prosthesis Design
Prosthesis Failure
Risk assessment
Severity of Illness Index
Surgical Procedures, Elective - statistics & numerical data
Survival Analysis
Treatment Outcome
Abstract
Interventional radiologists, cardiologists, and vascular surgeons are capable of performing endovascular procedures successfully in their respective environments. Suboptimal anatomy or intraoperative technical problems can be encountered, and endovascular management alone is not always suitable. The objectives of this study were to define the incidence of adjunctive surgical techniques, to discuss the rationale for endovascular reconstruction in a well-developed surgical environment, and to assess the effect of experience on the incidence of adjunctive repair.
All primary aortic and aortoiliac elective, urgent, and emergent endovascular procedures performed at the Peter Lougheed Center and entered into a prospective database from May 25, 1999 to June 01, 2005, were reviewed. All adjunctive surgical techniques to enable stent deployment, enhance attachment site, or solve intraoperative difficulties were captured. The study period was divided into two time periods based on learning curve data to assess the effect of experience on the rate of adjunctive repairs.
Four hundred thirty-eight patients underwent elective (80%), urgent (15%), or emergent (5%) endovascular procedures during the study period. These consisted of 101 thoracic and 337 abdominal operations, including the use of 13 fenestrated stents. One hundred thirty-nine patients (31.7%) required 180 open surgical procedures. Complete data were available for the entire patient cohort. The mean follow-up was 793.2 days (SD, 519.1 days). Procedures were necessary for vascular access, arterial dissection/rupture, limb ischemia, and enhancement/elongation of the stent attachment site. The persistent endoleak rate was 5.3%, the late rupture rate was 0.7%, the conversion rate was 1.6%, the 30-day surgical mortality rate was 3.2%, all-cause mortality to date is 7.3%, and the reintervention rate was 4.6%. There was no statistically significant effect of the learning curve on the incidence of surgical adjunctive procedures in either the thoracic group (11/26 [42.3%] for phase 1 vs 17/75 [22.6%] for phase 2) or the abdominal group (14/50 [28.0%] for phase 1 vs 97/287 [33.8%] for phase 2). Overall, 31.5% of patients required adjunctive surgical repair.
Successful endografting requires endovascular expertise in addition to a well-developed surgical environment to increase applicability and decrease patient risk. Despite advances in endovascular technology, hybrid techniques will continue to be required to achieve good overall success rates.
PubMed ID
16242547 View in PubMed
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Epidemiology of mountain search and rescue operations in Banff, Yoho, and Kootenay National Parks, 2003-06.

https://arctichealth.org/en/permalink/ahliterature153551
Source
Wilderness Environ Med. 2008;19(4):245-51
Publication Type
Article
Date
2008
Author
Finlay J Wild
Author Affiliation
University of Aberdeen, Scotland. fin_wild@hotmail.co.uk
Source
Wilderness Environ Med. 2008;19(4):245-51
Date
2008
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Athletic Injuries - classification - complications - epidemiology
Canada - epidemiology
Child
Emergency Treatment - statistics & numerical data
Female
Humans
Male
Middle Aged
Recreation
Rescue Work - statistics & numerical data
Retrospective Studies
Abstract
To describe the epidemiology of mountain incidents and mountain rescue operations occurring in Banff, Yoho, and Kootenay National Parks between 1 January 2003 and 31 December 2006.
Retrospective review of Banff, Yoho, and Kootenay Public Safety Occurrence Reports detailing rescue operations within the study period. Demographics, activity, reason for rescue, mode of rescue, type of injury, and fatalities were analyzed.
A total of 317 emergency mountain rescue operations involving 406 persons was documented. The mean age of the rescued population was 35.2 years, and this population was predominantly male (63.1%). Hikers were involved in 43.5% of incidents, and 'slips and falls' were responsible for 50.2%. Helicopter was the mode of rescue in 64% of cases. Almost half (40.7%) of all rescues involved people with no injuries. The limbs were the most common body part affected (68% of traumatic injuries). Forty fatalities occurred-45% due to avalanches and 27.5% due to slips and falls.
This study offers a synopsis of the rescue service provided by Parks Canada Rescue in the study area. Further work is needed to separate primary and contributory causes of mountain incidents, and this can be achieved by use of better data collection methods. Hospital follow-up is required to accurately assess the morbidity and mortality associated with mountain incidents. Data presented are expected to be of value to a variety of tourism, health, and safety organizations.
PubMed ID
19099329 View in PubMed
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Health-related quality of life is better for cardiac arrest survivors who received citizen cardiopulmonary resuscitation.

https://arctichealth.org/en/permalink/ahliterature183413
Source
Circulation. 2003 Oct 21;108(16):1939-44
Publication Type
Article
Date
Oct-21-2003
Author
Ian Stiell
Graham Nichol
George Wells
Valerie De Maio
Lisa Nesbitt
Josée Blackburn
Daniel Spaite
Author Affiliation
Clinical Epidemiology Unit, Office F657, Ottawa Health Research Institute, 1053 Carling Ave, Ottawa, Ontario K1Y 4E9, Canada. istiell@ohri.ca
Source
Circulation. 2003 Oct 21;108(16):1939-44
Date
Oct-21-2003
Language
English
Publication Type
Article
Keywords
Aged
Cardiopulmonary Resuscitation - education - statistics & numerical data
Cohort Studies
Electric Countershock - statistics & numerical data
Emergency Treatment - statistics & numerical data
Female
Heart Arrest - therapy
Humans
Logistic Models
Male
Middle Aged
Ontario
Prospective Studies
Quality of Life
Survivors - statistics & numerical data
Treatment Outcome
Volunteers - statistics & numerical data
Abstract
This study evaluated the prehospital factors associated with better health-related quality of life for survivors of out-of-hospital cardiac arrest.
This prospective, 20-community, cohort study involved consecutive, adult out-of-hospital cardiac arrest patients who survived to 1 year. Patients were contacted by telephone and evaluated for the Health Utilities Index Mark III (HUI3), which describes health as a utility score on a scale from 0 (dead) to 1.0 (perfect health). The 8091 cardiac arrest patients had overall survival rates of 5.2% to hospital discharge and 4.0% to 1 year. We successfully contacted and evaluated 268 of 316 (84.8%) of known 1-year survivors. The median HUI3 score was 0.80 (interquartile range, 0.50 to 0.97), which compares well with age-adjusted values for the general population (0.83). Logistic regression identified 2 factors independently associated with very good quality of life (HUI3 >0.90) and their odds ratios (95% CIs), as follows: age 80 years or older, 0.3 (0.1 to 0.84), and citizen-initiated cardiopulmonary resuscitation (CPR), 2.0 (1.2 to 3.4) (Hosmer-Lemeshow goodness-of-fit statistic, 0.74).
This study is the largest ever conducted for out-of-hospital cardiac arrest survivors, clearly shows that these patients have good quality of life, and is the first to demonstrate that citizen-initiated CPR is strongly and independently associated with better quality of life. These results emphasize the importance of optimizing community citizen CPR readiness. Given the low rate of citizen-initiated CPR in many communities, we believe that local and national initiatives should vigorously promote the practice of bystander CPR.
PubMed ID
14530198 View in PubMed
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20 records – page 1 of 2.