Differences In Diagnostic Criteria Research Articles

Standardized incidence ratios of stroke: a worldwide review.

Comparison of stroke incidence in various parts of the world is difficult because differences in diagnostic criteria, medical facilities and age-sex distributions are often not taken into account. We calculated age-sex standardized incidence ratios (SIR) of stroke in 37 regions based on recent reports. The USA (1976) was taken as the standard population. In western countries SIRs varied from 0.8 to 2.1. In China and Japan, SIRs varied from 0.7 to 3.6. While the lowest and highest SIRs differed by a factor of 5, only 6 of the 37 studies yielded a SIR of more than 2.0 or below 0.75. Of these, 4 were from China and Japan. The highest ratios were based on a very intensive door-to-door survey and probably should not be compared to less intensive studies. We conclude that world-wide variation in age-sex adjusted stroke rates is relatively small.

Cardiovascular Abnormalities in Children: A Ten-Year Forensic Pathologic Study

In order to obtain information on types, incidence, and significance of cardiovascular abnormalities in children, a total of 104 consecutive medicolegal autopsies of children aged 8 days to 16 years during a 10-year period from May 1974 to April 1984 were studied. Extensive histological examination of the hearts was performed in 92 out of 104 cases and complemented with chemical and microbiological analyses. In the natural death group consisting of 53 children, 26 (49%) showed abnormalities: 7 (13%) malformations, 11 (21%) cardiomyopathies, 5 (9%) idiopathic subaortic hypertrophy, and 3 (7%) a heart weight only 50% of the expected weight. In the violent death ("control") group, abnormalities were found in 8 of 39 cases (21%), all of which were cardiomyopathy. Only 5 of 34 cardiovascular abnormalities (every 7th case), all complex malformations, were clinically recognized. In 14 (15%) of the total 92 examined cases the cardiovascular abnormality was the only apparent cause of death, and in 12 (13%) a contributing cause of sudden unexpected natural death, while in 3 (3%) it was related to a fatal accidental injury. In 5 (13%) of the 39 cases of violent death, cardiomyopathy was an incidental finding without any connection to the circumstances or cause of death. The causes of cardiovascular abnormalities were associated with bacterial and viral infections, respiratory disorders, phenytoin sensitivity, or were unknown. Because of the differences in diagnostic criteria employed by previous investigators, it cannot be determined whether the incidence of the cardiovascular abnormalities and sudden cardiac death in children found in this material was higher than in other studies.

Metabolic and Therapeutic Assessment of Gestational Diabetes by Two-Hour and Twenty-Four-Hour Isocaloric Meal Tolerance Tests

Lean and obese women with gestational diabetes (GDM) were given two different isocaloric meal challenge tests to assess glucose and insulin responses. Forty-three pregnant women received a 400-kcal isocaloric breakfast meal tolerance test (mini-MTT). Twenty of the subjects were also given a 2000-kcal isocaloric diet with three meals and three snacks during a 24-h period (maxi-MTT). This was the first study to utilize the physiologic challenge of mixed meals to compare insulin and glucose responses of both obese and lean normal pregnant women and women with GDM around the clock. Normal obese pregnant women had higher integrated glucose and insulin values around the 24-h clock (P less than 0.003 and less than 0.03, respectively) than lean pregnant women. Lean and obese women with GDM also responded differently to the physiologic challenge of mixed meals. Some, but not all, obese diabetic subjects were markedly hyperinsulinemic in contrast to lean diabetic women who were relatively insulin deficient. One normoglycemic massively obese 18-yr-old pregnant woman was unexpectedly found to be severely hyperinsulinemic. The two meal tolerance tests clearly defined a delay in the release of insulin in women with GDM (lean and obese) and markedly different quantitative insulin responses to identical meal challenges in obese diabetic subjects. Maternal hyperinsulinemia was positively correlated with prepregnancy body mass index (kg/m2) and heavier infants, but not with plasma glucose levels. These studies provide evidence that GDM is a heterogeneous syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Can differences in diagnostic criteria be stopped?

Can differences in diagnostic criteria be stopped?

Clinical features of diabetes mellitus in Japan.

The first Symposium on Diabetes Mellitus in Asia was held in Kobe, Japan, in 1970 and the second symposium in Kyoto, Japan, in 1975. These two symposia raised many questions. Participants from various countries compared their findings on the frequency of diabetes and its complications. Such comparisons are usually complicated because of the differences in diagnostic criteria used, the age groups compared, and duration of diabetes observed, etc. In spite of these problems, careful analysis and close comparisons may offer important clues as to the pathogenesis of diabetes and the factors related to its complications. Japanese and Caucasian diabetes have some differences resulting from the Japanese diabetic pathophysiologic, ethologic, and ecologic factors. In this paper, diabetes is discussed from an ecologic viewpoint, especially characteristics of the disease and its prognosis in relation to the complications and food habits in Japan.

Schneider-oriented psychiatric diagnosis in Germany compared with New York and London

It has long been known 1–3 that there were considerable differences in diagnostic rates generated by mental hospitals in America and Britain. However, Kramer 4 was the first to systematically calculate the rates of various psychiatric diagnostic categories for the two countries. He found that the frequency in England and Wales for schizophrenia was one third lower, and for manic-depressive illness nine times higher, than the rates in the United States. At this point the U.S.-U.K. Diagnostic Project 5 was designed to discover why such discrepancies existed. The main question posed by the U.S.-U.K. Study 5 had been: are the reported differences in the diagnostic percentages for mental hospitals in the United States and Great Britain brought about by actual symptomatologic differences in the patients admitted in the two areas, or can diagnostic differences between countries by mainly responsible? The basic conclusion of this study was that the reported differences are largely, though not entirely, due to differences in diagnostic criteria used in New York and London. Another study 6 indicated that the diagnostic criteria used in London did not differ appreciably from those applied in other English centers. However, it seemed that the broad New York concept of schizophrenia did not extend to Illinois or California, 7 nor did it reach North Carolina. 8 There appeared to be a gradient across the United States from east to west, though in California the prevailing concept of schizophrenia was considerably wider than that used in Great Britain. 9

A comparison of first admissions of Mania in Prague, Aarhus and London

The incidence of admissions for the diagnosis of a manic episode of affective psychosis was investigated for a period of 10 years (1963–1972) in the Prague population by means of a manual case register. The incidence was 0.75 per 100,000 inhabitants in the 18 to 60 age group which is 6 to 7 times lower than the figures given in similar studies in Aarhus (Denmark) and London (U.K.). The relatively low admission incidence of mania in Prague can be accounted for only to a small extent by differences in diagnostic criteria. The main part of the difference cannot be elucidated without a special design not used in the present study. As to their symptoms, the Prague patients approximate to those from Aarhus and London, while differing from patients of non-European origin in the London sample.

A five to fifteen year follow-up study of infantile psychosis. I. Description of sample.

The psychoses of infancy have long been a matter for controversy. The nature of the disorders, their aetiology, relationship to adult forms of psychosis, long-term outcome and response to treatment are still areas of disagreement among clinicians. Follow-up studies should provide information relevant to some of these problems. Unfortunately, the findings of published investigations have been contradictory. To a large extent contradictions appear to be related to differences in diagnostic criteria, but the failure of many writers to describe their cases adequately has made it difficult to assess the significance of possible differences.

Streptococcal disease in the United States Army.

In the official medical history of the Civil War only 696 cases of scarlet fever, including 72 deaths, were reported as having occurred in federal troops.' However, some 25,000 cases of erysipelas were recorded and it is stated that one of every 225 wounded individuals developed this infection.2 It is particularly interesting to note that the disease was most common in troops in western areas, a finding strikingly similar to later findings about the incidence of streptococcal disease in general.3 From 1861 to 1866, 145,551 cases of acute rheumatism were reported among white federal troops, an incidence of 65 per 1,000 per year. Assuming that a large proportion of the rheumatism was actually what is now called rheumatic fever, it would appear that a tremendous amount of streptococcal infection actually took place. During the same period 642 deaths were attributed to acute rheumatism, endocarditis and pericarditis, and 610 to valvular disease of the heart.4 Ashburn5 reported the incidence of rheumatic fever in the United States Army to have been 5.28 per 1,000 per year during the period 1891-1900, 5.22 in 1902 and 0.53 in 1926. By way of comparison, the incidence in 1959 was 0.19 per 1,000 per year. The comparison, however, is probably not completely valid since many variable factors must be considered, including differences in diagnostic criteria and acumen and differences in composition and geographical distribution of the troops. Data collected during World War I indicates that there was unquestionably a high incidence of streptococcal disease and rheumatic fever. However, as these conditions were neither separately identified nor associated at that time, indirect evidence as provided by the incidence of scarlet fever, erysipelas, tonsillitis, pharyngitis, acute articular rheumatism, endocarditis, and valvular diseases of the heart must be used to adduce an idea of the true incidence of streptococcal disease and rheumatic fever. The greatest incidence of scarlet fever, of acute articular rheumatism, and of valvular heart disease was during the months of January, February, and March. The greatest incidence of tonsillitis and pharyngitis and of endocarditis occurred during the months of December through March.6 Thus, each of these conditions was most prevalent

NEW YORK NEUROLOGICAL SOCIETY AND THE NEW YORK ACADEMY OF MEDICINE, SECTION OF NEUROLOGY AND PSYCHIATRY

are under the control of the Ministry of Health, while research is directed by the Ministry of Health, the Academy of Medical Sciences, and the Academy of Sciences. The Russians present statistics which they state back their claims that psychiatric illnesses are not a major problem in the U. S. S. R. However, their statistics must not be accepted at face value because of the cultural differences and differences in diagnostic criteria. They stress the avoidance of psychiatric hospitalizations by acute treatment centers, called Statsionars, where intensive organic therapy and psychotherapy may be given to acutely disturbed patients. Sleep therapy, according to Pavlov's concepts of protective inhibition, is stressed. Neurologic and psychiatric research is dominated by the concepts and theories of Pavlov. The socalled second signal system is a higher phase of conditioned-reflex research that is prominently dis¬ cussed at this time.

COMPARISON OF METRAZOL CONVULSIVE THERAPY WITH ELECTRIC SHOCK IN TREATMENT OF SCHIZOPHRENIA

In 1940 I reported 1 results obtained in the treatment of 100 schizophrenic patients with metrazol convulsive therapy. A similar study has been conducted during the past one and one-half years in the treatment of 100 schizophrenic patients with electric shock. The present group was composed approximately of the same type of psychiatric material as that employed in the first study. It has been emphasized by several writers that the difference in diagnostic criteria used by various clinicians in arriving at the diagnosis of schizophrenia is responsible for contradictory reports as to the results obtained with shock therapy in many hospitals. It is even debatable at present whether the term schizophrenia is actually limited to one mental disorder or may include a variety of similar psychiatric conditions. Besides, patients seen by psychiatrists in private practice and outpatient mental hygiene clinics are often of different type than those committed to public