Five-year Observation Period Research Articles

Potential years of life lost as an indicator of public health in the Republic of Srpska

Mortality is one of the important indicators of health status of the population, especially the knowledge of causes of death that give the full picture in the analysis of certain diseases. Assessment of health status of the population is not only new ideas but also a new concept in health care. In other words, the assessment of health status should be the first step and a prerequisite for continued systematic and planned work to improve both their health and overall health care system, or work on their reform. Given these facts, this article through the data on mortality as an indicator of the health status of the population indicated the state of his health and efficiency through the use of prevention programs potential years of life lost due to premature death. The five-year period of observation in the Republic of Srpska largest number of potential years of life lost due to diseases of the circulatory system, malignant diseases, then injuries, poisoning and the influence of external factors, diseases of the digestive systems and diseases of glands with internal secretion, nutrition and metabolism.

Optimal strategy to identify incidence of diagnostic of diabetes using administrative data

BackgroundAccurate estimates of incidence and prevalence of the disease is a vital step toward appropriate interventions for chronic disease like diabetes. A growing body of scientific literature is now available on producing accurate information from administrative data. Advantages of use of administrative data to determine disease incidence include feasibility, accessibility and low cost, but straightforward use of administrative data can produce biased information on incident cases of chronic disease like diabetes. The present study aimed to compare criteria for the selection of diabetes incident cases in a medical administrative database.MethodsAn exhaustive retrospective cohort of diabetes cases was constructed for 2002 using the Canadian National Diabetes Surveillance System case definition (one hospitalization or two physician claims with a diagnosis of diabetes over a 2-year period) with the Quebec health service database. To identify previous occurrence of diabetes in the database, a five-year observation period was evaluated using retrograde survival function and kappa agreement. The use of NDSS case definition to identify incident cases was compared to a single occurrence of an ICD-9 code 250 in the records using the McNemar test.ResultsRetrograde survival function showed that the probability of being a true incident case after a 5-year diabetes-free observation period was almost constant and near 0.14. Agreement between 10 years (maximum period) and 5 years and more diabetes-free observation periods were excellent (kappa > 0.9). Respectively 41,261 and 37,473 incident cases were identified using a 5-year diabetes-free observation period with NDSS definition and using a single ICD-9 code 250.ConclusionA 5-year diabetes-free observation period was a conservative time to identify incident cases in an administrative database using one ICD-9 code 250 record.

Pollen production, flowering and insect visits on Euphorbia cyparissias L. and Euphorbia virgultosa Klok

SummaryThis study investigated the morphological features, flower biology, pollen output and insects which foraged on Euphorbia cyparissias L. and Euphorbia virgultosa Klok. The observations were made between 2002 and 2006 on ruderal plots in Lublin, south eastern Poland. Both species formed inflorescences of the pseudantium type, known as cyathia. The number of inflorescences was 117.06 per shoot for E. cyparissias and 84.72 for E. virgultosa. The opening of spathe in the successive cyathia occurred almost simultaneously in both species, as early as at 6.00 h with the peak between 7.00 and 8.00 h. All cyathia of E. cyparissias are hermaphroditic. In the case of E. virgultosa, the bisexual cyathia on the shoots accounted for 58.3%. Hermaphroditic cyathia are protogynous. Dichogamy in Euphorbia virgultosa is strengthened through the occurrence of exclusively male flowers in part of the cyathia. The mean number of anthers per cyathium in E cyparissias and E. virgultosa, was 17.22 and 14.22, respectively. The small stamens of E. cyparissias yielded a mean of 0.38 mg of pollen per 100 anthers while the larger stamens of E. virgultosa yielded 0.51mg per 100 anthers. The weight of pollen per plant averaged 2.64 mg in E. virgultosa and 3.68 mg in E. cyparissias. Several hymenopteran species (Apis mellifera L. and solitary bees) visit E. cyparissias flowers. Additionally, Bombus spp. forages on E. virgultosa. Among the pollinators of both plants taxa, Diptera were present. Over the five-year period of observation, the density of species studied per square unit varied, but the plants renew each year. The associations with E. cyparissiasand E. virgultosa are not subjected to rapid succession. Hence, the studied species should be considered as an important component of the food chain for Apoidea and Diptera.

Reduction of Restraint and Seclusion Through Collaborative Problem Solving: A Five-Year Prospective Inpatient Study

This study examined usage patterns of restraint and seclusion before and after the implementation of collaborative problem solving (CPS), a manualized therapeutic program for working with aggressive children and adolescents. The clinical setting was a 15-bed psychiatric inpatient unit for school-age children. A total of 755 children were hospitalized for a total of 998 admissions from fiscal years 2003 to 2007 (median age=11 years; 64% boys). Data were collected for three years before and 1.5 years after the six-month implementation of the CPS model of care. There were 559 restraint and 1,671 seclusion events during the study period. After implementation of the CPS model there was a reduction in the use of restraints (from 263 events to seven events per year, representing a 37.6-fold reduction, slope [beta]=-.696) and seclusion (from 432 to 133 events per year, representing a 3.2-fold reduction, beta=-.423). The mean duration of restraints decreased from 41+/-8 to 18+/-20 minutes per episode, yielding cumulative unitwide restraint use that dropped from 16+/-10 to .3+/-.5 hours per month (a 45.5-fold reduction, beta=-.674). The mean duration of seclusion decreased from 27+/-5 to 21+/-5 minutes per episode, yielding cumulative unitwide seclusion use that dropped from 15+/-6 to 7+/-6 hours per month (a 2.2-fold reduction; p for trend .01 or better for all slopes). During the early phases of implementation there was a transient increase in staff injuries through patient assaults. CPS is a promising approach to reduce seclusion and restraint use in a child psychiatric inpatient setting. Future research and replication efforts are warranted to test its effectiveness in other restrictive settings.

Epidemiology and Clinical Features of Patients with Visceral Leishmaniasis Treated by an MSF Clinic in Bakool Region, Somalia, 2004–2006

BackgroundThere are few reports describing the epidemiology of visceral leishmaniasis (VL) in Somalia. Over the years 2002 to 2005, a yearly average of 140 patients were reported from the Huddur centre in Bakool region, whereas in 2006, this number rose to 1002 patients. Given the limited amount of information on VL and the opportunity to compare features with the studies done in 2000 in this part of Somalia, we describe the epidemiologic and clinical features of patients who presented to the Huddur treatment centre of Bakool region, Somalia, using data routinely collected over a five-year observation period (2002–2006).MethodologyMethods used included the analysis of routine data on VL cases treated in the Huddur treatment centre, a retrospective study of records of patients admitted between 2004 and 2006, community leaders interviews, and analysis of blood specimens taken for parasite species identification in Antwerp Institute of Tropical Medicine.Principal FindingsA total of 1671 VL patients were admitted to the Huddur centre from January 2002 until December 2006. Nearly all patients presented spontaneously to the health centre. Since 2002, the average patient load was stable, with an average of 140 admissions per year. By the end of 2005, the number of admissions dramatically increased to reach a 7-fold increase in 2006. The genotype of L. donovani identified in 2006 was similar to the one reported in 2002. 82% of total patients treated for VL originated from two districts of Bakool region, Huddur and Tijelow districts. Clinical recovery rate was 93.2% and case fatality rate 3.9%.ConclusionsAfter four years of low but constant VL case findings, a major increase in VL was observed over a 16-month period in the Huddur VL centre. The profile of the patients was pediatric and mortality relatively low. Decentralized treatment centers, targeted active screening, and community sensitization will help decrease morbidity and mortality from VL in this endemic area. The true magnitude of VL in Somalia remains unknown. Further documentation to better understand transmission dynamics and thus define appropriate control measures will depend on the stability of the context and safe access to the Somali population.

Causes of hospitalization among extra-European Union children in a large hospital of Northern Italy, in a five-year observation period

The hospitalizations of 1,239 patients aged 14 years or less and immigrated from extra-European Union countries in Italy were assessed in the 6-year period, from 1999 to 2004. The main demographic and clinical features were analyzed according to several variables, also distiguishing patients aged less than one year, from those aged 1-14 years. The introduction of a deed of indemnity law in 2001 profoundly changed the pattern of admissions and health care needs and exploitation during subsequent years, leading to a massive regularization of clandestine immigrants.

Extremitätenerhalt für den diabetischen Fuß

Lower-extremity amputation (LEA) is a common complication among patients with diabetes. This study tests the effects of a structured disease management program for the diabetic foot (DF) aiming to reduce the number of LEA. DESIGN, METHODS: In a prospective study design we investigate patients with DF in a system of outpatient treatment, acute in-patient care and rehabilitative treatment. Subjects were recruited since January 1(st), 2000, with the latest admission being December 31, 2004. All study participants undergo a five-year follow-up observation period. The University of Texas Wound Classification System (UT) of foot ulcers serves as basis of the documentation and analysis. We evaluated numbers of LEA, rates of ulcer healing and underlying forms of peripheral vascular disease. We report the results of the first patient group completing the two-year follow-up examination. In 2000, 102 subjects with new foot ulcers were consecutively included into the study. 68.6% were men, the mean age of the study population was 68.1 +/- 11.4 years and the mean diabetes duration was 19.4 +/- 10.3 years. After two years, 68 patients can still be examined. Altogether, 22 patients (21.6%) died, and 12 (11.8%) dropped out for various reasons. At the point of discharge from the clinics 35.3% of the ulcers had healed and another 44.1% were in UT grade 1. After two years, a complete healing could still be determined with 51 patients (50.0% of the cohort of the original 102 patients, or 75.0% of the subjects reaching the two-year follow-up). 10 subjects (9.8% or 14.5%) were in the UT grade 1. Eight diabetics underwent major amputation (MA) during the two-year examination period (amputation rate 7.8%). The primary objective of the study, a significant reduction of MA with DF patients, has been achieved. The ulcer healing rates are comparable to the reports of leading centers.

Tendencias de la mortalidad por cáncer pulmonar en México, 1980-2000

To analyze trends in age-adjusted lung cancer mortality rates in Mexico for the period of 1980 through 2000. The trends were assessed using the adjusted rates of mortality from lung cancer, year of death, year of birth, age at death, state, and standard population. The standardized mortality rate and the index of potential years of life lost were used to compare incidence and premature deaths. The standardized mortality rate was analyzed by age groups according to the age at death (30-74 years), five-year observation period (1980-1999), and birth cohort (1910-1950). Nonparametric Spearman correlations were calculated for per capita tobacco consumption, social marginalization, and emigration. The adjusted mortality rate from lung cancer declined from 7.91 per 100 000 in 1989 to 5.96 per 100 000 in 2000. This pattern correlated with the reduction in per capita tobacco consumption, from 2.145 kg in 1959 to 0.451 kg in 1982. The latent period for the appearance of lung cancer in Mexico was 30 years. The male:female ratio was 2.4:1. The highest adjusted mortality rate was found in men who were 70-74 years old at the time of death. The adjusted mortality rates were low among the cohorts of persons born in 1945 or later, and those rates declined over the 1980-2000 period. The index of potential years of life lost and the incidence of premature death were greater among men. The mortality rates for the cohorts of men born between 1915 and 1940 showed a slight decline over the 1980-2000 period; beginning with men born in 1944 the rates increased slightly, mainly among men 30-34 and 35-39 years old at the time of death. For women the adjusted mortality rates were highest among those 75 or older; the rates gradually declined among the women born between 1945 and 1960, with the largest decrease among women 30-34 years old. The adjusted mortality rates varied according to the five-year observation period, the year of death, and birth cohort and gender. The correlation coefficient for the adjusted mortality rate by state and social marginalization was -0.70 (P = 0.00). There was no statistically significant correlation with the index of emigration (P = 0.56). Mortality from lung cancer has declined in Mexico. Morbidity and premature death due to lung cancer are greater in the states of northern Mexico.

Hexazinone site preparation improves black spruce seedling survival and growth

Granular (PRONONE 10G and 5G) and liquid (VELPAR L) hexazinone (1 to 4 kg ai ha−1) were applied to a northern New Brunswick clearcut (loams, silt loams, and clay loams) to reduce raspberry [Rubus idaeus L. var. strigosus (Michx.) Maxim] competition. Treatment, using skidder-mounted herbicide application equipment, was completed in May and September 1986, with planting of 2+2, bareroot, black spruce seedlings [Picea mariana (Mill.) B.S.P.] in June 1986 and in June 1987. Seedling survival and growth were measured yearly for five growing seasons after planting. By August 1991, raspberry cover for three treatments remained less than that for controls. Survival of seedlings planted approximately one month after spring treatment was less than controls, but seedling height and stem diameter were greater than that of control seedlings for most treatments. Survival and growth of seedlings planted approximately one year after spring treatment or nine months after fall treatment were greater than that of control seedlings for most treatments. Fifth-year height and stem diameter of seedlings planted nine months after fall treatment were negatively correlated with raspberry height (r2 = 0.729, height and 0.745, diameter), decreasing as raspberry height increased. Over the five-year observation period, hexazinone formulation did not affect raspberry control, but did affect seedling survival and growth. Spring treatment with PRONONE 10G (2 kg ai ha−1), with planting delayed by one year, provided the best treatment to achieve both optimal seedling survival and growth during plantation establishment. Key words: liquid hexazinone, granular hexazinone, site preparation, black spruce, growth parameters, seedling survival, raspberry competition

A laboratory model of canine leishmaniasis: the inoculation of dogs with Leishmania infantum promastigotes from midguts of experimentally infected phlebotomine sandflies.

Twenty-five dogs (beagles) were infected with Leishmania infantum by the intradermal inoculation of an estimated 5-8,000 metacyclic promastigotes harvested from the midguts of 320 experimentally infected P. perniciosus. Details are given of the methods of infecting the flies and harvesting the parasites. All dogs developed small, self-healing chancres at the sites of inoculation. Parasites were isolated from lymph nodes, bone marrow or spleen of 21 dogs, 12 of which developed signs of disease and raised IFAT litres to Leishmania. Nine of the 21 remained healthy over a five-year observation period. Six of the nine were shown to have a cell mediated immune response to Leishmania. No parasites were isolated from four of the 25 dogs, two of which had a demonstrable cell mediated immunity and another had low transitory IFAT titres. The fourth had chancres at the sites of inoculation. The results show that dogs can be readily infected with promastigotes from the midguts of sandflies. However, a high proportion develop a cell mediated immunity and show on signs of disease. It is suggested that serological surveys of dogs for canine leishmaniasis reveal neither the true prevalence of infection nor the intensity of transmission. The efficacy of controlling human visceral leishmaniasis caused by L. infantum by destroying seropositive dogs is questioned.

Atraumatic iris cilia.

We report two cases of ectopic cilia originating from the iris without any convincing history of injury to the eye. One required surgical removal to prevent further endothelial and lens damage developing over a five-year observation period.

A Clinical Trial of Beta Carotene to Prevent Basal-Cell and Squamous-Cell Cancers of the Skin

Beta carotene has been associated with a decreased risk of human cancer in many studies employing dietary questionnaires or blood measurements, and it has had protective effects in some animal models of carcinogenesis. We tested the possible cancer-preventing effects of beta carotene by randomly assigning 1805 patients who had had a recent nonmelanoma skin cancer to receive either 50 mg of beta carotene or placebo per day and by conducting annual skin examinations to determine the occurrence of new nonmelanoma skin cancer. Adherence to the prescribed treatment was good, and after one year the actively treated group's median plasma beta carotene level (3021 nmol per liter) was much higher than that of the control group (354 nmol per liter). After five years of follow-up, however, there was no difference between the groups in the rate of occurrence of the first new nonmelanoma skin cancer (relative rate, 1.05; 95 percent confidence interval, 0.91 to 1.22). In subgroup analyses, active treatment showed no efficacy either in the patients whose initial plasma beta carotene level was in the lowest quartile or in those who currently smoked. There was also no significant difference between treated and control groups in the mean number of new nonmelanoma skin cancers per patient-year. In persons with a previous nonmelanoma skin cancer, treatment with beta carotene does not reduce the occurrence of new skin cancers over a five-year period of treatment and observation.

A five-year study of tetanus in the Cayo Santiago rhesus monkey colony: Behavioral description and epizootiology.

Tetanus is a major cause of death in the free-ranging rhesus moonkey colony on the island of Cayo Santiago, Puerto Rico. During the five-year period of observation (July 1, 1976 through June 30, 1981), the mean annual tetanus mortality rate (± 1 SD) was 1.74% (±0.15). The mean annual total mortality rate was 6.77% (±0.78). The tetanus mortality rate varied sigificantly (P < 0.005) among the six troops on the island. Clinically confirmed tetanus accounted for 24.68% of the 231 deaths which occurred on the island during the study. Although the base population increassed from 479 to 914 monkeys or 90.8% in five years, there were no significant changes in either the total or the tetanus mortality rates. The mean age of tetanus deaths was 6.9 years (±3.9) in the males and 7.1 years (±5.4) in females. The mean age-specific tetanus mortality rate increased with age. Of the 67 confirmed tetanus cases, 57 proved fatal (26 males, 31 females) for a case fatality rate of 85.1%. There was no significant sex difference in the tetanus mortality rate. No confirmed cases of neonatal tetanus were observed. Infection of juveniles and adults of both sexes occurred chiefly through septic wounds, but postpartum infection of females was also noted. The peak incidence of tetanus deaths for both sexes occurred during the mating season of the annual reproductive cycle, as a consequence of increased levels of aggression and subsequent wounding. The diagnosis of tetanus was based solely on the clinicla signs and was characterized by early behavioural abnormalities consisting of torpor, reluctance to interact with other animals, inability to prehend food, inordinate thirst, difficulty in swallowing, progressive stiffening and adduction of the pectorla limbs, bipedeal running, "kangaroo hopping," "toppling over," and pilo-erection. As the disease advanced, severely affected individuals developed the classic human triad of tetanus symptomatology:trismus (lockjaw), extensor rigidity, and opisthotonus, which progressed in most cases to status epilepticus and death from respiratory paralysis or physical exhaustion. The course of the disease in fatal cases ranged in duration from 24 hours to ten dyas. Obese monkeys with mild cases of tetanus were the most likely to recover with some taking as long as a month to return to normal condition and regain body weight. Of ten recoveries, six were female and four male. Multiple cases were observed in one adult male, indicating that previous infections do not necessarily confer immunity to future attacks. Survivous did not have demonstrable antitoxin titers to Clostridium tetani toxin, thus confirming that tetanus is a nonimmunizing disease. One half of an annual birth crop of thesus monkeys inoculated with tetanus toxoid at the age of one year had protective levels of tetanus antitoxin seven years postinoculation. However, the immunization program had no significant effect on either the total or tetanus motality rates during the study.

Prognostic indicators of herpetic keratitis. Analysis of a five-year observation period after corneal ulceration.

Clinical features of 152 patients with herpetic keratitis after a five-year observation period were analyzed. When compared with dendritic ulceration, geographic ulcers that had been symptomatically present for a longer time were more likely to have been treated with a topical steroid and took longer to heal. After treatment of the corneal ulceration, 40% of the patients experienced a recurrent herpetic ulcer, 25% experienced disciform or irregular stromal keratouveitis, 5% experienced ocular hypertension, and 6% had a decrease in visual acuity caused by corneal scarring. Recurrent ulcerative herpetic keratitis occurred more frequently in men and in patients who entered the study with a history or previous herpetic ulceration.

Transient Cerebral Ischemia

A study was made of transient cerebral ischemia in a biracial rural community in Evans County, Georgia. Of the 2,455 stroke-free persons in the population sample, 28 were found to have had well-defined attacks of transient cerebral ischemia. The prevalence of transient cerebral ischemia in the white population was higher than that in the black community. Approximately one fifth of the people having transient cerebral ischemia developed a complete stroke or died of ischemic heart disease during the three- to five-year period of observation following the survey examination. Community surveys for transient cerebral ischemia appear to be a useful health measure for the detection of a small but important group of people who have a high risk of developing serious manifestations of cerebral or coronary vascular disease.

Transient cerebral ischemia. Prevalence and prognosis in a biracial rural community.

A study was made of transient cerebral ischemia in a biracial rural community in Evans County, Georgia. Of the 2,455 stroke-free persons in the population sample, 28 were found to have had well-defined attacks of transient cerebral ischemia. The prevalence of transient cerebral ischemia in the white population was higher than that in the black community. Approximately one fifth of the people having transient cerebral ischemia developed a complete stroke or died of ischemic heart disease during the three- to five-year period of observation following the survey examination. Community surveys for transient cerebral ischemia appear to be a useful health measure for the detection of a small but important group of people who have a high risk of developing serious manifestations of cerebral or coronary vascular disease.

A study of the antigenic relationships of isolates of Trypanosoma brucei collected from a herd of cattle kept in one locality for five years.

SUMMARY: During surveys of the prevalence of trypanosomiasis, 37 isolates of trypanosomes of the subgenus Trypanozoon were collected over a period of five years from a herd of cattle kept on a farm in an area in Nigeria where human and animal trypanosomiasis is endemic. Thirty-three were typical isolates of Trypanosoma brucei but four were unusual in several respects and their identity was uncertain. The antigenic relationships of the trypanosomes were determined by agglutination tests using antisera to the predominant variant antigens of each isolate. Comparisons of groups of isolates obtained in two of the surveys showed that some of the animals in the herd were infected with antigenically related trypanosomes. Four isolates obtained in one survey had antigens in common and probably belonged to one trypanosome strain, while 26 isolates obtained in another survey seemed to have been derived from three different strains. At least ten animals examined in the latter survey were infected with two strains of Trypanosoma brucei at the same time. Comparisons of trypanosomes obtained in successive surveys showed that one isolate was very closely related to four isolates obtained from different animals two years later. Agglutination and neutralization tests, and a study of variant antigen production by clones prepared from the first isolate and one of the later group of four isolates, established the antigenic similarity of these trypanosomes and provided direct evidence of the long-term antigenic stability of a trypanosome strain under field conditions. Apart from this notable exception, there was little antigenic relationship among the trypanosomes isolated from year to year and at least seven antigenically distinct strains of T. brucei were isolated from the herd in the five-year observation period.

Gärtner's duct lesions of the cervix

Gärtner's duct represents the persisting distal segment of the mesonephric or Wolffian duct. In the adult female it is rarely retained in toto. Segments are most frequently found in the supravaginal cervix. In specimens of cervix obtained by amputation, rests are uncommon. One instance was observed in 1,413 cases. The microscopic appearance is distinctive. Rests produce no symptoms or pathologic changes and are accidentally discovered. Adenomatoid hyperplasia may similarly be only a laboratory finding. Two cases are herein recorded. A case of papillary adenoma of Gärtner's duct origin has been observed. The symptoms, physical findings and pathologic features are noted. A five-year observation period reveals slow but progressive spread of the lesion.