Journal of chronic diseases最新文献

Consistency and plausibility are fundamental criteria for judging cause and effect from observational studies. They are applied here to the interpretation of data from a population-based case-control study of oral contraceptives and breast cancer. A preliminary analysis of oral contraceptive use in young nulliparous women, who had no family history of either breast cancer or benign breast disease, showed a statistically significant dose-response, with long-term users (49 months or more) having an apparent 4-fold elevation in risk of early breast cancer. Further analyses, however, revealed striking inconsistencies which were biologically implausible. These effectively undermine cause and effect as an explanation for the initial finding.

As soon as the first clinico-epidemiology reports appeared describing an association of herpes virus infection with genital cancer, relevant questions were introduced into an ongoing follow-up of a cohort already being studied for psychosocial risk factors in cancer. The study, which was initiated in 1966, comprised 1353 persons; disease incidence was determined in 1976.

Incidences of cancer (including extragenital cancer) were found to be directly related to the reported prevalence of genital herpes symptoms, but were related inversely to extragenital herpes prevalence and to previous fever episodes. With regard to the relatively common incidence of “fever blisters”, i.e. facial herpes, attributed to HSV-type 1, the latter finding is less surprising than the strong association of HSV type 2 lesions with overall cancer incidence. This association was particularly noticeable in individuals who had not reported episodes of fever earlier. These findings indicate the predictive role of certain host factors which are possibly related to systematic responses of the organism, including a diminished protection against (latent) herpes genitalis infection (recurrences). Further prospective studies are needed to investigate the proper time-relationship between clinically-overt herpes genitalis and the manifestation of cancer and its possible role in provoking the recurrent eruption of latent infections.

Physicians use the concept of stability to estimate the likelihood that a patient will deteriorate during a hospitalization. To determine whether physicians can accurately predict a patient's risk of morbidity, 603 patients admitted to the medical service during a one month period were rated prospectively as to how stable they were.

Overall, 15% of patients had deterioration of already compromised systems, while 17% had new complications, such as sepsis. Eight percent of patients had both. Twelve percent of stable patients experienced morbidity; 39% of the somewhat unstable and 61% of the most unstable. When all of the demographic and clinical variables were taken into account including the reason for admission and comorbid diseases, the residents' estimates of the patient's stability was the most significant predictor of morbidity (p < 0.001).

The judgment that a patient was stable had an 87% negative predictive accuracy, while the judgment unstable had a 46% positive predictive accuracy.

This study describes and compares the perceived sickness-related behavioral dysfunction of 859 end-stage renal disease (ESRD) patients from 11 centers according to treatment modality via the Sickness Impact Profile (SIP). The unadjusted functional status of ESRD patients differed significantly by treatment modality. Transplantation patients were least functionally limited followed in order by home dialysis, continuous peritoneal dialysis, and in-center dialysis patients. The largest overall differences were for the sleep and rest, work, recreation and pastimes, and home management SIP categories. Regression analysis revealed that many of the large observed intermodality differences in functional status may have resulted from casemix variations (e.g. age and comorbidity differences). Only SIP score differences between transplantation and other treatment modality patients remained significant following the introduction of casemix controls. Results do not justify choosing one dialysis modality over another because of differences in perceived dysfunction.

Surgery asks patients to trade present discomfort and risk for future gains. Although research reports on the effectiveness of surgery have largely focused on mortality, length of hospital stay, major complications, and laboratory analyses, the principal criteria guiding surgeons' clinical decisions and patients' acceptance of treatment are most often the patients' subjective feelings and capabilities, the quality of their lives. This is true for both major and minor surgical procedures. We discuss the role of information on functional capacity, overall well-being, and quality of life in the assessment of surgical outcomes. Broadening the choice of endpoints beyond traditional, so-called “hard” variables in surgical studies has advantages for both surgeons and patients.

Diabetes mellitus is a multifaceted disease which intervenes in the personal lives of those afflicted in many different ways. In this study prescription drug use among diabetics was analyzed in order to shed light on the characteristics of diabetic morbidity. Prescription drug use among diabetics and non-diabetics in a total population of 21,000 inhabitants in a defined geographic area were studied. The diabetic population was categorized according to the type of treatment received: insulin treatment, oral anti-diabetic treatment or dietary treatment only. The pattern of prescription drug use differed between diabetics and non-diabetics and important differences were observed also between diabetics according to type of treatment. Drug use among those treated with insulin and those treated orally was substantially higher than among non-diabetics while the difference between diabetics on dietary regimen and non-diabetics was much smaller. All three treatment groups had considerably higher consumption of cardiovascular drugs than non-diabetics. Additional findings include more frequent antibiotic use among diabetics treated orally and on diet only than among non-diabetics. The use of these drugs was also common among insulin treated diabetics but did not differ significantly from among non-diabetics. Use of psychotropics was more common among diabetics treated with insulin and orally than among non-diabetics.

This paper presents a definition of “acceptable risk” that is based on the concept of utility. The adverse effects of a specific use of a drug pose an acceptable risk if no alternative treatment has a higher cumulated expected utility in the relevant patient population than that associated with the use of the drug. The implications of this definition for postmarketing management of drugs are explored. In particular, postmarketing surveillance should be expanded to include the quantification of patients' values, a drug's beneficial effects, and its adverse effects. Management actions should be targeted at specific drug uses with unacceptable risks rather than at drugs themselves. This may require the use of education and service action options, as well as regulatory actions aimed at prescribers and dispensers.

Blood pressures (BP) were determined in 1409 boys aged 8–16 years at three one-year intervals in New York City (NYC) and in Greece, areas of high and low incidence of coronary heart disease (CHD), respectively. Non-Greek American boys had significantly lower systolic and diastolic BP than all the Greek boys from NYC and from Greece. The boys residing in Crete and in Athens had higher BP than all other cohorts. After covariance adjustment for height, ponderal index and age, significant differences among the cohorts showed the non-Greek American cohort to have the lowest and the Cretan cohorts the highest BP levels. The Cretans lead a lifestyle noted for the absence of other risk factors for CHD. Thus, while the incremental increase in blood pressure might have a corresponding increase in CHD risk among individuals, there are fewer individuals in Crete at elevated risk overall based on the CHD experience of the U.S. and Greece.