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  • 1
    Electronic Resource
    Electronic Resource
    Anaesthesia for patients over 90 years of age. Outcomes after regional and general anaesthetic techniques for two common surgical procedures (1989)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 44 (1989), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Peri-operative morbidity and mortality and long term outcome of patients over 90 years of age who underwent either total hip arthroplasty or transurethral prostate resection were studied retrospectively. The outcomes of patients who received regional or general anaesthesia were compared. One hundred and forty-one patients underwent total hip arthroplasty and 44 patients underwent transurethral prostate resection during the study period (1975-1985). Overall in-hospital mortality was 4.9%. Mortality at 30 days was 5.3% in patients who underwent hip arthroplasty during regional anaesthesia, compared with 6.8% in those who received general anaesthesia. Long term survival was similar for these two groups and was longer than projected for age and gender-matched general population cohorts. The 30-day mortality rate was 3.2% for patients who underwent prostatic resection under regional anaesthesia; no deaths occurred in the general anaesthesia group. This difference was not statistically significant. Long term survival was similar for patients in both groups and was better than predicted. Anaesthetic technique did not influence short term morbidity and mortality or long term outcome for these procedures.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1989.tb11166.x
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  • 2
    Electronic Resource
    Electronic Resource
    Incidence of a clinical diagnosis of the irritable bowel syndrome in a United States population (2004)
    Oxford, UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 19 (2004), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : The incidence of irritable bowel syndrome is uncertain. We aimed to determine the incidence of clinically diagnosed irritable bowel syndrome in the community.Methods : Using the Rochester Epidemiology Project, all diagnoses of irritable bowel syndrome made among adult residents of Olmsted County, Minnesota, over a 3-year period were identified. The complete medical records of a random sample of the potential subjects were reviewed for the 10 years prior to the irritable bowel syndrome diagnosis and any patient who had received a previous diagnosis of irritable bowel syndrome was excluded (prevalent cases).Results : The diagnostic index listed 1245 possible irritable bowel syndrome patients; 416 patient charts were reviewed and, of these, 149 were physician diagnosed incident cases of irritable bowel syndrome. The age- and sex-adjusted incidence rate was 196 per 100 000 person-years and increased with age (P = 0.006). The age-adjusted annual incidence per 100 000 in women was higher than in men: 238 vs. 141 (ratio 3:2; P = 0.005). The overall symptom frequency at the time of diagnosis was abdominal pain (73%), diarrhoea (41%) and constipation (16%).Conclusions : The incidence of a clinical diagnosis of irritable bowel syndrome in adults was estimated to be two per 1000 per year, increased with age and was higher in women than men. As many people with irritable bowel syndrome do not seek care, the true incidence of irritable bowel syndrome is likely to be higher.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2036.2004.01938.x
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  • 3
    Electronic Resource
    Electronic Resource
    Is irritable bowel syndrome more likely to be persistent in those with relatives who suffer from gastrointestinal symptoms? A population-based study at three time points (2003)
    Oxford, UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 17 (2003), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: We tested the hypothesis that subjects with relatives who suffered from abdominal pain or bowel dysfunction would be at an increased risk of more persistent irritable bowel syndrome.Methods: A valid, self-report questionnaire was mailed to an age- and gender-stratified random sample of residents, aged 30–64 years, in Olmsted County, MN, USA, on three occasions over a 4-year period. Persistent irritable bowel syndrome was defined as the presence of irritable bowel syndrome on at least two of the three surveys, and fluctuating irritable bowel syndrome was defined as the presence of irritable bowel syndrome on only one of the surveys.Results: Subjects were less likely to have persistent irritable bowel syndrome over the age of 50 years [odds ratio (OR), 0.20; 95% confidence interval (CI), 0.09, 0.47]. A positive family history was reported by 23%. A family history of gastrointestinal symptoms was independently associated with persistent irritable bowel syndrome (vs. no irritable bowel syndrome: OR, 2.5; 95% CI, 1.3, 4.9) and fluctuating irritable bowel syndrome (vs. no irritable bowel syndrome: OR, 2.4; 95% CI, 1.3, 4.4). However, subjects reporting a positive family history were not more likely to report persistent vs. fluctuating irritable bowel syndrome (OR, 1.2; 95% CI, 0.5, 2.9). The use of non-steroidal anti-inflammatory drugs (OR, 2.3; 95% CI, 1.2, 4.3) and a history of food sensitivity (OR, 3.6; 95% CI, 1.9, 6.9) were the only other predictors of persistent irritable bowel syndrome.Conclusions: A history of abdominal pain or bowel troubles in first-degree relatives appears to be independently associated with both persistent and fluctuating irritable bowel syndrome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2036.2003.01591.x
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  • 4
    Electronic Resource
    Electronic Resource
    Impact of functional gastrointestinal disorders on health-related quality of life: a population-based case–control study (2004)
    Oxford, UK : Blackwell Science Ltd
    Alimentary pharmacology & therapeutics 19 (2004), S. 0 
    Details
    ISSN: 1365-2036
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background : The health-related quality of life is impaired in patients with functional gastrointestinal disorders seen in referral centres.Aim : To determine whether the health-related quality of life is impaired in subjects with functional disorders in the community and whether any differences can be explained by psychological co-morbidity.Methods : In a population-based, nested, case–control study, subjects reporting symptoms of either dyspepsia or irritable bowel syndrome and healthy controls were interviewed and completed a battery of psychological measures plus a validated, generic, health-related quality of life measure (Medical Outcomes Study 36-item short form health survey, SF-36). The association between irritable bowel syndrome and dyspepsia and the physical and mental composite scores of SF-36 were assessed with and without adjustment for psychological state.Results : One hundred and twelve cases (30 dyspepsia, 39 irritable bowel syndrome, 32 dyspepsia and irritable bowel syndrome and 11 gastrointestinal symptoms but not dyspepsia or irritable bowel syndrome) and 110 controls were enrolled. In the unadjusted linear regression models, irritable bowel syndrome (but not dyspepsia) was negatively associated with the physical composite score (P 〈 0.05); in an adjusted model, the association between the physical health-related quality of life and irritable bowel syndrome was explained by the Symptom Checklist-90 somatization score alone. In unadjusted models, irritable bowel syndrome and dyspepsia were each negatively associated with the mental composite score (P 〈 0.05). The association between the mental health-related quality of life and dyspepsia remained after adjusting for psychological covariates, but the association between this and irritable bowel syndrome was not significant after adjustment.Conclusions : In the community, health-related quality of life is impaired in subjects with irritable bowel syndrome and dyspepsia; however, much of this association can be explained by psychological factors.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.0269-2813.2004.01807.x
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  • 5
    Electronic Resource
    Electronic Resource
    Evaluation of adverse health outcomes associated with vertebral fractures (1991)
    Springer
    Osteoporosis international 1 (1991), S. 134-140 
    Details
    ISSN: 1433-2965
    Keywords: Osteoporosis ; Pain and disability ; Psychosocial problems ; Risk analysis ; Statistical methods ; Vertebral fractures
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Little is known about the frequency or degree to which vertebral fractures cause pain and physical disability. The purpose of this investigation was to examine the advantages of risk analysis over other statistical techniques (e.g., correlation analysis) for quantifying relationships between vertebral fractures and outcomes such as pain and disability. Subjects who volunteered to participate in studies of osteoporosis were asked about pain and disability. The number and degree of vertebral deformities were assessed from radiographs. Strong associations were observed between the most severe vertebral deformities and the risk of high pain or disability scores, while weaker associations were observed for moderate deformities. There did not appear to be any association between vertebral deformity and risk of moderate levels of pain or disability. Because of the potential for bias in cross-sectional studies such as this, the magnitude of these findings must be considered tentative. We conclude that risk analysis is an appropriate method for quantifying the relationship of vertebral fractures with pain and disability, but that prospective studies are now needed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01625442
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  • 6
    Electronic Resource
    Electronic Resource
    Prevalence and incidence of vertebral deformities (1993)
    Springer
    Osteoporosis international 3 (1993), S. 113-119 
    Details
    ISSN: 1433-2965
    Keywords: Epidemiology ; Incidence ; Osteoporosis ; Prevalence ; Vertebral fracture
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract There is a need to identify vertebral fractures from radiographs taken at a single point in time, but considerable controversy surrounds the methods to be used. We extended a data set to comprise baseline radiographs of the thoracic and lumbar spine on an age-stratified random sample of 762 Rochester, Minnesota, women and used revised methods to define vertebral deformities morphometrically. Changes in the method of measuring vertebral heights, changes in the source of normal values for vertebral measurements and changes in the criteria for assessing vertebral deformity had little impact on estimated prevalence and incidence in this population. The prevalence of any vertebral deformity was estimated at 25.3 per 100 Rochester women aged 50 years and over (95% CI, 22.3–28.2), while the incidence of a new deformity in this group was estimated at 17.8 per 1000 person-years (95% CI, 16.0–19.7). Projected nationally, these data suggest that over 500 000 white women in the United States develop vertebral deformities for the first time each year and that over 7 million white women aged 50 years and over might be affected at any given time. These estimates are limited by the absence of a reliable ‘gold standard’ with which to determine false positive and false negative rates associated with this or any other morphometric method. Information on the health consequences of vertebral deformities of various sorts would be most helpful in choosing between alternative approaches to defining them.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01623271
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  • 7
    Electronic Resource
    Electronic Resource
    Bisphosphonates and vertebral fracture: An epidemiological perspective (1991)
    Springer
    Osteoporosis international 2 (1991), S. 1-4 
    Details
    ISSN: 1433-2965
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01627071
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  • 8
    Electronic Resource
    Electronic Resource
    Influence of breastfeeding and other reproductive factors on bone mass later in life (1993)
    Springer
    Osteoporosis international 3 (1993), S. 76-83 
    Details
    ISSN: 1433-2965
    Keywords: Contraceptives, oral ; Lactation ; Obesity ; Osteoporosis ; Parity ; Sex hormones
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The influence of reproductive factors on bone mass at six skeletal sites was assessed in an age-stratified random sample of white women residing in Rochester, Minnesota. After age-adjustment, whether or not women had ever breastfed, total duration of breastfeeding and duration of breastfeeding per child were not associated with reduced bone mineral, but breastfeeding for more than 8 months was associated with greater bone mineral at some sites. There were no consistent effects on bone mineral, after adjusting for age, of gravidity or parity, age at menarche, age at first delivery, use of oral contraceptives or estrogen replacement therapy, various sex hormones, nor any of the other reproductive factors assessed. There was a strong protective effect of obesity, which was also correlated with a number of the reproductive variables. While animal studies suggest that pregnancy and lactation may be associated with calcium loss from the skeleton, these data indicate that such factors have little long-term impact on bone mass in humans and little potential for identifying women at high risk of osteoporosis later in life.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01623377
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  • 9
    Electronic Resource
    Electronic Resource
    Hip fractures in the elderly: A world-wide projection (1992)
    Springer
    Osteoporosis international 2 (1992), S. 285-289 
    Details
    ISSN: 1433-2965
    Keywords: Epidemiology ; Hip fracture ; Incidence ; Osteoporosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Hip fractures are recognized to be a major public health problem in many Western nations, most notably those in North America, Europe and Oceania. Incidence rates for hip fracture in other parts of the world are generally lower than those reported for these predominantly Caucasian populations, and this has led to the belief that osteoporosis represents less of a problem to the nations of Asia, South American and Africa. Demographic changes in the next 60 years, however, will lead to huge increases in the elderly populations of those countries. We have applied available incidence rates for hip fracture from various parts of the world to projected populations in 1990, 2025 and 2050 in order to estimate the numbers of hip fractures which might occur in each of the major continental regions. The projections indicate that the number of hip fractures occurring in the world each year will rise from 1.66 million in 1990 to 6.26 million by 2050. While Europe and North America account for about half of all hip fractures among elderly people today, this proportion will fall to around one quarter in 2050, by which time steep increases will be observed throughout Asia and Latin America. The results suggest that osteoporosis will truly become a global problem over the next half century, and that preventive strategies will be required in parts of the world where they are not currently felt to be necessary.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01623184
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  • 10
    Electronic Resource
    Electronic Resource
    Age-related hip fractures in men: Clinical spectrum and short-term outcomes (1995)
    Springer
    Osteoporosis international 5 (1995), S. 419-426 
    Details
    ISSN: 1433-2965
    Keywords: Epidemiology ; Functional outcome ; Hip fracture ; Men ; Mortality ; Population-based study
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Clinical spectrum, treatment and short-term outcomes were assessed among the 131 Rochester, Minnesota, men who contracted an initial hip fracture due to moderate trauma during 1978–89. Three-fourths of falls leading to hip fracture occurred indoors with little seasonality, and 91% of fractures were in men 65 years of age or older. The ratio of cervical to intertro-chanteric femur fractures was 1.4:1, and there was a tendency toward more neurological conditions among the patients with cervical fractures. Hemiarthroplasty and total hip replacement were mostly performed for cervical fractures, while internal fixation was preferred for intertrochanteric fractures. In-hospital mortality was 11.5%, and the 30-day case fatality rate was 16.0%. Age and postoperative deterioration of mental status significantly increased the risk of early death, the latter even after adjustment in a multivariate model, while comorbidity had a suggestive but not statistically significant influence on mortality. More than half the men were discharged to nursing homes, and 79% of the patients who survived at 1 year resided in nursing homes or intermediate care facilities or were attended by home care. Only 41% of survivors recovered their prefracture level of functioning and nearly 60% of patients limped and required a cane or walker. After implementation of the prospective payment system in 1984, the length of hospital stay was reduced, but there was no change in early mortality rates, in the duration of physical therapy following fracture or in attendance at nursing homes. The results of this population-based study demonstrate the strong impact of hip fractures on short-term outcomes in men.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01626602
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