Multiple Chronic Health Conditions and Their Link with Labour Force Participation and Economic Status

Aims

To assess the labour force participation and quantify the economic status of older Australian workers with multiple health conditions.

Background

Many older people suffer from multiple health conditions. While multiple morbidities have been highlighted as an important research topic, there has been limited research in this area to date, particularly on the economic status of those with multiple morbidities.

Methods

Cross sectional analysis of Health&WealthMOD, a microsimulation model of Australians aged 45 to 64 years.

Results

People with one chronic health condition had 0.59 times the odds of being employed compared to those with no condition (OR 0.59, 95% CI: 0.49, 0.71), and those with four or more conditions had 0.14 times the odds of being employed compared to those with no condition (OR 0.14, 95% CI: 0.11, 0.18). People with one condition received a weekly income 32% lower than those with no health condition, paid 49 % less tax, and received 37% more in government transfer payments; those with four or more conditions received a weekly income 94% lower, paid 97% less in tax and received over 2,000% more in government transfer payments per week than those with no condition.

Conclusion

While having a chronic health condition is associated with lower labour force participation and poorer economic status, having multiple conditions compounds the affect – with these people being far less likely to be employed and having drastically lower incomes.     

Association between type 1 diabetes and Haemophilus influenzae type b vaccination: birth cohort study

ObjectivesTo determine the effect of Haemophilus influenzae type b vaccination and its timing on the risk of type 1 diabetes in Finnish children.DesignCumulative incidence and relative risk of type 1 diabetes was compared among three birth cohorts of Finnish children: those born during the 24 months before the H influenzae type b vaccination trial, those in the trial cohort who were vaccinated at 3 months of age and later with a booster vaccine, and those in the trial cohort who were vaccinated at 24 months of age only. The probability of type 1 diabetes was estimated using regression analysis assuming that there were no losses to 10 year follow up and no competing risks.SettingFinland (total population 5 million and annual birth rate 1.3%).Subjects128 936 children born from 1 October 1983 to 1 September 1985, and 116 352 children born from 1 October 1985 to 31 August 1987.ResultsNo statistically significant difference was found at any time during the 10 year follow up in the risk of type 1 diabetes between the children born before the vaccination period and those vaccinated at the age of 24 months only (relative risk 1.01). The difference in the risk between the cohort vaccinated first at the age of 3 months and the cohort vaccinated at the age of 24 months only was not statistically significant either (1.06).ConclusionIt is unlikely that H influenzae type b vaccination or its timing cause type 1 diabetes in children.

Key messages

• The gradual increase in vaccination programmes does not permit any particular one to be pinpointed as being responsible for the increase in type 1 diabetes in Finland
• There is no difference in the risk of type 1 diabetes between children not vaccinated against H influenzae type b and those vaccinated at the age of 24 months only
• The difference in risk between children vaccinated against H influenzae type b at the age of 3 months and those vaccinated at the age of 24 months was not statistically significant
• It is very unlikely that H influenzae type b vaccination or its timing causes type 1 diabetes in Finnish children

     

Health Benefits of Reducing Sugar-Sweetened Beverage Intake in High Risk Populations of California: Results from the Cardiovascular Disease (CVD) Policy Model

Background

Consumption of sugar-sweetened beverage (SSB) has risen over the past two decades, with over 10 million Californians drinking one or more SSB per day. High SSB intake is associated with risk of type 2 diabetes, obesity, hypertension, and coronary heart disease (CHD). Reduction of SSB intake and the potential impact on health outcomes in California and among racial, ethnic, and low-income sub-groups has not been quantified.

Methods

We projected the impact of reduced SSB consumption on health outcomes among all Californians and California subpopulations from 2013 to 2022. We used the CVD Policy Model – CA, an established computer simulation of diabetes and heart disease adapted to California. We modeled a reduction in SSB intake by 10–20% as has been projected to result from proposed penny-per-ounce excise tax on SSB and modeled varying effects of this reduction on health parameters including body mass index, blood pressure, and diabetes risk. We projected avoided cases of diabetes and CHD, and associated health care cost savings in 2012 US dollars.

Results

Over the next decade, a 10–20% SSB consumption reduction is projected to result in a 1.8–3.4% decline in the new cases of diabetes and an additional drop of 0.5–1% in incident CHD cases and 0.5–0.9% in total myocardial infarctions. The greatest reductions are expected in African Americans, Mexican Americans, and those with limited income regardless of race and ethnicity. This reduction in SSB consumption is projected to yield $320–620 million in medical cost savings associated with diabetes cases averted and an additional savings of $14–27 million in diabetes-related CHD costs avoided.

Conclusions

A reduction of SSB consumption could yield substantial population health benefits and cost savings for California. In particular, racial, ethnic, and low-income subgroups of California could reap the greatest health benefits.     

老年骨关节置换术围术期发生脑梗死的危险因素分析及预防对策研究

目的:分析老年骨关节置换术围术期发生脑梗死的危险因素并研究其预防对策。方法:选择2015年1月-2016年6月我院收治的200例行关节置换术患者,对所有患者的性别、年龄、体重、身高、患病情况、置入假体类型、手术时间、术中出血量、术后引流量、切口长度、住院时间、下地时间及高血压、糖尿病、冠心病等合并症情况进行回归分析,明确患者围术期发生脑梗死的危险因素,并提出针对性预防措施。结果:入组200例行骨关节置换术患者,围术期发生脑梗死患者53例。单因素分析结果显示年龄是否超过65岁、吸烟与否、疾病类型、麻醉方式、有无冠心病、糖尿病、高血压等合并症的骨关节置换术患者围术期脑梗死的发生率存在显著性差异(P0.05)。而进一步logistics回归分析显示年龄超过65岁、吸烟、患者股骨颈骨折、手术麻醉为全麻、有冠心病、糖尿病、高血压等合并症是影响行骨关节置换术患者围术期发生脑梗死的独立危险因素(P0.05)。结论:年龄超过65岁、吸烟、患者股骨颈骨折、手术麻醉为全麻、有冠心病、糖尿病、高血压等合并症的骨关节置换术患者围术期更易发生脑梗死,对有上述特点患者应密切注意预后情况,给予精细的护理措施,防止脑梗死的发生。     

Years of potential life lost caused by prostate cancer deaths in the United States—Projection from 2004 through 2050

BackgroundThe purpose of this study is to estimate and project the number of years of potential life lost (YPLL) among males who die of prostate cancer in the United States from 2004 through 2050 and compare the projections by race/ethnicity and age, accounting for demographic changes and population growth.MethodsWe applied the life expectancy method to estimate YPLL caused by deaths of prostate cancer and all cancers in men by using 1999–2004 national mortality data, 2008 census population demographic projections, and 2004 U.S. life tables. We performed sensitivity analyses by varying death rate and population projections, and examined increase in YPLL from population growth, changes in demographics, and death rates.ResultsThe number of YPLL caused by prostate cancer deaths was projected to increase by 226.1%, from 291,853 in 2004 to 951,753 in 2050. Hispanics were projected to have the fastest growth in YPLL (977.1% from 2004 to 2050) caused by prostate cancer, followed by non-Hispanic blacks (543.1%), and non-Hispanic others (269.7%). People aged 75 or older was projected to account for 62.0% of YPLL from prostate cancer in 2050 compared with 50.8% in 2004. Of the projected increase in YPLL caused by prostate cancer deaths by 2050, 9.8% were due to changes in demographic composition, 26.8% because of mortality change, and 63.4% because of population growth.ConclusionsYPLL due to prostate cancer deaths are projected to increase dramatically, and become a greater burden in the future. The projections highlight the importance of comprehensive cancer control and research on cancers including prostate cancer and racial/ethnic-specific estimates.     

Awareness,Treatment, and Control of Diabetes in Bangladesh: A Nationwide Population-Based Study

ObjectivesTo examine awareness, treatment, and control of diabetes mellitus among the adult population in Bangladesh.MethodsThe study used data from the 2011 nationally representative Bangladesh Demographic and Health Survey (BDHS). The BDHS sample is comprised of 7,786 adults aged 35 years or older. The primary outcome variables were fasting blood glucose, diagnosis, treatment, and control of diabetes. Multilevel logistic regression models were used to identify the risk factors for diabetes awareness.ResultsOverall, age-standardized prevalence of diabetes was 9.2%. Among subjects with diabetes, 41.2% were aware of their condition, 36.9% were treated, and 14.2% controlled their condition. A significant inequality in diabetes management was found from poor to wealthy households: 18.2% to 63.2% (awareness), 15.8% to 56.6% (treatment), and 8.2% to 18.4% (control). Multilevel models suggested that participants who had a lower education and lower economic condition were less likely to be aware of their diabetes. Poor management was observed among non-educated, low-income groups, and those who lived in the northwestern region.ConclusionsDiabetes has become a national health concern in Bangladesh; however, treatment and control are quite low. Improving detection, awareness, and treatment strategies is urgently needed to prevent the growing burden associated with diabetes.     

Applications of proportional odds ordinal logistic regression models and continuation ratio models in examining the association of physical inactivity with erectile dysfunction among type 2 diabetic patients

[Purpose]Many studies have observed a high prevalence of erectile dysfunction among individuals performing physical activity in less leisure-time. However, this relationship in patients with type 2 diabetic patients is not well studied. In exposure outcome studies with ordinal outcome variables, investigators often try to make the outcome variable dichotomous and lose information by collapsing categories. Several statistical models have been developed to make full use of all information in ordinal response data, but they have not been widely used in public health research. In this paper, we discuss the application of two statistical models to determine the association of physical inactivity with erectile dysfunction among patients with type 2 diabetes.[Methods]A total of 204 married men aged 20-60 years with a diagnosis of type 2 diabetes at the outpatient unit of the Department of Endocrinology at PSG hospitals during the months of May and June 2019 were studied. We examined the association between physical inactivity and erectile dysfunction using proportional odds ordinal logistic regression models and continuation ratio models.[Results]The proportional odds model revealed that patients with diabetes who perform leisure time physical activity for over 40 minutes per day have reduced odds of erectile dysfunction (odds ratio=0.38) across the severity categories of erectile dysfunction after adjusting for age and duration of diabetes.[Conclusion]The present study suggests that physical inactivity has a negative impact on erectile function. We observed that the simple logistic regression model had only 75% efficiency compared to the proportional odds model used here; hence, more valid estimates were obtained here.     

Impact of Gender,Co-Morbidity and Social Factors on Labour Market Affiliation after First Admission for Acute Coronary Syndrome. A Cohort Study of Danish Patients 2001–2009

Background

Over the last decades survival after acute coronary syndrome (ACS) has improved, leading to an increasing number of patients returning to work, but little is known about factors that may influence their labour market affiliation. This study examines the impact of gender, co-morbidity and socio-economic position on subsequent labour market affiliation and transition between various social services in patients admitted for the first time with ACS.

Methods

From 2001 to 2009 all first-time hospitalisations for ACS were identified in the Danish National Patient Registry (n = 79,714). For this population, data on sick leave, unemployment and retirement were obtained from an administrative register covering all citizens. The 21,926 patients, aged 18–63 years, who had survived 30 days and were part of the workforce at the time of diagnosis were included in the analyses where subsequent transition between the above labour market states was examined using Kaplan-Meier estimates and Cox proportional hazards models.

Findings

A total of 37% of patients were in work 30 days after first ACS diagnosis, while 55% were on sick leave and 8% were unemployed. Seventy-nine per cent returned to work once during follow-up. This probability was highest among males, those below 50 years, living with a partner, the highest educated, with higher occupations, having specific events (NSTEMI, and percutaneous coronary intervention) and with no co-morbidity. During five years follow-up, 43% retired due to disability or voluntary early pension. Female gender, low education, basic occupation, co-morbidity and having a severer event (invasive procedures) and receiving sickness benefits or being unemployed 30 days after admission were associated with increased probability of early retirement.

Conclusion

About half of patients with first-time ACS stay in or return to work shortly after the event. Women, the socially disadvantaged, those with presumed severer events and co-morbidity have lower rates of return.     

Career pathways and destinations 18 years on among doctors who qualified in the United Kingdom in 1977: postal questionnaire survey

ObjectiveTo determine the career destinations, by 1995, of doctors who qualified in the United Kingdom in 1977; the relation between their destinations and early career choice; and their intentions regarding retirement age.DesignPostal questionnaire.SettingUnited Kingdom.SubjectsAll (n=3135) medical qualifiers of 1977.ResultsAfter about 12 years the distribution of respondents by type of employment, and, for women, the percentage of doctors in part time rather than full time medical work, had stabilised. Of all 2997 qualifiers from medical schools in Great Britain, 2399 (80.0% (95% confidence interval 79.5% to 80.6%)) were working in medicine in the NHS in Great Britain 18 years after qualifying. Almost half the women (318/656) worked in the NHS part time. Of 1714 doctors in the NHS, 1125 intended to work in the NHS until normal retirement age, 392 did not, and 197 were undecided. Of the 1548 doctors for whom we had sufficient information, career destinations at 18 years matched the choices made at 1, 3, and 5 years in 58.9% (912), 78.2% (1211), and 86.6% (1341) of cases respectively.ConclusionsPlanning for the medical workforce needs to be supported by information about doctors’ career plans, destinations, and whole time equivalent years of work. Postgraduate training needs to take account of doctors’ eventual choice of specialty (and the timing of this choice).

Key messages

• A large scale national study in the United Kingdom followed doctors from qualification to mid-career and beyond
• Most doctors had made their choice of eventual career—at least in terms of broadly defined specialty—within 5 years of qualifying
• Eighteen years on, 80% of the doctors were working in the NHS and nearly half of women doctors were working part time
• Almost a quarter of NHS doctors planned to retire early

     

Comparison of the Expectation of Caregivers and Children with Type 1 Diabetes Mellitus Doe Independence in Diabetes Care-Related Tasks

ObjectiveChildren who are given unsupervised responsibility for their diabetes care prior to developmental and/or emotional readiness may have poorer glycemic control. The purpose of this study was to assess the age-related expectations of children and caregivers for independence in diabetes care-related tasks.MethodsA total of 150 participants with type 1 diabetes mellitus (T1DM) receiving multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) were enrolled in this study. All caregivers and participants older than 10 years of age completed questionnaires evaluating the expected age of independence for different diabetes care-related tasks.ResultsThe participants expected independence with no direct supervision in most diabetes care-related tasks at a younger age than their caregivers (P < .05). The difference was more prominent for those on CSII compared to MDI (P < .01). There was a positive correlation between the age when caregivers expect independence for most of the diabetes-related tasks and the age at diagnosis, regardless of the use of MDI or CSII (P < .01).ConclusionChildren with T1DM expect to assume independence at a younger age than their caregivers do. The younger the children are at diagnosis, the younger they are expected by their caregivers to be independent, especially those on CSII. (Endocr Pract. 2014;20:629-637)     

Midline episiotomy and anal incontinence: retrospective cohort study

ObjectiveTo evaluate the relation between midline episiotomy and postpartum anal incontinence.DesignRetrospective cohort study with three study arms and six months of follow up.SettingUniversity teaching hospital.ParticipantsPrimiparous women who vaginally delivered a live full term, singleton baby between 1 August 1996 and 8 February 1997: 209 who received an episiotomy; 206 who did not receive an episiotomy but experienced a second, third, or fourth degree spontaneous perineal laceration; and 211 who experienced either no laceration or a first degree perineal laceration.ResultsWomen who had episiotomies had a higher risk of faecal incontinence at three (odds ratio 5.5, 95% confidence interval 1.8 to 16.2) and six (3.7, 0.9 to 15.6) months postpartum compared with women with an intact perineum. Compared with women with a spontaneous laceration, episiotomy tripled the risk of faecal incontinence at three months (95% confidence interval 1.3 to 7.9) and six months (0.7 to 11.2) postpartum, and doubled the risk of flatus incontinence at three months (1.3 to 3.4) and six months (1.2 to 3.7) postpartum. A non-extending episiotomy (that is, second degree surgical incision) tripled the risk of faecal incontinence (1.1 to 9.0) and nearly doubled the risk of flatus incontinence (1.0 to 3.0) at three months postpartum compared with women who had a second degree spontaneous tear. The effect of episiotomy was independent of maternal age, infant birth weight, duration of second stage of labour, use of obstetric instrumentation during delivery, and complications of labour. ConclusionsMidline episiotomy is not effective in protecting the perineum and sphincters during childbirth and may impair anal continence.     

重症监护病房长期机械通气患者撤机困难的原因及死亡影响因素分析

目的:探讨重症监护病房(ICU)长期机械通气患者撤机困难的原因及撤机死亡的影响因素。方法:对2015年6月至2018年10月我院收治的80例长期机械通气患者的临床资料进行回顾性分析,按照患者撤机结果分为撤机成功组52例和撤机困难组28例,根据患者存活情况分为存活组59例和死亡组21例。比较各组临床资料,分析撤机困难的原因及撤机死亡的影响因素。结果:撤机困难组年龄、心功能不全比例、多器官功能障碍(MODS)比例、呼吸机相关肺炎(VAP)比例、肝功能不全比例、肾功能不全比例、血尿素氮显著高于撤机成功组,机械通气时间、气管切开时间显著长于撤机成功组,血清白蛋白显著低于撤机成功组(P0.05)。死亡组年龄、合并糖尿病比例、心功能不全比例、MODS比例、VAP比例、肝功能不全比例、肾功能不全比例、血尿素氮显著高于存活组,机械通气时间、气管切开时间显著长于存活组,血清白蛋白显著低于存活组(P0.05)。多因素Logistic回归分析显示:年龄、合并糖尿病、MODS、VAP、机械通气时间、气管切开时间、血清白蛋白是ICU长期机械通气患者撤机死亡的影响因素(P0.05)。结论:患者治疗期间发生脏器功能不全或器官功能衰竭、机械通气时间较长、气管切开时间较长、营养状态较差是长期机械通气患者撤机困难的主要原因,年龄、合并糖尿病、MODS、VAP、机械通气时间、气管切开时间、血清白蛋白是ICU长期机械通气患者撤机死亡的影响因素。     

Trends in disability-adjusted life years of lung cancer among women from 2004 to 2030 in Guangzhou,China: A population-based study

BackgroundForecast of disease burden in lung cancer is an important health agenda. One of the main challenges is to predict the evolution of trends in disability-adjusted life year (DALY) of lung cancer so as to anticipate the future burden and to coordinate the supply of sufficient health services and care.MethodsUsing 2004–2013 cancer registry data in Guangzhou, we fitted Bayesian age-period-cohort models with age, period, and cohort effects to analyze trends of lung cancer among women, and then made forecast for DALY of lung cancer until 2030.ResultsDuring 2004–2013, there was an annual average of 10,582 DALYs for lung cancer (15.84% of total DALY). In 2014–2030, DALY is expected to reach 234,752 person-years for lung cancer (12.25% of total DALY), with an annual mean of 13,809 DALYs. Lung cancer crude DALY rate is projected to rise steadily from 257.56 (95% uncertainty interval: 165.97–361.22) in 2014 to 316.99 (219.96–419.41) per 100,000 women in 2030, and the rise is mainly seen in 45–64 years age group. Lung cancer DALY rate remains the highest in the 65–89 years age group.ConclusionsWomen at 65–89 years carry the highest lung cancer burden among other age groups in Guangzhou. The DALY rate of lung cancer is projected to increase most precipitously for the 45–64 years age group. This indicates that concerted efforts are needed to develop adequate cancer services, and to reassess health resources for control and care of lung cancer in these populations.     

Prevalence of Anemia Among Unselected Adults with Diabetes Mellitus and Normal Serum Creatinine Levels

ObjectiveTo determine the prevalence of anemia in a cohort of patients with diabetes and normal serum creatinine concentration in a primary care clinic.MethodsWe undertook a retrospective cohort study, comparing adult patients who had diabetes, with or without anemia. Patients older than 18 years who had diabetes were identified by using the computerized database for the years 2006 and 2007 in a primary care clinic. Patients with hemoglobin levels < 13.7 g/dL (men < 60 years old), ≤ 13.2 g/dL (men ≥ 60 years old), or < 12.2 g/dL (women) with no known cause of anemia were identified and compared with patients who had diabetes but not anemia. All patients had normal serum creatinine levels (men ≤ 1.5 mg/dL and women ≥ 1.4 mg/dL).ResultsOf 594 eligible patients with diabetes, 192 (32%) had anemia. Older age, higher serum urea and creatinine levels, lower estimated glomerular filtration rates, and reduced serum iron levels were more common in the patients with diabetes who had anemia than in those without anemia. The prevalence of anemia was higher in patients treated with “glitazones,” insulin, and angiotensin receptor blockers in comparison with those receiving other orally administered hypoglycemic medications. In stepwise logistic regression analysis, only serum creatinine, age, and use of glitazones retained statistical significance.ConclusionIn a community clinic, the prevalence of anemia in unselected patients with diabetes and normal serum creatinine levels was 32%. Factors associated with anemia were older age, higher serum creatinine levels, and use of glitazone therapy. (Endocr Pract. 2009;15:714-719)     

Changing epidemiology of dengue in Sri Lanka—Challenges for the future

BackgroundDengue infections are on the rise in Sri Lanka and are spreading to all areas in the country. Here, we discuss the changes in dengue epidemiology in Sri Lanka in relation to changes in age distribution, changes in seroprevalence rates over time, and possible reasons contributing to such changes.Methods and findingsAlthough the incidence of dengue increased 20-fold from the year 2000 to 2012 and a further 3-fold from 2012 to 2019, this increase is not reflected in a similar increase in the age-stratified seropositivity rates for dengue. For instance, the annual seroconversion rates were 0.76% in 2013 and 0.91% in 2017. The annual seroconversion rates in the 6 to 17 age group were 1.5% per year in 2003, 3.9% in 2013, and 4.1% in 2017. In addition, although a 13-fold increase in dengue was seen in those who were <19 years of age, a 52.4-fold increase was seen in the 40- to 59-year age group. The case fatality rates (CFRs) have similarly changed, with 61.8% of deaths occurring in those <19 years of age in the year 2000, while in 2012 to 2018, the highest CFR were seen in those who were aged 20 to 39 years. Although there has been a marked increase in the number of cases, the vector densities did not change during a 4-year period. The proportion of adult individuals experiencing a secondary dengue infection has also remained between 65% and 75% between the years 2004 and 2018.ConclusionsA change in the ratio of symptomatic to asymptomatic infections can give rise to changes in the reported incidence of dengue. In order to take an appropriate policy decision in dengue control activities, it would be important to study the changes in virus serotypes, vector dispersion, and densities. Further, the contribution of the rise in metabolic diseases to an increase in the symptomatic as well as more severe infections due to dengue is explored.     

The genetic liability to disability retirement: a 30-year follow-up study of 24,000 Finnish twins

Background

No previous studies on the effect of genetic factors on the liability to disability retirement have been carried out. The main aim of this study was to investigate the contribution of genetic factors on disability retirement due to the most common medical causes, including depressive disorders.

Methods

The study sample consisted of 24 043 participants (49.7% women) consisting of 11 186 complete same-sex twin pairs including 3519 monozygotic (MZ) and 7667dizygotic (DZ) pairs. Information on retirement events during 1.1.1975–31.12.2004, including disability pensions (DPs) with diagnoses, was obtained from the Finnish nationwide official pension registers. Correlations in liability for MZ and DZ twins and discrete time correlated frailty model were used to investigate the genetic liability to age at disability retirement.

Results

The 30 year cumulative incidence of disability retirement was 20%. Under the best fitting genetic models, the heritability estimate for DPs due to any medical cause was 0.36 (95% CI 0.32–0.40), due to musculoskeletal disorders 0.37 (0.30–0.43), cardiovascular diseases 0.48 (0.39–0.57), mental disorders 0.42 (0.35–0.49) and all other reasons 0.24 (0.17–0.31). The effect of genetic factors decreased with increasing age of retirement. For DP due to depressive disorders, 28% of the variance was explained by environmental factors shared by family members (95% CI 21–36) and 58% of the variance by the age interval specific environmental factors (95% CI 44–71).

Conclusions

A moderate genetic contribution to the variation of disability retirement due to any medical cause was found. The genetic effects appeared to be stronger at younger ages of disability retirement suggesting the increasing influence of environmental factors not shared with family members with increasing age. Familial aggregation in DPs due to depressive disorders was best explained by the common environmental factors and genetic factors were not needed to account for the pattern of familial aggregation.     

Report Preparation on Result Turnaround Time and Savings in Cost,Time, and Space

ObjectiveTo evaluate whether introduction of a densitometry workflow, data-storage, and reporting software system would result in streamlined workflow with fewer expenses and quicker result turnaround time.MethodsBoneStation was implemented March 30, 2009, in a large, urban, tertiary referral center performing more than 6000 bone mineral density studies annually at 3 different geographic sites. The times of scan acquisition, report preparation, and final signature in the online medical record were recorded, and the delays from scan to report and from scan to final signature in the online medical record were calculated for each patient during 2 representative weeks before (n = 274) and 2 weeks after (n = 235) implementation of BoneStation.ResultsUse of BoneStation reduced time from scan to report from 2.11 ± 0.16 days to 0.46 ± 0.05 days (P <.001). BoneStation saved our practice $8.94 per scan, while costing only $3 per scan, resulting in net savings. Considering that the total reimbursement from Medicare in 2010 for dual-energy x-ray absorptiometry is projected to be $55.44, this constitutes cost savings of 10.7% of the total reimbursement.ConclusionThe introduction of a specialized electronic medical system for data storage and reporting reduced costs and improved result turnaround time in a densitometry practice. (Endocr Pract. 2010;16:30-35)     

Randomised controlled trial of cardiotocography versus Doppler auscultation of fetal heart at admission in labour in low risk obstetric population

ObjectiveTo compare the effect of admission cardiotocography and Doppler auscultation of the fetal heart on neonatal outcome and levels of obstetric intervention in a low risk obstetric population.DesignRandomised controlled trial.SettingObstetric unit of teaching hospitalParticipantsPregnant women who had no obstetric complications that warranted continuous monitoring of fetal heart rate in labour.InterventionWomen were randomised to receive either cardiotocography or Doppler auscultation of the fetal heart when they were admitted in spontaneous uncomplicated labour.ResultsThere were no significant differences in the incidence of metabolic acidosis or any other measure of neonatal outcome among women who remained at low risk when they were admitted in labour. However, compared with women who received Doppler auscultation, women who had admission cardiotocography were significantly more likely to have continuous fetal heart rate monitoring in labour (odds ratio 1.49, 95% confidence interval 1.26 to 1.76), augmentation of labour (1.26, 1.02 to 1.56), epidural analgesia (1.33, 1.10 to 1.61), and operative delivery (1.36, 1.12 to 1.65).ConclusionsCompared with Doppler auscultation of the fetal heart, admission cardiotocography does not benefit neonatal outcome in low risk women. Its use results in increased obstetric intervention, including operative delivery.

What is already known on this topic

The admission cardiotocogram is a short recording of the fetal heart rate immediately after admission to the labour wardOpinion varies about its value in identifying a potentially compromised fetusIn low risk women, the incidence of intrapartum fetal compromise is low

What this study adds

Compared with Doppler auscultation of the fetal heart, admission cardiotocography has no benefit on neonatal outcome in low risk womenAdmission cardiotocography results in increased obstetric intervention, including operative delivery     

The future excess fraction of occupational cancer among those exposed to carcinogens at work in Australia in 2012

BackgroundStudies in other countries have generally found approximately 4% of current cancers to be attributable to past occupational exposures. This study aimed to estimate the future burden of cancer resulting from current occupational exposures in Australia.MethodsThe future excess fraction method was used to estimate the future burden of occupational cancer (2012–2094) among the proportion of the Australian working population who were exposed to occupational carcinogens in 2012. Calculations were conducted for 19 cancer types and 53 cancer-exposure pairings, assuming historical trends and current patterns continued to 2094.ResultsThe cohort of 14.6 million Australians of working age in 2012 will develop an estimated 4.8 million cancers during their lifetime, of which 68,500 (1.4%) are attributable to occupational exposure in those exposed in 2012. The majority of these will be lung cancers (n = 26,000), leukaemias (n = 8000), and malignant mesotheliomas (n = 7500).ConclusionsA significant proportion of future cancers will result from occupational exposures. This estimate is lower than previous estimates in the literature; however, our estimate is not directly comparable to past estimates of the occupational cancer burden because they describe different quantities – future cancers in currently exposed versus current cancers due to past exposures. The results of this study allow us to determine which current occupational exposures are most important, and where to target exposure prevention.