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The aim of this study was to investigate the effect of age, gender, and occupation on the outcome of carpal tunnel decompression. A total of 479 patients (342 females, 137 males) with a mean age of 56 years undergoing 608 carpal tunnel decompressions were prospectively studied. Outcome was assessed using the Brigham Hospital carpal tunnel questionnaire at two weeks pre-operatively and six months post-operatively. Cases were divided into four age categories (less than 40 years of age, 40-59, 60-79, and over 80 years of age) and two occupation (repetitive and non-repetitive) groups. The mean differences for both the symptom-severity and functional-status scores amongst the four age categories were similar and no significant difference was found. The mean differences for both the symptom-severity and functional-status scores between females and males and the two occupation groups were similar and no significant differences were found. The majority of the patient's symptoms improved following carpal tunnel decompression. However, we found no influence of age, gender, or occupation on the outcome of carpal tunnel decompression in our series of patients.

Incontinent women have low rates of care seeking and treatment, some of which may be explained by their beliefs about the causes of their own urine loss. As little is known about these beliefs, our aim was to qualitatively assess what women perceive as the etiology of their urinary incontinence (UI).In a written survey on urinary symptoms administered to female HMO enrollees aged 30-90 years, incontinent women were asked the open-ended question: "Why do you think you lose urine?" Qualitative analyses of the responses identified themes, which were quantified and organized into major categories. Subjects were assigned multiple themes/categories as indicated. Relationships between major categories and subject/incontinence characteristics were explored.Of the 1458 women with incontinence who completed the survey, 1192 (82%) responded to the open-ended question. Qualitative analyses identified 23 themes, with 5 themes cited byor=10% of subjects: pelvic floor/bladder muscles (31%), pregnancy/childbirth (18%), age (14%), exertional triggers (12%), and waiting too long to void (10%). The 23 themes were organized into 5 major categories: pelvic floor/bladder related (53%), uncontrollable factors (23%), part of being female (21%), personal/lifestyle attributes (21%), and don't know (12%). Subjects expressed a range of 1-4 themes/categories. Major categories differed by age, and significant associations were seen between major categories and incontinence severity.Women attribute their UI to a number of causes, which can be condensed into workable themes and categories. By understanding women's beliefs about the etiology of incontinence, clinicians may improve their ability to educate, counsel, and treat women with incontinence.

We retrospectively analysed 106 consecutive traumatic humeral shaft fractures over a five-year period. The mechanism of injury, age, gender, fracture types, associated injury and the presence of injury to the radial nerve were reviewed. The incidence was about 10 per 100,000 per year; most were closed fractures in young males which had been sustained as a result of traffic accidents. The age–gender distribution was characterised by gradually increased incidence from the fifth decade in women, while it reached a peak at the third decade and decreased after the fifth decade in men. The results revealed different epidemiological features from previous studies. The epidemiology differs between ethnicity and country, and updating the epidemiological features of humeral shaft fractures may provide information for appropriate treatment programmes. This study documents the epidemiology of humeral shaft fracture in Taiwan, probably for the first time in this Asian community.

Reports in the literature have suggested a high incidence of congenital deformities, including congenital talipes equinovarus (CTEV), in many Pacific Islands. This study performed a retrospective analysis of cases of CTEV in an isolated region of Papua New Guinea over a 2-year period. Data was collected on the incidence of CTEV, together with an analysis of initial treatment and outcome. The incidence of CTEV was 2.7 per 1,000 live births per year. A peak incidence of CTEV births in September suggested that maternal anaemia secondary to malaria was a significant risk factor. Good functional outcome was confirmed in only 20% of cases following initial treatment. The authors suggest the Ponseti method as a realistic option for treating CTEV in this region and that it could be instigated with minimal resources and training.

The study was aimed at determining bacterial agents of the upper respiratory tract and the susceptibility patterns of isolates to antibiotics. In total, 200 throat swabs were obtained from students attending different boarding schools within the Buea Municipality and screened to obtain the prevalence of respiratory pathogens and to understand the antibiotic susceptibility patterns of isolates using standard microbiological procedure and the disc-diffusion test. Of the 200 samples screened, 112 (56%) had positive cultures with the dominant bacterial pathogens being Haemophilus influenzae (20%), followed by Streptococcus pneumoniae (15%), Klebsiella pneumoniae (11%), and Staphylococcus aureus (10%). Although 56% of the isolates were recovered from females compared to 44% from males, the difference was not statistically significant (p>0.05). Sixty-seven percent of the pathogens were isolated from the age-group of 10-13 years, 19.6% from the age-group of 14-17 years, and 12.5% from the age-group of 18-21 years. Antibiotic susceptibility testing revealed that gentamicin (92%) and cefuroxime (88.4%) were the most effective antibiotics against the isolates. Generally, susceptibility ranged from 0% to 92% depending on the antibiotic and the species of microorganism. Penicillin had the highest (100%) resistance to all the isolates. The findings revealed that students living in boarding schools in the Buea Municipality were at risk of acquiring upper respiratory tract infections from their peers since the upper respiratory tract of more than 50% of the students was colonized with respiratory pathogens. Although multidrug-resistant strains of organisms were identified, gentamicin and cefuroxime are recommended as the first-line antibiotics of choice against the pathogens. There is, therefore, a need for surveillance of nasopharyngeal carriage of resistant strains of these organisms, especially H. influenzae in unhealthy school children since the vaccine is yet to be introduced in Cameroon. The findings have clinical and epidemiological significance.

The use of MDRD-eGFR to diagnose Chronic Kidney Disease (CKD) is based on the assumption that the algorithm will minimize the influence of age, gender and ethnicity that is observed in S-Creatinine concentration and thus allow a single cut-off at which further diagnostic and therapeutic actions should be considered. This hypothesis is tested in a retrospective analysis of outpatients (N=93,404) and hospitalised (N=35,572) patients in UK and Sweden, respectively. An algorithm based on the same model as the MDRD-eGFR algorithm was derived from simultaneously measured S-Creatinine concentrations and Iohexol GFR in a subset of 565 patients. The combined uncertainty of using this algorithm was estimated to about 15 % which is about three times that of the S-Creatinine concentration results. The diagnostic performance of S-Creatinine concentration was evaluated using the Iohexol clearance as the reference procedure. It was shown that the diagnostic capacity of MDRD-eGFR, as it stands, has no added value compared to S-Creatinine. The gender and age differences of the S-Creatinine concentrations in the dataset persist after applying the MDRD-eGFR algorithm. Thus, a general use of the MDRD-eGFR does not seem justified. Furthermore the claim that the eGFR is adjusted for body area is misleading; the algorithm does not include any body size marker. It is thus a dangerous marker for guiding drug administration.

Objective: To calculate the best possible estimates for age specific life expectancy (LE) and anticipated age at the time of death (AAD) in patients with Parkinson’s disease (PD) compared with the general population in the UK. These may be of greater value to patients than standardised mortality ratios (SMRs), which are usually reported in studies on mortality in PD. Methods: A literature review identified articles with data on age stratified life expectancy or SMRs to calculate estimations of LE using the Gompertz function and data on mortality and LE in the UK from the Office of National Statistics and Actuarial Department for the year 2003. Results: Two UK studies and four from Western Europe were used to estimate LE and AAD for patients with PD from SMRs. The mean LEs of patients with PD compared with the general population were: 38 (SD 5) years for onset between 25 and 39 years compared with 49 (SD 5) years; 21 (SD 5) years for onset between 40 and 64 years compared with 31 (SD 7) years; and 5 (SD 4) years for onset age ⩾65 years compared with 9 (SD 5) years. The average AAD of patients with PD with onset between 25 and 39 years was 71 (SD 3) years and considerably lower than that of the general population (82 (SD 2) years). The difference between average AAD for older individuals with PD (onset ⩾65 years) and the general population was smaller, with an AAD of approximately 88 (SD 7) years compared with 91 (SD 5) years. Conclusions: The calculations showed that LE and AAD in PD are reduced for all onset ages but this reduction is greatest in individuals with a young onset. While the results are average estimates, these can provide useful indications of LE and AAD.

Aim: The clinical and epidemiological characteristics of chronic inflammatory demyelinating polyneuropathy (CIDP) in an Italian population were assessed. Subjects and methods: All subjects with a diagnosis of demyelinating neuropathy after 1990 in Piemonte and Valle d’Aosta (4 334 225 inhabitants) were considered. The diagnosis of CIDP was based on the research criteria of the American Academy of Neurology. 165 of 294 patients met the diagnostic criteria. Results: The crude prevalence rate was 3.58/100 000 population (95% CI 3.02 to 4.20). At the prevalence day, 76 (49.0%) cases had definite, 67 (43.2%) probable and 12 (7.7%) possible CIDP; disability was mild in 105 (67.7%) cases, moderate in 32 (20.6%) and severe in 18 (11.6%). The course was remitting–relapsing in 40 cases (25.8%), chronic progressive in 96 (61.9%) and monophasic in 19 (12.3%). Considering the 95 patients whose disorder presented in the period 1995–2001, the mean annual crude incidence rate was 0.36/100 000 population (95% CI 0.29 to 0.44), with a male to female ratio of 2.3:1. 14 cases were affected by diabetes mellitus. In multivariate analysis, factors related to severe disability at the prevalence day were: age>60 years; failure of immunomodulating therapies at the time of diagnosis; worse disability at nadir; and chronic course. Conclusion: Incidence and prevalence rates of CIDP in Italy were higher than those observed in most previous studies. At the prevalence day, more than 80% of cases had a mild or moderate disability, indicating either a good response to immunomodulating therapy or a tendency of CIDP to have a mild course in most cases.

Background and aim: To update our 1996 review on the incidence of subarachnoid haemorrhage (SAH) and assess the relation of incidence with region, age, gender and time period.Methods: We searched for studies on the incidence of SAH published until October 2005. The overall incidences with corresponding 95% confidence intervals were calculated. We determined the relationship between the incidence of SAH and determinants by means of univariate Poisson regression.Results: We included 51 studies (33 new), describing 58 study populations in 21 countries, observing 45 821 896 person-years. Incidences per 100 000 person-years were 22.7 (95% CI 21.9 to 23.5) in Japan, 19.7 (18.1 to 21.3) in Finland, 4.2 (3.1 to 5.7) in South and Central America, and 9.1 (8.8 to 9.5) in the other regions. With age category 45-55 years as the reference, incidence ratios increased from 0.10 (0.08 to 0.14) for age groups younger than 25 years to 1.61 (1.24 to 2.07) for age groups older than 85 years. The incidence in women was 1.24 (1.09 to 1.42) times higher than in men; this gender difference started at age 55 years and increased thereafter. Between 1950 and 2005, the incidence decreased by 0.6% (1.3% decrease to 0.1% increase) per year.Conclusions: The overall incidence of SAH is approximately 9 per 100 000 person-years. Rates are higher in Japan and Finland and increase with age. The preponderance of women starts only in the sixth decade. The decline in incidence of SAH over the past 45 years is relatively moderate compared with that for stroke in general.

Introduction: This retrospective study was performed to review the intermediate-term results of the laparoscopic repair of giant paraesophageal hernia (PEH) in the unit. Methods: This retrospective 8-year case series involved 42 patients. The clinical records were retrieved, reviewed individually, and data were collected regarding symptoms, investigation, operative details, and follow-up. Results: M:F ratio was 1:1.8 and median age was 64 years.Symptoms included epigastric/chest pain (69%), heart-burn (42.8%), dysphagia (38%), vomiting (23.8%), gastric volvulus (19%), and upper GI bleed (16.6%). The repair included reduction, sac excision, esophageal mobilization, and cruroplasty. Fundoplication (anterior partial) was done in 18 (42.8%) patients with radiologically documented reflux. Median hospital stay was 3 days. The complications included esophageal perforation in 1 (2.3%), gas-forming mediastinal abscess in 1 (2.3%), small bowel obstruction in 1 (2.3%), and bilateral basal atelectasis in 3 (7.1%). One patient (2.3%) died due to duodenal perforation and myocardial infarction. Of the 38 (90.4%) patients followed up (median 18m), 20 (52.6%) had a follow-up investigation. One patient (2.6%) had postoperative dysphagia, and 3 (7.8%) had postoperative heart-burn. Five (11.9%) had recurrence. Symptom outcome was Visick grades I/II (86.8%), III (10.5%), and IV (2.6%). Conclusion: Laparoscopic repair of PEH resulted in a short length of stay, excellent outcome in almost 87% of patients, and an overall recurrence rate of 11.9%.

Following the Tohoku Daishinsai or Great Tohoku Earthquake, one of the widely reported concerns was the potential for a significant increase in suicides among those leftto deal with the disaster. The Los Angeles Times, for example, reported the worries of Naoko Sugimoto-based on the "grapevine" of Japan's mental health system-that a trickle of suicides might turn into a "river" exemplified bythe farmer who hanged himself, distressed about a cabbage harvest ruined by radioactive fallout from the Fukushima Daiichi nuclear power plant; the overworked government worker near the complex who took his life; the father who killed himself after a fruitless search for his child after the tsunami. (Glionna, 2011)These fears seem quite reasonable given the fact that Japan has shown among the highest suicide rates in the world and experienced a significant increase in suicides in the late 1990s that has yet to return to earlier levels (Traphagan, 2010).Although there is much research to be done concerning suicide in general following the disaster, in this article, I explore the more specific issue of elder suicide in Tohoku since March of 2011. Throughout this article, the basis for my research is the following hypothesis:(a) Older adults in Tohoku were disproportionately affected by the disaster in March of 2011. (b) Elders in the Tohoku region show high rates of suicide when compared to other parts of Japan. Therefore, (c) given the levels of stress experienced, suicide rates among the older adults are likely to have increased following the disaster.I begin by discussing some of the general trends in recent years concerning suicide in Japan and specifically within the Tohoku region. Following this, I will explore some of the data related to suicide and the postdisaster situation in Tohoku. This article relies on qualitative data and will emphasize the use of descriptive statistics because the samples involved are not sufficiently large to employ more complex statistical methods.SUICIDE IN JAPANOver the past decade, suicide has grown to be viewed as one of the more pressing social problems in Japan. In 2007, the Japanese government published a White Paper on countersuicide that discusses methods for reducing the suicide rate and stresses the importance of developing systems of addressing the needs of suicide survivors, potential suicide victims, and the families of suicide survivors and those who have attempted suicide (Cabinet Office, Government of Japan, 2007). The government is also spending significant funds ($220 million by 2017) to develop programs for suicide prevention and support. Indeed, suicide is a leading cause of death in Japan, having raised as high as sixth among causes of death (Yamamura, Kinoshita, Nishiguchi, & Hishida, 2006:575), and the suicide rate for Japan has typically hovered around 25 per 100,000 for the past several years (Traphagan, 2010); by comparison, the suicide rate in the United States is normally around 11 or 12 per 100,000; and in 2000, the world suicide rate was estimated to be roughly 16 per 100,000 (Hasegawa et al., 2011:276). Japanese men are considerably more likely to commit suicide than women are; and particular age groups, such as teens and middle-aged men, are particularly prone to suicidal behavior (Yamamura et al., 2006:576-578). Yamamura et al. (2006) note that there is a correlation between population den- sity and suicide in Japan, with lower density population areas exhibiting higher suicide rates than more densely populated urban areas.Among the more troubling aspects of Japanese suicide over the past 15 years has been a sharp increase in the suicide rate since the late 1990s. Figure 11 shows suicide rates in Japan from 1970 to 2010. Although it is not clear where the cause in the increase during the late 1990s may lie-there were some changes made in how suicides are reported as well as ongoing problems with the Japanese economy- the suicide rates have hovered around 25 for more than a decade, a rate that represents an annual number of suicides that typically exceeds 30,000, which is higher than for the United States despite the much larger U. …

This paper investigates the factors associated with childhood immunization in Uganda. We used nationally-representative data from Uganda Demographic and Health Survey (UDHS) of 2006. Both bivariate and multivariate approaches were employed in the analysis. The bivariate approach involved generating average percentages of children who were immunized, with analysis of pertinent background characteristics. The multivariate approach involved employing maximum likelihood probit technique and generating marginal effects to ascertain the probability of being immunized, given the same background characteristics. It revealed that slightly over 50% of children in Uganda were fully immunized. Additionally, 89%, 24%, 52%, and 64% received BCG, DPT, polio and measles vaccines respectively. Factors which have a significant association with childhood immunization are: maternal education (especially at post-secondary level), exposure to media, maternal healthcare utilization, maternal age, occupation type, immunization plan, and regional and local peculiarities. Children whose mothers had post-secondary education were twice as likely to be fully immunized compared to their counterparts whose mothers had only primary education (p < 0.01). Thus, gender parity in education enhancement efforts is crucial. There is also a need to increase media penetration, maternal healthcare utilization, and to ensure parity across localities and regions.

Background Prospective national registries examining the incidence and aetiology of sports-related sudden cardiac death (SrSCD) not only in competitive athletes but also in recreational sports participants are uncommon. In May 2012, a prospective registry on SrSCD was installed to examine the incidence and particularly the aetiology of such events in the general population in Germany. Methods The registry consists of a web-based platform to record SrSCD cases. Media-monitoring and cooperation with 15 institutes of forensic medicine complemented the search. SrSCD was defined as death occurring during sports activity or up to 1 hour after its cessation, regardless of successful resuscitation. We included subjects at all levels of competition as well as recreational athletes. Results After 30 months of observation, 144 SrSCDs were recorded (mean age 46.8 ± 16.2 years). The overall incidence was 1.2–1.5/million/year, with 97% being male. Most of the cases occurred in the context of non-elite competitive or recreational sports. Football and running were the most common disciplines. In subjects ≤35 years, myocarditis prevailed, whereas in athletes ≥35 years, CAD predominated by far. Few cardiomyopathies were observed. Conclusions In Germany, the largest proportion of SrSCDs occurs in middle-aged men during recreational sports or non-elite competitive sports. The distribution of cardiac diseases responsible for SrSCD seems to vary among European countries. Our findings may indicate the need for a larger focus on myocarditis prevention in the young as well as widening the screening scope to younger athletes below the ‘elite’ level and to senior athletes.

SUMMARYAnnual periodicities of reported chickenpox cases have been observed in several countries. Of these, Japan has reported a two-peaked, bimodal annual cycle of reported chickenpox cases. This study investigated the possible underlying association of the bimodal cycle observed in the surveillance data of reported chickenpox cases with the meteorological factors of temperature, relative humidity and rainfall. A time-series analysis consisting of the maximum entropy method spectral analysis and the least squares method was applied to the chickenpox data and meteorological data of 47 prefectures in Japan. In all of the power spectral densities for the 47 prefectures, the spectral lines were observed at the frequency positions corresponding to the 1-year and 6-month cycles. The optimum least squares fitting (LSF) curves calculated with the 1-year and 6-month cycles explained the underlying variation of the chickenpox data. The LSF curves reproduced the bimodal and unimodal cycles that were clearly observed in northern and southern Japan, respectively. The data suggest that the second peaks in the bimodal cycles in the reported chickenpox cases in Japan occurred at a temperature of approximately 8·5 °C.

Objectives: Non-Hodgkin lymphomas are malignant neoplastic proliferations of the immune system that can manifest as nodal or extranodal lymphomas. The aim of this study was to retrospectively investigate the site of occurrence of lymphomas in the head and neck area and to analyze the typical symptoms of patients who presented at an oral and maxillofacial surgical department. Material and Methods: All patient files from1971 until 2012 from an Oral and Maxillofacial Surgery of a University were analyzed for the diagnosis non-Hodgkin lymphoma. Epidemiologic data and data regarding the localization of the malignant lymphoma were evaluated. Results: 62 patients, 34 women and 28 men with a non-Hodgkin lymphoma in the head and neck area were treated in the 41 years analyzed. In 87% of the cases the lymphoma belonged to B-cell and in 12% to the T-cell lineage. The average age at the time of diagnosis was 67 years for women (n=34) and 56 years for men. With 22 patients each, the non-Hodgkin lymphoma was localized in either the soft tissues or osseous structures. In the remaining 18 cases, multiple structures were affected. In 33 patients no accompanying nodal manifestation was noticed. In 33 cases the lymphoma was located in the oral cavity. The most common symptoms were swelling (97%), pain (40%) and the existence of an ulcer (11%). Conclusion: In the present study more than 50% of the lymphomas were located in the oral cavity. Due to the unspecific symptoms, a histopathological verification of the diagnosis is crucial.

Background Previous studies of problem Internet gamblers have failed to distinguish whether their problem gambling relates to Internet or land-based gambling modes. Therefore, characteristics and help-seeking behaviors of people whose gambling problems relate specifically to Internet gambling are unknown, but could inform the optimal alignment of treatment and support services with the needs and preferences of problem gamblers. Objective This study aimed to compare (1) characteristics of problem Internet gamblers and problem land-based gamblers and (2) uptake of different types and modes of help between problem Internet gamblers and problem land-based gamblers. Hypothesis 1 was that problem Internet gamblers are less likely to seek help. Hypothesis 2 was that problem Internet gamblers are more likely to use online modes of help. Methods A sample of 620 respondents meeting criteria for problem gambling was drawn from an online survey of 4594 Australian gamblers. Respondents were recruited through advertisements on gambling and gambling help websites, Facebook, and Google. Measures consisted of gambling participation; proportion of gambling on the Internet; most problematic mode of gambling; help seeking from 11 different sources of formal help, informal help, and self-help for gambling problems; psychological distress (Kessler 6); problem gambling severity (Problem Gambling Severity Index, PGSI); and demographics. Results Problem Internet gamblers were significantly more likely than problem land-based gamblers to be male (χ2 1=28.3, P

Purpose: The aim of this study is to investigate deterioration in mechanical integrity of the collagen network of bovine bone formed by non-enzymatic glycation (NEG), a process that mimics aging by microindentation technique. Methods: Young and old bovine cortical bone specimens were rested in solutions for four weeks for the process of NEG and were grouped as ribosylated and non-ribosylated. A series of indentations were made on bone specimens weekly for each of 3-masses of 50 g, 100 g and 200 g for 10 s to detect the effect of indentation load and for each of five durations of 5 s, 10 s, 20 s, 30 s for 100 g to study the effect of indentation duration. The applied load was increased to 300 g, 500 g, 1000 g and 2000 g for 10 s to be able to make microcracks. Specimens were tested in the wet and dry state to study the effects of hydration on microhardness measurement. Results: Loads of 50 g, 100 g and 200 g for 10 s were able to differ ribosylated bone from non-ribosylated bone for the young and old bovine bones. Microhardness values increased with increasing incubation period. Microhardness of dry specimens were found to be statistically higher than that of wet specimens. Presence of extrinsic toughening mechanisms including crack bridging due to uncracked ligaments and collagen fibers were directly observed by scanning electron microscope (SEM). Ribosylated bone was found to have lower number of collagen bridging compared to non-ribosylated bovine bone. Conclusion: Microhardness test by these are able to discriminate non-modified collagen structure from modified collagen. On the other hand, it is found that microindentation was not able to discriminate the degree of NEG. © 2015 World Scientific Publishing Company.

Objective: To examine patterns of smoking and snus use and identify individual pathways of Swedish tobacco users in order to clarify whether snus use is associated with increased or decreased smoking. Methods: Retrospective analysis of data from a cross-sectional survey completed by 6752 adult Swedes in 2001–2 focusing on identifying tobacco use history by survey items on current and prior tobacco use and smoking initiation and cessation procedures. Results: 15% of the men and 19% of the women completing the survey were daily smokers. 21% of the men and 2% of the women were daily snus users. Almost all (91%) male daily smoking began before the age of 23 years, whereas initiation of daily snus use continued throughout the age range (33% of initiation after age 22). 20% of male primary snus users started daily smoking compared to 47% of non-primary snus users. Thus, the odds of initiating daily smoking were significantly lower for men who had started using snus than for those who had not (odds ratio (OR) 0.28, 95% confidence interval (CI) 0.22 to 0.36). Among male primary smokers, 28% started secondary daily snus use and 73% did not. 88% of those secondary snus users had ceased daily smoking completely by the time of the survey as compared with 56% of those primary daily smokers who never became daily snus users (OR 5.7, 95% CI 4.9 to 8.1). Among men who made attempts to quit smoking, snus was the most commonly used cessation aid, being used by 24% on their latest quit attempt. Of those men who had used one single cessation aid 58% had used snus, as compared with 38% for all nicotine replacement therapy products together. Among men who used snus as a single aid, 66% succeeded in quitting completely, as compared with 47% of those using nicotine gum (OR 2.2, 95% CI 1.3 to 3.7) or 32% for those using the nicotine patch (OR 4.2, 95% CI 2.1 to 8.6). Women using snus as an aid were also significantly more likely to quit smoking successfully than those using nicotine patches or gum. Conclusion: Use of snus in Sweden is associated with a reduced risk of becoming a daily smoker and an increased likelihood of stopping smoking.

To compare simultaneous with sequential one-stage (same anaesthesia) combined anterior and posterior spinal surgery in the treatment of spinal infections in terms of the operation time, blood loss and complication rate. Fifty-six patients who underwent one-stage (same anaesthesia) simultaneous or sequential anterior decompression and posterior stabilisation of the involved vertebrae for spinal infection from January 1994 to December 2002 were reviewed. In group I (n=29), sequential anterior and posterior surgery was performed. In group II (n=27), simultaneous anterior and posterior spinal surgery was performed. With regard to age and gender, there was no statistical difference between both groups (P=0.05). The analysed and compared data between the two groups included the age, gender, blood loss, operation time and postoperative complications. There was a statistically significant difference between the two groups in terms of the duration of surgery, amount of blood transfusion needed and occurrence of major postoperative complications (P < 0.05). The mean correction of the kyphotic deformity was similar in both groups (P > 0.05) without a subsequent loss of correction on follow-up radiographic films at a mean follow-up of 6.5 years (range, 3 to 11 years). Simultaneous anterior and posterior surgery is a good alternative procedure. It provides the ability to manipulate both anterior and posterior aspects of the spine at the same time and appears to result in less blood loss, a shorter operative time and fewer complications. However, gaining experience and the availability of two surgical teams are important factors in the success of the procedure.

Objectives: In Russia, smoking prevalence has historically been high in men and relatively low in women. Female smoking prevalence is predicted to rise but assessment of changes has been limited by the lack of comparable data. Changes in the prevalence of smoking in Russia between 1996 and 2004, and whether theses changes differed by sociodemographic groups, were investigated. Design: Repeated national interview surveys in 1996 (731 men and 868 women) and 2004 (727 men and 864 women) aged 18 years or more. Main outcome measure: Prevalence of current smoking. Results: The age standardised prevalence of smoking in 1996 and 2004 was 61% and 63%, respectively in men and 15% and 16%, respectively in women (both p values > 0.4). In men, the prevalence of smoking seemed to decline in those with university education (from 51% to 40%, p = 0.085). Among women, smoking appeared to increase in those with university education (from 10% to 17%, p = 0.071) and low levels of self-reported material deprivation (from 11% to 18%, p = 0.053). There was a pronounced increase in prevalence among women living in villages (from 8% to 14%, p = 0.049); the strong urban/rural gradient seen in 1996 became considerably weaker by 2004. Conclusions: Overall smoking prevalence in both men and women in Russia remained stable between 1996 and 2004 but, given the sample size, a moderate increase in female smoking cannot be ruled out. In men, smoking increased among the least educated and declined in the most educated. In women the opposite appeared to occur, in addition to an increase in smoking in rural areas. More long term monitoring of smoking patterns in Russia, especially among women, using sufficiently large surveys, is required.

Objectives: To compare the effectiveness of health education on smoking cessation for all smokers regardless of their willingness to quit smoking and cumulative environmental changes including designation of smoking places, legislation, and price rise. Design: Comparison of smoking cessation rates over two time periods: the period of health education on smoking cessation (1997–1999), and the period of cumulative environmental changes (2002–2004). Setting: An occupational setting in a radiator manufacturing factory in Japan. Subjects: All habitual male smokers who remained in the worksite through the pertinent time period (n = 202 in the period of health education and n = 170 in the period of environmental changes). Main outcome measurements: Smoking cessation rates at the end of each time period. Results: The smoking cessation rates over the periods of health education and environmental changes were 8.9% and 7.1%, respectively. There was no difference between these two proportions in a χ 2 test (p = 0.513). The age adjustment did not significantly alter the cessation rate. Conclusions: Cumulative environmental changes are fairly effective in promoting smoking cessation, and may yield similar smoking cessation rates as a health education intervention reaching all smokers regardless of their willingness to quit smoking.

Objective Advances in surgical, anaesthetic and percutaneous interventional techniques may have led to higher risk patients being referred for coronary artery bypass graft surgery (CABG). The purpose of this study was to compare the predicted mortality risk (EuroSCORE) of a contemporary cohort of patients referred for isolated elective CABG (2002) with that of a cohort referred five years previously (1997) and to examine temporal trends in patient demographics. Methods Records (n = 2873) of weekly cardiac surgical referral meetings were examined and the age, sex, type of operation and surgical decision for every patient referred from 1997 to 2002 inclusive were recorded. Furthermore samples of patients referred in 1997 (n = 111) and in 2002 (n = 110) were chosen, and a complete EuroSCORE was calculated for each patient and compared between groups. Results In both 1997 and 2002 the median EuroSCORE among patients not accepted for surgery was significantly higher than those accepted (1997; 3 vs 2, p

Background An ageing population has service planners concerned about future levels of disease which are age dependent. Predictions of mortality for colorectal, lung and breast cancers, which account for 30% of cancer cases and 40% of cancers deaths, were calculated for 2010 and 2015, based on trends in death rates and the predicted change in the demography of the Northern Ireland population. Methods The US National Cancer Institute's “Joinpoint” program was used to check for structural breaks in the time series of cancer death rates from 1984 to 2004. The prediction models applied to the data allowed variations in trends across age groups to be taken into account. A linear model was used for increasing or constant trends and a log linear model was used where the trend was decreasing. The models assume the number of deaths in each stratum, defined by age-sex and time-period, is Poisson distributed, with the average value determined by a log or linear function. Results Recent trends in rates of cancers studied were downwards except for female lung. Predictions include decreased colorectal cancer deaths in females and lung cancer deaths in males. In females, lung cancer deaths are predicted to more than double by the year 2015 (473 deaths), based on the 1984 level. Colorectal death rates in males are predicted to drop, but the number of deaths will increase by more than 10%, due to demographic change. Numbers of breast cancer deaths are likely to rise slightly, despite falling age standardised death rates, due to an ageing population. Conclusions This work has provided estimates of early future trends, useful to service planners, and highlights the need for tobacco control, to reduce numbers of lung cancer deaths in females. The recently announced control of environmental tobacco legislation is one welcome development which should reduce lung cancer mortality in Northern Ireland.

Background Physician rating websites have been gaining in importance in both practice and research. However, no evidence is available concerning patients’ ratings of dentists on physician rating websites. Objective The aim of this study is to present a comprehensive analysis of the ratings of dentists on a German physician rating website over a 2-year period. Methods All dentist ratings on a German physician rating website (Jameda) from 2012 and 2013 were analyzed. The available dataset contained 76,456 ratings of 23,902 dentists from 72,758 patients. Additional information included the overall score and subscores for 5 mandatory questions, the medical specialty and gender of the dentists, and the age, gender, and health insurance status of the patients. Statistical analysis was conducted using the median test and the Kendall tau-b test. Results During the study period, 44.57% (23,902/53,626) of all dentists in Germany were evaluated on the physician rating website, Jameda. The number of ratings rose from 28,843 in 2012 to 47,613 in 2013, representing an increase of 65.08%. In detail, 45.37% (10,845/23,902) of dentists were rated once, 43.41% (10,376/23,902) between 2 and 5 times, and 11.21% (2681/23,902) more than 6 times (mean 3.16, SD 5.57). Approximately 90% (21,324/23,902, 89.21%) of dentists received a very good or good overall rating, whereas only 3.02% (721/23,902) were rated with the lowest scores. Better ratings were given either by female or older patients, or by those covered by private health insurance. The best-rated specialty was pediatric dentistry; the lowest ratings were given to orthodontists. Finally, dentists were rated slightly lower in 2013 compared to 2012 (P=.01). Conclusions The rise in the number of ratings for dentists demonstrates the increasing popularity of physician rating websites and the need for information about health care providers. Future research should assess whether social media, especially Web-based ratings, are suitable in practice for patients and other stakeholders in health care (eg, insurance providers) to reflect the clinical quality of care.

Background: While the incidence of amyotrophic lateral sclerosis (ALS) is similar across the world (range, 1.0 to 2.5/100 000), a latitude gradient from north to south has been observed. Objective: To determine the incidence of ALS in Puglia, a region of south eastern Italy, and to test the latitude gradient hypothesis comparing the present study with findings in studies conducted with the same design in a northern latitude. Methods: Puglia (4 086 613 residents in 2001) is the site of a multicentre-multisource prospective population based registry established in 1997. All incident ALS cases during the period 1998–99 were enrolled and followed up. Cases were classified using the first and the revised El Escorial criteria. Results: During the study period 130 cases were enrolled. The annual crude incidence for ALS in Puglia for the two year period 1998–99 was 1.6/100 000 (95% confidence interval, 1.3 to 1.9). The incidence was higher for men (incidence rate (IR) = 2.1 (1.7 to 2.7) than for women (IR = 1.2 (0.9 to 1.5)) in all age groups, with a male to female ratio of 1.6. For both men and women, the incidence increased through age 75 and declined rapidly afterwards. The mean annual incidence adjusted by age and sex to the 2001 Italian population was 1.7/100 000 (1.4 to 2.0). Conclusions: ALS incidence is within a narrow range across countries, with a peak between 65 and 75 years and a higher incidence in men . A north to south latitude gradient of ALS incidence is not supported by the results of cohort studies.

Purpose: To examine smoking behaviours in Taiwan and compare those behaviours to those in the USA. Methods: Using the National Health Interview Survey (NHIS) of Taiwan (2001), a survey of over 20 000 participants, frequencies were calculated for smoking, ex-smoking, quantity smoked, and exposure to environmental tobacco smoke (ETS). Breakdowns by age, sex, and socioeconomic status were also calculated. Results: The ratio of male to female smoking rates was 10.9 to 1 among adults (46.8%/4.3%), but 3.6 to 1 among underage teenagers (14.3%/4.0%). The proportion of underage to adult smokers was three times higher for girls than for boys. Smoking prevalence substantially increased during and after high school years, and peaked in those aged 30–39 years. Smoking rates of high school age adolescents increased more than threefold if they did not attend school or if they finished their education after high school. Low income and less educated smokers smoked at nearly twice the rate of high income and better educated smokers. The smoker/ex-smoker ratio was close to 7. Male daily smokers smoked on average 17 cigarettes/day, and females, 11. Half of the total population, especially infants and women of childbearing age, were exposed to ETS at home. Conclusions: Taiwan has particularly high male smoking prevalence and much lower female prevalence. The low female prevalence is likely to increase if the current sex ratio of smoking by underage youth continues. The low quit rate among males, the high ETS exposure of females and young children at home, and the sharp increase in smoking rates when students leave school, are of particular concern. These observations on smoking behaviour can provide valuable insights to assist policymakers and health educators in formulating strategies and allocating resources in tobacco control.

Objective: To describe the characteristics of betel quid chewers and to investigate the behavioural and mortality relations between betel quid chewing and cigarette smoking. Method: Prevalence and mortality risks of betel quid chewers by smoking status were calculated, based on the National Health Interview Survey in 2001 and a community based cohort, respectively. Cox's proportional hazards model was used to adjust mortality risks for age, alcohol use, and education. Results: Almost all betel quid chewers were smokers, and most started chewing after smoking. Chewers were predominantly male, mostly in their 30s and 40s, more likely being among the lowest educational or income group, and residing in the eastern regions of Taiwan. On average, betel quid chewers who smoked consumed 18 pieces of betel quid a day, and smoked more cigarettes per day. Far more smokers use betel quid than non-smokers (27.5% v 2.5%), but ex-smokers quit betel quid more than smokers (15.1% v 6.8%). The significantly increased mortality of betel quid users who also smoked, for all causes, all cancer, oral cancer, and cancer of the nasopharynx, lung, and liver, was the result of the combined effects of chewing and smoking. Smokers who chewed betel quid nearly tripled their oral cancer risks from a relative risk of 2.1 to 5.9. Increasing the number of cigarettes smoked among betel quid chewers was associated with a synergistic effect, reflective of the significant interaction between the two. Conclusion: To a large extent, the serious health consequences suffered by betel quid chewers were the result of the combined effects of smoking and chewing. Betel quid chewing should not be considered as an isolated issue, but should be viewed conjointly with cigarette smoking. Reducing cigarette smoking serves as an important first step in reducing betel quid chewing, and incorporating betel quid control into tobacco control may provide a new paradigm to attenuate the explosive increase in betel quid use in Taiwan.

Objective: To determine those groups who are at increased risk of smoking related diseases, we assessed in which male and female generations smoking was more prevalent among lower educated groups than among the higher educated, in 11 European countries. Design: Cross sectional analysis of data on smoking, covering the year 1998, from a social survey designed for all member states of the European Union. Subjects: Higher and lower educated men and women aged 16 years and older from 11 member states of the European Union. Outcome measures: Age standardised prevalence rates by education and prevalence odds ratios of current and ever daily smoking comparing lower educated groups with higher educated groups. Results: A north–south gradient in educational inequalities in current and ever daily smoking was observed for women older than 24 years, showing larger inequalities in the northern countries. Such a gradient was not observed for men. A disadvantage for the lower educated in terms of smoking generally occurred later among women than among men. Indications of inequalities in smoking in the age group 16–24 years were observed for all countries, with the exception of women from Greece and Portugal. Conclusions: Preventing and reducing smoking among lower educated subgroups should be a priority of policies aiming to reduce inequalities in health in Europe. If steps are not taken to control tobacco use among the lower educated groups specifically, inequalities in lung cancer and other smoking related diseases should be anticipated in all populations of the European Union, and both sexes.

Background: Smoking has been causally associated with increased mortality from several diseases, and has increased considerably in many developing countries in the past few decades. Mortality attributable to smoking in the year 2000 was estimated for adult males and females, including estimates by age and for specific diseases in 14 epidemiological subregions of the world. Methods: Lung cancer mortality was used as an indirect marker of the accumulated hazard of smoking. Never-smoker lung cancer mortality was estimated based on the household use of coal with poor ventilation. Estimates of mortality caused by smoking were made for lung cancer, upper aerodigestive cancer, all other cancers, chronic obstructive pulmonary disease (COPD), other respiratory diseases, cardiovascular diseases, and selected other medical causes. Estimates were limited to ages 30 years and above. Results: In 2000, an estimated 4.83 million premature deaths in the world were attributable to smoking, 2.41 million in developing countries and 2.43 million in industrialised countries. There were 3.84 million male deaths and 1.00 million female deaths attributable to smoking. 2.69 million smoking attributable deaths were between the ages of 30–69 years, and 2.14 million were 70 years of age and above. The leading causes of death from smoking in industrialised regions were cardiovascular diseases (1.02 million deaths), lung cancer (0.52 million deaths), and COPD (0.31 million deaths), and in the developing world cardiovascular diseases (0.67 million deaths), COPD (0.65 million deaths), and lung cancer (0.33 million deaths). The share of male and female deaths and younger and older adult deaths, and of various diseases in total smoking attributable deaths exhibited large inter-regional heterogeneity, especially in the developing world. Conclusions: Smoking was an important cause of global mortality in 2000, affecting a large number of diseases. Age, sex, and disease patterns of smoking-caused mortality varied greatly across regions, due to both historical and current smoking patterns, and the presence of other risk factors that affect background mortality from specific diseases.