The pre-registration year 1983-1988

The pre-registration year, a mandatory period of general clinical training in the United Kingdom, has been the subject of recent comment and criticism. The literature on the year is analysed, taking as a starting point and framework the 1983 review by the Association for the Study of Medical Education (ASME), and focusing on the 1987 Recommendations of the General Medical Council. It is concluded that the pre-registration programme has been improved, but that attention needs to be given to house officers' hours of duty, to career counselling for them and to training for teachers and supervisors.     

Fatal occupational injuries in California, 1972-1983

Prior reports have indicated that the crude incidence of fatal occupational accidents in California has substantially declined since at least 1972. We tested the hypothesis that this observation was an artifact of demographic shifts in the workforce towards lower-risk age groups and industries. Review of worker's compensation data from 1972 to 1983 identified 2,483 fatal injuries among males. Crude rates declined by an average of 7.0% annually (p less than .005). Age and industry adjustment reduced this decline to 6.7% annually, but the trend was still significant (p less than .005). Thus, the decline in fatal injury rates is not artifactual and will require further study to explain. In a separate analysis, age-specific death rates were found to follow a bimodal pattern in most industries with the highest rates observed at the extremes of age. These results conflict with those of several previous studies. However, these studies did not adjust for the prevalence of part-time work schedules among younger employees.     

Smoking behavior of Dutch family physicians in 1983-1988

General practitioners' smoking behaviour in The Netherlands is described on the basis of survey data collected in the period 1983-1988. Until 1983 a large majority of the Dutch family physicians were smokers (1957: 82%, 1983: 56%). The smoking prevalence then was higher among physicians than among the male population. After 1983 a new development set in. Three inquiries showed that among Dutch physicians the smoking prevalence in 1988 was lower than that among the male general population (29 versus 37%). Dutch family physicians have stopped smoking to a larger extent than the physicians in any other EC-country (43% ex-smokers). Young entry-level doctors more and more tend to be never-smokers.     

Prenatal exposure to prescribed drugs in Tennessee Medicaid, 1983-1988.

This report describes the prenatal exposure histories of 107,804 women to prescribed drugs other than vitamins, iron and other minerals. The data were obtained from Tennessee Medicaid pharmacy files linked to birth and fetal death certificates for 1983-1988. The utility of these data to other investigators in predicting power or estimating sample size for studies of drug exposure in pregnancy associated with adverse birth outcomes is discussed.     

Cesarean section in Kuwait, 1983 through 1988.

Examination of the cesarean section (CS) rate at the Ministry of Public Health hospitals in Kuwait during 1983 through 1988 revealed a rate of 9.36% and showed no significant trend. The rates in the individual 4 hospitals differed significantly. A significant weak positive correlation between the CS rate and instrumental delivery rates was found. No significant correlation was found between the CS rate and perinatal mortality rate, but a weak positive correlation was found between the CS rate and neonatal mortality rates. Based on the existing health information system in Kuwait, it was not possible to determine whether variations in CS rates were secondary to differences in the risk status of the population subgroups, or were related to physicians' practice style which offers a potential for reduction of the higher rates. Deficiencies identified in the existing health information system included unavailability of information about parity, indications of CS, and whether the procedure was a primary or repeat one. Recommendations to rectify these deficiencies were suggested.     

Stylistic variations in National Institutes of Health consensus statements, 1979-1983.

This paper describes a content analysis of the statements of 24 Consensus Development Conferences conducted by the Office of Medical Applications of Research (OMAR) of the National Institutes of Health in the years 1979-1983. The goal was to understand the potential influence of the consensus statements by identifying characteristics that might determine whether and how physicians become aware of their findings and adopt their recommendations. Three characteristics emerged, each suggestive of a different style of consensus statement: discursiveness, didacticism, and scholarliness. Variations in style among consensus statements may affect their acceptance by the medical profession.     

Incidence of insulin-dependent diabetes mellitus in Warsaw, Poland, in children and young adults, 1983-1988.

The 5-year results of the incidence study of insulin-dependent diabetes mellitus (IDDM) in children (0-14 years) and young adults (15-29 years) which began in Warsaw on 1 July 1983 are presented. The overall number of new IDDM patients aged 0-29 registered in Warsaw during 5 years was 165. The average incidence rates in the age groups 0-14 and 15-29 were respectively 5.2 and 6.5 per 100,000 population in males and 4.5 and 4.4 in females. The highest incidence was observed in the age groups 25-29, 10-14 and 15-19 in males, and 5-9 and 25-29 in females. More patients reported the onset of their first symptoms in autumn and winter than in spring and summer. The IDDM incidence rates in Warsaw appear to be lower than those in some other countries for which data on IDDM at ages 0-29 years are available.     

Injuries from motor-vehicle collisions with moose--Maine, 2000-2004

Moose are among the largest mammals in North America. Standing up to 7.5 feet at the shoulder and weighing up to 1,600 lbs, they are the largest members of the deer family. Maine's moose population (approximately 29,000) is the biggest in the United States outside of Alaska. During a collision with a motor vehicle, a moose usually is struck in the legs, causing its body to roll onto the hood of the vehicle, often collapsing the windshield and roof. As a result, motor-vehicle collisions involving moose are capable of causing substantial injury to vehicle occupants. To assess motor-vehicle collisions with moose in Maine and evaluate risk factors for injuries from these types of collisions, the Maine Department of Health and Human Services studied collision reports from 2000--2004. The results of that study indicated that collision rates varied by county but had clear patterns by season and time of day. Variables associated with risk for injury were posted speed limit, type of vehicle, and sex and age of the driver. Measures to reduce collisions with moose should focus on improving driver education programs and developing better engineering controls (e.g., removing roadside vegetation to improve visibility for drivers). In addition, herd management (i.e., decreasing moose population size through hunting) is currently being used in areas of Maine with high numbers of collisions, although studies are needed to assess its effectiveness.     

Nonfatal motor-vehicle animal crash-related injuries--United States, 2001-2002

In 2000, an estimated 6.1 million light-vehicle (e.g., passenger cars, sport utility vehicles, vans, and pickup trucks) crashes on U.S. roadways were reported to police. Of these reported crashes, 247,000 (4.0%) involved incidents in which the motor vehicle (MV) directly hit an animal on the roadway. Each year, an estimated 200 human deaths result from crashes involving animals (i.e., deaths from a direct MV animal collision or from a crash in which a driver tried to avoid an animal and ran off the roadway). To characterize nonfatal injuries from these incidents, CDC analyzed data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP). This report summarizes the results of that analysis, which indicated that, during 2001-2002, an estimated 26,647 MV occupants per year were involved in crashes from encounters with animals (predominantly deer) in a roadway and treated for nonfatal injuries in U.S. hospital emergency departments (EDs). Cost-effective measures targeting both drivers (e.g., speed reduction and early warnings) and animals (e.g., fencing and underpasses) are needed to reduce injuries associated with MV collisions involving animals.     

Trends in the incidence of and mortality from coronary heart disease in Finland, 1983-1988.

Trends in the incidence of and mortality from coronary heart disease during the period 1983-1988 were assessed in the population aged 35-64 years in three areas of Finland. The official mortality statistics and the FINMONICA (Finnish portion of the World Health Organization MONICA (Monitoring of Trends and Determinants in Cardiovascular Disease) project) Acute Myocardial Infarction Register were used as data sources. They both showed that coronary heart disease mortality declined steeply in Finnish men and women. This marked decline in coronary heart disease mortality was associated with a decline in the number of out-of-hospital coronary deaths. The changes in the incidence of acute myocardial infarction in men did not parallel the changes in mortality. No decline in incidence was seen in women in any of the study areas. These results suggest that the routine mortality statistics alone may give an overly favorable picture of coronary heart disease trends. Data on incidence are necessary to assess the need for the treatment and prevention of coronary heart disease.     

Fatal occupational injury rates: Quebec, 1981 through 1988.

OBJECTIVES. The purpose of the study was to estimate the death rates from occupational injuries in the province of Quebec for the period 1981 through 1988. METHODS. Worker's compensation files were used to ascertain numbers of deaths, which were used as the numerators in figuring the rates (it was estimated that these files reported 83% of the true number of deaths among men). Annual average estimates of the labor force were used as denominators. RESULTS. From 1981 through 1988, compensation was awarded for 1227 fatal work injuries. Among men (96% of the victims), rates declined from 1981 to 1988 (from 12.7 to 8.1 per 100,000); women's rates were stable (< or = 1.0 per 100,000). Compared with men, women had excess mortality from violent acts. Motor vehicle crashes accounted for 36% of all fatal injuries in 1984 and 1985 and declined thereafter. Fatal injury rates in forestry and mining rose to a 1987 maximum of 67.6 per 100,000. The construction sector had the largest number of deaths, despite a decline in rates from 1981 to 1988 (from 27.8 to 15.9 per 100,000). CONCLUSIONS. Except for construction and agriculture, reported fatal occupational injury rates in Quebec were similar to those in the United States. Motor vehicle crashes, falls, violent acts, and farming-related injuries were the most frequent causes of death.     

Trends in Down's syndrome prevalence in California, 1983–1988

Summary. Trends in the prevalence of Down's syndrome in livebirths were examined in California from 1983 to 1988, a time period when prenatal screening and subsequent termination of Down's syndrome pregnancies among women under 35 years of age was increasing. In the population-based ascertainment areas of the California Birth Defects Monitoring Program (CBDMP), 1058 infants with Down's syndrome were identified, giving a crude prevalence of 1.03 (95% confidence interval [CI]: 0.97,1.09). The risk ratio for 1988 compared with 1983, after adjusting for maternal age and other confounders, was 0.98 (95% CI: 0.78,1.23), showing that there was no change in livebirth prevalence over this period. The data were also examined for mothers under 35 years of age to determine whether increasing use of prenatal screening leading to termination masked an increase in prevalence. A modest increase was seen.     

Involvement by young drivers in fatal alcohol-related motor-vehicle crashes--United States, 1982-2001

Motor-vehicle crashes are the leading cause of death in the United States for persons aged 16-24 years, and a substantial proportion of these crashes are alcohol-related. Alcohol-impaired driving is highest among persons aged 21-24 years, and the percentage of fatal crashes that are alcohol-related is highest for this age group. However, alcohol-related crashes are a serious problem even for the youngest drivers. Not only are drivers aged <21 years more likely than older drivers to be involved in fatal crashes, but their added risk for fatal crash involvement increases more sharply at all levels of alcohol use. To characterize the rate of alcohol-related fatal crashes among young drivers, CDC analyzed unpublished data from the Fatality Analysis Reporting System (FARS), a national database of information on fatal crashes. The findings indicate that the largest decrease in alcohol-related fatal crashes during 1982-2001 was among drivers aged <21 years, who have been the target of several interventions to reduce alcohol-impaired driving. Public health and traffic safety professionals should ensure that communities implement comprehensive and effective strategies to reduce alcohol-impaired driving.     

Investigating variations in infant mortality in England and Wales by mother's country of birth, 1983-2001

The aim of this study was to investigate variations in infant mortality from 1983 to 2001 by birthweight, registration status, father's social class, age of mother at birth and cause of death, among babies of mothers born in countries that represent the largest ethnic minority groups in England and Wales. A total of 70,208 infant death registration records linked to their corresponding birth registration records were used. The study focused on infant deaths of babies of mothers born in the UK, Republic of Ireland, Caribbean, West Africa, East Africa, India, Pakistan and Bangladesh. From 1983 to 2001 infant mortality rates decreased overall, and this was also apparent in the rates by mother's country of birth. Overall, babies of mothers born in Pakistan consistently had the highest infant mortality rates. Low-birthweight babies of mothers born in West Africa had the highest infant, neonatal and postneonatal death rates. Differences were also seen by registration status, mother's age and between manual and non-manual occupations for all countries from 1983 to 2001. For babies of mothers born in the UK, Caribbean and West Africa, immaturity-related conditions were the most common cause of infant deaths. The leading cause of infant death among babies of mothers born in Pakistan and Bangladesh was congenital anomalies.     

Geographical variations in hospital use in Estonia

The purpose of this study was to analyse the utilisation of inpatient care in Estonia. Using small-area analysis the age and sex of municipality residents and travel time to the nearest hospital were linked to the frequency of use and length of stay of respective inpatients. Adjusted hospitalisation and readmission rates decreased with increasing travel time to the hospital. The travel time effect on the length of stay was inconsistent. Despite differences in hospital utilisation among municipalities, geographical access to inpatient care was substantially diminished only for 3% of the population living further than 30 min from hospital.     

Prenatal exposure to prescribed drugs in Tennessee Medicaid, 1983–1988

Summary. This report describes the prenatal exposure histories of 107 804 women to prescribed drugs other than vitamins, iron and other minerals. The data were obtained from Tennessee Medicaid pharmacy files linked to birth and fetal death certificates for 1983–1988. The utility of these data to other investigators in predicting power or estimating sample size for studies of drug exposure in pregnancy associated with adverse birth outcomes is discussed.     

Smoking in Italy, 1949-1983

Trends in the prevalence of cigarette smoking and the number of cigarettes smoked per day in Italy were derived from six national probability sample surveys conducted between 1949 and 1983. There was a steady and substantial decrease in reported smoking prevalence among adult men (from 71.4% of current smokers in 1949 to 45.6% in 1983), although the estimated average number of cigarettes smoked per day increased, at least up to 1980. Among women, large increases in smoking prevalence have occurred since the mid-1960s (up to 17.7% among women age 14 or over in 1983) and in average number of cigarettes smoked per day (10.9 in 1980). Both the reported decreasing prevalence among men and the increasing prevalence among women were concentrated mostly in the younger age groups. Data on national surveys of tobacco use may give interesting indications for the analysis of different trends in sex or age groups. They should, however, be interpreted critically, since large discrepancies between interview-based data and information on legal sales of manufactured cigarettes have emerged over the last years, indicating that interview data are largely biased in the sense of systematic underreporting. It seems, therefore, that more than any real changes in smoking habits taking place, it is the attitudes toward reporting smoking that have changed in Italy over the last three decades: in fact, in 1983 cigarette sales reached a maximum both in absolute terms and in average levels per adult.