RESUMEN
SETTING AND OBJECTIVE: We assessed the relative effects of age, gender, period of death and birth cohort on asthma mortality rates in Australia from 1907 to 2000. DESIGN: Asthma mortality data obtained from the Australian Institute of Health and Welfare were adjusted for changes to the International Classification of Diseases and examined for changes over time and age, period and cohort effects. RESULTS: Age-adjusted period asthma mortality rates indicated epidemics during the mid 1960s and 1980s, predominantly affecting those aged 5-34 years. The main 1960s epidemic coincided with the introduction of high-dose, non-selective beta-sympathomimetic amines. There was a gradual rise in mortality rates in younger age groups, with rates rising from 0.5/100 000 males and 0.9/100 000 females in the 1940s to a peak of 3/100 000 for both sexes in 1966. Fluctuations in mortality rates were influenced by period of death and birth cohort. There was an increased risk of death from asthma with increasing age. CONCLUSION: There was no overall trend in asthma mortality rates in any age group. The 1960s epidemic was probably treatment related. Other increases in mortality occurring despite therapeutic advances may reflect increasing prevalence and highlight the need for ongoing surveillance.
Asunto(s)
Asma/mortalidad , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Niño , Preescolar , Efecto de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de TiempoRESUMEN
The number of adults with cystic fibrosis (CF) is increasing. They are striving for independence and a fulfilling life with focus on career, relationships, education and finances at a time when lung function is likely to be declining and complications of this multi-system disease are increasing. Maintaining the quality and improving the duration of life are continuing challenges for the -clinician and the patient. Increased hope and greater expectations have been provided by a number of recent clinical advances and active research into novel treatments, including gene therapy. There has been increased recognition of the necessity for early diagnosis, adequate monitoring and effective intervention for complications such as diabetes and osteoporosis. Research into multi-resistant bacteria and clonal strains of Pseudomonas aeruginosa is ongoing and attention has focused on infection control policies. Although more high-level evidence is required on many issues confronting people with CF, a considerable effort has been made over the last decade to provide a more evidence-based approach to therapy with a number of large controlled clinical trials. For the adult with CF, there are also more decisions to be made. There is focus on reproductive health, with most couples enjoying the real possibility of having children. For those with advanced disease, the option for lung transplantation is well established. Maintenance of quality care will require adequate planning, effective transition programmes from paediatric to adult care, specialized training for doctors, nurses and allied health professionals and the allocation of sufficient resources to accommodate the inevitable increase in patient numbers.
Asunto(s)
Fibrosis Quística , Enfermedades Pulmonares/etiología , Osteoporosis/etiología , Infecciones por Pseudomonas/tratamiento farmacológico , Adulto , Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Ensayos Clínicos como Asunto , Fibrosis Quística/complicaciones , Fibrosis Quística/diagnóstico , Fibrosis Quística/microbiología , Fibrosis Quística/terapia , Humanos , Enfermedades Pulmonares/cirugíaAsunto(s)
Fibrosis Quística/complicaciones , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/etiología , Stenotrophomonas maltophilia/aislamiento & purificación , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Adulto , Resultado Fatal , Infecciones por Bacterias Gramnegativas/microbiología , Humanos , MasculinoRESUMEN
OBJECTIVE: To assess the efficacy of an antibiotic protocol to avoid empirical use of third-generation cephalosporins in community-acquired pneumonia (CAP). DESIGN AND SETTING: Retrospective case review of patients with CAP one year after implementing the protocol. Comparison was made with patients with CAP treated at a metropolitan tertiary referral hospital (where use of third-generation cephalosporins was common). PARTICIPANTS: 86 patients (district hospital with an antibiotic protocol) and 72 patients (metropolitan tertiary referral hospital), January - June 1999. OUTCOME MEASURES: Rate of staff adherence to the protocol; patient characteristics associated with poor protocol adherence; demographic and prognostic features of both groups at presentation; duration of intravenous therapy, time to defervescence, length of stay; inpatient mortality rates; and drug cost savings per patient treated according to the protocol. RESULTS: Overall protocol adherence rate was 60%. Patients with penicillin allergy were significantly less likely to receive treatment according to the protocol (P<0.001). At the district hospital, patients were generally older and taking more regular medications. Patients at each hospital had similar prognostic factors and demographic features at presentation. Inhospital mortality (P=0.92; 95% CI, -0.08 to 0.07), duration of fever (P=0.57) and length of stay (P=0.78) were not significantly different between patients treated empirically with penicillin and those treated empirically with third-generation cephalosporins. Treating a patient according to the protocol saved an average of $77.44 in drug costs. CONCLUSION: One year after implementation, our protocol for treating CAP is proving efficacious, although levels of adherence could improve.