Trends in hospital admissions and death rates for peptic ulcer in the United States from 1970 to 1978

During the period 1970-1978, admissions to short-term nonfederal hospitals in the U.S. for duodenal ulcer decreased by 43%, whereas admissions for gastric ulcer did not change significantly. The decline in admissions for duodenal ulcer was greatest for uncomplicated cases, less for those with hemorrhage, and least (and not significant) in those with perforation. During the period 1970-1977, U.S. Vital Statistics reports of deaths from peptic ulcer decreased 31%, with about equal declines in total deaths, those associated with hemorrhage, and those associated with hemorrhage, and those associated with perforation. The fall in death rate involved both gastric and duodenal ulcer in both men and women. The male/female ratio has been falling steadily, and now stands at about 1.2 for hospitalizations and about 1.5 for deaths. From 1970 to 1978 the percentage of persons over 60 yr of age rose from 14 to 15% in the U.S. population as a whole, from 23 to 29% in persons hospitalized for all causes, from 27 to 36% in those hospitalized for duodenal ulcer, and from 40 to 48% in those hospitalized for gastric ulcer.     

Health education manpower in the United States

Problems in collection of uniform data on health education manpower on a continuing basis are discussed. Sources of data on current health education manpower projections for future needs are reviewed. Possible directions for improving manpower planning in this field are cited.     

The impact of Helicobacter pylori eradication on peptic ulcer healing

OBJECTIVE: Current literature was reviewed analyzing the outcome of peptic ulcer healing in relation to the results of the posttherapeutic Helicobacter pylori (HP) status. METHODS: Literature was reviewed along with an analysis of 60 studies, comprising a total of 4329 patients. RESULTS: Successful Helicobacter pylori eradication was found to induce a better response in peptic ulcer healing, regardless of diagnosis: gastric ulcer 88% vs 73% (odds ratio [OR] 2.7, p < 0.01), duodenal ulcer 95% vs 76% (OR 5.6, p < 0.0001), and peptic ulcer 95% vs 76% (OR 6.6, p < 0.0001), for patients having their HP infection successfully cured versus those remaining HP-positive, respectively (Fisher's exact test). For all evaluated time points (< or = 6, 7-8, and 10-12 wk after beginning treatment), HP-negative patients had higher healing rates than HP-positive patients (95% vs 82%, 94% vs 69%, and 96% vs 78% with corresponding OR of 4.2, 6.5, and 7.4, all p < 0.0001, Fisher's exact test). The use of concomitant acid suppression therapy during initial HP eradication provided a benefit on peptic ulcer healing only for patients with persistent HP infection (improved healing rates of 78% vs 67%; otherwise rates were 94-96%). Likewise, prolonged acid inhibition in HP treatment failures after the initial HP treatment phase resulted in 7-20% improved healing rates, whereas patients becoming HP-negative did not profit. CONCLUSION: Successful HP eradication therapy accelerates peptic ulcer healing even without concomitant acid suppression.     

Health status of preweaned dairy heifers in the United States

Chronic fatigue and chronic fatigue syndrome (CFS) have become increasingly recognized as a common clinical problem, yet one that physicians often find difficult to manage. In this review we suggest a practical, pragmatic, evidence-based approach to the assessment and initial management of the patient whose presentation suggests this diagnosis. The basic principles are simple and for each aspect of management we point out both potential pitfalls and strategies to overcome them. The first, and most important task is to develop mutual trust and collaboration. The second is to complete an adequate assessment, the aim of which is either to make a diagnosis of CFS or to identify an alternative cause for the patient's symptoms. The history is most important and should include a detailed account of the symptoms, the associated disability, the choice of coping strategies, and importantly, the patient's own understanding of his/her illness. The assessment of possible comorbid psychiatric disorders such as depression or anxiety is mandatory. When the physician is satisfied that no alternative physical or psychiatric disorder can be found to explain symptoms, we suggest that a firm and positive diagnosis of CFS be made. The treatment of CFS requires that the patient is given a positive explanation of the cause of his symptoms, emphasizing the distinction among factors that may have predisposed them to develop the illness (lifestyle, work stress, personality), triggered the illness (viral infection, life events) and perpetuated the illness (cerebral dysfunction, sleep disorder, depression, inconsistent activity, and misunderstanding of the illness and fear of making it worse). Interventions are then aimed to overcoming these illness-perpetuating factors. The role of antidepressants remains uncertain but may be tried on a pragmatic basis. Other medications should be avoided. The only treatment strategies of proven efficacy are cognitive behavioral ones. The most important starting point is to promote a consistent pattern of activity, rest, and sleep, followed by a gradual return to normal activity; ongoing review of any 'catastrophic' misinterpretation of symptoms and the problem solving of current life difficulties. We regard chronic fatigue syndrome as important not only because it represents potentially treatable disability and suffering but also because it provides an example for the positive management of medically unexplained illness in general.     

Treatment of peptic ulcer

AIMS: To establish whether MIB-1 and p53 staining are useful for differentiating pilocytic astrocytomas and astrocytomas from anaplastic astrocytomas and glioblastomas. This study was restricted to children and young adults under 30 years of age because of the differences in p53 mutations between paediatric and adult astrocytomas. METHODS AND RESULTS: Forty-five astrocytic tumours, including 18 pilocytic astrocytomas, 14 astrocytomas, four anaplastic astrocytomas and nine glioblastomas, from 45 children and young adults, between 1 and 29 years (mean 11 years) of age, were examined pathologically, and sections from paraffin-embedded blocks were used for MIB-1 and p53 immunostaining. The MIB-1 labelling index and the frequency and intensity of p53 staining in both the pilocytic astrocytoma and the astrocytoma group were significantly lower than in the anaplastic astrocytoma plus glioblastoma group (P < 0.001). In 11.1% (two of 18) of pilocytic astrocytomas and 42.9% (six of 14) of astrocytomas, immunoreactivity of either MIB-1 or p53 staining was of almost the same intensity as that of anaplastic astrocytomas and glioblastomas. However, in these cases, results using both MIB-1 and p53 stain differed from those for anaplastic astrocytomas and glioblastomas. CONCLUSIONS: MIB-1 and p53 co-staining is very useful for differentiating pilocytic astrocytomas and astrocytomas from anaplastic astrocytomas and glioblastomas. However, MIB-1 or p53 staining alone cannot differentiate pilocytic astrocytomas and astrocytomas from anaplastic astrocytomas and glioblastomas.     

Recurrence of peptic ulcer

In the paper, the causes, clinic and treatment in 15 patients with recurrent peptic ulcer after repeated operative procedures for duodenal ulcer are described. The main causes of the recurrence were as follows: the remaining of the mucous membrane of the antral gastric portion in Finsterer gastric resection for ulcer exclusion (5) and Zollinger-Ellison syndrome (10). The surgical therapy consisted in resection of the antral portion and repeated gastric resection (the first group) or in subtotal gastrectomy associated with trunk vagotomy (the second group).     

Therapy of peptic ulcer

After a historical review of therapeutic methods of peptic ulcer the author discusses contemporary views on therapy. As a basis he uses the idea that Helicobacter pylori is the decisive factor for the development of peptic ulcers. Therefore the basis of treatment should be its eradication by bismuth salts. Despite this at present the basis of treatment are antagonists of H2 receptors. Economic aspects are important. In repeatedly relapsing ulcers with evidence of Helicobacter pylori the author recommends eradication by a combination of drugs.     

Has the impact of Helicobacter pylori therapy on ulcer recurrence in the United States been overstated? A meta-analysis of rigorously designed trials

OBJECTIVE: The aim of this study was to assess the effect of H. pylori eradication on ulcer recurrence in North American duodenal ulcer patients by examining only treatment studies that met rigorous methodologic criteria. METHODS: Data sources were computerized bibliographic searches from 1983, review of reference lists, communication with companies that manufacture medications used for H. pylori therapy in the U.S., and H. pylori investigators, review of open presentations to the Food and Drug Administration, and review of abstracts from annual scientific meetings. Criteria for study inclusion were double blind, randomized North American trials of H. pylori therapy for duodenal ulcer, scheduled endoscopic follow-up exams for > or = 6 months, and H. pylori cure documented > or = 4 wk after completion of therapy by at least two endoscopic biopsy tests. Seven relevant trials were identified. Data were abstracted independently and disagreement was resolved by consensus. We obtained missing data and identified erroneous assessments through contact with an author or sponsor of all studies. RESULTS: The common odds ratio for ulcer recurrence was 0.20 (95% CI, 0.13-0.31) and 2.8 patients would need to be successfully treated to prevent one ulcer recurrence at 6 months. The pooled ulcer recurrence rate at 6 months in patients with H. pylori eradication was 20%. CONCLUSION: Results of North American studies of highest methodological quality confirm that H. pylori eradication markedly decreases ulcer recurrence. Nevertheless, 20% of patients in these studies had ulcer recurrence within 6 months, despite successful cure of infection and no reported use of NSAIDs. Non-H. pylori, non-NSAID ulcers may be more common in the U.S. than previously believed.     

Intractable peptic ulcer disease

The intractable ulcer is usually complicated because of posterior penetration, obstruction, or postbulbar or channel location; or it is an atypical ulcer such as those occurring with the ZE syndrome, hyperparathyroidism, and the milk-alkali syndrome. The management of intractability depends upon finding the cause and initiating the appropriate therapy. Many abdominal diseases may masquerade as intractable ulcers, so every patient must be evaluated thoroughly to prove that his ulcer is indeed intracetable.     

Bleeding in chronic refractory peptic ulcer

The authors reviewed the clinical problems of the bleeding in refractory ulcers. Incidence of refractory and easily-relapsing ulcers are about 40% of all chronic ulcers and their bleeding rate seemed to be more than 10% of them. We discussed the relationship between bleeding and risk factors such as age, NSAID use, H. pylori infection, etc. The consideration to them is very important in the present time, being difficult to predict ulcer bleeding.     

The impact of peptic ulcer disease and infection with Helicobacter pylori on life expectancy

OBJECTIVE: Knowledge about the influence of H. pylori-related disease on life expectancy might affect physician behavior in dealing with such disease. The aim of this study was to assess how life expectancy is influenced by H. pylori infection and peptic ulcer disease. METHODS: The declining exponential approximation of life expectancy was used to model the effects of H. pylori and various peptic ulcer disease conditions on life expectancy. Deaths from peptic ulcer and gastric cancer were determined from the Vital Statistics of the United States. H. pylori prevalence rates were derived from the existing literature. RESULTS: Cure of active peptic ulcer increases life expectancy by 2.3 yr in persons aged 40-44 yr and 121 days in persons aged 70-74 yr. More substantial impact occurs in complicated ulcer, with increases in life expectancy ranging between 26.1 and 6.3 yr. Primary prevention of H. pylori could increase life expectancy by 190 days in those aged 40-44 yr and 26 days in 70-74-yr-old subjects. CONCLUSION: The benefit of ulcer cure or H. pylori prevention diminishes as age advances. Cure of ulcers in young patients or in those who have sustained complications results in an appreciable increase in life expectancy. Successful primary prevention of H. pylori in selected populations could substantially increase life expectancy.     

How psychologists are utilized in the United States Public Health Service.

Conducted a study of 234 psychologists employed by the US Public Health Service (USPHS) as of May 1966 and compared the results to national studies conducted by B. E. Compton (1966) and R. F. Lockman (1962) on functional and specialty areas of psychologists. 41% of the USPHS psychologists were involved in research, 43% in administration and consulting, 12% in practice, and 4% in other activities. The studies of Compton and Lockman found more psychologists in practice and teaching. USPHS psychologists involved in research were concentrating on the areas of developmental, clinical, experimental and physiological, and social psychology, working mainly for the National Institute of Mental Health. USPHS also provided an in-service program in grants administration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)