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Health Service Region (health + service_region)

Distribution by Scientific Domains

Medical Sciences	75%

Selected Abstracts

Maternal diabetes and renal agenesis/dysgenesis,,

BIRTH DEFECTS RESEARCH, Issue 9 2010
Erin M. Davis
Abstract BACKGROUND: Renal agenesis and dysgenesis are potentially lethal congenital malformations affecting 2 to 5 infants per 10,000 live births annually in the United States. The low prevalence of these malformations has complicated understanding of potential risk factors. Maternal diabetes (type 1, type 2, and gestational) has been evaluated extensively as a risk factor for other congenital malformations, but only a limited number of studies have assessed the association between diabetes and renal agenesis. METHODS: We conducted a population-based case-control study of deliveries after 20 weeks gestation in Texas Health Service Region 6 (Houston/Galveston area) from January 1, 2000 to December 31, 2002. Cases of renal agenesis/dysgenesis (n = 89) were ascertained from the Texas Birth Defects Registry. Cumulative incidence sampling was used to randomly select, from birth and fetal death records, 356 controls frequency matched to cases by delivery year and vital status. Maternal diabetes and other covariates were collected from vital records. RESULTS: The odds of renal agenesis/dysgenesis were 3.1 (95% confidence interval [CI], 1.1,9.3) times greater among deliveries of mothers with diabetes compared to deliveries of mothers without diabetes, controlling for matching factors. CONCLUSIONS: Our results are consistent with prior, but limited, research identifying diabetes as a risk factor for renal agenesis/dysgenesis. While these data did not differentiate diabetes diagnoses by type, the results suggest that maternal diabetes may be associated with renal malformations. Further study is warranted. Birth Defects Research (Part A), 2010. © 2010 Wiley-Liss, Inc. [source]

Research and development at the health and social care interface in primary care: a scoping exercise in one National Health Service region

HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2002
Jo Cooke MA
Abstract The present project aimed to identify research activity at the health and social care interface in primary care within one National Health Service region, and to determine levels of research capacity and support within social services. The study was commissioned by a primary care research network (PCRN) in order to assess opportunities to increase research capacity within social services. Data were collected in two phases from 61 managers, team leaders and senior practitioners in social care, and six public health representatives in health authorities, using telephone interviews and focus groups. The findings highlighted a lack of infrastructure and support for research and development in social care. However, many social care respondents wanted opportunities to develop research skills with healthcare colleagues. Despite poor support, many small-scale projects were described, and many respondents showed an enthusiasm for engaging with research. Methods in use included surveys, action research, needs analysis and evaluation of service developments. Many examples of user involvement were given. Interface projects were usually instigated by interagency forums and funded from multiple sources. Most project work was motivated by service improvement or development, rather than aiming to produce generalisable knowledge. Barriers to conducting research included lack of confidence, research skills and time, as well as workload demands, lack of cover to release staff for research and lack of supervision. Research was not seen as legitimate work in some social care environments or as part of a career path. Existing joint working initiatives (such as the National Service Frameworks) were highlighted as flashpoints for potential research and evaluation activity. The findings suggest clear opportunities for PCRNs to develop research capacity at the interface with social care; for example, by signposting available resources, providing training grants and secondments for social care staff, and supporting interagency networks with a focus on evaluation. In turn, experience in promoting user involvement in social services could add value to research expertise at the primary care,social care interface. [source]

One-year survey of carcinoma of the oesophagus and stomach in Wales

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 2 2001
J. K. Pye
Background: The aim of the study was to identify all patients who presented with oesophagogastric malignancy within a single National Health Service region (Wales) over 1 year, and to follow the cohort for 5 years. Management and outcome were analysed to identify current practice and draft guidelines for Wales. Methods: Patients were identified from hospital records. Details were recorded in structured format for analysis. Results: Analysable data were obtained for 910 of 916 patients. The overall incidence was 31·4 per 100 000 population. Treatment was by resection 298 (33 per cent), palliation 397 (44 per cent) or no treatment 215 (24 per cent). The 30-day mortality rate was 12 per cent and the in-hospital mortality rate was 13 per cent. Some 226 patients (25 per cent) were alive at 2 years. Resection conferred a significant survival advantage over palliation (P < 0·001) and no treatment. Anastomotic leakage occurred in 16 patients (5 per cent), of whom eight died in hospital. ,Open and close' operations were common (23 per cent), laparoscopy was infrequent (16 per cent), and many surgeons undertook small caseloads. Operating on fewer than six patients per year increased the mortality rate after partial gastrectomy (P < 0·05) and was associated with a trend to a higher mortality rate after mediastinal and cardia surgery. Operating on more than 70 per cent of patients seen resulted in a significantly higher mortality rate (P < 0·01) irrespective of case volume. Conclusion: Tumour resection conferred a survival advantage. Wider use of laparoscopy is advocated. Improved selection for surgery should result in a lower mortality rate. © 2001 British Journal of Surgery Society Ltd [source]