OBJECTIVE To determine the morbidity and mortality from childhood Haemophilus influenzae type b (Hib) meningitis in a well defined population. DESIGN Retrospective survey 1985-1987 and prospective surveillance of hospital laboratories 1989-1990. Information on outcome of meningitis was obtained from hospital records and attending physicians and, in 1989-1990, from a survey of the children's parents. SETTING Sydney Statistical Division, which had a population of children aged 0-4 years of 229,165 in 1986 and 263,758 in 1990. PATIENTS Eligible children were aged from one month to four years and had clinical and microbiological evidence of Hib meningitis on standard criteria. RESULTS There were 229 eligible children. Twelve were excluded (seven died and five had pre-existing neurological deficits). A neurological deficit was detected at the time of hospital discharge in 45 patients (21%) and persisted for 12 months or longer in 29 patients (13%). Follow-up information was available for 165 (96%) children who were normal at the time of hospital discharge and persistent deficits were recorded in 12 (7%) of these children. Forty-one children (19%) had readily recognisable neurological or hearing problems: nine (4%) had persistent severe neurological deficits and seven (3%) had severe hearing loss requiring hearing aids or a cochlear implant. Age had a significant influence on outcome. The youngest children were significantly more likely to be admitted to intensive care. Severe neurological deficits showed a significant negative trend with increasing age (P = 0.03). Severe unilateral or bilateral sensorineural loss (odds ratio [OR] 8.0, 95% confidence interval [CI] 1.5-81) and ataxia at discharge (OR 13.3, 95% CI 2.8-128) were noticeably more common in children over two years of age, with a significant positive trend (P < or = 0.001) with increasing age. Patients requiring intensive care were much more likely to have an adverse outcome, particularly if positive pressure ventilation was needed. CONCLUSIONS These data provide population-based estimates of the minimum incidence of adverse outcomes from Hib meningitis in an urban community with good access to medical services. This is important in assessing the impact of Hib vaccination, as meningitis is responsible for most of the long-term morbidity from childhood invasive Hib disease. Determination of the relationship between morbidity and age is important for assessing alternative vaccine strategies.

The outcome of childhood Haemophilus influenzae meningitis. A population based study.

2016 Alzheimer's disease facts and figures

BACKGROUND: More than 30 percent of patients with epilepsy have inadequate control of seizures with drug therapy, but why this happens and whether it can be predicted are unknown. We studied the response to antiepileptic drugs in patients with newly diagnosed epilepsy to identify factors associated with subsequent poor control of seizures. METHODS: We prospectively studied 525 patients (age, 9 to 93 years) who were given a diagnosis, treated, and followed up at a single center between 1984 and 1997. Epilepsy was classified as idiopathic (with a presumed genetic basis), symptomatic (resulting from a structural abnormality), or cryptogenic (resulting from an unknown underlying cause). Patients were considered to be seizure-free if they had not had any seizures for at least one year. RESULTS: Among the 525 patients, 333 (63 percent) remained seizure-free during antiepileptic-drug treatment or after treatment was stopped. The prevalence of persistent seizures was higher in patients with symptomatic or cryptogenic epilepsy than in those with idiopathic epilepsy (40 percent vs. 26 percent, P=0.004) and in patients who had had more than 20 seizures before starting treatment than in those who had had fewer (51 percent vs. 29 percent, P<0.001). The seizure-free rate was similar in patients who were treated with a single established drug (67 percent) and patients who were treated with a single new drug (69 percent). Among 470 previously untreated patients, 222 (47 percent) became seizure-free during treatment with their first antiepileptic drug and 67 (14 percent) became seizure-free during treatment with a second or third drug. In 12 patients (3 percent) epilepsy was controlled by treatment with two drugs. Among patients who had no response to the first drug, the percentage who subsequently became seizure-free was smaller (11 percent) when treatment failure was due to lack of efficacy than when it was due to intolerable side effects (41 percent) or an idiosyncratic reaction (55 percent). CONCLUSIONS: Patients who have many seizures before therapy or who have an inadequate response to initial treatment with antiepileptic drugs are likely to have refractory epilepsy.

Early Identification of Refractory Epilepsy

NOTE The report of the Committee without its annexes appears as Official Records of the General Assembly, Sixty-third Session, Supplement No. 46. The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. The country names used in this document are, in most cases, those that were in use at the time the data were collected or the text prepared. In other cases, however, the names have been updated, where this was possible and appropriate, to reflect political changes. Scientific Annexes Annex A. Medical radiation exposures Annex B. Exposures of the public and workers from various sources of radiation INTROdUCTION 1. In the course of the research and development for and the application of atomic energy and nuclear technologies, a number of radiation accidents have occurred. Some of these accidents have resulted in significant health effects and occasionally in fatal outcomes. The application of technologies that make use of radiation is increasingly widespread around the world. Millions of people have occupations related to the use of radiation, and hundreds of millions of individuals benefit from these uses. Facilities using intense radiation sources for energy production and for purposes such as radiotherapy, sterilization of products, preservation of foodstuffs and gamma radiography require special care in the design and operation of equipment to avoid radiation injury to workers or to the public. Experience has shown that such technology is generally used safely, but on occasion controls have been circumvented and serious radiation accidents have ensued. 2. Reviews of radiation exposures from accidents have been presented in previous UNSCEAR reports. The last report containing an exclusive chapter on exposures from accidents was the UNSCEAR 1993 Report [U6]. 3. This annex is aimed at providing a sound basis for conclusions regarding the number of significant radiation accidents that have occurred, the corresponding levels of radiation exposures and numbers of deaths and injuries, and the general trends for various practices. Its conclusions are to be seen in the context of the Committee's overall evaluations of the levels and effects of exposure to ionizing radiation. 4. The Committee's evaluations of public, occupational and medical diagnostic exposures are mostly concerned with chronic exposures of …

sources and effects of ionizing radiation

Background Many risk factors for hip fractures have been suggested but have not been evaluated in a comprehensive prospective study. Methods We assessed potential risk factors, including bone mass, in 9516 white women 65 years of age or older who had had no previous hip fracture. We then followed these women at 4-month intervals for an average of 4.1 years to determine the frequency of hip fracture. All reports of hip fractures were validated by review of x-ray films. Results During the follow-up period, 192 women had first hip fractures not due to motor vehicle accidents. In multivariable age-adjusted analyses, a maternal history of hip fracture doubled the risk of hip fracture (relative risk, 2.0; 95 percent confidence interval, 1.4 to 2.9), and the increase in risk remained significant after adjustment for bone density. Women who had gained weight since the age of 25 had a lower risk. The risk was higher among women who had previous fractures of any type after the age of 50, were tall at the age of 25, rated their own health as fair or poor, had previous hyperthyroidism, had been treated with long-acting benzodiazepines or anticonvulsant drugs, ingested greater amounts of caffeine, or spent four hours a day or less on their feet. Examination findings associated with an increased risk included the inability to rise from a chair without using one's arms, poor depth perception, poor contrast sensitivity, and tachycardia at rest. Low calcaneal bone density was also an independent risk factor. The incidence of hip fracture ranged from 1.1 (95 percent confidence interval, 0.5 to 1.6) per 1,000 woman-years among women with no more than two risk factors and normal calcaneal bone density for their age to 27 (95 percent confidence interval, 20 to 34) per 1,000 woman-years among those with five or more risk factors and bone density in the lowest third for their age. Conclusions Women with multiple risk factors and low bone density have an especially high risk of hip fracture. Maintaining body weight, walking for exercise, avoiding long-acting benzodiazepines, minimizing caffeine intake, and treating impaired visual function are among the steps that may decrease the risk.

Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group.

The incidence of epilepsy and of all unprovoked seizures was determined for residents of Rochester, Minnesota U.S.A. from 1935 through 1984. Age-adjusted incidence of epilepsy was 44 per 100,000 person-years. Incidence in males was significantly higher than in females and was high in the first year of life but highest in persons aged > or = 75 years. Sixty percent of new cases had epilepsy manifested by partial seizures, and two thirds had no clearly identified antecedent. Cerebrovascular disease was the most commonly identified antecedent, accounting for 11% of cases. Neurologic deficits from birth, mental retardation and/or cerebral palsy, observed in 8% of cases, was the next most frequently identified preexisting condition. The cumulative incidence of epilepsy through age 74 years was 3.1%. The age-adjusted incidence of all unprovoked seizures was 61 per 100,000 person-years. Age- and gender-specific incidence trends were similar to those of epilepsy, but a higher proportion of cases was of unknown etiology and was characterized by generalized onset seizures. The cumulative incidence of all unprovoked seizures was 4.1% through age 74 years. With time, the incidence of epilepsy and of unprovoked seizures decreased in children and increased in the elderly.

Incidence of Epilepsy and Unprovoked Seizures in Rochester, Minnesota: 1935–1984

Incidence of premature ovarian failure.

Background The risk of seizures is increased after traumatic brain injury, but the extent and duration of the increase in risk are unknown. The purpose of this study was to identify the characteristics of brain injuries that are associated with the development of seizures. Methods We identified 4541 children and adults with traumatic brain injury (characterized by loss of consciousness, post-traumatic amnesia, or skull fracture) in Olmsted County, Minnesota, during the period from 1935 through 1984. Injuries were classified as mild (loss of consciousness or amnesia lasting less than 30 minutes), moderate (loss of consciousness for 30 minutes to 24 hours or a skull fracture), or severe (loss of consciousness or amnesia for more than 24 hours, subdural hematoma, or brain contusion). We compared the incidence of new unprovoked seizures in this cohort with population rates, using standardized incidence ratios and Cox proportional-hazards analysis. Results The overall standardized incidence ratio was 3.1 (95 p...

A Population-Based Study of Seizures after Traumatic Brain Injuries

Summary: : The prevalence of epilepsy in Rochester, Minnesota has been determined for a specific date in each of 5 decennial census years. Individuals with a diagnosis of epilepsy (recurrent unprovoked seizures) who were known to have experienced a seizure or who had received antiepileptic medication in the preceding 5 years were considered active prevalence cases. By this definition, the age-adjusted prevalence per 1,000 population, increased steadily from 2.7 in 1940 to 6.8 in 1980. At each of five prevalence dates, for all prevalence cases, 60% had epilepsy manifest by partial seizures, and 75% had no known etiology. Prevalence was higher for males than females for all except the last prevalence day. After 1950, prevalence tended to increase with advancing age and was highest in the oldest age groups. On the average, the 1980 prevalence cases had epilepsy 50% had their first diagnosis in the first 20 years of life.

RESUME
La prevalence de ľ epilepsie dans le Comtede Rochester, dans le Minnesota, a eteevaluee pour une date precise de chacune des 5 annees du recensement decennal. Les individus pour lesquels le diagnostic ďepilepsie avait ete pose (crises spontanees recurrentes) et qui avaient presente une crise ou recevaient un traitement antiepileptiques dans les 5 annees precedentes, ont ete consideres comme des cas de prevalence active. Selon cette definition, la prevalence ajustee pour Page pour 1000 habitants a agumente constamment de 2.7 en 1940 a 6.8 en 1980. A chacune des 5 dates de prevalence, pour tous les cas, 60% ont presente une epilepsie se manifestant par des crises partielles, et 75% n'avaient pas ďetiologie connue. La prevalence teAait plus elevee chez les hommes que chez les femmes, sauf lors du dernier jour de prevalence. Apres 1950, la prevalence tendait a augmenter avec ľâge, elle etait la plus forte dans les groupes ďâge eleve En moyenne, les cas de 1980 avaient une epilepsie evoluant depuis moins de 10 ans et plus de 50% avaient une epilepsie diagnos-tiquee au cours des 20 premieres annees de vie.

RESUMEN
Se ha determinado la prevalencia de epilepsyia en Rochester, Minnesota, para una fecha especifica en cada uno de los 5 dece-nios del censo. Individuos con diagnostico de epilepsia “ataques recurrentes sin provocacion” que habian tenido un ataque o recibido medicateon antiepileptica en los 5 anos precedentes, fueron considerados como casos activos de prevalencia. Segun esta definition la prevalencia ajustada a la edad por 1.000 habitantes se incremento continuadamente de 2.7 en 1940 a 6.8 en 1980. En cada una de las 5 fechas de prevalencia para todos los casos prevalentes, el 60% tenia epilepsyia manifestada por ataques parciales y el 75% de etiologia desconocida. La prevalencia fue mas elevada en varones que en hembras en todos los dias de prevalencia excepto el ultimo. Despues de 1950 la prevalencia mostro una tendencia al aumento con incremento de la edad y fue mas elevada en los grupos de mayor edad. Como promedio, los casos de prevalencia en 1980 habian padecido epilepsyia durante menos de 10 anos y mas del 50% tuvieron el primer diagnostico en los primeros 20 anos de su vida.

ZUSAMMENFASSUNG
Die Praevalenz der Epilepsie in Rochester, Minnesota wurde an einem bestimmten Datum in funf aufeinanderfolgenden Cen-sus-Decenien bestimmt. Personen mit der Diagnose Epilepsie (wiederholte nicht provozierte Anfalle), die einene Anfall erlitten hatten oder Antiepileptika eingenommen hatten wurden als ak-tive Praevalenz-Falle betrachtet. Demnach stieg die altersberei-nigte Praevalenz fur 1000 Einwohner kontinuierlich von 2,7 1940 auf 6,8 1980 an. Zu jedem der funf Praevalenz-Daten aller Praevalenz-Falle manifestierte sich die Epilepsie in 60% durch Partialanfalle, davon 75% ohne bekannte Atiologie. Die Praevalenz war fur Manner hoher als fur Frauen wahrend aller Stichtage, ausgenommen des letzten. Nach 1950 stieg die Praevalenz mit zunehmendem Alter leicht an und erreichte ihren hochsten Wert in der altesten Altersgruppe. Im Durchschnitt hatten 1980 die Praevalen-Falle eine Epilepsie fur weniger als 10 Jahre. Bei mehr als 50% wurde die Erstdiagnose Epilepsie in den ersten 20 Le-bensjahren gestellt.

Prevalence of epilepsy in Rochester, Minnesota: 1940-1980.

Studies based on the Rochester Epidemiology Project medical records-linkage system have provided important insights into the epidemiology of epilepsy. The incidence of all convulsive disorders in Rochester, Minnesota, during a 50-year period exceeded 130 per 100,000 person-years. The age-adjusted incidence of epilepsy was 44 per 100,000 person-years; of a first unprovoked seizure, 61; and of acute symptomatic seizures excluding febrile convulsions, 31. In addition, 2% of the population experienced a febrile convulsion before the age of 5 years. The cumulative incidence of epilepsy through age 74 years was 3.0%, of all unprovoked seizures was 4.1% and of any convulsive disorder approached 10%. For epilepsy, single unprovoked seizures, and acute symptomatic seizures, the incidence was significantly higher in males than in females, and it was high in the first year of life but highest in those age 75 years or older. For epilepsy alone, approximately 60% of incidence cases experienced partial seizures, and two-thirds had no clearly identified antecedent. Cerebrovascular disease was the most commonly identified antecedent of epilepsy, accounting for 11 % of cases. Over time, the incidence of epilepsy and of unprovoked seizures decreased in children and increased in the elderly population. The age-adjusted prevalence of active epilepsy on Jan. 1, 1980, was 6.8 per 1,000 residents. Prevalence was low in the first decade of life, increased to a plateau in the adult years, and further increased in the elderly population. Almost 1.5% of the population older than 75 years of age had active epilepsy. About 25% of prevalence cases had an identified cause; 60% experienced partial epilepsy.

John F. Annegers

Papers

Incidence of Epilepsy and Unprovoked Seizures in Rochester, Minnesota: 1935–1984

Incidence of premature ovarian failure.

A Population-Based Study of Seizures after Traumatic Brain Injuries

Prevalence of epilepsy in Rochester, Minnesota: 1940-1980.

Descriptive Epidemiology of Epilepsy: Contributions of Population-Based Studies From Rochester, Minnesota