RESUMEN
Advancing knowledge of the existence of Helicobacter pylori and its association with gastrointestinal tract malignancy, and previous research showing higher-than-expected gastrointestinal tract malignancy in institutionalized adults with intellectual disability (ID) prompted a review of all deaths as a result of cancer in the Stoke Park group of hospitals for people with ID between 1946 and 1996. A 50-year, retrospective case note analysis of all deaths from cancer in an institution for people with ID was undertaken. Death from stomach cancer accounted for up to 48% of all cancer deaths. A further 25 residents had died of perforated stomach ulcers. The higher proportion of deaths specifically caused by stomach cancer in a population with ID has not been noted previously. It is postulated that the high levels of H. pylori infection found in institutionalized populations may be instrumental in this higher mortality rate and that the closure of the institutions without evaluation of H. pylori status transfers the problem unresolved to the community. Existing guidelines for the screening and eradication of H. pylori developed for the general population are inadequate when applied to people with ID, and therefore, the value of population screening and mass eradication programmes is explored.
Asunto(s)
Infecciones por Helicobacter/mortalidad , Helicobacter pylori , Institucionalización/estadística & datos numéricos , Discapacidad Intelectual/mortalidad , Neoplasias Gástricas/mortalidad , Causas de Muerte , Femenino , Infecciones por Helicobacter/microbiología , Mortalidad Hospitalaria , Humanos , Masculino , Úlcera Péptica Perforada/mortalidad , Estudios Retrospectivos , Neoplasias Gástricas/microbiología , Reino Unido/epidemiologíaRESUMEN
Those with a learning disability previously cared for in institutions have now been discharged into smaller community homes. This has meant that an increased burden has been placed on general practitioners (GPs) to evaluate and treat those who have symptoms that may be difficult to interpret. This report presents the prevalence of Helicobacter pylori in those still awaiting discharge and discusses the possible symptoms that GPs may encounter.
Asunto(s)
Infecciones por Helicobacter/complicaciones , Helicobacter pylori , Discapacidades para el Aprendizaje/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Servicios de Salud Comunitaria , Medicina Familiar y Comunitaria , Femenino , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/terapia , Humanos , Discapacidades para el Aprendizaje/terapia , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , PrevalenciaRESUMEN
There is increasing concern and dissent over the ethical implications of the NHS reforms, and many doctors and nurses who have chosen to bare their professional consciences now see themselves as dissidents.
