Rita J. Nickerson

Prevalence of Senile Cataract, Diabetic Retinopathy, Senile Macular Degeneration, and Open-Angle Glaucoma In The Framingham Eye Study

Of the Framingham, Massachusetts Heart Study population, 2,675 individuals underwent an ophthalmologic evaluation that stressed detection of senile cataract, diabetic retinopathy, open-angle glaucoma, and senile macular degeneration. Those examined were 52 to 85 years old at the time this study was initiated. The prevalence rate of each of these ocular conditions increased with age. Prevalence of senile cataracts ranged from 4.6% for those between the ages of 52 to 64 years to 46% for those 75 to 85 years of age. Diabetic retinopathy was present in 2% of those between 52 and 64 years of age or older. Overall prevalence of senile macular degeneration was 9%, with a prevalence rate of 2% in our youngest age group and 28% in the oldest age group. Open-angle glaucoma had an overall prevalence of approximately 3%. This disease also showed a statistically significant (P less than .01) increase with age from 1.4% (52 to 64 years old) to 7.2% (75 to 85 years old).

Epidemiologic evidence for the spectrum of change from dysplasia through carcinoma in situ to invasive cancer.

From a prospective study of precancerous lesions at the Boston Hospital for Women and from studies in the literature, evidence is examined for a relationship between dysplasia and carcinoma in situ. Epidemiologic observations indicate that dysplasia is the precursor of carcinoma in situ. The discovery rate of cervical epithelial abnormality (consisting of the combined rates of dysplasia, carcinoma in situ and invasive cancer) is constant throughout the decades from 20 to 70 years of age; the incidence of carcinoma in situ is 22 times greater in populations with dysplasia than in populations with negative cytology; in all age groups, entrance‐into the population with cervical epithelial abnormality is by way of dysplasia. The course of dysplasia in patients studied for periods up to 9 years is one of regression and recurrence. There is suggestive evidence that carcinoma in situ evolves from dysplasia during a period of recurrence.

Doctors who perform operations. A study on in-hospital surgery in four diverse geographic areas (second of two parts).

To facilitate manpower planning in the surgical field, a study was c onducted into the work loads of surgeons in various specialities in 4 different geographical areas. Surgeons in group practice and surgeons who were Board-certified specialists carried a statistically significant larger work load of surgery. The certified surgeons performed more and more complex operations. The mean operative work load increased steeply with age, reaching a maximum at 40-44 years, and fell linearly after that age. Approximately 18 years following medical school graduation were needed for a surgeon to achieve his maximum work load. The geographic factor had no appreciable effect on work loads. Tables which broke down frequencies for each major type of operation for each type of surgical specialist indicated that even commonplace operations were not frequent events on the average for any individual surgeon. It is concluded from the study that work loads are relatively low due to excessive supply of surgeons. This is of concern because there is some doubt about maintenance of surgical skills by those doctors who perform infrequent operations. The widest variation in practice was evident between ophthalmologists and thoracic surgeons, indicating that manpower planning in this field would have to be done on a specialty-by-specialty basis. 3 plans for redistributing the operative work load and reducing the number of specialist surgeons are considered.

UROLOGISTS AND THEIR SURGICAL PRACTICE

The work characteristics of urologists were studied as part of a national study of surgeon manpower. Urologists were found to work short hours relative to other surgical specialties, and their operative work load ranked sixth among the ten surgical specialties. The major conclusion was that the supply of urologists was greater than necessary to meet the need for urologic consultants.

Doctors Who Perform Operations

To facilitate manpower planning in the surgical field, a study was c onducted into the work loads of surgeons in various specialities in 4 different geographical areas. Surgeons in group practice and surgeons who were Board-certified specialists carried a statistically significant larger work load of surgery. The certified surgeons performed more and more complex operations. The mean operative work load increased steeply with age, reaching a maximum at 40-44 years, and fell linearly after that age. Approximately 18 years following medical school graduation were needed for a surgeon to achieve his maximum work load. The geographic factor had no appreciable effect on work loads. Tables which broke down frequencies for each major type of operation for each type of surgical specialist indicated that even commonplace operations were not frequent events on the average for any individual surgeon. It is concluded from the study that work loads are relatively low due to excessive supply of surgeons. This is of concern because there is some doubt about maintenance of surgical skills by those doctors who perform infrequent operations. The widest variation in practice was evident between ophthalmologists and thoracic surgeons, indicating that manpower planning in this field would have to be done on a specialty-by-specialty basis. 3 plans for redistributing the operative work load and reducing the number of specialist surgeons are considered.