Biomedical subjects

D Lezotte

Publications and source records attributed to D Lezotte.

At least 19 recordsLinked to original sources

PubMed2000

Motor vehicle crash fatalities: A comparison of Hispanic and non-Hispanic motorists in Colorado.

STUDY OBJECTIVES: We compare the population-based death rates from traffic crashes in the Hispanic and non-Hispanic white populations in a single state, and compare fatally injured Hispanic and non-Hispanic drivers with respect to safety belt use, alcohol involvement, speeding, vehicle age, valid licensure, and urban-rural location. METHODS: Hispanic and non-Hispanic white motorists killed in traffic crashes in 1991-1995 were studied (n=2,272). Data from death certificates (age, sex, education, race, and ethnicity) and the Fatality Analysis Reporting System (FARS; driver, vehicle, and crash information) were merged. Average annual age-adjusted fatality rates were calculated; to compare Hispanic and non-Hispanic white motorists, rate ratios (RR) and 95% confidence intervals (CIs) were calculated. Odds ratios (ORs), adjusted for age, sex, and rural locale, were calculated to measure the association between Hispanic ethnicity and driver and crash characteristics. RESULTS: Eighty-five percent of FARS records were matched to death certificates. Compared with non-Hispanic white motorists, Hispanics had higher crash-related fatality rates overall (RR 1.75, 95% CI 1.60 to 1.92) and for drivers only (RR 1.62, 95% CI 1.41 to 1.85). After adjustment for age, sex, and rural locale, Hispanic drivers had higher rates of safety belt nonuse (OR 1.81, 95% CI 1.20 to 2.72), legal alcohol intoxication (OR 2.73, 95% CI 1.97 to 3.79), speeding (OR 1.36, 95% CI 0.99 to 1.88), and invalid licensure (OR 2.58, 95% CI 1.78 to 3.75). The average vehicle age for Hispanic drivers (10.1 years, 95% CI 9.3 to 11.0) was greater than for non-Hispanic white motorists (8.8 years, 95% CI 8.4 to 9.2). CONCLUSION: Compared with non-Hispanic whites, Hispanic drivers have higher rates of safety belt nonuse, speeding, invalid licensure and alcohol involvement, with correspondingly higher rates of death in traffic crashes. As traffic safety emerges as a public health priority in Hispanic communities, these data may help in developing appropriate and culturally sensitive interventions.

Accidents, Traffic↗

PubMed2000

Surgical management of uncomplicated otitis media in a pediatric Medicaid population.

The objective of this study was to document the frequency and timing of otitis media-related visits, audiological consultations, and surgical interventions following a new episode of otitis media. A retrospective descriptive study was performed on a Medicaid administrative database that follows individual patients over time. The study included 14,453 children enrolled in Medicaid during 1991 and 1992 who were 30 months of age or younger and had a "new" episode of otitis media. Among 14,321 patients with an uncomplicated episode of otitis media, there were 10,443 with additional otitis media visits. Audiological testing was performed in 1,134 (10.9%). The testing occurred within 2 months of the onset of otitis media in 52.2% of the children and within 3 months in 66.6%. Physicians referred 400 children (3.8%) to an otolaryngologist; 299 (75%) underwent 1 or more surgical procedures. These surgical interventions included placement of ventilating tubes in 296 children, adenoidectomy in 34 children (all of whom also had placement of ventilating tubes), mastoidectomy in 2 children, and tympanoplasty in 1 child. The proportion of children who underwent surgical placement of ventilating tubes who had prior audiological testing was 174 of 296 (58.8%). The overall surgical rate for ventilating tubes was 2.9%. Among children who underwent surgery, the procedure occurred within 2 months of the onset of otitis media in 21.4% of children. Attempts to rationalize the management of otitis media in early childhood must deal with the difficulties in distinguishing among the otitis media conditions. The findings of this study suggest a need to know whether insertions of ventilating tubes within 3 months after a new episode of otitis media are related to unresponsive or recurrent infections.

Acute Disease↗

PubMed2000

Direct expenditures related to otitis media diagnoses: extrapolations from a pediatric medicaid cohort.

BACKGROUND: Treatment of otitis media in children is associated with substantial expenditures because of its high frequency during childhood. Vaccines against respiratory pathogens causing otitis media are now being developed. Information about otitis media-related medical expenditures will be needed to determine the cost-effectiveness of these preventive interventions. METHODS: This study used utilization data from claims to impute otitis media-related expenditures for medical visits, pharmaceuticals, and surgical procedures for 87 057 children 13 years of age and younger who were continuously enrolled in Colorado's fee-for-service Medicaid program during 1992. International Classification of Disease, Ninth Revision diagnostic codes were used to identify visits for otitis media. An antibiotic was considered to have been prescribed to treat otitis media if it was dispensed up to 24 hours before or within 48 hours after a physician encounter showing a diagnosis of otitis media. All tympanostomies, mastoidectomies, and adenoidectomies were assumed to be related to otitis media. Expenditures were imputed from utilization using a Medicaid fee schedule. National expenditures for 1992 to treat otitis media were extrapolated from Colorado's Medicaid data. We adjusted for differences between Colorado and the United States as a whole in terms of price, number, and intensity of services; for differences in reimbursement rates by service between Medicaid and private insurance; and for differences in utilization between Medicaid enrollees and the uninsured. To provide a more current expression of medical expenditures for otitis media, we inflated the 1992 expenditure estimates to 1998 dollars using the Consumer Price Index published by the US Bureau of Labor Statistics. RESULTS: Twenty-eight percent of children experienced at least 1 episode of diagnosed otitis media. The proportion of children with a diagnosis of otitis media was highest (42%-60%) in the 7-month to 36-month age range. The proportion was also higher among white (34.5%) and Hispanic (25.3%) children than among black children (18.5%), as well as among rural (34.5%) compared with urban children (27.2%). Children 19 to 24 months of age incurred the highest total annual expenditures per child with otitis media ($239.68). Expenditures for drugs, visits, and procedures were all highest for this group. The per-patient cost to Medicaid was greater for visits than for drugs or procedures across all age groups. Total per-patient expenditures were higher for males ($174.67) than for females ($154.47) and higher for white children ($176.59) than for Hispanic ($154.12) or black children ($134.44). The differences among the ethnic groups can be attributed almost entirely to differences in expenditures for procedures and drugs. Although mean expenditures per patient varied substantially by some patient characteristics (eg, race), these differences accounted for only a small fraction of the enormous variation in costs per patient. Including children with and without otitis media, age-specific estimated expenditures per child peaked among children 1 ($132.94) and 2 years of age ($88.72). Children 3 to 6 years of age incurred expenditures only one third as great as those incurred by children 1 year of age. Total national expenditures were estimated to have been approximately $4.1 billion in 1992 dollars and $5.3 billion in 1998 dollars. Over 40% of national expenditures to treat otitis media in children younger than 14 years of age were incurred for children between 1 and 3 years of age ($453 per capita in 1992 dollars over these 2 years vs $1027 for all years of age from 2 to 13). Nationally, expenditures for visits remained the largest component of expenditures. LIMITATIONS: This study assessed expenditures from the point of view of the health care system; that is, no social costs, such as lost work time, or expenditures not normally covered by insurance, such as those for transportation, we

Adolescent↗

PubMed1999

The influence of having an assigned Medicaid primary care physician on utilization of otitis media-related services.

OBJECTIVE: This study documents the influence of having an assigned Medicaid primary care physician (PCP) on the utilization of otitis media-related services. DESIGN/METHODS: This is a retrospective study using the 1991 Colorado Medicaid administrative database that followed 28 844 children <13 years who had at least 1 visit for otitis media. RESULTS: Children continuously enrolled in Medicaid throughout the entire year were >4 times (odds ratio: 4.2 and 4.89, respectively) as likely to always or sometimes have a PCP compared with children who were discontinuously enrolled. The likelihood of ever using the emergency department for an otitis media-related visit was increased by 26% and 50%, respectively, when a child sometimes or never had a PCP compared with always having a PCP. The likelihood of ever filling an antibiotic for otitis media was reduced by 23% and 34%, respectively, when a child sometimes or never had a PCP compared with always having a PCP. The likelihood of ever having otitis media-related surgery was not affected by PCP status, but young children, 13 to 18 months of age, had higher referral rates when they had an assigned PCP. CONCLUSIONS: These findings suggest that having an assigned Medicaid PCP influences the utilization patterns of some otitis media-related medical services.

Adenoidectomy↗

PubMed1998

Lipid levels in anorexia nervosa.

OBJECTIVE: Anorexia nervosa is a chronic disorder characterized by the patient's refusal to maintain body weight and a myriad of medical complications. Two frequently cited and poorly understood complications are hypercholesterolemia and hypercarotenemia. We therefore measured fasting cholesterol and beta-carotene levels in a cohort of moderately severe anorectics. METHOD: All subjects were female and met DSM-IV criteria for anorexia nervosa. Lipid profiles and beta-carotene levels were determined in 23 female anorexics. RESULTS: The mean total cholesterol for this group of anorectics was 179.3 mg/dl. Low-density lipoprotein values (LDL) ranged from 47 to 173, with a mean of 104.1 mg/dl. The mean high-density lipoprotein value (HDL) was 51.5 mg/dl. Beta-carotene levels were all normal. DISCUSSION: We conclude that total and LDL cholesterol in anorexia are well within the range of normal, and HDL levels are favorably high. Further, hypercarotenemia was not associated with anorexia nervosa.

Adolescent↗

PubMed1997

Otitis media-related antibiotic prescribing patterns, outcomes, and expenditures in a pediatric medicaid population.

BACKGROUND: Treatment of otitis media is the most frequent reason for administering antibiotics to children in the United States. However, only limited data are available on medical effectiveness of antibiotic prescribing patterns for otitis media and their associated expenditures or the factors that influence antibiotic prescribing. METHODS: The study population consisted of 131 169 children during 1991 and 157 065 children during 1992 who were </=13 years of age and enrolled in Colorado's fee-for-service Medicaid program. Among these children, 5127 (1991) and 7254 (1992) were enrolled in the cohort treated for a "new" episode of acute otitis media. An analysis using this cohort was performed to document the antibiotics used to treat a new episode of acute otitis media, factors influencing antibiotic selection, and the short-term outcomes of therapy. An analysis using the entire Medicaid population was performed to document the annual use of antibiotics for otitis, the associated antibiotic expenditures, and factors influencing antibiotic selection. RESULTS: In the cohort analysis, office-based physicians prescribed second- and third-generation cephalosporins more often than did physicians in other settings (17% vs 9.7% and 11.8%), whereas hospital clinics prescribed trimethoprim plus sulfamethoxazole more frequently than did office-based physicians (19.2% vs 7.1% and 10.9%). Family physicians prescribed second- and third-generation cephalosporins more often than did pediatricians (16.6% vs 12.3%) but trimethoprim plus sulfamethoxazole and erythromycin plus sulfisoxazole less often than did pediatricians (10.5% vs 17%). The average rate of prescribing a second course of antibiotics within 24 days after initial antibiotic treatment of a new acute otitis media episode was 11.6% when less expensive antibiotics (amoxicillin, trimethoprim plus sulfamethoxazole, or erythromycin plus sulfisoxazole) were prescribed, and 13.2% when more expensive antibiotics (cefaclor, amoxicillin plus clavulanate, or cefixime) were prescribed. The average adverse drug reaction rate was 5.9% when less expensive antibiotics were prescribed, compared with 6.1% when more expensive antibiotics were prescribed. In each of the two study years, amoxicillin accounted for almost half of the total antibiotic fills but only 9% to 10% of the expenditures. Low-cost antibiotics (amoxicillin, trimethoprim plus sulfamethoxazole, and erythromycin plus sulfisoxazole) were prescribed for 66% to 67% of the total fills and accounted for 21% of the total projected expenditures. More expensive antibiotics (cefaclor, cefixime, amoxicillin plus clavulanate) prescribed for 30% of the fills generated 76% to 77% of expenditures. Cefaclor, prescribed for 17% to 18% of the total fills, generated 43% to 45% of total antibiotic expenses. CONCLUSIONS: The findings of this study document a preference for amoxicillin as the initial antibiotic for a new episode of acute otitis media. Although there was a wide variation in the selection of antibiotics to treat otitis, the more expensive antibiotics were not associated with better outcomes. This wide variation has important financial implications because of differences in antibiotic costs. Changes in prescribing patterns among initially uncomplicated children that reduce the use of high-cost antibiotics could reduce expenditures substantially without compromising short-term outcomes.

Acute Disease↗

PubMed1996

Mortality from intentional and unintentional injury among infants of young mothers in Colorado, 1986 to 1992.

OBJECTIVES: To investigate the association between maternal age and other risk factors and infant injury deaths in the state of Colorado from 1986 to 1992. DESIGN: A retrospective cohort design was used to compare rates of unintentional and intentional infant injury mortality by maternal age group. A case-control design explored the importance of various risk factors, particularly maternal age, using multivariate logistic regression. PARTICIPANTS: The 2 case groups comprised all unintentional and intentional injury deaths in the first year of life. The control group was a random sample of both survivors and noninjury deaths selected from the entire birth cohort. RESULTS: The infant injury mortality rate for the 322766 live births in Colorado from 1986 to 1992 was 3.1 per 10000. Intentional injury death rates were highest for infants of teenaged mothers, peaking at 10.5 per 10000 live births for mothers aged 16 years. Unintentional injury death rates were highest for infants of mothers aged 20 to 24 years, peaking at 3.7 per 10000 live births for 22-year-old mothers. For intentional injury death, maternal marital status had a significant impact on maternal age; compared with the baseline group of married mothers older than 24 years, significantly higher risks were observed for infants of teenagers who were married (odds ratio [OR] = 32.0; 95% confidence interval[CI], 9.9-104.0) but also in infants of older mothers who were unmarried (OR = 3.6; 95% CI, 1.0-13.0 for unmarried mothers aged 20-24 years and (OR = 7.7; 95% CI, 2.4-25.0 for those > 24 years). Black race (OR = 3.5; 95% CI, 1.4-9.4) was also associated with intentional injury death. For unintentional injury death, the highest risk was for infants of mothers aged 20 to 24 years and unmarried (OR = 3.9; 95% CI, 1.7-9.3). Risk was also elevated for infants of married teenaged mothers (OR = 3.5; 95% CI, 0.7-17.8) but was not significantly different from the baseline group for unmarried teenagers, married 20- to 24-year-old mothers, or unmarried mothers aged 25 years or older. Risk was increased by the presence of older siblings (OR = 1.5 per sibling; 95% CI, 1.2-2.0). CONCLUSIONS: Maternal age and marital status significantly affect the rate of both unintentional and intentional infant injury mortality. These results suggest that child abuse prevention strategies should be targeted to teenaged mothers, and that strategies designed to prevent unintentional injuries should focus particularly on parents or caretakers of infants born to unmarried mothers in their early 20s as well as married teenagers.

Adult↗

PubMed1995

Improving identification of and intervention for alcoholism.

A retrospective hospital medical record review was done using 45 diagnoses or laboratory findings that are associated with alcohol abuse. The reviewer assessed the level of documentation of alcohol consumption in relation to alcohol-related disorders before and after an intervention to heighten house staff's recognition of alcoholism. Of the patients with at least 1 alcohol-related disease, 58% were explicitly asked about their consumption of alcohol. The mean number of alcohol-related diseases was 3.8 +/- 2.3 in the group questioned compared with 1.9 +/- 1.4 in the group not asked (P < .01). After the intervention, 90% of patients with at least 1 alcohol-related disease were asked about alcohol consumption. Once again, those asked had an average of 3.9 diseases compared with 2.1 in the other group (P < .01). Only younger age, increased specificity of alcohol-related disease, and the promotion of physician awareness were important factors for influencing documentation. Introducing a program for detecting alcoholism can have a beneficial effect on physicians' identification of alcoholism in patients with alcohol-related illnesses.

Alcoholism↗

PubMed1995

Sea-level physical activity and acute mountain sickness at moderate altitude.

The effect of previous physical conditioning on young well-conditioned mountaineers in relationship to acquiring acute mountain sickness is controversial. Data show both increased and decreased effects on the incidence of altitude illness. How general tourists at moderate altitudes are affected is unknown. To determine the influence of sea-level habitual physical activity on the incidence of mountain sickness, we surveyed 205 participants in a scientific conference at 3,000 m (9,840 ft). A 36-item questionnaire was distributed to the subjects 48 hours after arrival at altitude. Their sea-level physical activity (SLPA) was measured by a published and validated instrument that included questions about patterns of work, sporting, and leisure-time activities. Acute mountain sickness was defined as the presence of 3 or more of the following symptoms: headache, dyspnea, anorexia, fatigue, insomnia, dizziness, or vomiting. Most of the respondents were male (62%) from sea level (89%) with a mean age of 36 +/- 8.7 (standard deviation) years (range, 22 to 65). Nearly all (94%) were nonsmokers, and 28% had acute mountain sickness. The mean SLPA score was 8.0 +/- 1.3 (range, 5.1 to 12.0). No statistically significant difference in mean SLPA scores was found between those with and without acute mountain sickness (8.1 versus 7.8), nor in the individual indices (work, 2.5 versus 2.4; sport, 2.9 versus 2.7; leisure, 2.8 versus 2.7). We conclude that habitual physical activity performed at sea level does not play a role in the development of altitude illness at moderate altitude in a general tourist group.

Acute Disease↗

PubMed1987

Toxic shock syndrome.

Explore the source record for details and available documents.

Contraceptive Devices, Female↗

PubMed1984

Carrier screening for phenylketonuria: comparison of two discriminant analysis procedures.

Absence of a convenient, direct enzyme assay for detecting phenylketonuria (PKU) heterozygotes has resulted in continued effort to develop an accurate and reliable procedure to discriminate the heterozygous individual from the homozygous normal. Our study compares two statistical procedures that combine the semifasting plasma phenylalanine and tyrosine concentrations with the individuals' prior probability of being a heterozygous carrier in order to discriminate carriers from noncarriers. The results of this comparison indicate that the quadratic discriminant function is superior to the linear discriminant function as a method of carrier testing both in theory and in practice. An interactive computer system is described that facilitates the clinical utilization of the quadratic discriminant function.

Female↗

PubMed1981

The role of modeling methods in medical diagnosis.

Modeling methods in medical diagnosis are concerned with medical information processing as it pertains to utilizing biological modeling methods to facilitate patient care. Major considerations in this particular area are (1) the classification problem related to the establishment of disease entities-the taxonomy problem, and (2) the diagnosis of diseases. Available are properties, criteria, signs, symptoms, and manifestations of diseases that have been cumulated and categorized by clinicians and researchers. The problem is to optimally utilize the information content of a sign or set of signs in the practice of patient care as pertaining to the medical diagnosis problem. Some mathematical approaches implemented to facilitate such analyses include cluster analysis, discriminant analysis, Bayesian methods, computer approaches, game theory, information theory, stochastic representations, stepwise procedures, decision analysis, and pattern recognition techniques. Each of these has been studied in depth by numerous researchers advocating computer applications in medicine. Here we discuss the scope and limitations of utilizing modeling methods as a viable approach to interpreting vast amounts of biological data collected on a single patient during an encounter. We consider the following: (1) limitations associated with modeling methodologies; (2) levels of responsibilities, ranging over logging, summarizing, reporting, monitoring, and therapy selection; and (3) operational strategies and considerations as they affect hardware logistics, the actual algorithm utilized, and implementation of these sophisticated analysis systems.

Decision Theory↗

PubMed1980

The use of immunocytochemical techniques for the detection of steroid hormones in breast cancer cells.

Indirect immunofluorescence and immunoperoxidase assays were developed to detect estradiol and progesterone in breast cancer cells. Appropriate controls were used to confirm immunologic specificity. Studies of estradiol binding by human breast cancer cells identified three groups: no detectable binding (25%); all tumor cells exhibiting binding although to different degrees (4%); and tumors with varying numbers of positive and negative cells (71%). Similar observations were made with respect to progesterone binding. The percentage of cells with estradiol binding was correlated with the amount of estrogen receptors (ER) present in the tumor specimens. Post-hormone binding events e.g., nuclear binding of estradiol, were also evaluated. Some tumor cells showing cytoplasmic binding of estradiol did not show nuclear binding of estradiol; such tumors lacked detectable diethylstilbestrol under routine assay conditions, and relatively high concentrations of estradiol were needed to observe estradiol-specific staining. The results suggest that the immunocytochemical assays detect hormone-specific binding, but that the binding is probably due to multiple classes of steroid-binding sites.

Animals↗

PubMed1980

Islet cell and other organ-specific antibodies in U.S. Caucasians and Blacks with insulin-dependent diabetes mellitus.

Islet cell antibodies (ICA) were detected in 168 (33%) of 504 patients with insulin-dependent diabetes mellitus (IDDM). Mean age of onset of IDDM was 8.6 +/- 0.2 yr and mean age at testing was 13.4 +/- 0.3 yr. None of 162 controls without diabetes (mean age 21.8 +/- 0.9 yr) had ICA. Caucasian patients (404) had a 74% frequency of ICA within 3 mo of diagnosis and an overall ICA frequency of 36%. These results were similar to those reported from Europe. Black patients (100) had lower frequencies of ICA (P < 0.01) and thyroid antibodies (P < 0.05). Caucasian patients with onset of IDDM before 5 yr of age (107) had a lower frequency (P < 0.01) of ICA (21%) than those (297) with a later age of onset (42%). Patients with persistent ICA beyond 5 yr of IDDM had increased frequencies of gastric parietal and adrenal cortex cell antibodies. Thyroid microsomal antibodies were less frequent (P < 0.05) in blacks (4%) than in Caucasians (20%). The former did not have adrenal antibodies. Similar ICA frequencies among Caucasians with IDDM in the U.S. and in Europe suggest that etiologic factors are similar in the two geographic regions. The lower frequencies of ICA in patients with IDDM onset before 5 yr of age suggest that some of these patients may have a different etiology and/or a more rapid disappearance of islet cell antigens than patients with a later onset.l The lower ICA frequencies in black patients can be explained by heterogeneity of IDDM in this group and by admixture of IDDM susceptibility genes from the Caucasian genome to the black genome.

Adolescent↗

PubMed1979

Determining clinical significance in repeated laboratory measurements. The "Clinical Delta Range".

A study of healthy subjects was conducted at the University of Florida wherein 52 routine clinical laboratory procedures were measured durng normal operation of the clinical laboratories. The goal of the study ws to quantify nonsignificant personal variation for a number of laboratory procedures referred to as a "Clinical Delta Range," which results from taking several samples per day, several days during the week. Results of the statistical test of hypotheses are given together with summary statistics for the 52 different laboratory procedures. A discussion of the model and testing methods are provided. Further, examples are given to illustrate the methodology and certain limitations associated with the concept of a Clinical Delta Range.

Adult↗

PubMed1978

Unlimited volumes of laboratory data: a confusing and diagnostically deceptive product of modern technology.

The large volumes of laboratory data currently available in clinical practice can lead to erroneous conclusions. Our current statistical interpretation of these data is univariate (one variable at a time) and often not age- and sex-corrected. Using an optimal technique of multivariate analysis, a SMAC profile of 19 tests performed on normal subjects resulted in over a 500% improvement in defining the reference range. Using physiologic subsets of the SMAC profile for patients, improvements in interpretation of between 100% and 300% are possible. Results indicate a serious clinical problem that will require modification of laboratory reports using modern technology as an adjunct for diagnostic medicine.

Analysis of Variance↗

PubMed1978

Establishing a multivariate clinical laboratory data base.

A regional or hospital-based "reference" value study is well within the range of every clinical laboratory. A program is described that samples one to two "health" subjects each working day under tightly controlled conditions. Sixty-seven variables are tested simultaneously to provide univariate age and sex ranges, and variance/covariance matrices from which associated correlation coefficients are obtained. This ongoing "reference" value program offers essential information for both univariate and multivariate interpretations along with validation and quality control for certain methods within the clinical laboratory.

Clinical Laboratory Techniques↗

PubMed1977

The evolution of a functional real-time laboratory records retrieval and archival system.

The vast flood of information resulting from medical record keeping in a clinical laboratory must be cataloged and archived. To deal with this problem we designed an approach employing automated report generation by a laboratory computer, data base management of patient laboratory results, and automated microform generation via computer output microform (COM). This paper documents the steps that led to the system we are currently employing. The system described maintains the availability of current patient laboratory data, creates a microform archive and an on-line index, and serves as the data base for research inquiries. In addition, we have experienced a cost savings over manual procedures and now possess the capability of expansion without the costly addition of personnel.

Archives↗