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PubMed2003

[Prevalence of diabetes mellitus in Germany 1998-2001. Secondary data analysis of a health insurance sample of the AOK in Hesse/KV in Hesse].

AIMS: The aim of this population-based study was to assess the prevalence of subjects with diabetes mellitus by retrospectively analysing routine health insurance data. METHODS: This analysis comprised a 18.75% random sample of all members of the largest regional statutory health insurance (Allgemeine Ortskrankenkasse, AOK) in Hesse. Patients with diabetes were identified by criteria such as ICD-10 diagnoses and regular prescriptions of insulin and oral antidiabetic agents. The data were corrected for the age and gender distribution of the German population. RESULTS: Over the 4-year observation period there was a continuous increase in the prevalence of subjects with known diabetes mellitus, from 7.24% in 1998 to 8.79% in 2001. After correction for the German population the last figure corresponded to a prevalence rate of 6.00% in 1998 and 6.91% in 2001. During this period, there was an overproportional increase in the percentage of subjects treated with insulin, from 1.49% in 1998 to 1.91% in 2001, while there was only a moderate increase in the percentage of subjects under oral medication and under dietary treatment, respectively. In the age group of 70 and above roughly 25% of all subjects had known diabetes. In this age group, more than 6% of all people were treated with insulin. CONCLUSIONS: This data suggests that there was a continuous increase in the prevalence of individuals treated for diabetes between 1998 and 2001 in Germany by approximately 5% per year. After correction for the total German population the pre-valence of diagnosed diabetes is nearly 7%.

Adolescent↗
PubMed1992

[Estimation of the incidence of diabetes in the Federal Republic of Germany based on insurance data. A secondary data analysis of a representative random sample of locally insured persons in the city of Dortmund].

All records relating to medical prescriptions and services relating to diabetes for a representative sample (n = 6478) of inhabitants of Dortmund in 1988, who were members of the Local Health Insurance in Dortmund, were analysed. 264 patients (4.08%) were receiving antidiabetic drugs during that year, 198 (3.06%) oral ones, 42 (0.65%) insulin and 24 (0.37%) both. 12.41% of all those insured over the age of 60 were on antidiabetic drugs, more women than men (5.08 vs 2.94%; P less than 0.001). The most frequently used oral antidiabetics were sulphonylurea ones (95.1%), while the proportion of biguanides was only 4.4%. On the basis of established diagnosis, regular blood sugar and HbA1 tests, as well as optic fundi examination, a further 104 persons (1.60%) are assumed to have diabetes but not treated by drugs. This sample indicates an overall prevalence of diabetes of 5.68% among the population. Relating it to the age and sex pattern of the population of the Federal Republic of Germany this corresponds to a prevalence of diagnosed diabetes of 4.82%. Thus there are probably a little less than 4 million diabetic citizens of the Federal Republic of Germany.

Age Factors↗
PubMed2003

Maximizing research opportunities: secondary data analysis.

Knowledge development in nursing can be enhanced by broadening the understanding of legitimate scientific inquiry. SDA uses existing data to answer research questions and can be especially useful for nurse researchers. Advantages of SDA include its potential for resource savings and its cost-effectiveness. Also, the investigator can circumvent data collection challenges such as finding appropriate participants. However, SDA does not require less rigor. A sound conceptualization of the research problem is still required, and identifying and obtaining appropriate data for SDA can be quite time-consuming. Nevertheless, SDA can be both a practical and appropriate research process that enables nurses to maximize their opportunities for answering important clinical questions.

Bias↗
PubMed2000

Panic disorder in Thailand: a report on the secondary data analysis.

Panic disorder (PD) is one of the most common psychiatric illnesses in Thailand but the picture of PD in Thailand is not clear. Therefore, the objective of this research was to review, summarize, and analyse data from research reports concerning the clinical aspects of PD in Thailand. Relevant papers were searched comprehensively. Four groups of data including prevalence and incidence rates, sex differences, clinical symptoms during panic attacks, and scores of the Hamilton anxiety scale (HAM-A) were extracted where available. Data thus obtained were then grouped and compared. It was found that 2.1 per cent to 12.4 per cent of patients who visited the psychiatric outpatient clinic for the first time were diagnosed as having PD. Males were affected at a similar rate to females with a ranging ratio of female:male from 1.3:1 to 0.67:1. The most common symptoms during panic attacks were palpitations, chest pain or discomfort, and dizziness or vertigo, similar to South American studies. Regarding scores of original HAM-A, mean somatic anxiety scores of PD patients who attended the cardiology clinic were significantly higher than generalized anxiety disorder patients (15.0 vs 9.8, p < 0.05). PD patients who attended the psychiatric clinic had higher mean scores of HAM-A when compared to PD patients who visited the cardiology clinic, but it was not statistically significant (27.7 vs 26.6, p > 0.05). However, the fear item of PD patients at the psychiatric clinic had significantly higher scores (2.1) than the other one (0.7). The difference between these findings and those of Western studies may be caused by cultural factors. Thai men tend to react more promptly to panic attacks and seek medical attention while women mostly attributed their symptoms to "Air Disease". However, incidence rates from other rural areas are lacking. Before conclusions can be drawn, research on epidemiologic data in the community should be further investigated.

Female↗
PubMed1993

Obtaining and evaluating data sets for secondary analysis in nursing research.

Secondary analysis of existing data offers many advantages to the nurse researcher. Data from large-scale studies may be reanalyzed and refined by secondary analysts with a fresh perspective, thus enhancing the original study's contribution to scientific knowledge. High-quality data can be obtained for comparatively little expenditure of time and money. The secondary analyst, however, must exercise care in evaluating and analyzing a data set to maximize the internal and external validity of the reanalysis. Because the secondary analyst's lack of involvement in data collection procedures may decrease insight into the original study's limitations, vigilant skepticism should accompany all phases of the research process in secondary data analysis, just as it should in all other research. Miller (1982) advised, "Begin by assuming the worst and seek out the same kinds of information about sample selection procedures, sample size, response rates, field procedures, and coding conventions that you would insist on if you were collecting your own data" (p. 722). By systematically evaluating potential data sets according to rigorous predetermined criteria, the nurse researcher can minimize the possible pitfalls inherent in secondary analysis. On the other hand, investigators who use secondary sources appropriately can make significant contributions to nursing science at less cost than that engendered by traditional research methods.

Data Collection↗
PubMed2000

Critical thinking by nurses on ethical issues like the termination of pregnancies.

This research forms part of a larger interdisciplinary research project on the termination of pregnancies. The focus of this part of the project is on the ethical issues related to termination of pregnancies. The practice of the professional nurse is confronted with ethical dilemmas and disputes. Whether the nurse chooses to participate in the termination of pregnancies or not, the core function of the nurse is that of counseling and ethical decision-making. Effective counseling requires empathy, respect for human rights and unconditional acceptance of a person. Making ethical decisions implies making critical decisions. It is self-evident, therefore, that such decisions should be based on sound arguments and logical reasoning. It is of vital importance that ethical decisions can be justified on rational ground. Decision-making is a critical thinking approach process for choosing the best action to meet a desired goal. The research question that is relevant for this paper is: Are nurses thinking critically about ethical issues like the termination of pregnancies? To answer the research question a qualitative, exploratory, descriptive design was used (Mouton, 1996:103-169). Registered nurses were selected purposively (Creswell, 1994:15). 1200 registered nurses completed the open-ended questionnaires. Focus group interviews were conducted with 22 registered nurses from a public hospital for women and child health services. Data analysis, using secondary data from open-ended questionnaires and transcribed focus group interviews, were based on the approach of Morse and Field (1994:25-34) and Strauss and Corbin (1990). The themes and categories from open coding were compared, conceptualized and linked with theories on critical thinking (Paul, 1994; Watson & Glaser, 1991 and the American Philosophical Association, 1990). The measures of Lincoln and Guba (1985) and Morse (1994) related to secondary data analysis were employed to ensure trustworthiness. Based on these findings the researcher concluded that nurses are not thinking critically when making ethical decisions concerning the termination of pregnancies. Recommendations are made as a possible solution for this problem.

Abortion, Legal↗
PubMed2026

Effects of H-coil TMS on suicidality in major depression: A secondary analysis of data from a multisite randomized trial comparing accelerated to once-a-day stimulation.

Suicide is the 10th leading cause of death in US adults. Standard once-daily repetitive transcranial magnetic stimulation (rTMS) can reduce suicidal ideation. Yet, antidepressant and anti-suicidal effects often take several weeks to emerge, while rapid improvement is often required. Accelerated TMS has been proposed as a strategy to hasten therapeutic response. A recent FDA-regulated multicenter trial evaluated accelerated intermittent theta burst Deep TMS with the H1-coil versus standard high-frequency Deep TMS in MDD. Both groups demonstrated high remission and response rates for depression, with the accelerated protocol showing non-inferiority and a shorter time to remission. The goal of this exploratory secondary analysis was to evaluate the impact of these two H-coil TMS dosing paradigms on suicidal ideation. The Scale for Suicide Ideation (SSI), as well as suicidality items of HDRS, MADRS and CUDOS were collected and analyzed. On all scales, both accelerated and standard Deep TMS protocols were associated with meaningful reductions in suicidality. The accelerated protocol achieved a faster onset of improvement. Comparison between the timeline of improvement in suicidality and in overall depressive symptoms found a trend for faster improvement in suicidality, especially with the accelerated protocol. These findings highlight the importance of treatment frequency in determining time to clinical benefit and support the use of scalable accelerated protocols for patients requiring more rapid symptom relief.

Humans↗
PubMed1993

Education for executive nurse administrators: a databased curricular model for doctoral (PhD) programs.

This article reports a secondary analysis of qualitative data collected during an earlier study that investigated the educational preparation and role-related responsibilities of first-line nurse administrators employed in academe. Analysis of these original data raised several different and important research questions about role preparation for nurse administrators that had not been addressed in the earlier study, and that subsequently directed the secondary data analysis: (1) Are there knowledge domains specific to the executive nurse administrator role about which practicing administrators must have knowledge, and for which they are then accountable? And, if so, (2) What are the curricular implications for PhD programs in nursing that offer an executive nursing administration track? Secondary data analysis revealed that there are specific knowledge domains in executive nursing administration from which categories of courses can be identified. Implications are explored for role preparation in nursing administration at the PhD level based on the domains and categories of courses.

Computers↗
PubMed2005

Secondary anthropometric data analysis of the National Food Consumption Survey in South Africa: the double burden.

OBJECTIVE: There is an increase in the prevalence of overweight and obesity in children worldwide, including South Africa. We investigated the prevalences of overweight, obesity, and stunting in a current generation of children (ages 12 to 108 mo), which has a high prevalence of stunting, and evaluated the determinants of both nutritional disorders. METHODS: Secondary data analysis of the weight and height measurements of 12- to 108-mo-old children (weighted n = 2200, non-weighted n = 2894) during the 1999 National Food Consumption Survey in South Africa is reported. The body mass index reference percentiles recommended for use in children by the International Obesity Task Force were used to determine the prevalence of overweight and obesity, and the National Center for Health Statistics (NCHS) percentiles were used to determine the prevalence of stunting. RESULTS: Nationally, the prevalence of stunting (height-for-age < or = -2 standard deviations, NCHS 50th percentile) in these children was 19.3% (95% confidence interval [CI] = 17.49 to 21.16) and was highest in 1- to 3-y-old children (24.4%) and in children of farm workers on commercial farms (25.6%). The prevalence of combined overweight and obesity (body mass index > or = 25 kg/m(2) in 17.1%, 95% CI = 15.00 to 19.23) at the national level was nearly as high as that for stunting. Further, the types of determinants for stunting and overweight were generally similar (although directionally opposite in degree of risk conferred) and included type of housing, type of toilet in the home, fuel used in cooking, presence of a refrigerator or stove, presence of a television in the house, educational level of the caregiver, and maternal education level. An example of the directionally opposite degree of risk is exemplified by the use of paraffin as a fuel being protective against being overweight (odds ratio = 0.78, 95% CI = 0.63 to 0.97) but predictive of an increased risk for stunting (odds ratio = 1.24, 95% CI = 1.04 to 1.48). Stunting itself conferred an increased risk (odds ratio = 1.80, 95% CI = 1.48 to 2.20) of being overweight. CONCLUSION: Certain defined determinants appear to play important roles in children's nutritional outcomes in relation to stunting and to overweight and obesity.

Anthropometry↗
PubMedDate not supplied

A systematically tested intervention for managing reactive depression.

BACKGROUND: Patients and family caregivers repeatedly experience reactive depression that leads to medication errors, mismanagement of chronic disease, and poor self-care. These problems place them at high-risk for malnutrition, infection, heart diseases, and psychiatric sequelae. OBJECTIVES: A secondary data analysis compared findings across a series of studies to evaluate the acceptability, effectiveness, and cost of a therapeutic writing intervention to reduce reactive depression, a common and frequently recurring adverse symptom. METHODS: Secondary analysis of data from the series of studies was conducted. Data came from patients requiring lifelong, daily central intravenous catheter infusion of home total parenteral nutrition necessitated by nonmalignant bowel disease and their family caregivers who assist with this complex home care. Variables combined across the studies were pre- and postintervention scores from the Center for Epidemiological Studies-Depression Scale (CES-D), the number of weeks patients wrote in their diaries (adherence), and the written content in the diaries. Content analysis was used to analyze written data. The intervention materials and nurses' time spent were averaged across studies to determine costs. RESULTS: The weighted average baseline CES-D scores across studies for patients (17.94) and caregivers (15.75) showed the presence of depression. After journal writing had been used for an average of 10.4 weeks across studies, the effect sizes of the between (d =.27) and within (d =.65) patient group scores indicated moderate to large improvement in depression. Themes from written diaries showed that missing out on activities, financial worries, strain related to the severe illness, and the complexity of home care were related to depression across the studies. CONCLUSIONS: The intervention was acceptable to participants, effective for managing reactive depression, and low in cost. The next steps will address testing for the longitudinal effects of the intervention.

Adult↗
PubMed2006

Adverse events in Victorian admissions for elective surgery.

OBJECTIVES: To investigate a method to identify and understand patterns of adverse events by utilising secondary data analysis; to identify the types of complications associated with elective surgery; to identify any specific "adverse event-prone" elective procedures; and to consider the implications of these patterns for hospital patient safety programs. SETTING: Public hospitals in Victoria. DESIGN: Secondary analysis of data on acute hospital admissions for elective surgery in the period 1 July 2000 to 30 June 2001, for non-obstetric patients older than 15 years (n = 177 533). MAIN OUTCOME MEASURES: Estimated rates of adverse events for the most commonly performed elective surgery procedures; frequency of the most commonly recorded adverse event types. RESULTS: Of all admissions, 15.5% had at least one complication of care. The most frequent first-recorded single complication code, in 9.6% of cases with a complication, was "Haemorrhage and haematoma complicating a procedure". The most common adverse event categories were cardiac and circulatory complications (23%), symptomatic complications (18%), and surgical and drug-related complications (17%). The procedure blocks most frequently associated with an adverse event were coronary artery bypass surgery (67%), colectomy (52%), hip and knee arthroplasty (42% and 36%, respectively), and hysterectomy (20%). The types of complications associated with the four most adverse event-prone procedures were cardiac arrhythmias, surgical adverse events (haemorrhage or laceration), intestinal obstruction, anaemia, and symptomatic complications. CONCLUSION: Routinely collected data are valuable in obtaining information on complication types associated with elective surgery. International Classification of Diseases codes and surgical procedure "blocks" allow very sophisticated investigation of types of complications and differences in complication rates for different surgical approaches. The usefulness of such data relies on good documentation in the medical record, thorough coding and periodic data audit. The limitations of the method described here include the lack of follow-up after discharge, variable coding standards between institutions and over time (potentially distorting information on rates), lack of information on the causative factors for some adverse events, and a limited capacity to support investigation of particular cases. Hospitals should consider monitoring complication rates for individual elective procedures or blocks of similar procedures, and comparing adverse event rates over time and with peer hospitals as an integral part of their patient safety programs.

Adolescent↗