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PubMed1992

[The secular trend of standing height in adolescent girls from longitudinal data].

In this study which is based on the longitudinal data aggregated from health examination records, the subjects consist of 287 girls who attended a private school in Tokyo. The subjects are divided into five groups according to birth year from 1950 to 1970 in order to find secular trend during twenty years with one-way analysis of variance. Age at Peak Height Velocity (APHV), Peak Height Velocity (PHV) and Height attained at Peak Height Velocity (HPHV) were computed in each height velocity curve derived from differential calculus of height distance curve. The result show that HPHV is gradually getting taller by year although APHV and PHV do not change. It may be considered that our subjects of the private school are girls of families in the relatively upper-middle class.

Adolescent↗

PubMed1992

Surveillance for measles--New Zealand, 1991.

To monitor the extent and spread of the epidemic of measles that began in New Zealand in 1991, a special surveillance system was established. Reports from 13 area health boards were received on a weekly basis; the Bay of Plenty Area Health Board provided data aggregated over several weeks on a less frequent schedule. Nine thousand two hundred thirty-nine measles cases were reported during the 6-month period July-December 1991, with the highest incidence being reported from the Tairawhiti (1,027 cases/100,000 population) and Taranaki (558/100,000) Area Health Boards; South Island areas reported rates that were all below the national average of 280/100,000. Of the 8,684 cases for which information on age was obtained, over one-third (2,957, or 34%) occurred among children less than 5 years of age, most of whom had not been vaccinated. The failure to vaccinate a sufficiently high percentage of children against measles is the major factor that contributed to this epidemic.

Adolescent↗

PubMed2004

Self-reported frequent mental distress among adults--United States, 1993-2001.

Poor mental health is a major source of distress, disability, and social burden; in any given year, as many as one in five adults in the United States has a mental disorder. To identify differences among populations and factors contributing to poor mental health, CDC examined the prevalence of frequent mental distress (FMD) among U.S. adults by race/ethnicity, socioeconomic status (SES), and sex, by using aggregate data from Behavioral Risk Factor Surveillance System (BRFSS) surveys for 1993-2001. This report describes the results of that analysis, which indicated that the prevalence of FMD varied among racial/ethnic populations and increased substantially among whites and blacks. In addition, FMD was reported more frequently by women and by persons with low SES within each racial/ethnic population. Targeting adverse socioeconomic risk factors and improving access to mental health services might decrease FMD among adults and reduce racial/ethnic disparities in mental health.

Adult↗

PubMed1992

[What does the higher concentration of general practitioners mean for fee-for-service reimbursement].

The density of general practitioners has increased steadily in Norway. By the end of 1989, there were 1,339 inhabitants per general practitioner. General practitioners are partly remunerated per item of service, i.e., by reimbursement from the National Insurance Fund and partly by patient co-payment. The article analyses the connection between density of general practitioner and level of fee-for-service reimbursement. The average general practitioner received about 60% higher fee-for-service reimbursement in 1989 than in 1985. This increase is markedly higher than the nominal changes in the tariff. The increase was somewhat higher in areas with a relatively low density of general practitioners. Also, in each of the years 1985-1989, the average fee-for-service reimbursement was slightly higher in areas with a low density of general practitioners. The variations have only a slight impact on the gross revenues of general practitioners. Three models explaining the use of general medical services are outlined. The results can be interpreted in the light of changes in health, changes in health-related behaviour, and supplier-induced demand. Since only aggregate data are available, it is difficult to further explore possible explanations.

Fees, Medical↗

PubMed1992

Sensitivity analyses for the backcalculation method of AIDS projections.

In Australia, AIDS is a notifiable disease and the data have been of a relatively high quality. In this article, the cases among Australian residents diagnosed by mid-1989 and reported by January 1990 are used to evaluate the sensitivity of estimates of numbers infected with the human immunodeficiency virus (HIV) and of projections of numbers of new AIDS diagnoses to major uncertainties in the method of backcalculation. We find that the estimates and long-term projections are sensitive to all uncertainties, including the incubation period distribution, the new infection intensity distribution, and the level of data aggregation chosen for analysis. Further, we find the projection that is least sensitive to all uncertainties, namely AIDS diagnoses for the next year (mid-1989 to mid-1990), falls in a relatively narrow range that encompasses the number that had been reported by April 1991.

Acquired Immunodeficiency Syndrome↗

PubMed1992

Do sex hormones play a role in ankylosing spondylitis?

Ankylosing spondylitis (AS) has a striking disease marker, i.e., HLA-B27, indicating the major genetic predisposition; however, expression of disease is also strongly influenced by age- and sex-related factors. Sex steroids studies suggest greater androgenicity in AS than normal control persons. Therapeutic interventions that normalize such sex steroid status have shown clinical improvements in males and females. Muscle histopathology in AS shows frequent changes early in disease consistent with neuropathic and myopathic mechanisms of a noninflammatory nature. Accepting the available, aggregate data, one may infer that sex steroid imbalance in persons susceptible to AS may target axial and proximal muscle tissues, resulting in relative functional hypertonicity. Such phenomenon, developing in preteen and younger adult ages, may contribute to peripheral and axial manifestations of enthesopathy in this disease by complex and currently unknown mechanisms.

Aging↗

PubMed2005

The HIM role in patient safety and quality of care.

IOM reminds us that technology is only part of the initiative to make the nation's health system a safer one. Another significant factor is the human element. Change will occur when the culture and commitment to patient safety shift. According to IOM, change will "require a culture of safety and the active participation of all health care professionals, organizations and patients themselves." It is up to all of us to create a trusting, safe environment to look at the truth around patient safety and ensure open, blameless dealing with findings. We are letting go of a culture that no longer works. The efforts we make at a local level will play into safety in the larger environment. It is a journey--we will make patient care safer over time by taking action on what we learn from accurate and complete aggregate data. And it is a balance, with patient safety getting the greatest weight in commitments and difficult resource decisions. Patient safety will come from universal cooperation to uncover the truth--letting go of blame and finding resolution to problems, known and not yet uncovered.

Humans↗

PubMed2004

Tegner and Lysholm scores in brace-free rehabilitation.

OBJECTIVE: To compare results of aggressive method of rehabilitation after reconstruction of anterior cruciate ligament against results of standard braced method of rehabilitation, and to determine prognostic factors. This is a retrospective comparative study with statistical analysis. METHODS: In this study, 85 patients were operated in the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia between December 1998 and December 2001, and underwent rehabilitation with a minimum follow up of 2 years. The patients were split into 2 groups. Group A consist of 32 patients and they underwent the standard rehabilitation program according to established braced programs. Group B is the subsequent 53 consecutive patients who were subjected to aggressive brace-free rehabilitation program. All knees were measured for Tegner and Lysholm scores as the main indicator of assessment in the preinjury hindsight appraisal, and compared with scores obtained 4 months and 2 years post reconstruction. RESULTS: Linking the preinjury Tegner and Lysholm scores to the 4 months follow up scores for group A, there was a mean loss of 1.9 and 14 constituting 26% and 22.2% (p=0.015), range 1.07-3.5 and 9.8-23.5. Linking the preinjury Tegner and Lysholm scores to the 4 months follow up scores for group B, there was a mean loss of 1.1 and 9.0 constituting 15.4% and 13.6% (p=0.012), range 0.67-3.5 and 6.8-13.5. When comparing the preinjury Tegner and Lysholm scores to the 2 years follow up scores for group A, there was a mean loss of 1.0 and 8.0 constituting 13.6% and 11.6% (p=0.024), range 0.67-3.5 and 6.8-13.5. When comparing the preinjury Tegner and Lysholm scores to 2 years follow up scores for group B, there was a mean loss of 0.4 and 1.0 constituting 5.5% and 1.5% (p=0.015), range 0.1-1.5 and 6.8-13.5. Appraisal of the aggregate data of 2 groups has shown that the loss from preinjury Tegner and Lysholm scores was 20.7% versus 16.9% lower at 4 months (p=0.013), but only 12.6% versus 3.55% lower at 2 years (p=0.036). CONCLUSION: Results of aggressive rehabilitation after anterior cruciate ligament reconstruction both subjectively and clinically are superior to that of the standard braced rehabilitation. A better prognostic result with aggressive rehabilitation can be predicted for patients with high preinjury scores compared to patients with a low preinjury score. The result of this study support the use of accelerated brace free rehabilitation in autogenous patellar tendon graft, and has shown that intensive rehabilitation facilitate return to sport activities at 4 months postoperatively.

Adolescent↗

PubMedDate not supplied

DRG analysis reveals potential problems, trends.

Specific DRGs are frequently the targets of review if they are connected to errors. But documentation review alone to identify problems may not be sufficient. The author describes a strategy to review aggregate data for two tricky DRGs.

Aged↗

PubMedDate not supplied

The American College Health Association National College Health Assessment (ACHA-NCHA), Spring 2003 Reference Group report.

Assessing and understanding the health needs and capacities of college students is paramount to creating healthy campus communities. The American College Health Association-National College Health Assessment (ACHA-NCHA) is a survey instrument developed by the American College Health Association (ACHA) in 1998 to assist institutions of higher education in achieving this goal. The ACHA-NCHA contains approximately 300 questions assessing student health status and health problems, risk and protective behaviors, access to health information, impediments to academic performance, and perceived norms across a variety of content areas, including injury prevention; personal safety and violence; alcohol, tobacco, and other drug use; sexual health; weight, nutrition, and exercise; and mental health. Twice a year, ACHA compiles aggregate data from institutions using the ACHA-NCHA to provide a reference group for data comparison. A portion of the data from the Spring 2003 Reference Group is provided in this article for use by professionals, researchers, institutions, departments, and organizations invested in advancing the health of college students.

Adolescent↗

PubMed2005

Genotoxicity of environmental agents assessed by the alkaline comet assay.

Generation of DNA damage is considered to be an important initial event in carcinogenesis. A considerable battery of assays exists for the detection of different genotoxic effects of compounds in experimental systems, or for investigations of exposure to genotoxic agents in environmental or occupational settings. Some of the tests may have limited use because of complicated technical setup or because they only are applicable to a few cell types. The single cell gel electrophoresis (comet) assay is technically simple, relatively fast, cheap, and DNA damage can be investigated in virtually all mammalian cell types without requirement for cell culture. The aim of this thesis was to evaluate the comet assay as a genotoxicity test in genetic toxicology of environmental agents, encompassing both experimental animal models and biomonitoring. The comet assay detects strand breaks (SB). The cells are embedded in agarose and lysed, generating nucleus-like structures in the gel (referred to as nucleoids). Following alkaline electrophoresis, the DNA strands migrate toward the anode, and the extent of migration depends on the number of SB in the nucleoid. The migration is visualized and scored in a fluorescence microscope after staining. Broad classes of oxidative DNA damage can be detected as additional SB if nucleoids are incubated with bacterial DNA glycosylase/endonuclease enzymes. Oxidized pyrimidines and purines can be detected by incubation with endonuclease III and formamidopyrimidine DNA glycosylase, respectively. The animal experimental studies indicated that the comet assay was able to detect genotoxic effects of diesel exhaust particles in lung tissue, 2-amino-3-methylimidazo[4,5-f]quinoline (IQ)-induced DNA damage in colon epithelial cells and liver tissue, and benzene-induced damage in bone marrow and liver cells. The strength of the comet assay was further outlined by application of repair enzymes, indicating no oxidative DNA base damage following IQ treatment. High levels of oxidative DNA lesions were detected after exposure to benzene or X-ray irradiation. The comet assay did not detect DNA damage in colon or liver following ingestion of diets containing of high contents of animal fat or sucrose, although other indices of DNA damage were found. Determined from the results of a large Japanese study, the discrimination between carcinogens and non-carcinogens appears to be similar between the comet assay and alkaline elution, which also detects SB. This suggests that the comet assay is a reliable genotoxicity test in animal experimental systems. In the biomonitoring studies, we investigated the effect of common exposures and lifestyle factors (rather than effects of known carcinogens) on the level of oxidative DNA damage in mononuclear blood cells of humans. In the first study, based on repeated measurements, it was shown that interindividual variation and seasonal variation were major determinants for the basal level of SB, whereas no effect of age, exercise, or antioxidant intake could be detected. The effect of exercise was further investigated under both normoxic and hypoxic circumstances, showing a strong effect of hypoxia, and only effect of exercise in terms of SB in hypoxia. In a placebo-controlled parallel dietary fruit and vegetable (or the corresponding amount of antioxidants) intervention study, no effects of the level of oxidative DNA damage or sensitivity to hydrogen peroxide were observed. Although this may seem in contrast to other antioxidant intervention studies, a critical literature survey of antioxidant intervention studies on oxidative DNA damage suggested that well-controlled studies tended to show no effect of antioxidant supplementation. In summary, the aggregated data from the publications included in this thesis, and other publications encompassing the comet assay, indicate that the comet assay is a reliable method for detection of DNA damage in tissues of experimental animals. Although not all types of genotoxic exposures should be expected to result in DNA damage in mononuclear blood cells, the comet assay seems to be a valuable tool for detection of genotoxic exposure in humans. The comet assay indicates that DNA damage is abundant in mammalian cells and affected by lifestyle and many environmental exposures, including diet, exercise, hypoxia, and sunlight.

Animals↗

PubMed2005

Increasing inequalities in the distribution of dental caries in the Brazilian context in Finland.

OBJECTIVE: To document the process of concurrent decline and polarization of dental caries distribution in the Brazilian context. BASIC RESEARCH DESIGN: Ecologic assessment of dental outcomes of surveys performed in 1998 and 2002, and several covariates using data aggregated at city-level. PARTICIPANTS: 9,327 (1998) and 5,722 (2002) 12-year-old schoolchildren surveyed for oral health status in 131 and 34 towns respectively of the state of São Paulo, Brazil. MAIN OUTCOME MEASURES: DMFT index and Gini coefficient for caries distribution. RESULTS: The DMFT index declined from 3.72 in 1998 to 2.52 in 2002, while the Gini coefficient for the distribution of caries increased from 0.479 to 0.565. An improved profile of socio-economic standings, preventive dental treatment, access to fluoridated tap water and initiatives of dental education associated significantly with reduced levels of caries distribution. However, as these conditions were non-homogeneously distributed in the population, they are also associated with increasing levels of inequality in the distribution of caries. These observations indicate that there is room for further reduction of caries levels, by targeting the expansion of dental services and access to fluoridated water to groups and areas with higher levels of needs. CONCLUSIONS: Improved characterisation of the skewed distribution of caries experience demands that monitoring of the inequality in the distribution of caries by statistics such as the Gini coefficient be used. This information will inform programmes aimed at reducing levels of caries without reinforcing inequalities in the experience of the disease, a strategy that may contribute to the development of socially appropriate programmes of oral health promotion.

Brazil↗

PubMedDate not supplied

A microcomputer-based information management system for a nurse-managed clinic.

A project team from a nurse-managed health care center designed and used a microcomputer-based information management system to document the activities of their clinic. Commercial software, dBase III Plus, was used to program the system, called Nurse Education Link to Aged Center (NELAC). NELAC reflects the center's philosophy of helping clients attain maximum satisfaction of their health care needs through self care. NELAC's specific purposes include 1) matching student nurses with potential clients for clinical experiences; 2) providing an efficient reminder system to improve follow-up care for clients; 3) maintaining longitudinal client records; 4) producing reports of services and activities of the center; and 5) providing aggregate data for research.

Database Management Systems↗

PubMed1992

Quality improvement: the nurse's role.

Continuous quality improvement is a concept which includes: Quality assurance--the provision of services that meet an appropriate standard. Problem resolution--including all departments involved in the issue at hand. Quality improvement--a continuous process involving all levels of the organization working together across departmental lines to produce better services for health care clients. Deming (1982b) and others have espoused total system reform to achieve quality improvement--not merely altering the current system, but radically changing it. It must be assumed that those who provide services at the staff level are acting in good faith and are not willfully failing to do what is correct (Berwick, 1991). Those who perform direct services are in an excellent position to identify the need for change in service delivery processes. Based on this premise, the staff nurse--who is at the heart of the system--is the best person to assess the status of health care services and to work toward improving the processes by which these services are provided to clients in the health care setting. The nurse manager must structure the work setting to facilitate the staff nurse's ability to undertake constructive action for improving care. The use of quality circles, quality councils, or quality improvement forums to facilitate the coordination of quality improvement efforts is an effective way to achieve success. The QA coordinator assists departments in documenting that the quality improvement efforts are effective across all departments of the organization, and aggregates data to demonstrate that they meet the requirements of external regulatory agencies, insurers, and professional standards. The nurse executive provides the vision and secures the necessary resources to ensure that the organization's quality improvement efforts are successful. By inspiring and empowering the staff in their efforts to improve the process by which health care is provided, nurse managers participate in reshaping the health care environment. The professional nurse plays a vital role in the quality improvement of health care services. However, nurses cannot make these improvements in a vacuum; they must include other professionals and ancillary personnel in their efforts. Total quality commitment must include all levels of an organization's structure. Quality patient care services will be achieved as the result of positive interactions among departments working together to build a dynamic mechanism that continuously improves the processes and outcomes of health care services.

Humans↗

PubMed2006

[A registry study of hospital admissions of children with asthma and bronchitis in different counties].

INTRODUCTION: In Denmark, asthma is the most widespread chronic childhood disease, imposing great demands on the health services. Considerable variations exist among Danish counties with respect to the percentage of asthmatic children treated by general practitioners and paediatric specialists, which makes it relevant to investigate whether there are differences among Danish counties in admission and readmission rates to hospitals in relation to the capacity of the outpatient clinics. MATERIALS AND METHODS: We performed a cross-sectional study using county-level aggregated data derived from the National Hospital Register and from StatBank Denmark documenting hospital admissions and visits to outpatient clinics in 2001 of children aged 0-4 years and 5-14 years with asthma or bronchitis. The chi2-test was used to calculate the differences by county. RESULTS: The results showed statistically significant differences among the counties in hospital admission rates, readmission rates and number of visits to outpatient clinics. DISCUSSION: The differences among counties in admission rates and number of visits to outpatient clinics indicate that there are considerable variations in the amount of specialist resources being allocated to management of childhood asthma. No study results are available about where asthmatic children are treated most advantageously, which makes further research relevant in view of the large differences in use of resources.

Adolescent↗

PubMed2006

[Prematurity and methods of its screening].

OBJECTIVE: Premature delivery is an essential problem in the modern obstetrics. Revealing and marking the high-risk group of pregnant women in time could be used as one of the methods of its prevention. DESIGN: Retrospective epidemiological study of the aggregated data of pregnant patients. SETTING: OBGYN Clinic of the 1st and 3rd Faculty of Medicine, Prague, FNB, FNKV. METHOD: A routine database of pregnant patients was generated. In our study was included the group of 2368 patients who underwent the screening and fulfilled the condition of completion the data in the period from the 15th to the 20th week of pregnancy, during and after the birth. Database is a component of a lager database generated in the last 15 years. The group of premature delivery patients was marked as those who delivered before the beginning of the 10th month of pregnancy. MS-AFP (maternal serum AFP) screening values of pregnants were measured and transformed to the multiples of medians (MOM), corresponding to the particular week of pregnancy for enabling the comparison during the whole period of screening. Statistical investigation was performed using data analysis advanced methods. RESULTS: A significant statistical correlation between higher values of MS-AFP, during the period from the 15th to the 20th week of pregnancy, and premature deliveries were found. The cut-off value of 1.8 MOM MS-AFP was included to determine the higher risk group of patients. Women with equal or higher values of AFP were 3.8 times more likely to have premature delivery than those with lower AFP values (95% CI: 2.2;6.3). Sensitivity of 25% and specificity of 92% were proven. CONCLUSION: According to our opinion, MS-AFP could not only be used for the hereditary diseases screening, but as well for performing the premature delivery screening at the beginning of the 2nd trimester. Cut-off value of 1.8 MOM for marking the higher risk group was used for marking the high-risk group. Thus the extension of the classical screening technique of hereditary diseases could yield also in other areas of the obstetrical care.

Biomarkers↗

PubMed2005

Key design elements of a data utility for national biosurveillance: event-driven architecture, caching, and Web service model.

The National Retail Data Monitor (NRDM) has monitored over-the-counter (OTC) medication sales in the United States since December 2002. The NRDM collects data from over 18,600 retail stores and processes over 0.6 million sales records per day. This paper describes key architectural features that we have found necessary for a data utility component in a national biosurveillance system. These elements include event-driven architecture to provide analyses of data in near real time, multiple levels of caching to improve query response time, high availability through the use of clustered servers, scalable data storage through the use of storage area networks and a web-service function for interoperation with affiliated systems. The methods and architectural principles are relevant to the design of any production data utility for public health surveillance-systems that collect data from multiple sources in near real time for use by analytic programs and user interfaces that have substantial requirements for time-series data aggregated in multiple dimensions.

Commerce↗

PubMedDate not supplied

National survey of the quality of 2nd level in screening for cervical cancer.

We collected, from the local registration systems of Italian organised cervical screening programmes, aggregated data (a) on the correlation between colposcopic grading and histology in routine colposcopies and (b) on treatment performed for screen-detected biopsy-proven cervical intraepithelial lesions (CIN). We obtained data on colpo-histological correlation from 40 programmes, reporting on 12,901 colposcopies, classified according to the 1990 international classification. Among them 37% were classified as normal and 25% as unsatisfactory (transformation zone not entirely visible). CIN1 or more severe histology was detected in 2273/4140 (65%) colposcopies classified as grade 1. CIN2 or more severe histology was detected in 566/853 (66.4%) colposcopies classified as grade 2. Of all women with CIN2 or more severe histology 42% had a colposcopy classified as grade 2 or higher. We obtained data on treatment from 57 programmes. Of the 2123 CIN1 cases 63% had follow-up only. However 20 (0.9%) had cold-knife conisation, 2 (0.1%) had hysterectomy and 191 (9.0%) were treated by diathermo-coagulation. Of the 1600 women with diagnosis of CIN2 or CIN3 4.2% had not been treated when data were collected and no data were available for another 8.2%. Electrosurgical excision was the most common treatment in these women (79% of those with known treatment). Some 0.7% of all CIN2 and 5.1% of all CIN3 had hysterectomy. Some 12% of the 111 invasive carcinoma, plausibly microinvasive, had excisional treatment only.

Biopsy↗