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PubMed1993

Quality assessment of occupational health services instruments.

Interest in the quality of instruments for occupational health services is growing as a result of European legislation on preventive services stressing, for example, risk identification and assessment. The quality of the services can be enhanced when the quality of the applied instruments can be judged and improved. To judge quality aspects of instruments, a basic draft scheme and criteria are presented. A first category of criteria covers measurement objective and study design and comprises for example sample strategy and data aggregation level. Technical quality aspects are validity, reliability, standardization and precision. Acceptability of an instrument by employees, employers and professionals belongs to the process quality. At last, strategic quality or presumed utility has to be assessed. As an illustration four instruments have been judged: periodic occupational health surveys, pre-employment medicals, the company audit on work and health, and specific working conditions assessment instruments. Finally the presented basic scheme and criteria are brought into discussion.

Europe↗

PubMed1993

A framework for modelling the electronic medical record.

This paper presents a model for an electronic medical record which satisfies the requirements for a faithful and structured record of patient care set out in a previous paper in this series. The model underlies the PEN & PAD clinical workstation, and it provides for a permanent, completely attributable record of patient care and the process of medical decision making. The model separates the record into two levels: direct observations of the patient and meta-statements about the use of observations in decision making and the clinical dialogue. The model is presented in terms of "descriptions" formulated in the Structured Meta Knowledge (SMK) formalism, but many of its features are more general than the specific implementation. The use of electronic medical records based on the model for decision support and the analysis of aggregated data are discussed along with potential use of the model in distributed information systems.

Computer Simulation↗

PubMedDate not supplied

A new approach to eliciting information about induced abortion.

Reliable quantitative data on abortion are sorely needed, particularly in developing countries. Past experience in large-scale survey research has demonstrated that direct questioning on this subject results in significant underreporting. This article presents results of an experiment to collect data on induced abortion in Côte d'Ivoire within the context of a family planning operations research study. First, questions were employed to broach the topic of unwanted pregnancy in a value-free manner, and then the potential for a variety of actions, including abortion, was acknowledged. The results indicate that approximately 25 percent of all women attending a family planning clinic on the day of the survey had had an induced abortion. The use of improved abortion-related questions shows promise for providing more complete measurement of a neglected dimension of women's reproductive health.

Abortion, Induced↗

PubMed1995

Current status of pediatric home peritoneal dialysis training in the United States.

There are little aggregate data that examine attributes of peritoneal dialysis (PD) training programs for children. We determined characteristics of pediatric home PD training programs in a sample of 54 centers in the NAPRTCS PD registry by telephone interview. Sixty-seven percent of the programs trained pediatric patients only (P-only); 33% were combined pediatric/adult (P/A) programs; 33 programs had dedicated training rooms. Most programs trained 5 to 8 patients/year; only 2 trained more than 12 patients/year. Forty-eight of 54 programs (89%) taught both automated and manual PD techniques; the preferred type of PD varied. All units preferred to train 2 people. The patient was often one of the trainees, but the minimal eligible age varied greatly. The patients were trained as inpatients (IP) in 38 units (70%) and as outpatients (OP) in 16 units (30%). P-only programs were less likely to train as OP (20%) than P/A programs (50%) (p < 0.01). There was no difference in the mean training time for P-only versus P/A programs. However, training that took more than 6 days occurred more often when done as an IP (79%) than as an OP (56%) (p = 0.057). Furthermore, only 25% of IP units that took more than 6 days to train offered training on the weekend; none of the IP units that took more than 10 days offered weekend training. In conclusion, the structure of PD training programs for children in the United States varies tremendously. OP training is usually shorter in duration and potentially more cost-effective.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗

PubMed1995

Linkage failures in ecological studies.

Ecological studies require a methodological theory distinct from that used in individual-level epidemiological studies. This article discusses the special problems that need to be considered when planning ecological studies or using the results of such studies. Ecological studies are much more sensitive to bias from model mis-specification than are results from individual-level studies. For example, deviations from linearity in the underlying individual-level regressions can lead to inability to control for confounding in ecological studies, even if no misclassification is present. Conditions for confounding differ in individual-level and ecological analyses. For ecological analyses of means, for example, a covariate will not be a confounder if its mean value in a study region is not associated with either (i) the mean exposure level across regions, or (ii) the mean outcome (disease rate) across regions. On the other hand, effect modification across areas can induce ecological bias even when the number of areas is very large and there is no confounding. In contrast to individual-level studies, independent and nondifferential misclassification of a dichotomous exposure usually leads to bias away from the null hypothesis in aggregate data studies. Failure to standardize disease, exposure and covariate data for other confounders (not included in the regression model) can lead to bias. It should be borne in mind that there is no method available to identify or measure ecological bias. While this conclusion may sound like a general criticism of ecological studies, it is not. It does, however, serve as a reminder of the problems that need to be considered when one designs, analyses, or critically evaluates ecological studies.

Bias↗

PubMed1995

Delivering health information databases on World Wide Web at the National University of Singapore.

The National University of Singapore (NUS) is one of the first medical schools in Asia to exploit the use of the World Wide Web on the Internet for the delivery of health information databases. Its WWW server was established in 1993 by the NUS Biocomputing Research and User Support (BRUS) technology group in collaboration with the Computer Resource Planning committee of the Faculty of Medicine. As a result of the early recognition of the powerful platform on which health information services can be delivered worldwide, the NUS effort has been accredited with a number of Internet firsts in the area of health informatics. The following are some of the NUS achievements: NUS-NCI CancerNet on the Web. The NUS developed and implemented the first WWW version of the popular CancerNet database offered by the National Cancer Institute, NIH, USA. Health Info-Com Network Medical Newsletter. The NUS developed and implemented the first WWW version of the medical newsletter, MEDNEWS which is edited by Dr. David Dodell, USA. It is now mirrored by the University of Pennsylvania in the United States and De Montfort University, U.K. Poisons Information Database. This first WWW implementation of a database on known plant, snake and other animal toxins with directories of antivenoms, toxinologists and poisons control centers around the world is offered by the NUS Venom and Toxin Research Group. HistoNet. This is a large collection of histology specimens from the NUS Department of Anatomy. MEDISTAT. This is the first WWW implementation of a Health and Population Statistical Database which contains information for Singapore, selected Asian countries and aggregate data for world regions. The Singapore Biotechnology Database. This database features companies and organizations involved in biotechnology and related activities in Singapore. Efforts are continuing to offer more value-added health information databases on the NUS WWW server and to link the server with other top-class information centers worldwide. Our mission is to identify the National University of Singapore as a global health information hub on the Internet.

Computer Communication Networks↗

PubMed1996

[Costs of medical treatment of injuries in Norway].

The objective of this study was to estimate the cost of medical treatment of injuries in Norway. We analysed aggregated data from two sources, the National Hospital Discharge Register and the National Injury Register, in order to calculate such costs in 1994. Approximately 400,000 injuries treated in hospitals and emergency departments in 1994 cost NOK 1.7 billion in terms of medical treatment. Unintentional injuries accounted for 91%, self-inflicted injuries for 3%, and injuries stemming from violence for 6% of the costs. Injuries requiring hospitalisation accounted for 71% of the total costs. Persons aged 65 years or more constituted 14% of the cases but accounted for 46% of the cost of treating unintentional injuries. Injuries at home or during leisure time accounted for 75% of the costs of the unintentional injuries, while traffic injuries accounted for 7%, occupational injuries for 8%, and 10% of the costs could not be classified. Hip fractures alone accounted for 27% of the total costs. Traffic and occupational injuries remain important targets for prevention, but greater efforts are required to reduce risk of injuries in the home and during leisure time, injuries to elderly people, hip fractures, and injuries that stem from violence.

Accidents↗

PubMed1996

Evaluating physical functional outcomes: one category of the NOC system.

All professional health care disciplines are now being held accountable to demonstrate the outcomes they produce. It is imperative that nurses demonstrate the difference they make in patient care to justify the cost of professional nursing. Standardized language is needed to aggregate data and report information on nursing interventions and associated outcomes. The Nursing Outcomes Classification (NOC) system is the first comprehensive classification of nursing-sensitive patient outcomes. In this review, the development of this classification system with specific results related to physical functional status and implications of NOC for nursing practice are discussed.

Activities of Daily Living↗

PubMed1996

Cohort size and age-specific suicide rates: a contingent relationship.

Trends in age-specific suicide rates relate to debates about the consequences of population aging and changes in cohort size for social well-being. Easterlin argues that large cohort size increases suicide rates by reducing relative income; Preston claims that suicide rates fall in large cohorts with high levels of political and social power. To integrate these competing arguments, this paper uses aggregate data on 18 high-income nations from 1953 to 1986 to demonstrate that the direction and strength of the relationship between cohort size and suicide depend on (1) age of the cohort, (2) gender, (3) national context, and (4) time period. The results show that large cohort size raises suicide for the young and middle-aged, but reduces it for the elderly. Also, the effects of cohort size prove stronger for men than for women, for nations with less collectivist institutions than for nations with more collectivist institutions, and for the 1950s and 1960s than for the 1970s and 1980s.

Actuarial Analysis↗

PubMed1996

Outcomes and their management.

There is a growing demand on the part of a wide variety of consumers to document and trend outcomes of health care interventions. To avoid confusion, it is important to clarify the many dimensions of outcome terminology. At the core, patient-related outcomes signify the result or effects of care processes. There are three major categories of outcomes: clinical, financial, and traditional (eg, morbidity, mortality, readmissions). Clinical outcomes have the least historical and aggregate data available and are currently the focus of major efforts for definition and quantification. Changes in the health care environment are also refocusing where outcomes are measured, from the traditional acute care base to a more continuum or episode outlook. This will require new strategies to collect outcome data in various sites across the continuum.

Efficiency, Organizational↗

PubMed1998

One-two rural residency tracks in family practice: are they getting the job done?

BACKGROUND: In the 1990s, the Residency Review Committee for Family Practice (RRCFP) and the American Board of Family Practice used the development of rural training programs as a strategy to bridge training experiences across urban referral centers and rural community hospitals. These programs are relatively small and attract trainees who are predisposed to rural practice. Aggregating data from several programs yields insight about their challenges and their ability to produce graduates who enter rural practice. METHODS: This descriptive analysis is based on self-reported data from a 1996 survey mailed to the residency program directors of rural training programs, identified by the RRCFP office as one-two programs. RESULTS: More than half of the rural training programs surveyed were located in health professions shortage areas, most in communities with little urban influence. These programs are equally likely to be sponsored by university- or community-based residency programs. Most (75%) placed two or fewer residents per year in the rural site; minorities accounted for 4% of placements. Thirty percent of programs report unfilled positions. Seventy-five percent use televideo communications and find experiences in surgery and obstetrics relatively easy to arrange but dermatology and critical care difficult. Seventy-six percent of graduates enter rural practice after graduation. CONCLUSIONS: This survey suggests that family practice rural one-two residencies are meeting the goal of providing trainees with a rural immersion experience, in anticipation of selecting rural practice after graduation.

Community Health Services↗

PubMed1998

HIV infection among rural trauma patients: a blind serosurvey and literature review.

Human immunodeficiency virus (HIV) seroprevalence rates among rural trauma patients range between 0.15 and 1.32 per cent. A random sample of trauma patients treated at our rural trauma center between September 1994 and November 1995 was enrolled into a blind HIV serosurvey. Five hundred sixty-six of 1315 trauma patients (43%) were tested. Two of the 566 patients (0.35%) were HIV positive. A review of aggregate data for HIV infection among rural trauma patients in the United States show that 28 of the 4639 patients (0.60%) are HIV positive. We conclude that there was a low HIV incidence among our trauma patients from September 1994 to November 1995, and the cost-effectiveness of HIV testing for rural trauma patients is questionable with incidences between 0.5 and 1.0 per cent.

AIDS Serodiagnosis↗

PubMed1997

Oral health finance and expenditure in South Africa.

The objective of this paper was to examine the cost of oral health in South Africa over the past decade Particular emphasis was placed on the contribution made by medical schemes which is the main source of private health care funding. Some of the problems facing this huge industry were also briefly explored. Primary aggregate data on oral health expenditure were obtained from the Department of Health, Pretoria and from the offices of the Registrar of Medical Schemes, Pretoria. The results show that in 1994, 4.7 per cent of the total health care budget was allocated to oral health. Of this amount, 14.2 per cent came from the state, 71.9 per cent from medical schemes and the remainder calculated to be from direct out-of-pocket payments. Furthermore, real expenditure for oral health by medical schemes grew robustly and almost continuously from 1984 through to 1994, generally outstripping medical inflation.

Dental Care↗

PubMed1998

[Target agreements between insurance carriers and hospitals as instrument for modifying hospital length of stay].

In 1995 the statutory sickness fund (AOK) in Magdeburg arranged target agreements with 10 of 23 acute care hospitals in its district to exercise an influence on the development of the average length of hospital stay. With the aim of decreasing the length of stay as well as the administrative cost and effort, these agreements set upper limits on the average length of stay which were hospital-specific and period-specific. In return, with only a few exceptions, the AOK Magdeburg refrained from limiting the coverage of individual cases. Hospital cases discharged from 1994 and 1996 were analysed to determine whether the development of the length of stay in the ten hospitals with target agreements differed from that in the other 13 hospitals. Only some of the hospitals were successful in reaching their target agreements. The average length of stay dropped by 4.2% in the hospitals with target agreements and by 7.9% in those without target agreements. This must be considered in the context of the development of the case load and number of available hospital beds. For instance, in spite of a target agreement, one hospital showed a (compensatory) increase in the average length of stay in association with an increase in the number of authorized beds and a concurrent decrease in the number of cases. The number of days billed by AOK patients per authorized bed (as an indicator of hospital productivity) showed a more favourable development in the group of hospitals with target agreements than in the other group. This was not a controlled trial as far as the selection of the hospitals is concerned. The results suggest that there is no harm in incentives that induce hospitals to manage primarily on their own the average length of stay. The use of routine aggregate data in monitoring this development, rather than the current more expensive individual case approach, also seems reasonable. Well planned studies that further test the "tool" of target agreements can be recommended.

Cost Control↗

PubMed2005

Partner aggression and problem drinking across the lifespan: how much do they decline?

Cross-sectional analyses from nationally-representative samples demonstrate significant age-related trends in partner aggression and problem drinking. Both behaviors are most prevalent in the early to mid-twenties and increasingly less common thereafter. Aggregate associations based on percentage of individuals displaying the behavior in each age range are dramatically stronger than those found when correlating individuals' ages and behavior. Multilevel modeling demonstrates that group-level effects do not mask associations found at the level of the individual for either problem drinking or partner aggression. An analysis of recent abstracts from psychology journals showed that issues of aggregate and individual data are rarely if ever discussed, and even well-known statistics books in psychology rarely discuss such issues. The interpretation of aggregate data will become increasing important as psychologists themselves, and in collaboration with epidemiologists and sociologists, have access to large data sets that allow for data aggregation. Both aggregate and individual analyses are valid, although they provide answers to different questions. Individual analyses are necessary for predicting individual behavior; aggregate analyses are useful in policy planning for large scale prevention and intervention. Strengths and limitations of cross-sectional community samples and aggregate data are also discussed.

Adolescent↗

PubMed1998

Familial aggregation of osteoarthritis: data from the Baltimore Longitudinal Study on Aging.

OBJECTIVE: To evaluate the familial aggregation of osteoarthritis (OA) in a cohort of healthy volunteers drawn from a community setting. METHODS: Hand radiographs obtained between 1978 and 1991 and bilateral standing knee radiographs obtained between 1984 and 1991 were read for changes of OA, using Kellgren-Lawrence (K-L) scales. The hand sites were distal interphalangeal (DIP) joints, proximal interphalangeal (PIP) joints, and first carpometacarpal (CMC1) joints. For each joint group, the presence of OA in at least 1 joint in a joint group, the number of affected digits in each joint group, and the sum of the K-L grade across all joints were analyzed. Polyarticular OA was recorded if there were OA findings in 2 of 3 hand joint groups plus 1 or both knees. Data from 167 families with hand radiographs, 157 families with knee radiographs, and 148 families with both hand and knee radiographs were analyzed for sib-sib correlations. RESULTS: After adjustment for age, sex, and body mass index, clinically relevant sib-sib common correlations were found for OA of the DIP, PIP, and CMC1 joints, for OA at 2 or 3 hand sites, and for polyarticular OA (r = 0.33-0.81) when OA was defined according to the number of affected joints or as the sum of the K-L grade across all joints. CONCLUSION: These results from a cohort of volunteers drawn from a community setting and ascertained without regard to OA status demonstrate familial aggregation of OA and contribute to the evidence for heritability of OA.

Adult↗

PubMed2001

[Hospital infections and risk factors in the intensive care units of 16 Dutch hospitals, results of surveillance of quality assurance indicators].

OBJECTIVE: To gain insight into the incidence of nosocomial infections and associated risk factors in Intensive Care Units (ICUs). DESIGN: Prospective. METHOD: From July 1997 to December 1999, standardised surveillance of nosocomial infections was implemented in ICUs in 16 hospitals in the Netherlands. Surveillance was performed in patients with an ICU stay of > or = 48 hrs; data were collected from admission until discharge from ICU. Data-collection included demographic data and patient- and treatment-related risk factors. The data were aggregated in a national database. RESULTS: In the research period, hospitals sent good quality data for aggregation in the national database on 2795 patients (61% male) and 27,922 ICU patient days. The median length of stay was six days, the median 'Acute physiology and chronic health evaluation' (APACHE) II score was 17 and the median age was 67 years. A total number of 749 infected patients were found with 1,177 nosocomial infections (27% of patients, 42 infections/1000 patient days), consisting of 43% pneumonia, 20% sepsis, 21% urinary tract infections, 16% other types of infections. Out of all the patients, 62% was on mechanical ventilation, 64% had a central venous line and 89% had a urinary catheter in situ. Selective decontamination of the gastrointestinal tract was used for 12% of the patients, and systemic antibiotics for 68%. Micro-organisms most frequently isolated were Pseudomonas aeruginosa in patients with pneumonia, Staphylococcus epidermidis in catheter-related bloodstream infections and Escherichia coli in patients with urinary tract infections. Large differences in device use and incidence of infections were observed between the ICUs. CONCLUSION: The aggregated data gave insight into the incidence of nosocomial infections and associated risk factors in ICUs. The data are meant as references to support decision- and policy-making in local infection control programs.

APACHE↗

PubMed2025

Direct estimation and inference of higher-level correlations from lower-level measurements with applications in gene-pathway and proteomics studies.

This paper tackles the challenge of estimating correlations between higher-level biological variables (e.g. proteins and gene pathways) when only lower-level measurements are directly observed (e.g. peptides and individual genes). Existing methods typically aggregate lower-level data into higher-level variables and then estimate correlations based on the aggregated data. However, different data aggregation methods can yield varying correlation estimates as they target different higher-level quantities. Our solution is a latent factor model that directly estimates these higher-level correlations from lower-level data without the need for data aggregation. We further introduce a shrinkage estimator to ensure the positive definiteness and improve the accuracy of the estimated correlation matrix. Furthermore, we establish the asymptotic normality of our estimator, enabling efficient computation of P-values for the identification of significant correlations. The effectiveness of our approach is demonstrated through comprehensive simulations and the analysis of proteomics and gene expression datasets. We develop the R package highcor for implementing our method.

Proteomics↗