[Theory and techniques of demographic forecasting].
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Cohort Studies↗
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[Notes on the GKV-modernization law (GMG)--a dentist's trend analysis].
Effective January 1st 2004 medical aid for patients receiving aid by means of the Federal German social welfare act has been transferred from the local social welfare offices to the statutory health insurances by decree regarding act modernisation of the statutory health insurance (GMG). The authors analyse the epidemiological and economical parameters concerning dental medical care for the city of Wuppertal on the basis of the experiences from 1994 to 2003 and attempt a well-founded forecast: the quality of medical standards will decline, whereas cost will rise.
Forecasting↗
[Poisoning with leather-impregnation sprays. A retrospective analysis of 224 cases of poisoning].
Annually, there are about 100-200 intoxications in the Federal Republic of Germany caused by inhalation of leather impregnation sprays. The course of these intoxications is moderately severe in 60% and severe in 18% of the cases. The signs and symptoms are characterized by a respiratory distress syndrome which sets in about 15-60 min after spraying and which requires several days of hospitalisation in severe cases. The sprays contain about 7-11 components; their toxicity is not exclusively associated with one substance only. Lower toxicity can be achieved by preparing a basic formulation adjusted to the low-hazard components.
Aerosols↗
Comparative analysis of passive dosimetry and biomonitoring for assessing chlorpyrifos exposure in pesticide workers.
Under the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA), the US Environmental Protection Agency (EPA) has the authority to regulate the use of pesticides to prevent unreasonable adverse human health effects associated with pesticide exposure. Accordingly, the EPA requires pesticide registrants to perform studies evaluating the potential for pesticide handler exposure. Data from five such studies that included exposure measurements based on both external measurements and biological monitoring were used to examine methods of assessment, routes and determinants of exposure and dose to the pesticide chlorpyrifos. Eighty workers across four job classes were included: mixer/loaders (M/L, n = 24), mixer/loader/applicators (M/L/A, n = 37), applicators (A, n = 9) and re-entry scouts (RS, n = 10). Results showed that doses were highly variable and differed by job class (P < 0.05) with median total (inhalation and dermal combined) exposure-derived absorbed doses (EDADtot) of 129, 88, 85 and 45 microg/application for A, M/L/A, M/L and RS, respectively. Doses derived from the measurement of 3,5,6-trichloro- 2-pyridinol (3,5,6-TCP) in urine were similar in magnitude but differed in rank with median values of 275, 189, 122 and 97 microg/application for A, M/L, RS, and M/L/A, respectively. The relative contribution of dermal to inhalation exposure was examined by their ratio. The median ratios of exposure-derived absorbed dermal dose (EDADderm) (assuming 3% absorption) to exposure-derived absorbed inhalation dose (EDADinh) (assuming 100% absorption) across job classes were 1.7, 1.5, 0.44 and 0.18 for RS, M/L, A and M/L/A, respectively, with an overall median of 0.6. For 34 of 77 workers (44%), this ratio exceeded 1.0, indicating the significance of the dermal exposure pathway. Different dermal absorption factor (DAF) assumptions were examined by comparing EDADtot to the biomarker-derived absorbed dose (BDAD) as a ratio where EDADtot was calculated assuming a DAF of 1, 3 and 10%. Median ratios of 0.45, 0.71 and 1.28, respectively, were determined suggesting the DAF is within the range of 3-10%. A simple linear regression of urinary 3,5,6-TCP against EDADtot indicates a positive association explaining 29% of the variability in the 3,5,6-TCP derived estimate of dose. A multiple linear regression model including the variables EDADderm, EDADinh and application type explained 46% of the variability (R2 = 0.46) in the urinary dose estimate. EDADderm was marginally significant (P = 0.066) while EDADinh was not (P = 0.57). The EDADderm regression coefficient (0.0007) exceeded the coefficient for EDADinh (0.00002) by a factor of 35. This study demonstrates the value of the pesticide registrant database for the purpose of evaluating pesticide worker exposure. It highlights the significance of the dermal exposure pathway, and identifies the need for methods and research to close the gap between external and internal exposure measures.
Agriculture↗
An analysis of policies regulating medication in Ohio public schools.
The development of medicines, state and federal laws requiring the enrollment and mainstreaming of handicapped students and the use of behavior modifying drugs has resulted in more requests by parents to have medication administered to their children during school hours. The problem in schools without immediate access to nurses is to accommodate students who need medication while at the same time avoid the dangers that are inherent in administering medication to children. The purpose of this investigation was to determine what guidelines are being followed in Ohio schools on the storage and administration of prescribed medication. Policies and regulations on the administration of medication, solicited from a random sample of Ohio school districts, were found to be not in keeping with pertinent legislation, litigation and recommended procedures. The investigation of the sample districts revealed enough inadequacies to suggest that: 1) many Ohio school districts need formal policies and regulations in the administration of medication; and 2) Ohio school districts having policies and regulations in the administration of medication should seriously consider eliminating whatever inadequacies exist for the safety and well-being of students and staff. A sample board policy statement, regulations for administering prescription and nonprescription medication in schools, a request form and a model statute designed to protect the employee from tort liability as a result of ordinary negligence in the administration of medication were developed in keeping with the findings of this study and are recommended for consideration as models by school districts nationwide.
Adolescent↗
Automated analysis of the American College of Radiology mammographic accreditation phantom images.
A significant metric in federal mammography quality standards is the phantom image quality assessment. The present work seeks to demonstrate that automated image analyses for American College of Radiology (ACR) mammographic accreditation phantom (MAP) images may be performed by a computer with objectivity, once a human acceptance level has been established. Twelve MAP images were generated with different x-ray techniques and digitized. Nineteen medical physicists in diagnostic roles (five of which were specially trained in mammography) viewed the original film images under similar conditions and provided individual scores for each test object (fibrils, microcalcifications, and nodules). Fourier domain template matching, used for low-level processing, combined with derivative filters, for intermediate-level processing, provided translation and rotation-independent localization of the test objects in the MAP images. The visibility classification decision was modeled by a Bayesian classifer using threshold contrast. The 50% visibility contrast threshold established by the trained observers' responses were: fibrils 1.010, microcalcifications 1.156, and nodules 1.016. Using these values as an estimate of human observer performance and given the automated localization of test objects, six images were graded with the computer algorithm. In all but one instance, the algorithm scored the images the same as the diagnostic physicists. In the case where it did not, the margin of disagreement was 10% due to the fact that the human scoring did not allow for half-visible fibrils (agreement occurred for the other test objects). The implication from this is that an operator-independent, machine-based scoring of MAP images is feasible and could be used as a tool to help eliminate the effect of observer variability within the current system, given proper, consistent digitization is performed.
Accreditation↗
Analysis of health education sections of health systems plans.
Health Systems Agencies are required by federal guidelines to plan for and provide educational opportunities for residents of their health service areas. A study was conducted of 9 health education components of health systems plans developed by HSAs in Region III. The health education plans were analyzed and scored using the "Health Education Plan Scorecard" developed by Sullivan and adapted by the present authors. Specifically this modified scorecard consists of eight dimensions of the health education planning process: Involvement, Principles and Practice of Health Education, Defining Problems, Setting Goals and Objectives, Recommending Actions, Obtaining Resources, Planning for Implementation, and Planning for Evaluation. Ratings were generally higher on the first five dimensions of the scorecard. The last three dimensions produced lower scores. The overall average score was 41 points out of a possible 100. Thus indicating the general overall low scores received by the plans. The paper includes 18 recommendations to HSAs for improving the quality of health education plans. A key recommendation is that the Health Education Plan Scorecard should be used as a guide and check list during the plan development process.
Evaluation Studies as Topic↗
Personal account retirement plans: an analysis of the survey of consumers finances.
This report is based on data from the Federal Reserve Board's triennial Survey of Consumer Financies (SCF), which provides the most comprehensive data available on the wealth of American households. The most recent SCF data are for 1998, and this report tracks information from the 1992, 1995, and 1998 surveys. The percentage of families with a participant in a pension plan from a current job increased from 38.8 percent to 41.0 percent over this six-year period. If one focuses exclusively on those families with a worker and in which the head is under age 65, the percentage for 1998 increases to 56.8 percent. The previously documented trend toward defined contribution plans was confirmed and the significance of 401(k)-type plans for those families participating in a pension plan more than doubled, from 31.6 percent in 1992 to 64.3 percent in 1998. The percentage of family heads eligible to participate in a defined contribution plan that did so increased from 73.8 percent in 1995 to 77.3 percent in 1998. Of those families choosing not to participate in a defined contribution plan, 40.3 percent were already participating in a defined benefit plan. Overall, "personal account plans" represented nearly one-half (49.5 percent) of all the financial assets for those families with either a defined contribution plan account, IRA, or Keogh, in 1998. This was a significant increase from 43.6 percent in 1992. The average total account balance in personal account plans for families with a plan in 1998 was $78,417, an increase of 54 percent in real terms over the 1992 balance of $50,914 (expressed in 1998 dollars). For families participating in a defined contribution plan, IRA, or Keogh in 1998, 52 percent of the overall average was attributed to IRA/Keogh balances (43 percent from IRAs alone), and 44 percent of the average was from account balances in defined contribution plans with the current employer. There is a marked tendency for lower-income families to have larger percentages of their total personal account plan retirement portfolio in IRAs, although this trend appears to be fading with time. The impact of rollovers on the average total account balance for all individual account balances appears to be quite large: $152,451 for those with at least one rollover, versus $78,471 for all families participating in at least one personal account plan, regardless of whether they have had a rollover. The vast majority of the rollovers would appear to be going to IRAs, as opposed to a defined contribution plan with a new employer.
Aged↗
Testing for Salmonella in raw meat and poultry products collected at federally inspected establishments in the United States, 1998 through 2000.
The Food Safety and Inspection Service (FSIS) issued Pathogen Reduction; Hazard Analysis and Critical Control Point (HACCP) Systems; Final Rule (the PR/HACCP rule) on 25 July 1996. To verify that industry PR/HACCP systems are effective in controlling the contamination of raw meat and poultry products with human disease-causing bacteria, this rule sets product-specific Salmonella performance standards that must be met by slaughter establishments and establishments producing raw ground products. These performance standards are based on the prevalence of Salmonella as determined from the FSIS's nationwide microbial baseline studies and are expressed in terms of the maximum number of Salmonella-positive samples that are allowed in a given sample set. From 26 January 1998 through 31 December 2000, federal inspectors collected 98,204 samples and 1,502 completed sample sets for Salmonella analysis from large, small, and very small establishments that produced at least one of seven raw meat and poultry products: broilers, market hogs, cows and bulls, steers and heifers, ground beef, ground chicken, and ground turkey. Salmonella prevalence in most of the product categories was lower after the implementation of PR/HACCP than in pre-PR/HACCP baseline studies and surveys conducted by the FSIS. The results of 3 years of testing at establishments of all sizes combined show that >80% of the sample sets met the following Salmonella prevalence performance standards: 20.0% for broilers, 8.7% for market hogs, 2.7% for cows and bulls, 1.0% for steers and heifers, 7.5% for ground beef, 44.6% for ground chicken, and 49.9% for ground turkey. The decreased Salmonella prevalences may partly reflect industry improvements, such as improved process control, incorporation of antimicrobial interventions, and increased microbial-process control monitoring, in conjunction with PR/HACCP implementation.
Animals↗
X-linked lymphoproliferative disease. Detection of a paternally inherited mutation in a German family using haplotype analysis.
OBJECTIVE: To study the inheritance of the X-linked lymphoproliferative disease (XLP) locus in a German family. DESIGN: Haplotype segregation analysis. SETTING: Departments of Pediatrics and Human Genetics, University of Würzburg and University of Ulm, Federal Republic of Germany. PARTICIPANTS: Fourteen members of a family with XLP. INTERVENTIONS: None. MEASUREMENTS/MAIN RESULTS: Using molecular genetic techniques, we diagnosed the XLP status of the members of a German family. Restriction fragment length polymorphism analysis with closely linked polymorphic X-chromosomal DNA markers (Xq25-q27) revealed XLP carrier status in a female infant. Moreover, the XLP mutation was suggested to have occurred in the germ cell of the grandfather. CONCLUSION: This is the first report of a paternally inherited XLP mutation. The recurrence risk for germ cell mosaicism in XLP may be similar to that of X-linked Duchenne muscular dystrophy.
Base Sequence↗
Long-term follow-up and benefit-cost analysis of the Jobs Program: a preventive intervention for the unemployed.
Results are reported from a 2 1/2 year follow-up of respondents who participated in a randomized field experiment that included the Jobs Program, a preventive intervention for unemployed persons. The intervention was intended to prevent poor mental health and loss of motivation to seek reemployment and to promote high-quality reemployment. The results of the long-term follow-up were consistent with those found 1 and 4 months after intervention (Caplan, Vinokur, Price, & van Ryn, 1989). The results demonstrate the continued beneficial effects of the intervention on monthly earnings, level of employment, and episodes of employer and job changes. These findings are supported by a benefit-cost analysis, which demonstrates large net benefits of the intervention to the participants and to the federal and state government programs that supported the project.
Cost-Benefit Analysis↗
Prognostic value of flow cytometric deoxyribonucleic acid index in endometrial carcinoma: comparison with other clinical-pathologic parameters.
OBJECTIVE: The aims of the current study were to verify the impact of flow cytometric deoxyribonucleic acid index on clinical outcome in endometrial carcinoma and to assess whether its value is independent from the other clinical-pathologic features. STUDY DESIGN: In a prospective series 74 cases of endometrial carcinoma with surgery performed at our institution were studied. Flow cytometry was performed on fresh tumor samples. The median follow-up period was 31 months (range 8 to 52). Disease-free survival and actuarial survival were the end points of the study. RESULTS: Among the 74 patients (53 with diploid and 21 with aneuploid tumors) there were 14 recurrences and 10 deaths caused by the disease. The recurrence rate was 7.5% for the diploid and 47.6% for the aneuploid tumors (p < 0.001). Mortality was 3.8% for diploid and 38% for aneuploid cases (p < 0.001). Disease-free survival was 89.1% in the former group and 36.3% in the latter. Actuarial survival (Kaplan-Meier method) was 94.7% and 49.5%, respectively. Deoxyribonucleic acid index, stage (International Federation of Gynecology and Obstetrics), and grade of differentiation were significantly correlated with survival, whereas age, depth of myometrial invasion, and histologic type were not. In a multivariate analysis (Cox proportional hazards) deoxyribonucleic acid index was the strongest independent predictor of clinical outcome, followed by International Federation of Gynecology and Obstetrics stage, whereas grade of differentiation yielded no independent prognostic information. CONCLUSIONS: The flow cytometric deoxyribonucleic acid index is an important independent prognosticator, and its determination should be included in the standard management of endometrial cancer.
Actuarial Analysis↗
Consequence analysis: Its effects on verbal statements about an environmental project.
Typically, citizens lack relevant information concerning possible consequences of proposed environmental projects. Despite federal requirements for citizen participation in decisions about proposed roadway projects, no systematic procedures exist for educating citizens as to the possible consequences of such projects. The effects of a consequence analysis procedure on community residents' verbal statements about the favorability of a proposed roadway project were assessed. The consequence analysis procedure involved asking residents to rate the desirability and magnitude of each of 48 possible consequences of the proposed roadway project. Following the intervention, overall ratings of favorability of the project changed for nine of ten residents. Community residents' ratings of the quality of participants' justifications of their position on the roadway issue provided evidence of generalization to this collateral behavior.
Journal Article↗
Leiomyosarcoma of somatic soft tissues: a tumor of vascular origin with multivariate analysis of outcome in 42 cases.
Leiomyosarcomas of the somatic soft tissues (SST) are rare compared with their retroperitoneal and cutaneous counterparts and, therefore, have not been extensively studied. We have analyzed the clinicopathologic features of 42 SST leiomyosarcomas referred in consultation to determine what factors affect outcome. Cutaneous, visceral, retroperitoneal, uterine, gastrointestinal, and major vessel leiomyosarcomas were excluded. By definition all lesions possessed at least focal cytologic atypia and mitotic activity, although the latter varied from <1/10 high power fields to 66/10 high power fields. The patients (21 females and 21 males) ranged in age from 26 to 86 years (mean 60 years); tumors developed in the lower (n = 28) or upper extremity (n = 11) and trunk (n = 3). Most arose in deep (n = 27) as opposed to superficial (n = 15) soft tissue; 39 arose from a small vein. During the follow-up period (mean 47 months, range 9-162 months), 3 of 38 (8%) patients developed local recurrence and 17 of 38 metastasized (45%) mostly to the lungs. In a univariate analysis age >62 years, size >4 cm, extensive necrosis, modified updated French Federation of Cancer Centers (FFCC) grade, and whether the tumor had been "disrupted" by a previous incisional biopsy or incomplete excision were significantly correlated with metastasis. AJCC stage also approached significance (p = 0.096) but could not be reliably tested because of the sparseness of the data. In multivariate analyses the logistic regression model that best predicted metastasis at 36 months incorporated the effects of age, FFCC grade, and disruption and had a sensitivity of 94.1% and a specificity of 95.2%. Disruption was the only significant risk factor for metastasis in a multivariate analysis (relative risk 2.70; p = 0.0001) but was strongly correlated with large size and deep location. Other parameters did not improve the predictive power of the model significantly. We concluded that the majority of SST leiomyosarcomas are actually of vascular origin, an observation that has clinical and possibly biologic ramifications. Our histologic definition of leiomyosarcoma to include atypia and any level of mitotic activity appears warranted by the biologic outcome in our cases. The risk of metastasis can be calculated from a model incorporating age, FFCC grade, and disruption. Because disruption correlates with size and depth, it could represent a surrogate as opposed to causal marker for metastasis. Nevertheless, in view of their vascular origin, the possibility that tumor disruption may facilitate or promote access to the bloodstream merits further study.
Adult↗
[Developments in the Scandinavian countries' nurses' salaries and employment conditions in the 80s].
This article is based on a report published by the Northern Nurses' Federation (NNF) as background material for a conference on Nordic Nurses' Remuneration and Employment Conditions 22-24 October 1991, Denmark. The report contains an overview and analysis of data on nurses' remuneration and employment conditions obtained from the five Nordic nurses' associations: the Swedish Federation of Health Officers, the Danish Nurses' Organization, the Norwegian Nurses' Association, the Finnish Federation of Nurses and the Islandic Nurses' Association comprising the NNF. To make the report accessible for international use, English summaries have been added at the end of each chapter, and the headings of tables and figures are translated into English.
Economics, Nursing↗
[The need of providing a comprehensive civil service for the management of geriatric health care problems in the coming decades].
From (1) the Swiss population census 1980, (2) the calculations of the Swiss Federal Office of Statistics, referring to the probable age composition of the stable Swiss population from 1990 to 2025 (scenario 2A-86), (3) the meta-analysis of Jorm et al. [8] on the prevalence of dementia, and (4) a study of the Swiss Federal Office of Statistics on the nursing personnel employed by inpatient institutions for the care of the aged, it is concluded that the number of elderly patients suffering from moderate to severe dementia will increase in Switzerland from 48,000 to 92,000 during the years 1980-2020. In 1990 the nursing staff for the ambulatory and inpatient care of 62,900 patients with dementia numbered 17,100 full-time positions. The calculated need for such positions was 37,700 in 1990 and will be 55,200 in 2020. This major shortfall in nursing capacities, now and in the near future, can probably not be covered by an extension of extrahospital services and certainly not by increased training of nursing personnel. By analogy with the obligatory military service for young men in Switzerland, an obligatory civilian service for men and women, for the care of the aged, is therefore proposed.
Aged↗
The artificial heart's threat to others.
A member of the two federal advisory panels on artificial hearts reflects that the nuclear-powered artificial heart, had it been developed, would have posed a physical threat to others. Today's artificial heart poses a different threat. Because of the high costs, many people may be deprived of access to other forms of medical care and other social goods.
Advisory Committees↗
OMB estimates indicate that 900,000 children will lose health insurance due to reductions in federal SCHIP funding.
Despite the success of the State Children's Health Insurance Program (SCHIP) in reducing the ranks of uninsured children, the program now faces significant financing challenges. Analysis based on a model developed by the Centers for Medicare and Medicaid Services indicates that by 2007, 20 states will have insufficient federal funding to sustain their current programs, with the first states affected in 2004. As a result, the Office of Management and Budget projected last year that SCHIP enrollment will fall by 900,000 children between 2003 and 2007. The funding shortfalls are the result of several factors. Federal SCHIP funding fell by 26 percent--by more than dollar 1 billion-in each of fiscal years 2002, 2003, and 2004; dollar 1.2 billion in SCHIP funds has already expired and reverted to the Treasury at the end of fiscal year 2002, and another dollar 1.5 billion will expire at the end of 2003. The SCHIP program also has a redistribution system with targeting and timing problems. However, proposed Congressional legislation restoring federal funding, extending the dollar 2.7 billion in expiring funds, and targeting the funds to the states that most need them could avert most, if not all, of the projected enrollment decline. On the other hand, the Bush administration proposed to extend the expiring funds but does not target them to needy states; the proposal will do little to reduce the magnitude of the decline.
Budgets↗