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PubMed2003

The prevalence of obesity and undernutrition in Scottish children: growth monitoring within the Child Health Surveillance Programme.

OBJECTIVE: To assess whether anthropometric data, routinely collected as part of the Scottish Child Health Surveillance System (CHSP-PS, pre-school children; CHSP-S, school age children) could provide a means of monitoring/surveillance for obesity and undernutrition at national and health board level. DESIGN: A survey of 15 health boards and both surveillance systems to identify the nature of data collected, format of data, and extent to which data were accessible (e.g., via Information and Statistics Division of the Common Services Agency). Measurements of weight and height collected as part of the CHSP-PS and CHSP-S were extracted from ISD. They were then audited and missing values or implausible values quantified, and degree of dispersion of values used as an index of quality of measurements. SETTING: Health Board Child Health Surveillance Systems and Information and Statistics Division, Edinburgh. RESULTS: Data on height and weight are currently available for 9 health boards for pre-school children and 4 health boards for school age children. This represents coverage of around 80% of the pre-school child population. Analysis of a data extract from the 39-42 month check in 1998/99, used as an example, revealed that 8% of weight and height data were missing, and approximately 1% were implausible measures. Population and health board level estimates of prevalence of obesity and undernutrition were possible and are presented. Data on height and weight are routinely collected in school age children in all health boards, however only four health boards have growth data electronically available via the school CHSP. CONCLUSIONS: Growth data routinely collected as part of child health surveillance for Scotland can be used to estimate population prevalence of undernutrition and obesity. These can in turn be used to monitor trends at local and national level, to monitor achievement in relation to public health targets, identify risk factors and high risk groups, and to follow cohorts over time. We describe a system of surveillance for undernutrition and obesity and identify its strengths and weaknesses.

Adolescent↗
PubMed2005

Integrating quantitative and qualitative methodologies for the assessment of health care systems: emergency medicine in post-conflict Serbia.

BACKGROUND: Due to the complexity of health system reform in the post-conflict, post-disaster, and development settings, attempts to restructure health services are fraught with pitfalls that are often unanticipated because of inadequate preliminary assessments. Our proposed Integrated Multimodal Assessment - combining quantitative and qualitative methodologies - may provide a more robust mechanism for identifying programmatic priorities and critical barriers for appropriate and sustainable health system interventions. The purpose of this study is to describe this novel multimodal assessment using emergency medicine in post-conflict Serbia as a model. METHODS: Integrated quantitative and qualitative methodologies--system characterization and observation, focus group discussions, free-response questionnaires, and by-person factor analysis--were used to identify needs, problems, and potential barriers to the development of emergency medicine in Serbia. Participants included emergency and pre-hospital personnel from all emergency medical institutions in Belgrade. RESULTS: Demographic data indicate a loosely ordered network of part-time emergency departments supported by 24-hour pre-hospital services and an academic emergency center. Focus groups and questionnaires reveal significant impediments to delivery of care and suggest development priorities. By-person factor analysis subsequently divides respondents into distinctive attitudinal types, compares participant opinions, and identifies programmatic priorities. CONCLUSIONS: By combining quantitative and qualitative methodologies, our Integrated Multimodal Assessment identified critical needs and barriers to emergency medicine development in Serbia and may serve as a model for future health system assessments in post-conflict, post-disaster, and development settings.

Attitude of Health Personnel↗
PubMedDate not supplied

Phantoms in the snow: Canadians' use of health care services in the United States.

To examine the extent to which Canadian residents seek medical care across the border, we collected data about Canadians' use of services from ambulatory care facilities and hospitals located in Michigan, New York State, and Washington State during 1994-1998. We also collected information from several Canadian sources, including the 1996 National Population Health Survey, the provincial Ministries of Health, and the Canadian Life and Health Insurance Association. Results from these sources do not support the widespread perception that Canadian residents seek care extensively in the United States. Indeed, the numbers found are so small as to be barely detectible relative to the use of care by Canadians at home.

Adult↗
PubMed2003

Primary care: is there enough time for prevention?

OBJECTIVES: We sought to determine the amount of time required for a primary care physician to provide recommended preventive services to an average patient panel. METHODS: We used published and estimated times per service to determine the physician time required to provide all services recommended by the US Preventive Services Task Force (USPSTF), at the recommended frequency, to a patient panel of 2500 with an age and sex distribution similar to that of the US population. RESULTS: To fully satisfy the USPSTF recommendations, 1773 hours of a physician's annual time, or 7.4 hours per working day, is needed for the provision of preventive services. CONCLUSIONS: Time constraints limit the ability of physicians to comply with preventive services recommendations.

Adolescent↗
PubMed1998

Community occupational structure, basic services, and coronary mortality in Washington state, 1980-1994.

OBJECTIVE: Examine the association between county occupational structure, public expenditures, services availability, prevalence of risk factors, and coronary mortality rates, for 1980-1994, in Washington state. DESIGN: Washington's 39 counties were classified into three occupational structure categories: counties with the lowest percentages of the labor force in managerial, professional, and technical occupations were classified in category I; counties with the highest percentages were in category III. Directly age-adjusted coronary heart disease (CHD) mortality rates, aged 35-64 years, (from vital statistics and Census data), per capita expenditures (Washington Department of Revenue data), per capita services (U.S. Statistical Abstracts data), and the prevalence of CHD risk factors (BRFSS data) were calculated for each occupational structure category. RESULTS: CHD mortality rates and the prevalence of risk factors were inversely associated with occupational structure. Per capita expenditures for health, social, and employment services were 2.2 times, and for schools and recreation were 1.4 times higher in category III vs. I counties. Per capita numbers of child care, job training, employment services, exercise facilities, schools, and medical services were 1.5-6.4 times greater in category III vs. I counties. CONCLUSIONS: Strategies to improve community living conditions and decrease economic disparities between counties may be important to decrease geographic differences in premature CHD mortality.

Adult↗
PubMed2005

Urologic diseases in America Project: analytical methods and principal findings.

PURPOSE: The burden of urological diseases on the American public is immense in human and financial terms but it has been under studied. We undertook a project, Urologic Diseases in America, to quantify the burden of urological diseases on the American public. MATERIALS AND METHODS: We identified public and private data sources that contain population based data on resource utilization by patients with benign and malignant urological conditions. Sources included the Centers for Medicare and Medicaid Services, National Center for Health Statistics, Medical Expenditure Panel Survey, National Health and Nutrition Examination Survey, Department of Veterans Affairs, National Association of Children's Hospitals and Related Institutions, and private data sets maintained by MarketScan Health and Productivity Management (MarketScan, Chichester, United Kingdom), Ingenix (Ingenix, Salt Lake City, Utah) and Center for Health Care Policy and Evaluation. Using diagnosis and procedure codes we described trends in the utilization of urological services. RESULTS: In 2000 urinary tract infections accounted for more than 6.8 million office visits and 1.3 million emergency room visits, and 245,000 hospitalizations in women with an annual cost of more than 2.4 billion dollars. Urinary tract infections accounted for more than 1.4 million office visits, 424,000 emergency room visits and 121,000 hospitalizations in men with an annual cost of more than 1 billion dollars. Benign prostatic hyperplasia was the primary diagnosis in more than 4.4 million office visits, 117,000 emergency room visits and 105,000 hospitalizations, accounting for 1.1 billion dollars in expenditures that year. Urolithiasis was the primary diagnosis for almost 2 million office visits, more than 600,000 emergency room visits, and more than 177,000 hospitalizations, totaling more than 2 billion dollars in annual expenditures. Urinary incontinence in women was the primary cause for more than 1.1 million office visits in 2000 and 452 million dollars in aggregate primary cause for more than 1.1 million office visits in 2000 and 452 million dollars in aggregate annual expenditures. Other manuscripts in this series present further detail for specific urologic conditions. CONCLUSIONS: Recent trends in epidemiology, practice patterns, resource utilization and costs for urological diseases have broad implications for quality of health care, access to care and the equitable allocation of scarce resources for clinical care and research.

Cost of Illness↗
PubMedDate not supplied

Development of the New York State Nutrition Surveillance Program.

New York State established a Nutrition Surveillance Program (NSP) in 1984. Precedents for the program included the Pediatric Nutrition Surveillance System of the Public Health Service's Centers for Disease Control and Prevention and periodic food and nutrition surveys conducted by the National Center for Health Statistics and the Human Nutrition Information Service, Department of Agriculture. The first phase of NSP was connected to a new program, the Supplemental Nutrition Assistance Program (SNAP), which established support for more than 1,000 emergency food programs across the State. SNAP also expanded the home delivered meal program for the frail elderly and the Special Supplemental Food Program for Women, Infants, and Children. NSP provided information on the extent of unmet nutrition needs that was used to establish funding requests and provided data describing the characteristics of SNAP participants that were used in developing new SNAP program components. The second phase of NSP began in 1988. It identified populations that were thought to be at nutrition risk and compiled information about the extent of unmet need, the characteristics of the population, and the status of current nutrition programs to meet the needs. As a result of this review, NSP added a nutrition component to the Dental Survey of School Children; conducted a dietary survey; developed an inventory of information sources in all State agencies; and established an annual work plan using department of health objectives. The third phase of NSP is the policy and planning phase, monitoring the Year 2000 Objectives and the Five-Year Plan of the New York State Food and Nutrition Policy Council.

Aged↗
PubMed2003

Autoregression as a means of assessing the strength of seasonality in a time series.

BACKGROUND: The study of the seasonal variation of disease is receiving increasing attention from health researchers. Available statistical tests for seasonality typically indicate the presence or absence of statistically significant seasonality but do not provide a meaningful measure of its strength. METHODS: We propose the coefficient of determination of the autoregressive regression model fitted to the data () as a measure for quantifying the strength of the seasonality. The performance of the proposed statistic is assessed through a simulation study and using two data sets known to demonstrate statistically significant seasonality: atrial fibrillation and asthma hospitalizations in Ontario, Canada. RESULTS: The simulation results showed the power of the in adequately quantifying the strength of the seasonality of the simulated observations for all models. In the atrial fibrillation and asthma datasets, while the statistical tests such as Bartlett's Kolmogorov-Smirnov (BKS) and Fisher's Kappa support statistical evidence of seasonality for both, the quantifies the strength of that seasonality. Corroborating the visual evidence that asthma is more conspicuously seasonal than atrial fibrillation, the calculated for atrial fibrillation indicates a weak to moderate seasonality ( = 0.44, 0.28 and 0.45 for both genders, males and females respectively), whereas for asthma, it indicates a strong seasonality ( = 0.82, 0.78 and 0.82 for both genders, male and female respectively). CONCLUSIONS: For the purposes of health services research, evidence of the statistical presence of seasonality is insufficient to determine the etiologic, clinical and policy relevance of findings. Measurement of the strength of the seasonal effect, as can be determined using the technique, is also important in order to provide a robust sense of seasonality.

Journal Article↗
PubMed1988

Experiences with a statistical quality control system (QCS) for coagulation diagnostics parameters.

With the Quality-Control-Service (QCS) for blood coagulation a system for the statistical quality control of blood coagulation methods is presented. The system is based on the universal control plasma PreciClot which contains target values in the normal and abnormal range. As the control plasma is used daily from the participants for quality control exercises and datas are statistically analyzed each month this programme of quality assessment can be compared with a monthly ring trial. For the methods prothrombin time (PT/Quick), activated partial prothrombin time (APTT), fibrinogen assay (Fibrinogen) and thrombin time (Thrombin) datas of a survey period (January-December 1985) with 75 labs were evaluated. Calculated results for the methods are given and accuracy and precision of the methods are compared with the results of former ring trials. Based on the results the interlaboratory reliability of the methods is discussed and the advantages of QCS for blood Coagulation for a better information about quality of coagulation tests are presented.

Blood Coagulation Tests↗
PubMed2005

Birth rate and its correlation with the lunar cycle and specific atmospheric conditions.

OBJECTIVE: This study was undertaken to use the Arizona State birth certificate database for Phoenix metropolitan hospitals, in conjunction with National Weather Service records to determine whether there is a relationship between birth rate and meteorologic or lunar conditions. This study attempts to dispel or lend significance to beliefs among hospital staff that the phase of the moon and/or meteorologic conditions are related to birth rate. STUDY DESIGN: Birth records were limited to spontaneous vaginal deliveries, 37 to 40 weeks' gestation, in Phoenix, between 1995 and 2000 (n = 167,956). Daily birth counts were merged with daily surface weather statistics from the National Weather Service for Sky Harbor Airport, and records of lunar phase for the same period. RESULTS: The analyses revealed no significant correlates of birth rate. CONCLUSION: Although there exists a popular belief that the phase of the lunar cycle and weather conditions affect birth rate, no such evidence was found in this study.

Arizona↗
PubMed2000

[Analysis of the claims in a specialist primary care center].

OBJECTIVE: To analyze the written claims attended at a specialists unit of a Primary Health Care Center in Nou Barris, Barcelona. DESIGN: Evaluative observational study. SETTING: Health Care District of Nou Barris, with a population of 170,849. Period of study covers claims attended between 1-6-1996 to 31-12-1998. PARTICIPANTS: 220 claims registered at a specialist unit of a primary health care center. MEASUREMENTS: Claimer's age and gender, heath care net of origin, claim's motive, claimed person or service and health care activity. Statistical analyses performed included descriptive techniques and Khi-square (chi 2) tests (alpha = 0.05). RESULTS: Cumulative incidence of claims was 4.03 per 10,000 person-year in 1996, 4.70 in 1997 and 5.88 in 1998 (p = 0.0128). 220 claims were analyzed, 53.1% of them came from women. Mean age was 51.12 +/- 15.8 years. 60% of claims came from people using the traditional health care net, and 40% from reformed health care net. Mean time of response was 12.3 +/- 12.7 days. Ophthalmology was the most claimed service (18.64%), followed by "the system" (13.64%), and "the center" (13.64%). 64% of claims pointed to specialists, and don't adjusted with their health care activity (p = 0.0001). Relative risk of being claimed at the specialists unit was 2.91, compared to the rest of the primary health care centers of Nou Barris in 1998. CONCLUSIONS: Health care user's claims become useful to detect some difficult aspects. However, improvements in the methodology of their evaluation are needed.

Adult↗
PubMed1995

Impact of home-based respite care on families of children with chronic illnesses.

The recent dramatic medical and technological advances have meant that many children, who would have died previously of their chronic illnesses, now survive and live longer with their families. The purpose of this undertaking was to evaluate whether the implementation of home-based pediatric respite care reduced stress and improved the quality of life for families caring for children with chronic illnesses. Utilization of respite services was associated with a statistically significant (p < .05) reduction in somatic complaints by primary caregivers. There was also a trend in the data suggestive of an association between respite utilization and a subsequent decrease in the number of hospitalization days required by children (p < .07). Public health policy implications of the intervention are discussed.

Adolescent↗
PubMed1997

Inmate suicides in the Correctional Service of Canada.

This article presents descriptive statistics on the 66 suicides occurring in federal institutions in Canada over a 4-year period. Criminological and institutional factors of those who committed suicide included lengthy involvement in the criminal justice system, a greater likelihood of being incarcerated for robbery or murder, and involvement in institutional incidents of a serious nature. In addition, 62% of the inmates who committed suicide had been transferred from other institutions within 6 months prior to suicide, though 59% evidenced no indicators of suicidal intent and 44% were not considered to be depressed at the time of suicide. Family problems (29%) were the most commonly hypothesized motivating factor in the suicides, followed by denial of a request for appeal, parole, or transfer (26%), fear of other inmates (24%), and substance abuse problems (21%). Current and planned suicide prevention and intervention strategies of the Correctional Service of Canada are discussed in the context of these findings.

Adult↗
PubMed2001

Accounting for overlap? An application of Mezzich's kappa statistic to test interrater reliability of interview data on parental accident and emergency attendance.

STUDY RATIONALE: The number of interview studies with service users is rising because of growth in health services research. The level of agreement between multiple interview data coders requires statistical calculation to support results. Basic kappa statistics are often used but this depends on having mutually exclusive data. Researchers should be aware that this is not valid when an interview word or paragraph can be coded into more than one category. The 'proportional overlap' kappa extension by Mezzich et al. (1981, Journal of Psychiatric Research 16, 29-39) has been investigated as an original solution. OBJECTIVES: To assess the level of agreement beyond chance between several raters of interview data by applying the 'proportional overlap' kappa statistic by Mezzich et al. to verbal interview data. The clinical area investigated was child attendance at an Accident and Emergency Department, where parental attendance experiences have been under-explored. METHODS: Two researchers using a coding schedule coded a random sample of interview transcripts. These data were applied to Mezzich's procedure; coder 1 notes that a paragraph refers to category A and B but coder 2 notes A, B and C. The total agreement overlap in this case was 0.66 because two actual agreements out of three possible agreements were made. This was repeated for each paragraph and divided by the number of coding pairs. All agreement values were summed then subsequently divided by the total number of paragraphs to get Po (total number of observed agreements) and by the total number of coding pairs to get Pe (total number of agreements by chance alone). Po and Pe were used in the basic kappa formula to assess interview coding reliability. RESULTS: The overall mean Po was 0.61, the mean Pe was 0.32, with a kappa score of 0.43; a moderate level of agreement which was statistically significant (t=4.8, P < 0.001, d.f.=23). CONCLUSION: Mezzich's procedure may be applied to interview data to calculate agreement levels between several coders.

Accidents↗