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Biomedical subjects

D A Goldman

Publications and source records attributed to D A Goldman.

18 recordsLinked to original sources
PubMed2000

Are standardized mortality ratios valid for public health data analysis?

Standardized mortality ratios (SMRs) have been criticized as lacking validity, and it has been recommended to use standardized rate ratios (SRRs) instead. A review of the epidemiology literature and standard epidemiology textbooks showed disagreement concerning the validity of SMRs and a lack of data to support claims concerning their validity. Therefore, we sought to determine the validity of SMRs in public health data analysis. Simulations were carried out using widely disparate study population age distributions and disease rates encountered in public health data analysis. We compared SMRs and SRRs as absolute measures of increased mortality in a population, and for ranking mortality in different populations. The simulations showed that SMRs changed by 6 per cent to 8 per cent when the age distribution was changed from that of a 'young' age distribution to that of an 'old' age distribution. In comparison, SRRs changed by 4 per cent to 5 per cent when the age-adjustment standard was changed from the 1940 U.S. Census population to the 1990 U.S. Census population. County rankings by SRR were somewhat more similar among themselves than when compared with rankings by SMR, but the differences were not large. Based on our findings, SMRs are of similar usefulness to SRRs in public health data analysis, will lead to similar conclusions, and may be used to compare different geographic areas.

Adolescent↗
PubMed1998

Language differences in interpretation of breast cancer health messages.

BACKGROUND: Little is known about how women interpret terminology used in breast cancer messages. The authors assessed the understanding of common cancer terms and whether understanding differed by language of interview. METHODS: In interviews, low-income women 50 years old or older were asked open-ended questions about the meanings of specific terms and phrases in commonly used health messages. RESULTS: Of 232 completed interviews, 167 were conducted in English and 65 in Spanish. Both English- and Spanish-speaking women poorly understood the terms "risk factors," "at risk," and "cancer." Spanish speakers were less likely to provide technical definitions of "diagnosed" and "mammogram" and had different interpretations of several cancer terms compared with English speakers. CONCLUSIONS: Cancer terms mean different things to English and Spanish speakers. Client education could be vastly improved if these cultural differences in interpretation were addressed.

Aged↗
PubMed1998

Improving the quality of care for children in health systems.

OBJECTIVE: To summarize the state of the art in quality improvement, review its application to care for children, and define the information that will be needed so that care for children can be further improved. PRINCIPAL FINDINGS: Health services for children exhibit numerous deficiencies in quality of care. The deficiencies cross all major domains of pediatric care--preventive services, acute care, and chronic care--and provide the opportunity for creative application of improvement strategies with a potential to benefit the health and well-being of children. Approaches to quality improvement have changed over the past two decades from those emphasizing the inspection of structural aspects of care and the imposition of sanctions to more dynamic strategies that emphasize measurement and comparison to motivate change; the use of evidence to specify aims for improvement; and the adoption of a variety of management strategies adapted from business and the social sciences to achieve these aims. These modern approaches to quality improvement have rarely been subjected to rigorous testing of their effectiveness. Moreover, their application in pediatrics has been less widespread than in adult healthcare. For children, several aspects about health services, such as the relative rarity of chronic illness, the important effects of social factors on health, and the limited cost, make some of these approaches even more challenging and may require new approaches or meaningful modifications. RECOMMENDATIONS: Research to understand better the general process of improvement will benefit improvement efforts for children. Research that builds the base of knowledge about best practices for children--effectiveness research--will also result in an enhanced capacity for improvement of those systems that care for children's health. Quality of care for children would be enhanced by targeted research examining ways both to foster improvement across segments of society, and to make recommendations for care more sensitive to children's development and environmental context. Research that supports incorporating the child's perspective into care is both uniquely challenging to perform and central to improving pediatric care.

Adult↗
PubMed1997

Sustaining CQI.

Explore the source record for details and available documents.

Attitude of Health Personnel↗
PubMed1994

Survey of El Paso physicians' breast and cervical cancer screening attitudes and practices.

One hundred and ninety-eight primary care physicians in El Paso, Texas, were surveyed for their practices and attitudes concerning breast and cervical cancer screening. The response rate was 83%. For women 40-49 years old, 77% of respondents stated that they ordered a screening mammogram at least every two years. For women 50-74 years old, 73% said they ordered an annual screening mammogram. For women 75 years and older, 61% stated they ordered an annual screening mammogram. For women 40 years or older, 89% of respondents said they performed annual or more frequent clinical breast examinations. Eighty-four percent of respondents stated they ordered a Pap smear every 1-3 years, both for pre- and post-menopausal women. The most common reasons given for not ordering or doing a breast or cervical screening exam were patient refusal, knowledge that other doctor performs exam, high price, inadequate insurance, patient not under regular care, do not see patient for gynecologic care, and patient being seen for different reason. Seventy percent of respondents do vaginal smears on women who have had a total hysterectomy for a benign condition, and 38% use a cytobrush for endocervical sampling. Respondents were generally more comfortable with their ability to do Pap smears (72% comfortable, 1% uncomfortable) than they were in performing clinical breast examinations (52% comfortable, 4% uncomfortable). Obstetricians and gynecologists were more likely than other physicians to do vaginal smears, use a cytobrush, and feel comfortable with their Pap smear technique.

Adult↗
PubMed1992

Multiple realities. Teaching rounds in an inpatient pediatric service.

Teaching rounds are a mainstay of most educational programs for interns and residents, but little is known about how they are conducted and the role they play in house staff members' learning. We performed a qualitative study of teaching rounds in an inpatient adolescent service using five data sources: observations, interviews, house staff ratings, results of a house staff retreat, and documents outlining faculty responsibilities. Interns, senior residents, and faculty members expressed differing views regarding the purpose, process, and content of rounds; mutual roles and expectations; and time management. An interactive teaching format focused around the visit of a patient to the conference room stimulated house staff interest and learning to a greater extent than did more traditional case presentations and lectures. These results suggest a need to develop a consensus among faculty and house staff regarding the purpose, content, and process of rounds.

Adolescent↗
PubMed1990

Coordinate expression of lactase-phlorizin hydrolase mRNA and enzyme levels in rat intestine during development.

The development of rat intestinal lactase-specific activity displays a well-known post-weaning decline. In contrast, total lactase activity increases to reach maximal levels around weaning, and remains high subsequently. In order to elucidate the molecular basis for these patterns, a rat lactase cDNA was isolated and characterized, and used in the quantification of lactase mRNA during development. This lactase cDNA uniquely hybridized to a 6.8-kilobase mRNA in the small intestine. To assess the amount of lactase mRNA encoding for lactase enzyme activity in the small intestine, total intestinal RNA was isolated and analyzed by Northern and dot-blot hybridization. The pattern of total lactase mRNA during development followed that of total lactase activity, suggesting that over this time span the level of lactase activity is primarily controlled at the transcriptional level. However, the magnitude of increase of total lactase activity during lactation compared to that of total lactase mRNA suggests that additional mechanisms are involved in regulating lactase levels. Analysis of the regional distribution of lactase mRNA along the small intestine at 14 days revealed that mRNA was high in the proximal three regions, but was dramatically lower in the distal regions. Total lactase activity, in contrast, displayed maximum activity in the mid-intestine with decreased levels both proximally and distally. Thus, lactase activity in the intestine appears to be regulated during development predominantly by transcriptional mechanisms, while alterations during lactation, and along the proximal to distal gradient, are the result of other control mechanisms.

Aging↗
PubMed1988

Definition and identification of homology domains.

A method is described for identifying and evaluating regions of significant similarity between two sequences. The notion of a 'homology domain' is employed which defines the boundaries of a region of sequence homology containing no insertions or deletions. The relative significance of different potential homology domains is evaluated using a non-linear similarity score related to the probability of finding the observed level of similarity in the region by chance. The sensitivity of the method is demonstrated by simulating the evolution of homology domains and applying the method to their detection. Several examples of the use of homology domain identification are given.

Algorithms↗
PubMed1978

Group C streptococcal surgical wound infections transmitted by an anorectal and nasal carrier.

Streptococcus equisimilis (Lancefield group C), an unusual cause of nosocomial surgical infection, was isolated from two orthopedic postoperative wound infections. Both operations had been performed by the same surgeon within a three-day period. Examination of the surgeon revealed perianal dermatitis from which S. equisimilis was isolated. The organism was also recovered from the surgeon's nose and rectum. The wound infections responded to treatment with penicillin derivatives. The surgeon was successfully treated with topical bacitracin and oral penicillin and vancomycin. This report documents the pathogenicity of the C Streptococcus in postoperative infection and suggests a possible nosocomial source of the organism.

Adolescent↗
PubMed1977

Scarlet fever and group A streptococcal surgical wound infection traced to an anal carrier.

Four patients developed group A streptococcal wound infections shortly following orthopedic surgery. Two of these patients developed scarlet fever which provided an early indication of the presence of a streptococcal epidemic. A single antigenically characteristic strain of group A streptococci was recovered from the wounds of all four patients and from the anus of one surgeon who had participated in the surgery on three of the patients.

Adolescent↗
PubMedDate not supplied

Validity of Pap smear and mammogram self-reports in a low-income Hispanic population.

This study measures the validity of self-reported mammography and Pap smear usage in Mexican-American women. We compared Pap smear and mammography reports in medical records to self-reports obtained in a household survey of 450 women in El Paso, Texas. The women were generally low-income, older, and Spanish-speaking. Forty-six percent of self-reported Pap smears in the previous year were verified (60.8% within previous two years, 67.1% within previous three years). Forty-nine percent of self-reported mammograms within the previous year were verified (74.7% within previous two years). For both Pap smears and mammograms, twice as many tests in the past five years were reported as were documented. Self-reports of Pap smears at a public health clinic were more valid than those at other sites. Denials of mammography within the past five years were more accurate (97.5%) than denials of Pap smears (81.8%). We conclude that self-reports of mammograms and Pap smears in Mexican-American women greatly overestimate the prevalence of screening. Intensive cancer prevention activities in this population are needed to approach the Year 2000 Objectives set by the U.S. Department of Health and Human Services.

Adolescent↗
PubMedDate not supplied

The EPIGRAM computer program for analyzing mortality and population data sets.

EPIGRAM is a computer program designed to improve access to State-level underlying cause mortality data. The program produces results for population, deaths, death rate, age-adjusted death rate, years of potential life lost (YPLL), YPLL rate, and confidence intervals. Results can be compared variously among age groups, counties, causes of death, races, regions, and years. The program's menu-driven interface facilitates the selection or modification of analysis parameters. Current selections are retained so the user can modify one parameter at a time. Based on the parameters that the user selects, the program produces a series of tables, one for each instance of a particular parameter. Each output table has columns for male, female, and both sexes combined, and an indefinite number of user-defined rows for age groups, causes of death, counties, races, regions, or years. EPIGRAM has major advantages over other methods for analyzing mortality and population data. The program uses relatively small amounts of memory and disk space, executes rapidly, is flexible, can be used by inexperienced computer users, provides online help screens and tutorials, and runs under DOS or UNIX without modification. The program currently is used to analyze mortality and population data for Texas. Although it is not currently available for distribution, support is being sought for its evaluation and possible implementation in State health departments to analyze data for other States, or other data sets, such as hospital discharge data or cancer incidence data.

Cause of Death↗