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PubMed1992

[Breast feeding in a metropolitan area: (I). Analysis of the current situation].

In order to elaborate a program to promote breast-feeding, it is necessary to know in advance the difficulties encountered by the mothers in the target population. For this purpose, we surveyed a sample of 400 mothers who were representative of those who gave birth in Móstoles in 1989. We found that 56% of the mothers did not exceed two months of breast-feeding. Breast-feeding was shorter in low-income families. Its duration was influenced by the husband's and grandmother's opinions and also by previous failure with elder siblings. Mothers made their choice of feeding method before getting pregnant. We also found that most health professionals acted unsatisfactorily. Other unfavorable factors included excessive insecurity of the mother and misinformation.

Breast Feeding↗
PubMed1992

[The new biomedical and health research program of the European Economic Community--BIOMED 1 (1990-94)].

The new EEC Biomedical and Health Research Programme (BIOMED 1) is presented. After a brief introduction on the background of the Programme--in which an overview of the ongoing Medical and Health Research Programme (MHR 4) is given--the main features of the new Programme are pointed out. On what concerns its aims and objectives, concertation and coordination of national research programmes at community level are stressed as well as the need to apply to the maximum possible extent the principles of subsidiary and community added value, in order to ensure an European dimension to the actions which are going to be supported and to achieve the harmonization of research methodologies, procedures and data. As regards the content of the Programme a description is made of its four main areas: Area 1--Development of co-ordinated research on prevention, care and health systems (main topics: drugs and the administration of medicines; risk factors and occupational health; biomedical technology; health services research); Area 2--Major health problems and diseases of great socio-economic impact (AIDS; cancer; cardiovascular disease; mental illness and neurological disease; the ageing process, and age-related health problems and handicaps); Area 3--Human Genoma Analysis (improvement of the genetic map; physical mapping; DNA sequencing; data-handling and databases; technology development and applications of human genome analysis); Area 4--Research on biomedical ethics (compilation of legislation; evaluation of questions of biomedical ethics linked with the Programme; evaluation of the social impact of the Programme and its risks).(ABSTRACT TRUNCATED AT 250 WORDS)

European Union↗
PubMed1989

What physicians should know about small area variation analysis.

Geographic variations in the use of medical care may occur because of differences in patient severity of illness, patient access or use of medical care, physician practice patterns, availability of technology, economic incentives, and malpractice concerns. These variations are leading to greater scrutiny of appropriateness and cost effectiveness of medical care.

Health Services↗
PubMed1989

Area variation of avoidable causes of death in Auckland, 1977-85.

An area analysis is presented of deaths in Auckland that were ostensibly avoidable, by appropriate medical intervention and treatment. Mortality data from the National Health Statistics Centre for the period 1977-85 were used in the analysis. The definition of an avoidable death was based on the International Classification of Diseases (ICD) code using established criteria. Eight percent of deaths of people under 65 years of age met the criteria. The basic spatial entity for the analysis is the census area unit and maps of Auckland are presented to show the distribution of avoidable mortality. It is found that there are significant and consistent spatial variations. Three areas with avoidable mortality that is generally higher than elsewhere are apparent: in south Auckland; to the north-west of the central urban sector centered on Grey Lynn; and in the eastern parts of the central sector from Glenn Innes to Onehunga.

Adolescent↗
PubMed1993

[Bulbar hematoma of the olivary area. An analysis of the autonomic syndrome].

The consequences of an anterolateral medullary hematoma in a 50 year old patient are reported. The lesions principally involved the inferior olive nuclei, the lateral reticular nucleus, and, partially, the nucleus ambiguus. Long-lasting postural control deficit and hypotonia were observed, associated with alpha motoneurons hyperexcitability. Analysis of the heart rate regulation showed a severe reduction of the normal accelerating reactions and a relative preservation of slowing down reactions that suggested a deficit of the ortho-sympathetic control. Unilateral palsy of the tongue and pharynx was also observed without sensory or sensorial deficit. The long term course was favourable.

Autonomic Nervous System Diseases↗
PubMed1989

[Skiing injuries: analysis in a German ski area].

An analysis of frequencies, causes and injury patterns in skiing with emphasis to knee injuries was done. In our clinic next to the slopes of the ski resort Pfronten and the skiing region Ostallgäu skiing injuries contribute with 58% of all stationary treated sports injuries to a big part of our in-patients. Out of all skiing injuries 52% are ligament lesions and 63% concern the knee joint. Thus the knee ligament lesions are leading in our sports related orthopaedic surgery. The results of this analysis were compared with data from Swiss skiing areas and Austrian and German university clinics. Possible ways of injury prophylaxis are presented.

Adult↗
PubMed2005

Mortality and socioeconomic deprivation in census tracts of an urban setting in southern Europe.

In southern European cities, research on deprivation and mortality inequalities using small-area analysis is recent. In many countries, the census tract (CT) is the smallest territorial unit for which population data are available. The aim of this study was to examine the association between mortality from all causes and socioeconomic deprivation in CTs in Barcelona (Spain). A cross-sectional ecologic study was carried out using mortality data for 1987-1995 and 1991 census variables. Mortality data were obtained from death certificates. Socioeconomic deprivation indicators were drawn from the census and included unemployment, inadequate education, and low social class. They were correlated, and a deprivation index was elaborated with them. The analysis was descriptive, and multivariate Poisson regression models were adjusted. The most deprived CTs tend to present higher mortality (49.7% of CT in the quartile associated with greatest deprivation were included in the top male mortality quartile and 40.4% in the top female mortality quartile), whereas the less deprived ones present lower mortality. For male mortality, the risk of dying among those in the quartile representing most deprivation is from 25 to 29% higher (depending on the indicator chosen) than the least deprived quartile, and for women, it is from 12 to 14% higher. We concluded that the mortality from all causes in the CT of a southern European city has shown a clear positive association with a variety of socioeconomic deprivation indicators drawn from the census. Studies of this nature may help to orient more specific studies in which CTs are grouped together as a function of particular population and/or health characteristics.

Bias↗
PubMed1999

Fractures of the femoral shaft in children. Incidence, mechanisms, and sociodemographic risk factors.

BACKGROUND: Fractures of the femoral shaft in children are caused by major musculoskeletal trauma and result in high direct and indirect medical costs. To date, the American literature has focused on treatment options and outcomes, but the epidemiology of these injuries has been generalized from Scandinavian studies reported in the 1970s and early 1980s. The goals of the current study were (1) to determine the age, gender, and race-specific rates and mechanisms of fractures of the femoral shaft in children in a large United-States-based population and (2) to identify associations between the rates of these fractures and multiple sociodemographic indicators. Such information is vital for preventive efforts. METHODS: The Hospital Discharge Database of the Maryland Health Services Cost Review Commission for the years 1990 through 1996 was used to obtain demographic data on 1485 cases of acute fracture of the femoral shaft in patients who were less than eighteen years old, and data from the United States Bureau of the Census for the state of Maryland for the year 1990 were used to obtain denominator data. Reliable external-cause data were available from the 1995 and 1996 databases for 472 patients. Small-area analysis was performed at the zip-code level to determine associations between numerous sociodemographic indicators and the rate of femoral shaft fracture. RESULTS: The annual rate of femoral shaft fracture in children was 19.15 per 100,000. With regard to age, there was a bimodal distribution, with peaks at two and seventeen years. Boys had higher rates of fracture than did girls at all ages, and blacks had higher rates than did whites. The primary mechanisms of fracture were age-dependent and included falls, for children less than six years old; motor vehicle-pedestrian accidents, for those six to nine years old; and motor-vehicle accidents, for teenagers. Firearm-related injuries accounted for 15 percent of the fractures among black adolescents. Adverse socioeconomic conditions were significantly associated with higher rates of fracture. CONCLUSIONS: The rates and mechanisms of femoral shaft fractures in children depend on age, gender, and race. For children living in the United States today, the epidemiology of these fractures is different than that described in earlier, Scandinavian reports.

Adolescent↗
PubMed1993

Outcomes Research in Orthopaedics.

A new agenda in outcomes research has developed in the past decade. The stimulus has come as the result of rapidly increasing health care costs, marked variations in utilization of health care services, and deficiencies in the research literature. Outcomes research includes methods such as analysis of large databases, small-area analysis, structured literature reviews (meta-analysis), prospective clinical trials, decision analysis, and guideline development. Clinical research should be prospective and should employ modern statistical and assessment methods. The focus of this research is on patient-oriented outcomes of care rather than on assessments of the process of care. To illustrate these applications in orthopaedics, lumbar spine fusion with internal fixation for "spinal instability" is presented as an example. Completed large-database analyses, small-area variation studies, and a meta-analysis indicate the need for clinical studies. An outline of the form and content of such a study is presented.

Journal Article↗
PubMed2004

Validity of rim area measurements by different reference planes.

PURPOSE: Reference plane description of the neuroretinal rim in scanning laser tomography should correctly represent optic nerve morphology. We evaluated how well rim area analysis by different reference planes agreed with the appearance of rim area in disc images. METHODS: Three expert observers subjectively and repeatedly analyzed rim area in Heidelberg Retina Tomograph (HRT) images so that each optic disc was measured six times in 100 eyes, 50 normal and 50 glaucoma. Rim area was evaluated globally and in 30 degree sectors. Agreement between rim appearance, as subjectively analyzed, and objective analysis by an experimental reference plane, the standard reference plane, and a reference plane fixed 320 microm below the reference ring was assessed in HRT images. RESULTS: Subjective analysis of rim area in HRT images was consistent between expert observers. Their analysis of rim appearance agreed more closely with experimental reference plane analysis than analysis by the standard or 320-microm reference planes; this was true globally and in every region of the nerve (P = 0.000). The experimental reference plane yielded higher estimates of rim area than did the standard or 320-microm reference planes. CONCLUSION: There was closer correspondence between the appearance of the neuroretinal rim in images and description by the experimental reference plane compared with description by the standard and 320-microm reference planes.

Aged↗
PubMed2003

Rates of advanced spinal imaging and spine surgery.

STUDY DESIGN: Small area analysis. OBJECTIVES: To determine the association between the rates of advanced spinal imaging and spine surgery across geographic areas. SUMMARY OF BACKGROUND DATA: The rates of spine surgery in the United States have increased along with a concurrent rise in the use of advanced spinal imaging: CT and MRI. Spine surgery rates vary six-fold across geographic areas of the United States. Differences in patient populations and health care supply have explained only about 10% of this variation. METHODS: We used a random 5% sample of Medicare's National Claims History Part B files for 1996 and 1997 to determine procedure rates across 306 Hospital Referral Regions. We analyzed the association between spinal imaging and spine surgery using linear regression. Main outcome measures were rates of procedures and coefficients of determination (R2). RESULTS: The rates of advanced spinal imaging (CT and MRI combined) varied 5.5-fold across geographic areas. Areas with higher rates of MRI had higher rates of spine surgery overall (r = 0.46) and spinal stenosis surgery specifically (r = 0.37). The rates of advanced spinal imaging accounted for 22% of the variability in overall spine surgery rates (R2 = 0.22, P < 0.001) and 14% of the variability in lumbar stenosis surgery rates (R2 = 0.14, P < 0.001). A simulation model showed that MRIs obtained in the patients undergoing surgery accounted for only a small part of the correlation between MRI and total spine surgery rates. CONCLUSIONS: A significant proportion of the variation in rates of spine surgery can be explained by differences in the rates of advanced spinal imaging. The indications for advanced spinal imaging are not firmly agreed on, and the appropriateness of many of these imaging studies has been questioned. Improved consensus on the use and interpretation of advanced spinal imaging studies could have an important effect on variation in spine surgery rates.

Aged↗
PubMed1997

The antibody response in human autoimmune thyroid disease.

1. The analysis of the antibody response in autoimmune thyroid disease has followed several historical trends. It was the investigation of thyroid-reactive antibody that allowed the initial characterization of the three principle thyroid autoantigens, thyroglobulin, thyroid peroxidase and the thyroid stimulating hormone receptor. 2. Analysis can be grouped under two broad areas: analysis of the physiological and pathological effects of the antibody, and analysis of the structure of the antibodies themselves. This review will focus on the latter. 3. Within recent years there has been a great increase in knowledge of thyroid-reactive antibody structure, principally through the adoption of phage display combinatorial library methodologies. While this latter technique has established some general principles for antibodies to thyroglobin and especially thyroid peroxidase, there is still a substantial gap in our knowledge of the antibody response to the thyroid stimulating hormone receptor. 4. Thyroid peroxidase antibodies have a relatively restricted V-region usage, and there is a correlation between the V-regions used and the epitope on thyroid peroxidase bound. In particular the V kappa light chain V kappa I(O12), is associated with reactivity to one epitope. 5. The purpose of this review is to bring together the latest results concerning the molecular analysis of the antibody response in autoimmune thyroid disease, to highlight areas of ignorance and conflict, and to discuss the methods adopted to circumvent the problems associated with analysis of the antibody response.

Antibody Formation↗
PubMedDate not supplied

[An analysis of mortality in small areas: the problem of residency].

This study was designed to assess the influence of residence misclassification in small areas mortality analysis. Data from a health area in the Valencian Community, which has high mortality from coronary diseases (ICD410-414) has been used. Deaths occurred during 1988 (n = 190) have been divided, using the information reported in the Boletín Municipal de Defunción in two groups: with (n = 109) and without (n = 81) private residence in the area. The Standardized Mortality Ratio (SMR) for the studied diseases was 219.8 (CI 95%: 257.6; 182) for males and 174.8 (CI 95%: 218.7; 130.9) for females. When deaths of persons without residence in the area subtracted from the numerator a change in the SMRs is observed to 120.8 (CI 95%: 149.3; 92.3) in males and 135.9 (CI 95%: 175; 96.2) in females. The excess in coronary heart diseases observed in the area could be partially explained by the "Benidorm-Effect" produced by an important volume of foreign residents with a high risk of dying from these diseases which are not included in the area census.

Confidence Intervals↗
PubMed1996

International comparison of baccalaureate nursing degrees: collaboration in qualitative analysis.

This paper describes a study which investigated the perceived similarities and differences of a selection of baccalaureate nursing degrees from different continents. An international research team was formed, and by using a modified version of the Delphi process and nominal group techniques the group undertook a qualitative analysis of curriculum documents. The major areas analysis were: aims, content, methods and assessment. Under these headings the group produced a list of key issues supported by a number of indicative statements by collating the independent analyses undertaken by each of the team members. Examples of findings are that critical thinking and personal development are most obvious in aims but that the progression of curricula may not achieve this, there are differences in 'western' and 'asian' orientations to the concept of personal autonomy. Sciences are valued more than arts or humanities. The lecture method as well as practice placement dominate the teaching methods. Transcultural nursing is not significant except where there are two therapeutic ideologies in existence. Assessment methods are largely summative. The findings have application in the development of credit transfer and international exchange schemes. The conclusions highlight areas of special considerations when designing such schemes.

China↗
PubMed2005

Capability of B-type natriuretic peptide (BNP) and amino-terminal proBNP as indicators of cardiac structural disease in asymptomatic patients with systemic arterial hypertension.

BACKGROUND: The aim of the present study was to prospectively evaluate the diagnostic utility of B-type natriuretic peptide (BNP) and amino-terminal proBNP (NT-proBNP) measurements for the detection of cardiac structural disease in asymptomatic patients with systemic arterial hypertension and to test the hypothesis that the 2 analytes are equally useful in this clinical setting. METHODS: We studied a consecutive series of 149 asymptomatic patients referred for echocardiographic evaluation of the cardiac effects of systemic arterial hypertension. Diagnosis of cardiac structural disease was based on the presence of systolic or diastolic dysfunction, left atrial dilatation, left ventricular dilatation or hypertrophy, pulmonary hypertension, and wall motion or valvular abnormalities. Blood concentrations of BNP and NT-proBNP were measured by 2 commercially available assays (Abbott AxSYM and Roche Elecsys, respectively). Diagnostic accuracies of BNP and NT-proBNP were assessed by ROC curve analysis. Areas under the curves were compared by analysis of equivalency. RESULTS: In distinguishing between hypertensive patients with cardiac structural disease (n = 118) and hypertensive patients without (n = 31), areas under the curves were 0.740 (95% confidence interval, 0.662-0.808) for BNP and 0.762 (0.685-0.828) for NT-proBNP and were significantly equivalent (P = 0.015). Cutoff values with a 90% sensitivity for cardiac structural disease were 17 ng/L for BNP and 39 ng/L for NT-proBNP, with 29% and 32% specificity, respectively. CONCLUSIONS: BNP and NT-proBNP have similar capabilities for detecting cardiac structural disease in asymptomatic patients with systemic arterial hypertension. However, in the setting evaluated, a screening strategy relying on measurement of BNP or NT-proBNP may be of limited value because of the low specificity at the selected cutoff values.

Aged↗
PubMed1997

[Risk profile: multivariate cluster analysis of urban small areas based on socioeconomic indicators - census tracts from the Greater Rio de Janeiro Metropolitan Area]

A method based on small area data analysis was developed to build a health risk classification for the Greater Rio de Janeiro Metropolitan Area. The approach uses 1991 census data and studies data pertaining to sanitation, ownership and type of housing, size and occupancy of the household, demography, schooling, and income. Principal component analysis applied over each dimension allowed for the choice of 15 variables, which summarized most of the observed variances. Additional analysis with these variables suggested that just six variables are sufficient for the construction of a classification using k-means method of multivariate cluster analysis. Five classes were obtained: (A) high income; (B) lower income; (C) poor; (D) low schooling and income; (E) low-level access to sanitation. The existing inequality in each of the geopolitical established areas was clearly identified. The proposed method allowed for the construction of compound indices to evaluate quality of life, based on widespread and easily obtained data (the census). Moreover, the method contributed to the detection of socioeconomic inequality, identifying, not only the larger poor regions but also the small excluded areas.

Journal Article↗