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PubMed1990

Sydney--a demographic profile.

"The present paper presents a demographic profile of [Sydney, Australia] as a teaching resource base. The paper briefly examines Sydney's recent population history, current patterns and likely demographic future. A Sydney region local government area data base is provided in an appendix for use in student exercises and other analyses. The statistical information presented in the tables through the paper and in the appendix provide a baseline for an on-going data file teachers will be able to maintain as relevant demographic data becomes available in the future. Demographic terms used in the paper are defined in a glossary at the end."

Australia↗
PubMed1992

M NET: a statewide referring physician computer network.

M NET, the Referring Physician Computer Network, is a joint project between the University of Michigan Medical Center (UMMC) and IBM. A graphical user interface was developed to allow referring physicians easy access to a variety of patient, clinical, and institutional data. File transfer mechanisms were created and current clinical database files and programs were enhanced and restructured to facilitate remote data transmission. M NET is currently installed in referring physician office sites across the state, with additional physician sites identified and program enhancements under development.

Computer Communication Networks↗
PubMed2003

Accidental alcohol poisoning mortality in the United States, 1996-1998.

This study examines the prevalence and patterns of mortality resulting from unintentional poisoning by alcohol (ICD-9 code E860) in the United States. Relevant data for the most recently available years (1996 through 1998) were derived from the Multiple Cause of Death public-use computer data files compiled by the National Center for Health Statistics (NCHS). Data on deaths ascribed to alcohol poisoning as either the underlying cause or as 1 of up to 20 contributing causes were selected and analyzed. The annual average number of deaths for which alcohol poisoning was listed as an underlying cause was 317, with an age-adjusted death rate of 0.11 per 100,000 population. An average of 1,076 additional deaths included alcohol poisoning as a contributing cause, bringing the total number of deaths with any mention of alcohol poisoning to 1,393 per year (0.49 per 100,000 population). Males accounted for more than 80 percent of these deaths. The rate was lower among married than unmarried people (i.e., never married, divorced, or widowed) and was inversely related to education. Among males, the alcohol poisoning death rate was higher for Hispanics and non-Hispanic Blacks than non-Hispanic Whites. Among females, racial/ethnic differences were small, but Black women had higher alcohol poisoning death rates than White or Hispanic women. Alcohol poisoning deaths tended to be most prevalent among people ages 35 to 54; only 2 percent of alcohol poisoning decedents were younger than age 21. Among deaths with a contributing cause of alcohol poisoning, almost 90 percent had an underlying cause related to some type of poisoning from other drugs.

Accidents↗
PubMed2005

Treatment of complicated and uncomplicated hypertension with nifedipine in Palestine.

OBJECTIVE: It is generally agreed that short acting calcium channel blockers (CCB) as nifedipine are not safe as the reflex increase in sympathetic activity and thus, their use in hypertension (HTN) is questionable. The objective of this study was to determine the extent of utilization of short acting nifedipine in the treatment of complicated and uncomplicated HTN in one of the major districts in Palestine, Nablus. METHODS: The data for this study were collected from patient's medical files. Data collection was made over a period of 6 months (April - October 2003) in Nablus, Palestine. The sample studied included 876 patients with cardiovascular diseases. Focus was made on the 262 patients with uncomplicated HTN and the 147 patients with both HTN and diabetes mellitus. RESULTS: A total of 247 (28.2%) patients in the study sample were receiving CCB. One third (33.7%) of patients with uncomplicated HTN were receiving CCB mainly as monotherapy with most of them (61%) were receiving the old generation nifedipine as a short acting formulation. Use of nifedipine was also more common among elderly patients above the age of 60 years. CONCLUSION: There was a tendency to use short acting nifedipine as antihypertensive monotherapy among patients with either uncomplicated or complicated HTN. This irrational use needs to be reviewed since it is associated with higher risks.

Calcium Channel Blockers↗
PubMed1985

[Statistical analysis of a file of angiologic data on a micro- computer. Discriminant analysis of occlusive impedance rheoplethysmography data].

The statistical analysis by multidimensional analysis of the data of a computerized file should lead to the improvement of the quality of the examinations. A discriminant analysis of the data of occlusive impedance rheoplethysmography allows a global analysis of all of the indices, by taking into account both their absolute values and their relative values. This results in a better compromise between the sensitivity and the specificity. The graphic representation gives an immediate conclusion and allows the functional outcome to be monitored.

Arterial Occlusive Diseases↗
PubMed1980

Computer programs for the radioactive microsphere technique. Determination of regional blood flows and other haemodynamic variables in different experimental circumstances.

Computer programs in FORTRAN IV have been designed to calculate regional blood flow values from injections of gamma radiation-emitting radioactive microspheres. The first program PRSO constitutes a file containing the names of organs, organ groups and systemic haemodynamic variables and data about the isotopes in use. The second program PRSI transfers the data of the particular experiment concerning protocol, systemic haemodynamic variables, organ weights, number of vials belonging to each organ and the radioactivity from each vial into a data file that is subsequently analyzed by the third program PRSII. One of 5 data conditions which later directs calculations in PRSII is determined by PRSI. PRSII deducts background radioactivity, decomposes the spectrum from the mixture of up to 6 nuclides using the "stripping' method, and corrects for isotope decay during the counting period. Depending upon the data condition, PRSII calculates one or more of the following variables: (i) cardiac output (CO); (ii) the distribution of CO; (iii) regional blood flow values and tissue vascular resistances; (iv) the distribution of blood flow within an arterial bed; (v) arteriovenous anastomotic blood flow; (vi) some specified systemic haemodynamic variables; and (vii) blood flow ratios. The systemic and regional haemodynamic data belonging to experiments are saved for later statistical analyses (e.g., mean, standard error of the variables, changes from the base line, comparison between two groups of experiments) by other programs. PRSO, PRSI and PRSII can be operated by investigators with little or no special training in computer use.

Animals↗
PubMed1994

Measuring the incidence of cancer in elderly Americans using Medicare claims data.

BACKGROUND: The Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute is the most frequently used and best estimate of the incidence of cancer in the United States. Although synthetic estimates based on the SEER information can be used to plan cancer prevention and intervention programs, the evaluation of these action programs and the monitoring of cancer incidence in states or other geographic areas requires information on the population for whom the program is directed. METHODS: The age-adjusted incidence of six cancers among persons 65 years of age and older for 1986-1987 living in the five states participating in the SEER program was compared with the incidence derived from hospitalization records contained in the Health Care Financing Administration's (HCFA) administrative data files. Age-adjusted incidence rates for 1990 developed from HCFA data for persons living in the nine SEER program areas were contrasted with the incidence rates for persons living in the rest of the United States and were developed for each of the 50 states and the District of Columbia. RESULTS: The comparison of the SEER and HCFA overall age-adjusted cancer incidence rates in the elderly for 1986-1987 showed that for four of the six cancers (breast, colon, lung, and corpus uteri) the rates differed by 5% or less. The HCFA derived rates were 6.37% and 7.65% greater than the SEER rates for prostate and esophagus cancer, respectively. The incidence of cancer between 1986 and 1990 was neither uniformly higher nor lower among elderly SEER program area residents compared with residents of the rest of the country. Incidence rates varied greatly among states for each of the cancers. CONCLUSIONS: HCFA administrative data can be used by states or other geographic units to monitor the incidence of cancer in the elderly as well as to plan and evaluate cancer prevention and intervention programs.

Age Factors↗
PubMed1996

An evaluation of the New Zealand graduated driver licensing system.

Young drivers have a disproportionately high risk of experiencing a road traffic crash. On 1 August 1987 a Graduated Driver's Licensing System (GDLS) was introduced in New Zealand. This system was designed to give young drivers (i.e. 15-24 years inclusive) experience in driving while being excluded from high risk driving situations. We sought to determine the impact of the GDLS on serious injury crashes. The source of the injury crash data was New Zealand's Health Information Services' national public hospital inpatient morbidity data files for the years 1979-1992 inclusive. We disaggregated the occupant data into three age groups 15-19 years, 20-24 years, and persons 25 years of age or older and compared their trends in injury. In order to determine whether the incidence of motor vehicle crashes was simply following trends in other injury events we also included two 15-19 year old non-traffic injury comparison groups. Using time series analyses we showed that the introduction of the GDLS was closely followed by substantial reductions in car crash injuries for all age groups, especially 15-19 year olds (23% reduction). After considering effects for older occupants we speculate that the effect is likely to be substantially less than 23%. An analysis of licensure data suggests that the reduction in crashes may, in large part, be attributable to an overall reduction in exposure.

Accidents, Traffic↗
PubMed1999

Analysis of gene expression data using self-organizing maps.

DNA microarray technologies together with rapidly increasing genomic sequence information is leading to an explosion in available gene expression data. Currently there is a great need for efficient methods to analyze and visualize these massive data sets. A self-organizing map (SOM) is an unsupervised neural network learning algorithm which has been successfully used for the analysis and organization of large data files. We have here applied the SOM algorithm to analyze published data of yeast gene expression and show that SOM is an excellent tool for the analysis and visualization of gene expression profiles.

Algorithms↗
PubMed1998

Management factors associated with swine breeding-herd productivity in the United States.

A database containing 24 key production measurements was created by abstracting data files of 673 U.S. farms which participated in the PigCHAMP data-share program in 1995. Summary statistics for breeding-herd performance data were presented for the Cornbelt and the South or Eastern regions. Eight models were built to assess the association between production system, operation management factors and productivity outcomes. Lactation length, percentage of multiple matings, parity of culled sows, percent gilts in the breeding-female inventory, and female culling rate were the management factors identified as having important associations with productivity outcomes. For example, shorter lactation length, higher percentage of multiple matings, and lower culling rate were associated with more pigs weaned per mated female per year. In addition, a lower percentage of gilts in the breeding-female inventory and a higher percentage of multiple matings were associated with fewer average non-productive female days. We recommend that producers change their management systems to decrease lactation length, the percentage of gilts in the breeding-female inventory, and female culling rate, and increase percentage of multiple matings in order to improve breeding-herd productivity on swine farms.

Animal Husbandry↗
PubMed1997

Comorbidity measurement in elderly female breast cancer patients with administrative and medical records data.

The inter-rater reliability, cross-source (Medicare claims versus medical record) agreement, and ability to predict all-cause mortality of three aggregate comorbidity indices were evaluated in a group of 404 elderly, incident breast cancer cases identified from the Virginia Cancer Registry and linked to Medicare administrative data files. Comorbidity was based on both medical records and Medicare claims data using indices from Charlson et al (1987), Satariano and Ragland (1994), and Kaplan and Feinstein (1974). Inter-rater agreement was good for all indices (kappas > or = 0.80). Agreement between comorbidity indices measured by claims and medical records was considerably poorer (kappas between 0.30 and 0.40). However, claims-based and medical records-based comorbidity indices were similarly associated with mortality. For the Charlson index, the index best predicting survival, the adjusted relative risk for an increase from a lower to higher comorbidity category was 1.48 (95% confidence interval 1.23, 1.78) based on medical records compared to 1.53 (95% confidence interval 1.23, 1.93) based on Medicare claims. The claims-based Charlson index score still appeared to be associated with survival (relative risk = 1.30; 95% confidence interval = 1.00, 1.70) after controlling for the medical records-based score. This suggests that both comorbidity data sources add valuable prognostic information and, conversely, that the use of either source alone will result in some misclassification of comorbidity.

Aged↗
PubMed2004

The relationship of Medicaid payment rates, bed constraint policies, and risk-adjusted pressure ulcers.

OBJECTIVE: To examine the effect of Medicaid reimbursement rates on nursing home quality in the presence of certificate-of-need (CON) and construction moratorium laws. DATA SOURCES/STUDY SETTING: A single cross-section of Medicaid certified nursing homes in 1999 (N = 13,736). STUDY DESIGN: A multivariate regression model was used to examine the effect of Medicaid payment rates and other explanatory variables on risk-adjusted pressure ulcer incidence. The model is alternatively considered for all U.S. nursing home markets, those most restrictive markets, and those high-Medicaid homes to isolate potentially resource-poor environments. DATA EXTRACTION METHODS: A merged data file was constructed with resident-level information from the Minimum Data Set, facility-level information from the On-Line, Survey, Certification, and Reporting (OSCAR) system and market- and state-level information from various published sources. PRINCIPAL FINDINGS: In the analysis of all U.S. markets, there was a positive relationship between the Medicaid payment rate and nursing home quality. The results from this analysis imply that a 10 percent increase in Medicaid payment was associated with a 1.5 percent decrease in the incidence of risk-adjusted pressure ulcers. However, there was a limited association between Medicaid payment rates and quality in the most restrictive markets. Finally, there was a strong relationship between Medicaid payment and quality in high-Medicaid homes providing strong evidence that the level of Medicaid payment is especially important within resource poor facilities. CONCLUSIONS: These findings provide support for the idea that increased Medicaid reimbursement may be an effective means toward improving nursing home quality, although CON and moratorium laws may mitigate this relationship.

Aged↗
PubMed2006

Vaccine adverse event reporting system reporting source: a possible source of bias in longitudinal studies.

OBJECTIVE: The US Vaccine Adverse Event Reporting System (VAERS) is a passive reporting system to which anyone can report an event. Publicity related to potential adverse events may change reporting patterns. The objective of this paper is to show how litigation-related reports have influenced the trends in possible adverse event reports to VAERS. METHODS: The VAERS public-use data files were downloaded in July 2004 and translated into identical SAS data sets for analysis. Cases that were related to litigation were identified using a word search algorithm. All cases for the most frequently reported symptoms in litigation (overdose, neuropathy, autism, "mental retardation," arthralgia, and "speech disorder") were reviewed. RESULTS: In recent years, most case reports to VAERS that were related to overdose, neuropathy, and thimerosal were related to litigation. Many cases that were related to autism and mental retardation were as well. CONCLUSIONS: This review shows a previously undisclosed rise in the number of reports to the VAERS related to pending litigation for vaccine injury. The implications of this for understanding longitudinal reporting patterns are discussed.

Adverse Drug Reaction Reporting Systems↗
PubMed2001

Web-based educational tool for cleft lip repair using XVL.

Recent web-based technologies have brought a variety of new possibilities to the field of medical information. Nevertheless, transferring 3D patient models through usual low-band-width networks is difficult because of the large size of data file. XVL (eXtensive VRML with Lattice), a new framework for 3D Data representation with high quality surface shape, has solved this problem. In cooperation with Lattice Technology Inc., we have created XVL-formatted patient 3D models. The XVL model takes less than 100 kilobytes, whereas the same quality model in Virtual Reality Modeling Language(VRML) format requires more than 5 megabytes. Because of the many advantages of XVL, we have created a 3D web-based educational tool for repair of cleft lip--plastic surgery for congenital defects of the lips that requires complex incisions and reconstruction. Our system can interact with the model and 3D visualization of the incision lines, displacement of skin flaps, and suturing. Our educational tool for cleft lip repair has demonstrated that the XVL model and its web-based application can open up new possibilities for 3D medical information systems. We are currently refining the XVL model and developing XVL-based applications to simulate the actual surgery on the World Wide Web.

Cleft Lip↗
PubMed1984

[Combined computer-assisted neuro-otologic diagnosis of inner ear function in children].

Among 10 284 data files of neuro-otological patients of our neuro-otological data bank NODEC III, 8,6% pertain to children between 0 and 15 years of age. 350 (3,5%) of these are in the age group of 0-5 years, 261 (2,5%) in the group of 6-10 years and 267 (2,6%) in the group of 11-15 years. Modern inner ear functional diagnostic methods combine computerised neuro-otological audiometric as well as equilibriometric tests. Ranking of diagnostic applicability and efficiency comprises the following 6 steps of neuro-otological equilibriometric and audiometric tests: Child-adapted psychophysical hearing tests, Perrotatory nystagmus tests via electronystagmography, Postrotatory nystagmus tests via electronystagmography, Acoustic brain-stem evoked potentials ( ABEP ) with 2-channel averager, Caloric vestibular test via electronystagmography, Optokinetic nystagmus test via electronystagmography. It has been proved both clinically and statistically that the perrotatory as well as the postrotatory nystagmus recordings are accepted much better by the preschool children than the caloric test. The latter, however, provides us with superior topodiagnostic information. Acoustically evoked potentials usually require to be performed under sedation in preschool children. Automatic nystagmus evaluation via the computer system NYDIAC immediately yields all the important monocular nystagmus parameters and synoptical test charts, i.e. the butterfly calorigram . The computerbased neuro-otological equilibriometric as well as audiometric investigations should be performed by an experienced and specifically trained otolaryngologist. This diagnostic method promotes intense co-operation with colleagues in paediatrics, ophthalmology, neurology and traumatology.

Adolescent↗
PubMedDate not supplied

Respiratory distress syndrome mortality in the United States, 1987 to 1995.

OBJECTIVE: To review respiratory distress syndrome (RDS) mortality since the introduction of surfactant. DESIGN: Population-based historical cohort study. METHODS: United States vital statistic data were used for the years 1987 to 1995. Linked birth and infant death file data were available for the years 1987 to 1991 and for 1995. US natality and mortality files were used for the years 1992 to 1994. RESULTS: Whereas overall infant mortality decreased 25% over the-9 year period from a rate of 979 deaths/100,000 live births (LB) to a rate of 736, mortality attributed to RDS decreased 56% from a rate of 84 to 37. The crude black:white relative risk for RDS-related mortality increased from 2.02 in 1987 to 2.76 in 1995. The largest and most consistent drop in RDS-related mortality occurred in the 2000 to 2499 gm birth weight and 33- to 36-week gestation groups; average annual decline = 20%. There was a change in the distribution of the underlying causes of death over the 9-year period with an increase in the proportion of mortality attributed to prematurity. CONCLUSION: Since the advent of surfactant there has been a marked reduction in mortality attributed to RDS. Of concern is the increasing disparity between black and white RDS-related mortality.

Ethnicity↗
PubMed2002

The lack of effect of market structure on hospice use.

OBJECTIVE: To describe the relative importance of health care market structure and county-level demographics in determining rates of hospice use. DATA SOURCES: Medicare claims data for a cohort of elderly patients newly diagnosed with lung cancer, colon cancer, stroke, or heart attack in 1993, followed for up to five years, and linked to Census and Area Resource File data. STUDY DESIGN: Variation between markets in rates of hospice use by patients with serious illness was examined after taking into account differences in individual-level data using hierarchical linear models. The relative explanatory power of market-level structure and local demographic variables was compared. DATA COLLECTION METHODS: The cohort was defined within the Medicare hospital claims data using validated algorithms to detect incident cases of disease with a three-year lookback. Use of hospice was determined by linkage at an individual level to the Standard Analytic Files for Hospice through 1997. Individual-level data was linked to the Area Resource File using county identifiers present in the Medicare claims. PRINCIPAL FINDINGS: There is substantial variation in hospice use across markets. This variation is not explained by differences in the major components of health care infrastructure: the availability of hospital, nursing home, or skilled nursing facilities, nor by the availability of HMOs, doctors, or generalists. CONCLUSIONS: Intercounty heterogeneity in hospice use is substantial, and may not be related to the set-up of the medical care system. The important local factors may be local preferences, differences in the particular mix of services provided by local hospices, or differences in community leadership on end of life-issues; many of these differences may be amenable to educational efforts.

Aged↗
PubMed1990

PNSCROLL, a software package for graphical interactive analysis of single channel patch clamp currents and other binary file records: under mouse control.

The PNSCROLL program has been specifically developed for interactively scrolling through binary data files under mouse control, in order to analyse single channel current records and printout, or plot, records and histograms of currents. PNSCROLL requires the use of a Microsoft Mouse and runs on an IBM or IBM-compatible microcomputer operating under MS DOS, ideally with 256K EGA or VGA graphics card and colour display. It will print on Epson dot matrix printers and plot records and histograms on HP plotters and LaserJet laser printers.

Computer Graphics↗