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PubMed1996

Source propagation of interictal spikes in temporal lobe epilepsy. Correlations between spike dipole modelling and [18F]fluorodeoxyglucose PET data.

Source localization methods were applied to interictal spikes from scalp EEGs and correlated with metabolic (PET scan) data in eight patients suffering from drug-resistant temporal lobe epilepsy (TLE). Dipolar sources, [18F]fluorodeoxyglucose (18FDG)-PET data and anatomical images (MRI) were projected into the same three-dimensional coordinates system. Averaged spikes were adequately modelled by two or three dipolar sources with different onset time of activation but overlapping activity (mean residual variance 3.4 +/- 2.1%). Although, in all patients, spike modelling demonstrated dipolar sources in both mesial and lateral temporal cortex, dipole propagation was consistent with the early involvement of only one of these two areas (mesio-temporal, five patients; lateral and polar neocortex, three patients). Six patients showed a unilateral interictal decrease in glucose uptake, as measured with 18FDG-PET, in the temporal lobe ipsilateral to the EEG spike focus. Temporal hypometabolism was bilateral in one patient and absent in the remaining case. When projected onto PET-scan slices, the dipolar sources of these patients were always included within the hypometabolic area. However, within the hypometabolic zone, the decrease in glucose uptake was not found to be more pronounced in regions containing dipoles. Therefore the spatio-temporal spread of neuronal hyperactivity underlying interictal spiking suggests the presence of preferential epileptogenic networks inside the hypometabolic temporal lobe. Fusion of bioelectric, metabolic and anatomical data proves to be a convenient way of summarizing multimodal information from non-invasive investigations in TLE patients entering an epilepsy surgery programme, and suggests that both interictal spike dipole modelling and 18FDG-PET data might be useful, as a complement to ictal electro-clinical data, in the presurgical evaluation of such patients.

Adult↗
PubMed2004

Physical network models.

We develop a new framework for inferring models of transcriptional regulation. The models, which we call physical network models, are annotated molecular interaction graphs. The attributes in the model correspond to verifiable properties of the underlying biological system such as the existence of protein-protein and protein-DNA interactions, the directionality of signal transduction in protein-protein interactions, as well as signs of the immediate effects of these interactions. Possible configurations of these variables are constrained by the available data sources. Some of the data sources, such as factor-binding data, involve measurements that are directly tied to the variables in the model. Other sources, such as gene knock-outs, are functional in nature and provide only indirect evidence about the variables. We associate each observed knock-out effect in the deletion mutant data with a set of causal paths (molecular cascades) that could in principle explain the effect, resulting in aggregate constraints about the physical variables in the model. The most likely settings of all the variables, specifying the most likely graph annotations, are found by a recursive application of the max-product algorithm. By testing our approach on datasets related to the pheromone response pathway in S. cerevisiae, we demonstrate that the resulting model is consistent with previous studies about the pathway. Moreover, we successfully predict gene knock-out effects with a high degree of accuracy in a cross-validation setting. When applying this approach genome-wide, we extract submodels consistent with previous studies. The approach can be readily extended to other data sources or to facilitate automated experimental design.

Computational Biology↗
PubMedDate not supplied

A practical approach to public health surveillance of violent deaths related to intimate partner relationships.

OBJECTIVES: Articles describing the epidemiology of intimate partner homicide (IPH) have often been positioned as one-time research projects utilizing a single data source for case identification. However, researchers without access to centralized repositories for data pertinent to IPH can ascertain cases by using multiple extant data sources. The authors describe a surveillance system that can serve as a model for state health departments and others seeking to quantify and characterize violent deaths related to intimate partner relationships on an ongoing basis. METHODS: Retrospective surveillance was conducted to identify and characterize deaths related to intimate partnerships by linking the following data sources: death certificates, newspaper articles, law enforcement reports, and medical examiners' records. RESULTS: The authors identified at least 34% more IPHs using multiple data sources than would have been recognized solely using Supplementary Homicide Reports--the most frequently cited data source for IPH case ascertainment--and 22% more cases than newspaper data alone would have allowed for. CONCLUSIONS: While it was discovered that at least 181 IPHs--and at least 128 other deaths related to intimate partnerships--occurred in Michigan from 1999-2001, this frequency of occurrences is probably conservative. This limitation is due, in part, to the researchers not having access to information from all possible data source contributors. However, in the absence of statewide data systems, the authors demonstrate the utility of using multiple data sources for violent death surveillance to address incomplete case ascertainment.

Female↗
PubMed2002

Measuring medication: do interviews agree with medical record and pharmacy data?

BACKGROUND: Medication measurement is crucial in assessing quality for chronic conditions yet agreement of alternate data sources remains uncertain. OBJECTIVES: To evaluate medication agreement between interviews, medical records, and pharmacy data; to assess data source contribution to attributing medication exposure; and to describe the impact of combining data sources on models that predict medication use. RESEARCH DESIGN: Prospective cohort study. SUBJECTS: Probability sample of HIV-infected participants in the HIV Cost and Services Utilization Study. MEASURES: Medications reported in 2267 interviews, 1936 medical records, and 457 pharmacy records were compared using crude agreement, kappa, and the proportion of average positive and negative agreement. The percent of medications reported in each source alone was used to assess their relative contribution to attributing exposure status. We performed weighted logistic regression in alternate data sources. RESULTS: Kappa varied from 0.38 for nucleoside reverse transcriptase inhibitors to 0.70 for protease inhibitors, when comparing drug classes in interview versus medical record, interview versus pharmacy data, and medical record versus pharmacy data. The percentage of medications reported in medical records was greater than that reported in interviews or pharmacy data. Pharmacy data contributed little to the attribution of medication exposure. Adding medication data to interview data did not appreciably change analytic models predicting medication use. CONCLUSIONS: For specific medications, agreement between alternative data sources is fair to substantial, but is lower for key drug classes. Relying on one data source may lead to misclassification of drug exposure status, but combining data sources does not change the results of analytic models predicting appropriate medication use.

Antiretroviral Therapy, Highly Active↗
PubMed2006

Occupational tuberculosis: a review of the literature and the local situation.

OBJECTIVE: To review the risks and control of occupation-related tuberculosis. DATA SOURCES: Statutory notification data, local tuberculosis programme data, and census data were reviewed. Literature search of PubMed was performed up to December 2005. STUDY SELECTION: Original and major review articles related to tuberculosis among health care workers and guidelines for prevention were reviewed. DATA EXTRACTION: Relevant data were extracted from our literature review and local sources. DATA SYNTHESIS: Earlier experimental data demonstrated an airborne spread of tuberculosis and a steady state mathematical model for quantification of the transmission risk. In the post-chemotherapy era in developed countries, few studies demonstrated an occupational risk of tuberculin conversion outside of outbreak settings, and few studies were able to conclusively demonstrate an increased risk of active tuberculosis among health care workers. In countries with limited resource, the situation may be different, with a higher tuberculosis incidence among health care workers. Local tuberculosis programme and notification data from the Labour Department did not show an increased risk of active tuberculosis among health care workers. Although administrative control, engineering control, and personal protection are widely accepted control measures, it is difficult to quantify their cost-effectiveness. CONCLUSIONS: Although an increased liability to tuberculosis among health care workers is expected due to the concentration of infectious patients in their environment, prompt diagnosis and initiation of treatment may minimise the risk. A high background rate of disease and possible healthy worker effect may make it difficult to pick up a small risk differential. With the ongoing threat of a nosocomial outbreak, continuing vigilance is called for.

BCG Vaccine↗
PubMed1995

Philanthropy and hospital financing.

OBJECTIVE: This study explores the relationships among donations to not-for-profit hospitals, the returns provided by these hospitals, and fund-raising efforts. It tests a model of hospital behavior and addresses an earlier debate regarding the supply price of donations. DATA SOURCES: The main data source is the California Office of Statewide Health Planning data tapes of hospital financial disclosure reports for fiscal years 1980/1981 through 1986/1987. Complete data were available for 160 hospitals. STUDY DESIGN: Three structural equations (donations, returns, and fund-raising) are estimated as a system using a fixed-effects, pooled cross-section, time-series least squares regression. PRINCIPAL FINDINGS: Estimation results reveal the expected positive relation between donations and returns. The reverse relation between returns and donations is insignificant. The estimated effect of fund-raising on donations is insignificantly different from zero, and the effect of donations on fund-raising is negative. Fund-raising and returns are negatively associated with one another. CONCLUSION: The empirical results presented here suggest a positive donations-returns relations and are consistent with a positive supply price for donations. Hospitals appear to view a trade-off between providing returns and soliciting donations, but donors do not respond equally to these two activities. Attempts to increase free cash flow through expansion of community returns or fund-raising activity, at least in the short run, are not likely to be highly successful financing strategies for many hospitals.

California↗
PubMed2001

Strategies for cutting hospital beds: the impact on patient service.

OBJECTIVE: To develop insights on the impact of size, average length of stay, variability, and organization of clinical services on the relationship between occupancy rates and delays for beds. DATA SOURCES: The primary data source was Beth Israel Deaconess Medical Center in Boston. Secondary data were obtained from the United Hospital Fund of New York reflecting data from about 150 hospitals. STUDY DESIGN: Data from Beth Israel Deaconess on discharges and length of stay were analyzed and fit into appropriate queueing models to generate tables and graphs illustrating the relationship between the variables mentioned above and the relationship between occupancy levels and delays. In addition, specific issues of current concern to hospital administrators were analyzed, including the impact of consolidation of clinical services and utilizing hospital beds uniformly across seven days a week rather than five. PRINCIPAL FINDINGS: Using target occupancy levels as the primary determinant of bed capacity is inadequate and may lead to excessive delays for beds. Also, attempts to reduce hospital beds by consolidation of different clinical services into single nursing units may be counterproductive. CONCLUSIONS: More sophisticated methodologies are needed to support decisions that involve bed capacity and organization in order to understand the impact on patient service.

Bed Conversion↗
PubMed1995

A comparison of meta-analytic results using literature vs individual patient data. Paternal cell immunization for recurrent miscarriage.

OBJECTIVE: To compare the meta-analytic results from published literature vs those obtained from pooling original patient data. DATA SOURCES: Individual patient data from 15 completed or ongoing trials on paternal white blood cell immunization as treatment for recurrent miscarriage were obtained through the American Society for Reproductive Immunology. STUDY SELECTION: Only randomized controlled trials were selected. Within these eight selected trials, 202 patients were from four published studies, 43 were added by the same investigators after publication, and 140 were from four unpublished trials. DATA EXTRACTION: Individual patient data were collected using a standardized form and double data entry. DATA SYNTHESIS: Using the fixed treatment effect model, we found that the effect of immunization, denoted as the relative live-birth ratio (RR), was greater by pooling summary data from published articles (RR, 1.29; 95% confidence interval [CI], 1.03 to 1.60) than by pooling all individual patient data from the same investigators (RR, 1.17; 95% CI, 0.97 to 1.37) or when individual patient data were pooled from four unpublished trials (RR, 1.01; 95% CI, 0.74 to 1.28). A similar diminishing treatment effect for the same comparisons was observed using the random treatment effect model (RR, 1.38; 95% CI, 0.89 to 1.87 using published summary data; RR, 1.18; 95% CI, 0.98 to 1.42 using individual patient data; RR, 1.01; 95% CI, 0.74 to 1.28 using unpublished trials). CONCLUSIONS: Meta-analytic results may differ depending on the use of various data sources: whether the source was from summary statistics in the literature, from individual patient data provided by trialists, or from unpublished trials.

Abortion, Habitual↗
PubMed2001

Geographic variation in determinants of Medicare managed care enrollment.

OBJECTIVE: To examine the effect of adjusted average per capita cost (AAPCC) rate and volatility on Medicare risk plan enrollment at the county level. DATA SOURCES: Secondary data from the Health Care Financing Administration's office of managed care and other sources were merged to create comprehensive data on all Medicare risk plans in 3,069 of the 3,112 U. S. counties in December 1996. STUDY DESIGN: A two-step least squares regression was estimated to examine the effects of AAPCC rate and volatility, commercial HMO enrollment, market factors, and characteristics of the county population on Medicare HMO enrollment. The model was also used to simulate the effects of the Balanced Budget Act of 1997. Data from the Health Care Financing Administration were merged with other sources at the county level. The Federal Information Processing Standards code and a crosswalk file matching that code with the county name linked the data across sources. PRINCIPLE FINDINGS: The AAPCC rate has a small positive effect on the probability of Medicare HMO availability and enrollment. However, commercial HMO enrollment has a much stronger positive effect on Medicare HMO enrollment. Volatility has a negative effect on the probability of any Medicare HMO enrollment. CONCLUSIONS: The results suggest that payment changes enacted as part of the Balanced Budget Act will have a limited effect on Medicare HMO enrollment, especially in rural areas. Other policy changes are needed to stimulate Medicare HMO enrollment.

Aged↗
PubMed1996

Elbow, forearm, wrist, and hand injuries among sport rock climbers.

OBJECTIVES: Sport rock climbing with its repetitive high-torque movements in gaining the ascent of a rock face or wall, often in steep overhanging positions, is associated with a unique distribution and form of upper limb injuries. In this article, we review the biomechanical aspects of sport rock climbing and the types of injuries commonly encountered in the forearm, wrist, and hand regions of elite sport rock climbers. Because elbow, forearm, wrist, and hand injuries predominate, representing 62% of the total injuries encountered, these anatomical areas have been selected for review. DATA SOURCES: The predominant source of data are the published work of Bollen et al. The remaining sources were obtained through electronic search of the Medline and Current Contents Databases (last searched May 1995). German and French articles were included in the search criteria. STUDY SELECTION: Only studies dealing with acute soft tissue and overuse injuries amongst sport rock climbers were selected. DATA EXTRACTION: Data were extracted directly from the sourced articles. DATA SYNTHESIS: The following injuries have been described in detail with regard to their presentation, diagnosis, treatment, and prevention amongst sport rock climbers: medial epicondylitis, brachialis tendonitis, biceps brachii tendonitis, ulnar collateral ligament sprain of the elbow, carpal tunnel syndrome, digital flexor tendon pulley sheath tears, interphalangeal joint effusions, fixed flexion deformities of the interphalangeal joints, and collateral ligament tears of the interphalangeal joints. CONCLUSION: Many of the injuries are specific to the handhold types used by the rock climber. Accurate diagnosis and effective treatment of these unique injuries will be facilitated by a wider understanding of the biomechanical aspects of rock climbing and an awareness of the patterns and incidence of injuries in this sport.

Arm Injuries↗
PubMed1996

Variations in the management of acute myocardial infarction. Importance of clinical measures of disease severity.

OBJECTIVE: To determine the extent to which resource use for patients hospitalized with acute myocardial infarction varies with clinical status, and to see if an observed difference in resource use between two states can be explained by clinically detailed risk adjustment. DESIGN: Retrospective review of the clinical characteristics and resource use of 342 patients hospitalised in two states with acute myocardial infarction. DATA SOURCES: Merged data from three sources: a large, existing research database used in developing the Medicare Mortality Predictor Score, clinical data abstracted from medical charts specifically for this study, and Medicare Parts A and B claims records. PATIENTS: A probability sample of Medicare patients hospitalized in 1986 with a diagnosis of acute myocardial infarction and residing in either Wisconsin or Washington state; patients dying within 30 days are oversampled. MEASUREMENTS AND MAIN RESULTS: Although patients were clinically similar in the two states, there were systematic differences in resource use. Patients in Wisconsin spent more than one extra day in the intensive care unit (ICU) (2.8 vs 1.7) as well as more than one extra non-ICU day in the hospital (8.0 vs 6.5) than patients in Washington. Patients in Wisconsin were also more likely to receive an echocardiogram (35.6% vs 15.8%), nuclear ventriculogram (12.8% vs 4.1%), exercise tolerance test (21.5% vs 3.4), and Holter monitoring (5.4% vs 0%). (All p < .01.) Differences in utilization were greater for patients at lower risk of dying. The average cost of care was 20.8% higher in Wisconsin (p = .01); risk adjustment for clinical and other factors reduced this difference to 11.8%, but did not eliminate it (p = .04). CONCLUSIONS: Patients with acute myocardial infarction vary in resource use as a function of clinical factors present at admission and occurring during the hospital stay; comparisons that do not take account of these factors may not discriminate well between providers who care for sicker patients and those who are inefficient. The greater use of resources for patients in Wisconsin is at least partially explained by differences in clinical characteristics that are not presently captured in administrative data.

Aged↗
PubMed2003

Hospital economics of the hospitalist.

OBJECTIVE: To determine the economic impact on the hospital of a hospitalist program and to develop insights into the relative economic importance of variables such as reductions in mean length of stay and cost, improvements in throughput (patients discharged per unit time), payer methods of reimbursement, and the cost of the hospitalist program. DATA SOURCES: The primary data source was Tufts-New England Medical Center in Boston. Patient demographics, utilization, cost, and revenue data were obtained from the hospital's cost accounting system and medical records. STUDY DESIGN: The hospitalist admitted and managed all patients during a six-week period on the general medical unit of Tufts-New England Medical Center. Reimbursement, cost, length of stay, and throughput outcomes during this period were contrasted with patients admitted to the unit in the same period in the prior year, in the preceding period, and in the following period. PRINCIPAL FINDINGS: The hospitalist group compared with the control group demonstrated: length of stay reduced to 2.19 days from 3.45 days (p<.001); total hospital costs per admission reduced to 1,775 dollars from 2,332 dollars (p<.001); costs per day increased to 811 dollars from 679 dollars (p<.001); no differences for readmission within 30 days of discharge to extended care facilities. The hospital's expected incremental profitability with the hospitalist was -1.44 dollars per admission excluding incremental throughput effects, and it was most sensitive to changes in the ratio of per diem to case rate reimbursement. Incremental throughput with the hospitalist was estimated at 266 patients annually with an associated incremental profitability of 1.3 million dollars. CONCLUSION: Hospital interventions designed to reduce length of stay, such as the hospitalist, should be evaluated in terms of cost, throughput, and reimbursement effects. Excluding throughput effects, the hospitalist program was not economically viable due to the influence of per diem reimbursement. Throughput improvements occasioned by the hospitalist program with high baseline occupancy levels are substantial and tend to favor a hospitalist program.

Bed Occupancy↗
PubMed2003

EURO-MED-STAT: monitoring expenditure and utilization of medicinal products in the European Union countries: a public health approach.

BACKGROUND: There is uncertainty about the level of utilization and expenditure for medicines in the European Union (EU), making assessment of their impact on public health difficult. Our aim is to develop indicators to monitor price, expenditure and utilization of medicinal products in the EU, so as to facilitate comparisons. METHODS: There are four major tasks. Task 1: To catalogue data sources and available data in each EU Member State. Task 2: To assess the reliability and comparability of data among the EU Member States by ATC/DDD on country coverage, reimbursement, prescriptions, price category (e.g. wholesale, hospital, retail) and private versus public spending. Task 3: To develop Standard Operating Procedures for data management and to define clearly the proposed indicators in terms of objective, definition, description, rationale, and data collection. Task 4: To pool, compare and report the validated data according to the established indicators, using cardiovascular medicines as an example. RESULTS: Preliminary results from Tasks 1 and 2 are available and demonstrate the methodological difficulties in comparing data from different countries. Multiple data sources must be used. These cover different populations, and refer to different prices or costs. Nevertheless, useful data can be derived, illustrated by the example of lipid lowering medicines. The data shows that only five products are commonly available in all countries. Even when a medicine is available in all countries, there may be substantial differences in packages, which can hinder comparison. Data on utilization of statins shows high usage in Scandinavian countries and least in Italy. CONCLUSION: The preliminary results of EURO-MED-STAT show wide differences in availability, and use of medicines across Europe that may have substantial implications for public health.

Cardiovascular Diseases↗
PubMed2001

Surveillance of work-related carpal tunnel syndrome in Massachusetts, 1992-1997: a report from the Massachusetts Sentinel Event Notification System for Occupational Risks (SENSOR).

BACKGROUND: This surveillance study was undertaken to target efforts to prevent work-related carpal tunnel syndrome (WR-CTS) and to assess physician case-reports as a source of surveillance data. METHODS: Physician case-reports and workers' compensation disability claims were used to document patterns of WR-CTS in Massachusetts from March 1992 to June 1997 by age, gender, industry, occupation, and calendar year. Characteristics of cases identified through the two data sources were compared. RESULTS: 4,836 cases of WR-CTS were ascertained; 6% were identified by both data sources. Whereas the two sets of cases were similar with respect to age and occupation categories, physician-reported cases were more likely male and employed in manufacturing. The number of compensation claims filed by women declined over time, and a substantial number of cases under age 25 years were identified. Manufacturing workers had the highest rates; the highest numbers of cases were employed in hospitals, grocery stores, and the insurance industry. Several technical/administrative support occupations likely to use video display terminals had both high rates and frequencies. CONCLUSION: WR-CTS is a significant public health problem. Physician reports are useful in understanding problem magnitude and targeting specific establishments for intervention but are currently of limited use in targeting specific industries and occupations.

Administrative Personnel↗
PubMed1987

Variation in nutrient intake of infants and its implications for collecting reliable dietary intake data.

Sources of variance in dietary intake data for infants in the fourth to sixth months of life were examined. Twenty-eight mothers of infants in the Special Supplemental Food Program for Women, Infants, and Children gave 24-hr recall information on their infants' diets on 4 random days over approximately 1 month. ANOVA found no day of the week or sequence effects on nutrient variation. Variance was partitioned into between- and within-subject (residual) components. Interindividual variation exceeded intraindividual variation for all nutrients except vitamin C. Variance ratios ranged from 0.3 to 1.3. Calculations of 95% confidence limits for group and individual mean intakes indicated that, whereas a single recall would estimate the group mean within 20% for most nutrients, five recalls would be necessary for the same accuracy in individual means. Magnitude and patterning of variance components differ substantially from those found in studies of adults, suggesting that infant data collection strategies should be tailored to the unique nature of the infant diet.

Adolescent↗
PubMed1994

Case-mix adjustment using objective measures of severity: the case for laboratory data.

OBJECTIVE: We evaluate the use of routinely gathered laboratory data to subclassify surgical and nonsurgical major diagnostic categories into groups homogeneous with respect to length of stay (LOS). DATA SOURCES AND STUDY SETTING: The source of data is the Combined Patient Experience database (COPE), created by merging data from computerized sources at the University of California San Francisco (UCSF) Medical Center and Stanford University Medical Center for a total sample size of 73,117 patient admissions. STUDY DESIGN: The study is cross-sectional and retrospective. All data were extracted from COPE consecutive admissions; the unit of analysis is an admission. The outcome variable LOS proxies hospital resource utilization for an inpatient stay. Nine (candidate) predictor variables were derived from seven lab tests (WBC, Na, K, C02, BUN, ALB, HCT) by recording the whole-stay minimum or maximum test result. DATA COLLECTION/EXTRACTION METHODS: Patient groups were formed by first assigning to major diagnostic categories (MDCs) all 73,117 admissions. Each MDC was then partitioned into medical and surgical subgroups (sub-MDCs). The 13 sub-MDCs selected for study define a study population of 32,599 patients that represents approximately 45 percent of inpatients. Within each of the 13 sub-MDCs, patients were randomly assigned to one of two data sets in a ratio of 2:1. The first set was used to create, the second to validate, three different LOS predictors. Predictive accuracies of individual DRG classes were compared with those of two alternative classification schemes, one formed by recursive partitioning (the sub-MDC) using only lab test results, the other by partitioning with both lab test results and individual DRGs. PRINCIPAL FINDINGS: For the eight largest sub-MDCs (81 percent of study population), individual DRGs explained 23 percent of the within sub-MDC variance in LOS, laboratory data classes explained 31 percent, and classes derived by considering individual DRGs and laboratory data explained 37 percent. (Each result is a weighted average R2. The average number of LOS classes into which the eight largest sub-MDCs were partitioned were 20, 10, and 10, respectively. Within six of the eight, partitioning on the basis of laboratory data alone explained more within sub-MDC variance than did partitioning into individual DRGs. CONCLUSIONS: Routine lab test data improve the accuracy of LOS prediction over that possible using DRG classes. We note that the improvements do not result from overfitting the data, since the numbers of LOS classes we use to predict LOS are considerably fewer than the numbers of individual DRGs.

California↗
PubMed1992

A population-based prevalence survey of known diabetes mellitus in northern Italy based upon multiple independent sources of ascertainment.

The aims of this survey were (1) to estimate the prevalence of known diabetes mellitus in 1988 in Casale Monferrato (Northern Italy); (2) to validate different data sources available in Italy; (3) to identify a population-based cohort of diabetic patients. Multiple independent data sources were used and the capture-recapture method was applied to estimate the completeness of ascertainment of the survey. The primary data source was the list of all patients attending the diabetic clinic or those referred by family physicians and paediatricians of the area. The secondary data sources were the list of hospital discharges, the prescriptions data source and the list of all people using reagent strips and insulin syringes. On 1 October 1988 (the cut-off date) 2,069 cases of known diabetes were identified. The estimated completeness of ascertainment of the survey was 91%. Prevalence of known diabetes, Type 1 (insulin-dependent), Type 2 (non-insulin-dependent) and insulin-treated diabetes were, respectively, 2.21% (95% CI 2.13-2.29), 0.80/1,000 (0.62-0.98) and 2.10% (2.01-2.19), 2.92/1,000 (2.57-3.27). A higher prevalence of Type 2 diabetes was observed in women (2.30%, 2.18-2.42) than in men (1.88%, 1.76-2.00). Age-specific prevalence of Type 2 diabetes increased with age. Computerized data sources routinely available in the Piedmont Region (hospital discharges and prescriptions data sources) showed a low completeness of ascertainment when considered together (65%, 1,338 of 2,069), indicating the need to involve the diabetic clinic and family physicians in the ascertainment of known diabetes. In conclusion, the prevalence of known diabetes in Italy was lower than in Northern Europe and the United States.

Adolescent↗
PubMed2003

Dependent seniors at home--formal and informal help.

OBJECTIVES: This article documents the number of hours of help that seniors living in private households received from formal and/or informal sources in 1996. DATA SOURCE: Data are from Cycle 11 of the General Social Survey, conducted in 1996. This analysis focuses on 1,089 respondents aged 65 or older who, because of a long-term health problem, required assistance to remain in their homes and who indicated the source of assistance and the amount of help time received. ANALYTICAL TECHNIQUES: Analysis of variance, followed by Tukey's HSD test, was used to examine differences in help time received from each source. Medians are presented using an independent medians test. Linear regression was used to model associations between the amount of help time received from each source and certain characteristics. MAIN RESULTS: In 1996, dependent seniors living in the community received a median of 3 hours of help a week. Most of this assistance came from informal sources. Living arrangements and age were the major influences on hours received from informal sources. Having no surviving children and being disabled in terms of dexterity or mobility/flexibility were associated with increased hours of formal care. For those getting both types of help, increased hours from formal sources did not significantly reduce the hours received from informal sources.

Activities of Daily Living↗