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At least 613 records · Page 34Linked to original sources
PubMed2000

The first object oriented monitor for intravenous anesthesia.

OBJECTIVE: To describe the design and implementation of "INFUSION TOOLBOX," a software tool to control and monitor multiple intravenous drug infusions simultaneously using pharmacokinetic and pharmacodynamic principles. METHODS: INFUSION TOOLBOX has been designed to present a graphical interface. Object Oriented design was used and the software was implemented using Smalltalk, to run on a PC. Basic tools are available to manage patient, drugs, pumps and reports. These tools are the PatientPanel, the DrugPanel, the PumpPanel and the HistoryPanel. The screen is built dynamically. The panels may be collapsed or closed to avoid a crowded display. We also built control panels such as the Target ControlPanel which calculates the best infusion sequence to bring the drug concentration in the plasma compartment to a preset value. Before drug delivery, the user enters the patient's data, selects a drug, enters its dilution factor and chooses a pharmacokinetic model. The calculated plasma concentration is continually displayed and updated. The anesthetist may ask for the history of the delivery to obtain a graphic report or to add events to the logbook. A panel targeting the effect is used when a pharmacodynamic model is known. Data files for drugs, pumps and surgery are upgradable. DISCUSSION: By creating a resizeable ControlPanel we enable the anesthetist to display the information he wishes, when he wishes it. The available panels are diverse enough to meet the anesthetist needs; they may be adapted to the drug used, pumps used and surgery. It is the anesthetist who builds dynamically its different control screens. CONCLUSION: By adopting an evolutionary solution model we have achieved considerable success in building our drug delivery monitor. In addition we have gained valuable insight into the anesthesia information domain that will allow us to further enhance and expand the system.

Anesthesia, Intravenous↗
PubMed2005

A method for measuring system safety and latent errors associated with pediatric procedural sedation.

The practice of sedating patients in the hospital for diagnostic and therapeutic procedures may be associated with life-threatening respiratory depression. We describe a method that uses a simulated event to identify latent system failures. A simulated scenario was developed that was reproducible with realistic physiology that degraded over time if no interventions occurred and improved when treated appropriately. Management of the scenario was observed in an ideal setting, a radiology department, and an emergency department. Event management was videotaped. The simulator's physiological data were saved automatically at 5-s intervals. Deviations from "best practice" were measured by using a set of video markers for event detection, diagnosis, and treatment. The simulator data files were used to calculate time out of range for critical variables. Hypoxia and hypotension lasted 4.5 and 5.5 min in the radiology and emergency departments, respectively, compared with 0 min in the gold standard setting. Many latent failures were identified by reviewing the video. This study supports the feasibility of using available human simulation as a crash-test dummy to more objectively quantify rescue system performance in actual sedation care settings. This method revealed vulnerabilities in personnel and in care systems even though sedation care regulatory requirements were met.

Anesthesiology↗
PubMed1990

Computer-assisted methods for assessing strain relatedness in Candida albicans by fingerprinting with the moderately repetitive sequence Ca3.

When used to probe EcoRI-digested Candida albicans DNA, the moderately repetitive sequence Ca3 generated a Southern blot hybridization pattern which included 15 to 25 bands, depending upon the strain. The pattern was stable through 400 generations in each of three independent strains but variable between most of 46 unrelated tester strains, making it a very effective probe for discrimination between strains. Computer-assisted methods (Dendron) were developed for storage of Ca3 patterns in data files, calculation of similarity (SAB) values between strains based upon band positions and intensities, and generation of histograms and dendrograms based on SAB values for all strains or any subset of strains in large epidemiological studies. In testing the effectiveness of the system, it was found that (i) multiple isolates from different body locations of the same healthy individual could represent either the same strain or different strains, (ii) isolates from oral lesions of a husband and wife represented the same strain, (iii) strains isolated from the mouths of 10 healthy individuals on the same day and in the same geographical location were as dissimilar on average as the 46 unrelated tester strains, and (iv) strains isolated from seven immunocompromised patients hospitalized over a 2.5-month period in the same hospital were highly similar, indicating nosocomial origin. The apparent effectiveness of these fingerprinting methods and the Dendron program suggests that interlaboratory procedures for fingerprinting should be standardized and all patterns should be analyzed and stored in a common and accessible data base for broad epidemiological analysis.

Blotting, Southern↗
PubMed1998

Evaluation of the effect of breast cancer screening by record linkage with the cancer registry, The Netherlands.

OBJECTIVE: To evaluate the effect of a breast cancer screening programme by record linkage with the cancer registry. SETTING: Breast cancer screening programme in mid- and southern Limburg, the Netherlands. METHODS: The data files of the breast cancer screening programme and the Maastricht Cancer Registry were linked in order to evaluate the effect of breast cancer screening. Only the first primary breast tumour was included in the evaluation. RESULTS: From 1990 until 1995 90 001 women participated in the first round of the breast cancer screening programme and 64 637 in subsequent rounds. After the introduction of screening the annual number of breast cancer diagnoses increased by almost 50%. The incidence decreased to previous levels after completion of the first screening round. Record linkage detected 219 interval cancers (within two and a half years of a screening), a proportionate incidence of 31% in the first year and 60% in the second year of the two-year interval between screenings. The incidence of node positive breast cancer was 1% lower in 1994 and 15% lower in 1995 than the incidence in the period 1987-90. CONCLUSIONS: Evaluation of the effect of breast cancer screening in the Netherlands can be performed using routinely available cancer registry data. The results of this evaluation seem promising, but further studies are necessary to find ways to reduce the incidence of interval cancer.

Adult↗
PubMed2000

The pattern of diabetes care in New South Wales: a five-year analysis using Medicare occasions of service data.

OBJECTIVE: To use Medicare occasions of service data to establish the pattern and standard of care received by people with diabetes. METHOD: Information about visits to medical practitioners as well as utilisation of diabetes related procedures for people living in New South Wales (NSW) for the individual years between 1993 to 1997 was retrieved using a Health Insurance Commission data file. Individuals were deemed to have diabetes if an HbA1c which can only be ordered for a person with known diabetes, had been performed over the five-year period. RESULTS: On average over the study period, persons with diabetes accounted for 3.1% of the population but they used 5.5% of general practitioner services. A large proportion of patients also received care at the specialist and consultant physician level, 51.2% and 38.6% respectively, a three to four fold increase when compared with their non-diabetic counterparts. There was also a 1.3 to 1.8 fold increase in the mean number of attendances to the various medical practitioners. Surveillance of diabetes parameters was inadequate but small improvements were seen over the 5 year study period (proportion of persons with diabetes with a HbA1c performed: 48.8% to 56.8%; Lipids: 49.4% to 52.0%; HDL cholesterol: 18.3% to 18.8%; microalbuminuria: 4.7% to 11.6%). CONCLUSION: This study has highlighted the heavy burden imposed by diabetes on our health care system. IMPLICATIONS: The use of Medicare occasions of service data represents a cost efficient way of monitoring health service utilisation.

Diabetes Mellitus↗
PubMed1991

The impact of economic considerations on clinical decisionmaking: the case of thrombolytic therapy.

This study examines the intravenous use of two thrombolytic agents [streptokinase (SK) and tissue plasminogen activator (tPA)] in the acute phase of myocardial infarction (MI). These two agents have very different costs and offer an excellent opportunity to study both the impact of economic factors on clinical decisionmaking and the potential for cost savings by limiting the use of expensive new therapeutic agents. A nationwide survey of the 5,792 acute care general hospitals listed in the American Hospital Association's 1988 data file was responded to by 2,651 hospitals (46%) and revealed that 2,384 of these responding hospitals (90%) were using thrombolytic therapy. For 2,200 of these 2,384 hospitals (92%), the respondent was a physician who primarily used one of the two drugs. Eight hundred eighty-six of these 2,200 physicians (40%) primarily used SK while 1,314 (60%) primarily used tPA. SK users were more concentrated in federal public hospitals (69% used SK) than in nonfederal public hospitals (47% used SK), and were least concentrated in private hospitals (36% used SK). There was no difference between the rate of SK vs tPA use in investor-owned and not-for-profit private hospitals. SK users most often (62%) cited various economic factors as the reason for their choice. The users of tPA primarily (73%) cited clinical preferability as the reason for their choice even though trials are still ongoing to see which drug is preferable. Several multivariate analyses shed light upon the association between choice of thrombolytic agent and various additional physician and hospital characteristics. These data clearly indicate that while new therapies are rapidly implemented by the medical community, considerations of cost have a substantial impact upon the pattern of implementation and reflect a desire to implement cost savings in the use of new drugs.

Data Collection↗
PubMed2005

The incidence of endophthalmitis after cataract surgery among the U.S. Medicare population increased between 1994 and 2001.

OBJECTIVE: To estimate the annual incidence rate of presumed endophthalmitis after cataract surgery, evaluate any changes in this rate over time, and examine demographic risk factors for endophthalmitis after cataract surgery. DESIGN: Population-based review of Medicare beneficiary claims data. DATA SOURCE: Medicare 5% sample beneficiary data files for inpatient and outpatient claims from 1994 through 2001 were examined to identify all cataract surgeries and subsequent cases of presumed endophthalmitis after cataract surgery. METHODS: All cataract surgery and presumed endophthalmitis cases after cataract surgery were identified based on claims submitted. The annual rate of presumed endophthalmitis after cataract surgery was calculated, and demographic risk factors for endophthalmitis were examined using multivariate models. MAIN OUTCOME MEASURES: Incidence rate of endophthalmitis after cataract surgery and prevalence of demographic risk factors for endophthalmitis over an 8-year period. RESULTS: One thousand twenty-six cases of presumed endophthalmitis occurred after 477,627 cataract surgeries, yielding an incidence rate of 2.15 per 1000 for this 8-year period. Rates of endophthalmitis adjusted for age, gender, and race were significantly higher in 1998 to 2001 than in earlier years (relative risk [RR], 1.41; 95% confidence interval [CI], 1.24-1.60). Older age and black race also were associated with increased risk of endophthalmitis (RR, 1.83; 95% CI, 1.19-2.81; age, > or =90 years, and RR, 1.30; 95% CI, 1.02-1.65, respectively). CONCLUSIONS: Analysis of Medicare claims data suggests that the incidence of endophthalmitis after cataract surgery has been increasing, but does not provide an explanation for this occurrence. An increase in the incidence of endophthalmitis after cataract surgery is of concern, because cataract surgery is the most commonly performed operation in the United States, and the number of cataract surgeries performed annually will likely increase substantially over the coming decades due to the aging of the U.S. population.

Age Distribution↗
PubMed1997

Accuracy and completeness of the registration of childhood leukaemia in The Netherlands, 1989-1992.

In the Netherlands, childhood leukaemia is recorded by the Dutch Childhood Leukaemia Study Group (DCLSG, set up in 1972) and by nine regional cancer registries which together form the Netherlands Cancer Registry (NCR, set up in 1989). The data files from the incidence years 1989-1992 of the two registries were linked in order to evaluate accuracy and completeness and to calculate and equalise the incidence rates for childhood leukaemia in The Netherlands. Unlinked records or records with disagreements (birth date, sex, type of leukaemia and incidence date) were checked by the DCLSG and by the regional cancer registries. The DCLSG recorded 431 cases of childhood leukaemia, while the NCR recorded 434 cases. After record linkage and review of the cases, it was concluded the 445 records should have been recorded as childhood leukaemia. The NCR had recorded 425 of the 445 correct cases (95.5%), but had missed 20 cases (4.5%). The DCLSG had recorded 431 of the 445 correct cases (96.9%) and had missed 14 cases (3.1%). In addition, the NCR had recorded 9 cases incorrectly as childhood leukaemia. Part of the disagreement was caused by differences in coding rules (definition of non-Hodgkin's lymphoma (NHL) and the myelodysplastic syndrome versus leukaemia). It could be concluded that the quality and completeness of the two registries was very high. Regular comparison of the recorded data will help to reveal the inherently problematic disagreement between definitions and coding.

Adolescent↗
PubMed2006

A high-throughput method to measure the sensitivity of yeast cells to genotoxic agents in liquid cultures.

The sensitivity of yeast Saccharomyces cerevisiae to DNA damaging agents is better represented when cells are grown in liquid media than on solid plates. However, systematic assessment of several strains that are grown in different conditions is a cumbersome undertaking. We report an assay to determine cell growth based on automatic measurements of optical densities of very small (100 microl) liquid cell cultures. Furthermore, an algorithm was elaborated to analyze large data files obtained from the cell growth curves, which are described by the growth rate--that starts at zero and accelerates to the maximal rate (mu(m))--and by the lag time (lambda). Cell dilution spot test for colony formation on solid media and the growth curve assay were used in parallel to analyze the phenotypes of cells after treatments with three different classes of DNA damaging agents (methyl methanesulfonate, bleomycin, and ultraviolet light). In these experiments the survival of the WT (wild type) and a number of DNA repair-deficient strains were compared. The results show that only the cell growth curve assay could uncover subtle phenotypes when WT cells, or mutant strains that are only weakly affected in DNA repair proficiency, were treated with low doses of cytotoxic compounds. The growth curve assay was also applied to establish whether histone acetyltransferases and deacetylases affect the resistance of yeast cells to UV irradiation. Out of 20 strains tested the sir2delta and rpd3delta cells were found to be more resistant than the WT, while gcn5delta and spt10delta cells were found to be more sensitive. This new protocol is sensitive, provides quantifiable data, offers increased screening capability and speed compared to the colony formation test.

Bleomycin↗
PubMed2002

Quantitative descriptors of corneal topography that influence soft toric contact lens fitting.

PURPOSE: Empirical soft toric contact lens fitting based on manifest refraction and keratometry often presents unanticipated fitting and power errors upon initial lens dispensing. However, corneal topography may provide features that influence soft toric lens performance, flexure, and back vertex power in situ, which may assist in improved fitting guidelines. In this study, quantitative topographic descriptors were generated and analyzed as potential variables in predicting soft toric fitting success. METHODS: One hundred five eyes of 54 patients were empirically fit with back surface toric, prism ballasted, soft contact lenses after videokeratography was performed with the EyeSys 2000 (v. 4.0) or Humphrey Atlas (v. A6) instrument. Custom software was written to generate 54 separate quantitative descriptors of shape and astigmatism from the raw data files. A logistic regression was used to determine which variables significantly contributed to a successful or failed fit. RESULTS: Two types of empirical fitting failures were identified: loose fit (n = 15) and power errors (n = 17). The following variables were associated with a fitting failure: flat simulated keratometry (SimKf2b) within the central 3 mm zone, steep simulated keratometry (SimKs2b) within the central 3 mm zone, a difference between central and peripheral flat meridian axis (DIFFAXIS), and a difference between central and peripheral astigmatism (DIFFASTIG). For fitting failures caused by power errors, a larger steep SimKs2b (p< 0.01) and smaller DIFFAXIS (p< 0.05) were associated with a failed fit. For failures caused by physical fit of a selected base curve, a smaller DIFFAXIS (p< 0.05), larger steep SimKs2b (p< 0.05), and larger DIFFASTIG (p< 0.01) were associated with a failed fit. CONCLUSIONS: Novel quantitative descriptors of corneal shape and toricity derived from topography are associated with empirical soft toric contact lens fitting failures. Future algorithms or recommendations for improved soft toric lens selection may be derived from such indices to develop a predictive model for successful soft toric lens fitting using corneal topography data.

Contact Lenses, Hydrophilic↗
PubMed1995

MARIAN: an analysis tool for the assessment of left ventricular function measured by velocity encoding MRI.

Velocity encoding MRI is a new non-invasive technique for measuring cardiac blood flow velocities. Flow in the three directions of space can be measured during the entire heart cycle. However, the analysis of large amount of data obtained from this technique requires specialized computational software packages to provide physicians with efficient analysis tools. A data visualization software package named Magnetic Resonance Imaging Analyzer (MARIAN) was developed. This software package uses visualization, animation, analysis, and computational tools adapted to time series of cardiac MRI data files, all accessible through a sophisticated graphics user interface. MARIAN was used as a tool for the analysis of the left heart blood flow patterns in two groups of human subjects: ten volunteers and eight patients. The patients were diagnosed with incapacitating angina pectoris and previous left ventricular myocardial infarction. Vector plot animations of the left atrial flow were realized for all volunteer examinations. The temporal flow velocity profiles were sampled at the tips of the mitral leaflets and in the lumen of the right upper pulmonary vein, when possible. The isovolumic relaxation time (IVRT) was estimated. The following flow parameters were obtained from the velocity profiles: at the mitral valve, the early diastolic E-wave, the late diastolic A-wave, the time of occurrence of the E- and A- waves; at the right upper pulmonary vein, the systolic S-wave, the early diastolic D-wave and the reverse late diastolic R-wave. The results obtained were consistent with previous studies using similar MRI techniques. Compared to the control group, the patient group exhibited higher isovolumic relaxation time, a lower peak E-wave, and a lower D-wave. MARIAN thus provided a fast, efficient and accurate data visualization tool for the analysis of human data.

Adult↗
PubMed2003

Highly accurate classification of Watson-Crick basepairs on termini of single DNA molecules.

We introduce a computational method for classification of individual DNA molecules measured by an alpha-hemolysin channel detector. We show classification with better than 99% accuracy for DNA hairpin molecules that differ only in their terminal Watson-Crick basepairs. Signal classification was done in silico to establish performance metrics (i.e., where train and test data were of known type, via single-species data files). It was then performed in solution to assay real mixtures of DNA hairpins. Hidden Markov Models (HMMs) were used with Expectation/Maximization for denoising and for associating a feature vector with the ionic current blockade of the DNA molecule. Support Vector Machines (SVMs) were used as discriminators, and were the focus of off-line training. A multiclass SVM architecture was designed to place less discriminatory load on weaker discriminators, and novel SVM kernels were used to boost discrimination strength. The tuning on HMMs and SVMs enabled biophysical analysis of the captured molecule states and state transitions; structure revealed in the biophysical analysis was used for better feature selection.

Algorithms↗
PubMed2002

Regional variation in drug purchase opportunity among youths in the United States, 1996-1997.

This study was designed to examine geographic variation in illegal drug purchase opportunity among young people living in the United States; there was a subfocus on age, sex, and urban/rural residence. Data from the 1996-1997 National Household Surveys on Drug Abuse were analyzed; the nationally representative sample of community residents included 21,531 participants aged 12-24 years old. Respondents were asked if someone had approached them to sell them an illegal drug during the past 30 days. To protect respondents' confidentiality, there is no finegrained geographical coding of data in the National Household Surveys on Drug Abuse public use data files, but nine geographical divisional indicators are provided (i.e., West North Central, New England, etc.). Results indicated males were an estimated 1.8 times more likely than females to have had a recent illicit drug purchase opportunity, and urban residents were 1.5 times more likely than rural residents to have had a recent drug purchase opportunity. As for geographic divisions, the Pacific division surpassed all other divisions: Its residents were 1.5 times more likely to have recent drug purchase opportunities than the West North Central division (used here as a reference category). After controlling statistically for age, sex, and urban/rural residence, residence in four divisions was found to be associated with greater likelihood of an illicit drug purchase opportunity. The observed patterns of drug purchase opportunity add new features to our understanding of illicit drug involvement across the United States.

Adolescent↗
PubMed2003

Molecular modeling calculations of HIV-1 reverse transcriptase nonnucleoside inhibitors: correlation of binding energy with biological activity for novel 2-aryl-substituted benzimidazole analogues.

The energies and physical descriptors for the binding of 20 novel 1-(2,6-difluorobenzyl)-2-(2,6-difluorophenyl)benzimidazole analogues (BPBIs) to HIV-1 reverse transcriptase (RT) have been determined using Monte Carlo (MC) simulations. The crystallographic structure of the lead compound, 1-(2,6-difluorobenzyl)-2-(2,6-difluorophenyl)-4-methylbenzimidazole, was used as a starting point to model the inhibitors in both the bound and the unbound states. The energy terms and physical descriptors obtained from the calculations were correlated with their respective experimental EC(50) values, resulting in an r(2) value of 0.70 and a root-mean-square deviation (rms) of 0.53 kcal/mol. The terms in the correlation include the change in total Coulombic energy and solvent-accessible surface area. Structural analysis of the data files from the BPBI calculations reveals that all of the analogues with good biological activity show the formation of a hydrogen bond between the ligand and the backbone nitrogen atom of lysine 103. By use of the structural results, two novel BPBI inhibitors have been designed and calculations have been carried out. The results show the formation of the desired hydrogen bonds, and the DeltaG(binding) values predict the compounds to be excellent RT inhibitors. Subsequent synthesis and biological activity testing of these analogues have shown the validity of the predictive calculations. If the BPBIs are modeled in a site constructed from the crystal coordinates of a member of another class of nonnucleoside inhibitors (the 4,5,6,7-tetrahydroimidazo[4,5,1-jk][1,4]benzodiazepine-2(1H)-thione and -one (TIBO) compounds), the correlation with the same terms drops slightly, giving an r(2) value of 0.61 with an associated root-mean-square value of 0.53 kcal/mol. Conversely, if the TIBO compounds are modeled in a site constructed from the BPBI complex crystal coordinates, a correlation can be obtained using the drug-protein interaction energy and change in the total number of hydrogen bonds, giving an r(2) value of 0.63. These are the same descriptors that were used for the TIBO compounds modeled in their own sites, where the r(2) value was 0.72. These data suggest that it may be possible, in some cases, to design novel inhibitors utilizing structural data from related, but not identical, inhibitors.

Benzimidazoles↗
PubMed1993

Identification of carbohydrate structures in glycoprotein peptide maps by the use of LC/MS with selected ion extraction with special reference to tissue plasminogen activator and a glycosylation variant produced by site directed mutagenesis.

Electrospray ionization mass spectrometry utilizing a single quadrupole on line with reversed-phase HPLC (LC/MS) enables the characterization of glycoproteins in a relatively short period of time. In this approach the protein is digested with a suitable protease and the peptides are separated by reversed-phase HPLC and detected by electrospray ionization mass spectrometry. The glycopeptides are initially observed as a cluster of negatively sloping ions in a contour plot of data from the LC/MS run (m/z vs retention time) or as a characteristics series of masses at different elution times. The search for a particular glycopeptide is based on previously known carbohydrate structures and on consensus glycosylation sites. Further structural information is obtainable with glycosidase digestion and LC/MS analysis. The mass shifts following glycosidase digestion allow further confirmation of the structure. This approach identifies the site of attachment of two hybrid glycoforms to the T11 tryptic peptide in a reversed-phase tryptic map of recombinant tissue plasminogen activator (rt-PA). Use of selected ion extraction of the LC/MS data files allows one to graphically describe the elution order of closely related glycopeptides. The potential of LC/MS for the characterization of small amounts of unknown glycoproteins is shown by the study of an rt-PA mutant. A new potential site for glycosylation is created by site directed mutagenesis of wild type rt-PA with replacement of a threonine residue with asparagine at residue 103. An examination of a tryptic map shows that the mutant contains two new complex carbohydrate chains. The introduction of the new asparagine proximal to asparagine 117 changes this native high-mannose site in rt-PA to a complex-type glycosylation. This method allows rapid identification of carbohydrate containing peptides and yields useful structural information on microgram amounts of material.

Amino Acid Sequence↗
PubMed1985

A comparison of computer-assisted and hard copy telephone interviewing.

In computer-assisted telephone interviewing, questions are displayed on a computer screen, and responses are entered directly into a computerized data file. In 1981-1982, a randomized trial of computer-assisted telephone interviewing, compared with telephone interviewing with responses directly recorded on printed questionnaires, was carried out. The respondents were surrogates for 400 white Florida residents who died in 1979 and were randomly selected from a death certificate-based case-control study of colorectal cancer. Outcomes examined included participation rate after initial phone contact, length of interview, recorded number of comments, recorded number of probes, unresolved "don't know" responses, and the interviewer's evaluation of the quality of the interview. The computer-assisted telephone interviewing system resulted in the 25-30-minute interviews lasting, on the average, 3.4 minutes (14%) longer. The average number of comments decreased from 5.5 to 4.1 (a 25% difference) and probes from 10.2 to 8.3 (a 19% difference) in the computer-assisted interviews. These differences were markedly smaller than the differences noted between individual interviewers.

Analysis of Variance↗
PubMed2006

Caregiver psychological distress as a barrier to influenza vaccination among community-dwelling elderly with dementia.

OBJECTIVE: This study examined whether informal caregiver psychologic distress decreases the likelihood of influenza vaccination for community-dwelling elderly with dementia. A secondary aim was to determine whether psychologic distress mediates the relationship between other predisposing, enabling, and medical need variables and vaccination. METHODS: Data were drawn from the 1998 National Longitudinal Caregiver Survey. The final sample consisted of 1406 community-dwelling male veterans with dementia and their coresiding female informal caregivers. Presence of caregiver psychologic distress was measured using the Boston Short Form of the Center for Epidemiologic Studies Depression Scale. Vaccination was identified by examining Veteran Administration Outpatient Data Files for visits indicating influenza vaccine administration during the 1998 influenza vaccine season (September 1 to December 31). Multivariate path analysis with observed variables was used to estimate direct and indirect probit path coefficients between independent variables, caregiver psychologic distress, and veteran vaccination. RESULTS: As hypothesized, caregiver distress was significantly associated with a decreased likelihood of care-recipient vaccination (unstandardized coefficient [b] = -0.023, P < 0.01). Adjusted for other variables, the predicted probability of vaccination was 37.7% for care-recipients with nondistressed caregivers compared with 29.4% for care-recipients with distressed caregivers. Furthermore, a number of factors significantly influenced vaccination via their influence on psychologic distress. CONCLUSION: We conclude that caregiver psychologic distress may interfere with access to influenza vaccination in persons with dementia. Access to vaccination may be improved directly by detecting and treating emotional health problems in caregivers and indirectly by addressing precursors to caregiver distress.

Aged↗
PubMed1997

Injury mortality among children and teenagers in New Zealand compared with the United States of America.

OBJECTIVES: New Zealand (NZ) has an unenviable track record in childhood injury mortality. We sought to describe this burden and to compare it with the United States of America (USA), with a view to taking the first step in identifying potential areas in which NZ might benefit from injury control as practiced in the USA. METHODS: We identified all children and teenagers who had died of injury for the period 1984-93 from the NZ Health Information Service mortality data files. We compared their rates of injury with previously published rates for USA. RESULTS: The age specific rates follow a J shaped distribution, with high rates in the first year of life followed by a decline to the lowest rate, among 5-9 year olds, a marginally higher rate among 10-14 year olds, and a dramatic rise among those in the 15-19 age group. The specific causes of death vary considerably by age group. NZ's overall rate of child and adolescent injury is not substantially different from that of the USA, but marked differences are apparent when examining cause specific rates. CONCLUSIONS: In terms of the theoretical potential to reduce the total injury mortality rate, priority must be given to 15-19 year olds who account for 61% of all NZ injury deaths. Priorities for this age group are: motor vehicle traffic crashes (especially those involving occupants and motorcyclists), and suicide. Among the children, priorities are: pedestrian and occupant deaths, and drownings. Among infants, the priority is suffocation.

Adolescent↗