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At least 613 records · Page 34Linked to original sources
PubMed2003

Economics of suboptimal drug use: cost-savings of using JNC-recommended medications for management of uncomplicated essential hypertension.

OBJECTIVES: To quantify potential cost-savings associated with better compliance with the guidelines of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure UNC V) and to determine whether suboptimal utilization of medications is associated with higher costs for other health services. STUDY DESIGN: Secondary data analysis using the Medical Expenditure Panel Survey (MEPS) conducted by the Agency for Healthcare Research and Quality and the National Center for Health Statistics. A complex sampling design was used to provide nationally representative estimates. METHODS: From interviews with a population-based and nationally representative sample of 22 601 individuals, 1588 patients with essential hypertension without other comorbid cardiovascular conditions were selected, representing 19.6 million patients in the United States in 1996. All medical treatments for essential hypertension in 1996 were extracted from the MEPS. Using the JNC V guidelines, prescriptions used in treating essential hypertension were categorized into first-line drugs (diuretics and beta-blockers), second-line drugs (calcium-channel blockers and angiotensin-converting enzyme inhibitors), and third-line (nonrecommended) drugs. Nonprescription expenditures were calculated. Multivariate analyses were performed to determine whether use of the first-line drugs was associated with cost-savings. RESULTS: Compliance rate with the JNC guidelines was low. About 36%, 67%, and 87% of patients in the nation received first-, second-, and third-line drugs, respectively, at some point during 1996. Prescription expenditure constituted more than 67% of the total expenditures for treating essential hypertension. The use of first-line drugs (vs second-line drugs) was associated with expenditures that were dollar 2.6 billion to dollar 3.2 billion lower. CONCLUSIONS: Compliance with the JNC guidelines for treating essential hypertension may reduce the costs of prescriptions and other medical services. Raising awareness of the JNC guidelines is crucial to achieve cost effectiveness in choosing treatment alternatives.

Antihypertensive Agents↗
PubMedDate not supplied

Accuracy of drawing blood through infusing intravenous lines.

OBJECTIVE: To determine the usefulness of peripheral intravenous lines as an alternative route for obtaining blood samples. DESIGN: Quasiexperimental. SETTING: Wilford Hall Medical Center, a regional level I trauma center and military teaching hospital in San Antonio, Tex. SAMPLE: A convenience sample of 64 subjects was enrolled between September 1997 and June 1998. OUTCOME MEASURES: Comparative analysis of a complete blood count and chemistry, using the patients as their own control, on the same Coulter Analyzer and Boelrringer Mannheim/Hitachi 747-200. RESULTS: A total of 559 values were evaluated. Only 2.5% of the specimens exceeded the Clinical Laboratory Improvement Act standards. None of the values was clinically significant. CONCLUSION: Intravenous devices, if used properly, are reliable tools for blood specimen collection. They yield accurate analyte levels that may used in the treatment of patients.

Adolescent↗
PubMed2005

Oral white patches in a national sample of medical HIV patients in the era of HAART.

OBJECTIVES: Several types of HIV-related oral mucosal conditions have been reported to occur during the course of HIV disease progression. Of these, few may be manifested as 'white' lesions and many are noticeable to the patient. This paper examines the relationships between social, behavioral and medical aspects of HIV infection and reporting an occurrence of oral white patches (OWP) by HIV-infected patients. METHODS: The subjects are participants in all three interviews in the HIV Cost and Services Utilization Study (HCSUS). The subjects were selected using a three-stage probability sampling design. The multivariate analysis is based on 2109 subjects with nonmissing binary outcome variable for all three waves representing a national sample of 214 000 individuals. The multivariate model was fitted using generalized estimating equations (GEE) by implementing the XTGEE command in STATA. RESULTS: We estimate that 75 000 persons (35%) reported at least one incident of OWP, of these 14 000 reported having OWP during all three interviews, and that the rate of reporting declined over the three HCSUS waves. The multivariate analysis showed seven variables that were significant predictors of at least one report of OWP. CONCLUSIONS: Compared with persons on HAART therapy, patients on other regimens or taking no antiviral medications were 23-46% more likely to report an incident of OWP. Compared with whites, African Americans were 32% less likely to report OWP, while current smokers were 62% more likely than nonsmokers. Being diagnosed with AIDS and having CD4 counts less than 500 significantly increased the likelihood of reporting OWP.

Adolescent↗
PubMed1979

A composite estimator for small area statistics.

Samples designed to provide estimates for large geographic areas are sometimes used to provide estimates for small areas. In such cases the sample in a small area may be "unrepresentative" or of small size. Various estimators, including a composite estimator, which is weighed function of two component estimators, have been suggested for use in these situations. The choice of weights for the composite estimator is considered in this paper. It is shown that with appropriate weights the composite estimator has smaller mean square error than either component estimator and also that this estimator is remarkably robust against poor choices of weights. Data from the National Center for Health Statistics' Health Interview Survey and the Bureau of the Census' Public Use Tapes are used to illustrate results when direct and synthetic estimators are used as components of the composite estimator.

Health Surveys↗
PubMed1992

Differences in quality of care for hospitalized elderly men and women.

OBJECTIVE: To analyze whether important gender differences exist in the quality of hospital care provided to patients with four major medical conditions. DESIGN: Bivariate and multivariate comparisons of clinically detailed sickness at admission, quality, utilization, and outcome measures. SETTING: Acute care hospitals located in five states. PATIENTS OR OTHER PARTICIPANTS: A total of 11,242 patients 65 years or older who were hospitalized with one of four diseases: congestive heart failure, acute myocardial infarction, pneumonia, and cerebrovascular accident. We derived our data from the nationally representative sample used to study the quality of hospital care for Medicare patients before and after the implementation of the prospective payment system. A hierarchical (nested) cluster sampling design was used to draw disease-specific samples of patients hospitalized in 1981, 1982, 1985, or 1986 in one of 297 hospitals located in 30 areas within five states. INTERVENTIONS: This was an observational study. MAIN OUTCOME MEASURES: Sickness at admission, process, use rates, length of stay, discharge status, discharge destination, and mortality. RESULTS: Sex differences in sickness at admission varied by disease. There was some evidence that women received worse process of care, but the difference was very small. We found many similarities in the process and outcomes of care for male and female patients. CONCLUSIONS: After controlling for sickness at admission, age, and other important covariates, the in-hospital experiences of elderly men and women showed greater similarities than differences. The concern that sex bias enters into clinical decision making during hospitalization is eased, although not entirely eliminated.

Aged↗
PubMed2001

Addressing an idiosyncrasy in estimating survival curves using double sampling in the presence of self-selected right censoring.

We investigate the use of follow-up samples of individuals to estimate survival curves from studies that are subject to right censoring from two sources: (i) early termination of the study, namely, administrative censoring, or (ii) censoring due to lost data prior to administrative censoring, so-called dropout. We assume that, for the full cohort of individuals, administrative censoring times are independent of the subjects' inherent characteristics, including survival time. To address the loss to censoring due to dropout, which we allow to be possibly selective, we consider an intensive second phase of the study where a representative sample of the originally lost subjects is subsequently followed and their data recorded. As with double-sampling designs in survey methodology, the objective is to provide data on a representative subset of the dropouts. Despite assumed full response from the follow-up sample, we show that, in general in our setting, administrative censoring times are not independent of survival times within the two subgroups, nondropouts and sampled dropouts. As a result, the stratified Kaplan-Meier estimator is not appropriate for the cohort survival curve. Moreover, using the concept of potential outcomes, as opposed to observed outcomes, and thereby explicitly formulating the problem as a missing data problem, reveals and addresses these complications. We present an estimation method based on the likelihood of an easily observed subset of the data and study its properties analytically for large samples. We evaluate our method in a realistic situation by simulating data that match published margins on survival and dropout from an actual hip-replacement study. Limitations and extensions of our design and analytic method are discussed.

Arthroplasty, Replacement, Hip↗
PubMed2003

Autocorrelation problems in short time series.

The work of Huitema (1985) on autocorrelation in behavioral data suggests that the use of conventional statistical methods is justified. The present study restates the problem of autocorrelation by analyzing 100 baselines of small samples designs published in the Journal of Applied Behavior Analysis during 1992. The results show a negative bias in the autocorrelations, especially with very small samples. The autocorrelation values are normally distributed, and the method of Davies, Trigg, and Newbold (1977) is the most accurate in calculating the standard deviation.

Data Interpretation, Statistical↗
PubMed2006

Obstructive sleep apnea and plasma natriuretic peptide levels in a community-based sample.

STUDY OBJECTIVES: We hypothesized that alterations in cardiac hemodynamics associated with obstructive sleep apnea-hypopnea (OSAH) would be reflected in higher natriuretic peptide levels. We examined the association of OSAH with natriuretic peptides in a community-based sample. DESIGN: Cross-sectional, retrospective, observational study. SETTING: Framingham Heart Study Offspring Cohort and Sleep Heart Health Study. PARTICIPANTS: Community-based sample of 623 individuals. MEASUREMENTS: Full-montage home polysomnography was used to determine apnea-hypopnea index (AHI) and percentage of time with an oxyhemoglobin saturation < 90% (PctLt90). Sensitive immunoradiometric assays were used to measure plasma B-type (BNP) and N-terminal pro-atrial natriuretic peptide (NT-ANP). Multivariable regression was used to examine the relations between natriuretic peptides and indicators of OSAH, adjusting for age, sex, body mass index, and clinical covariates. RESULTS: No statistically significant relations between OSAH indices and BNP were observed in the multivariable model. Compared with an AHI < 5, relative levels of 1.20, 0.88, and 0.91 were observed forAHI categories 5-15, 15-30, >30 events per hour, respectively. For NT-ANP, no significant relations were seen with AHI in the multivariable model (relative levels of 0.98, 0.91, and 0.90). An inverse association was observed between NT-ANP and PctLt90 in age- and sex-adjusted models (relative levels of 0.93, 0.87, and 0.80), although this association became statistically nonsignificant after adjusting for body mass index. CONCLUSION: Lack of association of natriuretic peptides with OSAH indices suggests that undiagnosed OSAH may not be associated with major alterations in left ventricular function, as reflected in morning natriuretic peptide levels.

Atrial Fibrillation↗
PubMed2004

Obesity in the Caribbean: the Jamaican experience.

AIM: This study was designed to investigate the point prevalence and pattern of obesity in the Jamaican adult population. METHODS: A two-stage-stratified random sampling design was used, and individuals aged 15 years and over were interviewed. In addition, anthropometric measurements were performed. The data were analysed using the SPSS statistical software version 8. Non-response was documented and factored into the final analysis of the survey data. RESULTS: A total of 2105 individuals responded to the all island survey, with 69% being females. Truncal obesity and gynoid obesity showed similar prevalence data. Both were affected by increasing age, being female, level of education attained and smoking status. CONCLUSIONS: Jamaica has a point prevalence of obesity, truncal 36.2% and gynoid 34.1%, in the 15 and over age group.

Adolescent↗
PubMed2005

Simplifying detection of cognitive impairment: comparison of the Mini-Cog and Mini-Mental State Examination in a multiethnic sample.

OBJECTIVES: To compare detection of cognitive impairment using the Mini-Cog and Mini-Mental State Examination (MMSE) and to identify sociodemographic variables that influence detection in an ethnoculturally diverse sample. DESIGN: Cross-sectional. SETTING: A registry of the University of Washington Alzheimer's Disease Research Center Satellite. PARTICIPANTS: A heterogeneous community sample (n=371) of predominantly ethnic minority elderly assessed using a standardized research protocol, 231 of whom met criteria for dementia or mild cognitive impairment (MCI). MEASUREMENTS: Demographic data, a standardized research protocol for cognitive assessment and dementia diagnosis, MMSE, and Mini-Cog. RESULTS: Both screens effectively detected cognitive impairment, the Mini-Cog slightly better than the MMSE (P<.01). Overall accuracy of classification was 83% for the Mini-Cog and 81% for the MMSE. The Mini-Cog was superior in recognizing patients with Alzheimer-type dementias (P=.05). Low education negatively affected detection using the MMSE (P<.001), whereas education did not affect the Mini-Cog, and low literacy minimally affected it. CONCLUSION: The Mini-Cog detects clinically significant cognitive impairment as well as or better than the MMSE in multiethnic elderly individuals, is easier to administer to non-English speakers, and is less biased by low education and literacy.

Aged↗
PubMedDate not supplied

Increasing self-efficacy through empowerment: preoperative education for orthopaedic patients.

PURPOSE: To examine whether patients who received an empowerment model of education for preoperative orthopaedic teaching had improved outcomes compared to patients who received the traditional education. DESIGN: An experimental (empowerment teaching method) group vs. comparison (traditional teaching method) group posttest design. SAMPLE: Seventy-four patients undergoing elective orthopaedic surgery. METHODS: Following the preoperative teaching session, patients in both groups completed a questionnaire designed to measure their perceptions of the teaching (empowerment) and self-efficacy (belief in their ability to carry out perioperative tasks). A chart audit and phone interview was done after discharge to assess length of stay, pain management, complications, and patient perceptions of the ability to complete perioperative tasks. FINDINGS: Patients in the empowerment group felt the educational approach was more empowering and had significantly higher self-efficacy scores than those in the traditional teaching group. There was much less variation in empowerment and self-efficacy scores in the empowerment group. The empowerment group reported feeling greater confidence in performing perioperative tasks. There were no differences in length of stay, complications or pain control. CONCLUSION: Use of an empowerment teaching approach enabled patients to become more confident in their ability to carry out perioperative tasks and become a more integral part of the preoperative teaching process. IMPLICATIONS FOR NURSING RESEARCH: The theoretical model will be used to structure other educational programs and guide research. More sensitive measures of complications and pain control should be considered for future studies.

Adolescent↗
PubMed1992

Estimates from two survey designs: national hospital discharge survey.

The methodology for the National Hospital Discharge Survey (NHDS) has been revised in several ways. These revisions, which were implemented for the 1988 NHDS, included adoption of a different hospital sampling frame, changes in the sampling design (in particular the implementation of a three-stage design), increased use of data purchased from abstracting service organizations, and adjustments to the estimation procedures used to derive the national estimates. To investigate the effects of these revisions on the estimates of hospital use from the NHDS, data were collected from January through March of 1988 using both the old and the new survey methods. This study compared estimates based on the old and the new survey methods for a variety of hospital and patient characteristics. Although few estimates were identical across survey methodologies, most of the variations could be attributed to sampling error. Estimates from two different samples of the same population would be expected to vary by chance even if precisely the same methods were used to collect and process the data. Because probability samples were used for the old and new survey methodologies, sampling error could be measured. Approximate relative standard errors were calculated for the estimates using the old and new survey methods. Taking these errors into account, less than 10 percent of the estimates were found to differ across survey methodologies at the 0.05 level of significance. Because a large number of comparisons were made, 5 percent of the estimates could have been found to be significantly different by chance alone. When there were statistically significant differences in nonmedical data, the new methods appeared to produce more accurate estimates than the old methods did. Race was more likely to be reported using the new methods. "New" estimates for hospitals in the West Region and government-owned hospitals were more similar than the corresponding "old" estimates to data from the census of hospitals conducted by the American Hospital Association. The numerous significant differences in estimates for bed size categories between the two survey methodologies reflected the change in the universe and definition of beds for the new survey. Few statistically significant differences were found in the medical data using the old and the new survey methods. Two main differences, in estimates for cataract and alcohol dependence syndrome, may have resulted from problems with the new survey. A measurement error, reporting outpatients to the NHDS, is one possible explanation of the higher estimates for diagnosis of cataract using the new survey methods.(ABSTRACT TRUNCATED AT 400 WORDS)

Bias↗
PubMed2000

Emotional well-being predicts subsequent functional independence and survival.

OBJECTIVE: To determine whether positive affect has an independent effect on functional status, mobility, and survival in an older Mexican American sample. DESIGN: A 2-year prospective cohort study. SETTING: Five Southwestern states: Texas, California, Arizona, New Mexico, and Colorado. PARTICIPANTS: A population-based sample of 2282 Mexican Americans aged 65 to 99 who reported no functional limitations at baseline interview. MEASUREMENTS: In-home interviews in 1993-1994 and again in 1995-1996 assessed demographic variables, health conditions, activities of daily living, performance-based mobility, survival, and a rating of positive and negative affect. RESULTS: In multivariate analyses, there was a direct relationship between positive affect scores at baseline and mobility, functional status, and survival 2 years later, controlling for functional status, sociodemographic variables, major chronic conditions, body mass index (BMI), smoking status, drinking status, and negative affect at baseline. Subjects with high positive affect were half as likely (odds ratio (OR) = 0.48; 95% confidence interval (CI) 0.29, 0.93) to become disabled in activities of daily living (ADLs), two-thirds as likely (OR = 0.64; 95% CI 0.51, 0.79) to have a slow walking speed, and half as likely (OR 0.53; 95% CI 0.30, 0.93) to have died during the 2-year follow-up compared to those with lower positive affect scores. CONCLUSIONS: Our results support the concept that positive affect, or emotional well-being, is different from the absence of depression or negative affect. Positive affect seems to protect individuals against physical declines in old age.

Activities of Daily Living↗
PubMed2003

Socioeconomic differences in attitudes and beliefs about healthy lifestyles.

STUDY OBJECTIVE: s: The factors underlying socioeconomic status differences in smoking, leisure time physical activity, and dietary choice are poorly understood. This study investigated attitudes and beliefs that might underlie behavioural choices, including health locus of control, future salience, subjective life expectancy, and health consciousness, in a nationally representative sample. DESIGN: Data were collected as part of the monthly Omnibus survey of the Office of National Statistics in Britain. PARTICIPANTS: A stratified, probability sample of 2728 households was selected by random sampling of addresses. One adult from each household was interviewed. MAIN RESULTS: Higher SES respondents were less likely to smoke and more likely to exercise and eat fruit and vegetables daily. Lower SES was associated with less health consciousness (thinking about things to do to keep healthy), stronger beliefs in the influence of chance on health, less thinking about the future, and lower life expectancies. These attitudinal factors were in turn associated with unhealthy behavioural choices, independently of age, sex, and self rated health. CONCLUSIONS: Socioeconomic differences in healthy lifestyles are associated with differences in attitudes to health that may themselves arise through variations in life opportunities and exposure to material hardship and ill health over the life course.

Adult↗
PubMedDate not supplied

Tobacco use among teachers [corrected] in Uttar Pradesh & Uttaranchal, India.

Information about tobacco use prevalence, knowledge and attitude was assessed among school personnel in Uttar Pradesh. A single cluster sample design with probability proportional to the enrolment in grades 8-10 was used. Statistical analysis was done using SUDAAN and the C-sample procedure in Epi-Info. The school response rate was 100%. School personnel response rate ranged from 72-80%, the proportion of men being 84-92%. Current cigarette smoking and smokeless tobacco use reported by all teachers was 21.9% and 75.6% respectively. The prevalence of daily cigarette smoking was ranged by 12.6-15.1%; bidi and other smoking 4.8-13.4%; smokeless tobacco use 16.3-19.8%. Existing school policy on four measures were reported poor however over 72% school personnel felt need for policy prohibiting tobacco use among students and school personnel. Tobacco prevention instruction by teachers did not fare much better on six different measures (4.9-30.9%). However over 2/3rd school personnel were very supportive on tobacco control issues. There was no training among school personnel on tobacco use prevention skills (3.7%). However most of the school personnel (67.1%) were curious about getting such trainings. A positive environment for tobacco use prevention needs to be created by adopting comprehensive tobacco control policies for schools. First step towards this may be training of school personnel on tobacco use prevention skill and supply of teaching materials.

Adolescent↗
PubMed2003

Assessment of fresh and frozen-thawed boar semen using an Annexin-V assay: a new method of evaluating sperm membrane integrity.

Detection of early changes in the sperm plasma membrane during cryopreservation is of utmost importance when designing freezing protocols. The present study evaluated the ability of an Annexin-V binding assay to detect early changes in sperm membrane integrity using flow cytometry (FC) in two different portions of the boar ejaculate, in cryopreserved semen. Using a split sample design, sperm motility was evaluated in fresh (controls) and frozen-thawed (FT) samples, both subjectively and by means of a computer-assisted motility assessment (CASA) system, while membrane integrity was assessed using Annexin-V (A) and propidium iodide (PI) staining in spermatozoa derived from the first sperm-rich fraction (Portion I) or the remaining ejaculate (Portion II). The A/PI technique revealed four sperm subpopulations, two PI negative (either A- (alive) or A+ (apoptotic)); and two PI positive (dead cells), either A+ (dead, late apoptotic or early necrotic cells) or A- (dead, late necrotic cells). Significant differences were found between the two portions of the ejaculate in the fresh (control) and FT samples. In the fresh controls, significantly more live, nonapoptotic spermatozoa (A-/PI-) were present in Portion I than in Portion II (P<0.001). Although apoptotic spermatozoa were detected in both semen portions, the frequency of live, early apoptotic (A+/PI-) cells was significantly lower in Portion I than in Portion II (P<0.001). Irrespective of the ejaculate portion considered, freezing and thawing significantly decreased the mean percentages of live spermatozoa (P<0.01), and dramatically increased the percentages of apoptotic or early necrotic cells (P<0.01), but not of early apoptotic cells (N.S.). The latter finding might suggest that apoptotic changes due to cryopreservation using the procedures applied in this trial are transient and lead to cell death. In conclusion, the Annexin-V binding assay was able to detect deleterious changes in the sperm plasma membrane at an earlier point than PI staining, thus representing a novel approach to investigating membrane integrity in this species. The finding that fewer spermatozoa in Portion I of the ejaculate showed early apoptosis post-freezing, suggests boar spermatozoa in this portion of the seminal plasma are less sensitive to the stress induced by cryopreservation.

Animals↗
PubMed2001

Delays in receipt of immunizations in low-birth-weight children: a nationally representative sample.

BACKGROUND: Studies of very low-birth-weight (VLBW) children discharged from neonatal intensive care units have shown delays in receipt of routine childhood immunizations. However, a recent study of VLBW children in 3 health maintenance organizations found no significant delays in immunizations. OBJECTIVE: To assess the risk of immunization delays for moderately low-birth-weight (MLBW; 1500 g-2499 g) and VLBW (<1500 g) children compared with normal-birth-weight children in a nationally representative birth sample. DESIGN: Logistic regression analysis using the 1988 National Maternal and Infant Health Survey and the 1991 Longitudinal Follow-up Survey. SETTING: Nationally representative sample of children born in 1988 in the United States. PARTICIPANTS: A total of 8285 children whose mothers completed both surveys. MAIN OUTCOME MEASURES: Age at receipt of each of the first 4 doses of diphtheria and tetanus toxoids and pertussis vaccine, the first 3 doses of polio vaccine, and the first dose of measles-mumps-rubella vaccine for MLBW and VLBW children, and normal-birth-weight children. We also examined whether children were up-to-date for all immunizations at ages 12, 24, and 36 months based on birth-weight groups. RESULTS: Very low-birth-weight children received their first 3 doses of diphtheria and tetanus toxoids and pertussis vaccine and their first 2 doses of polio vaccine significantly later than normal-birth-weight children (P <.001). Very low-birth-weight children were significantly less likely to be up to date for all immunizations at ages 12 months (odds ratio [OR] =.556; P =.001), 24 months (OR =.439; P <.001), and 36 months (OR =.446; P <.001) compared with normal-birth-weight children. CONCLUSION: Very low-birth-weight children are at risk for immunization delays compared with normal-birth-weight children.

Age Distribution↗
PubMed2000

A single, sequential, genome-wide test to identify simultaneously all promising areas in a linkage scan.

Inflation of type I error occurs when conducting a large number of statistical tests in genome-wide linkage scans. Stringent alpha-levels protect against the high numbers of expected false positives but at the cost of more false negatives. A more balanced tradeoff is provided by the theory of sequential analysis, which can be used in a genome scan even when the data are collected using a fixed-sample design. Sequential tests allow complete, simultaneous control of both the type I and II errors of each individual test while using the smallest possible sample size for analysis. For fixed samples, the excess N "saved" can be used in a confirmatory, replication phase of the original findings. Using the theory of sequential multiple decision procedures [Bechhoffer et al., 1968], we can replace the series of individual marker tests with a new single, simultaneous genome-wide test that has multiple possible outcomes and partitions all markers into two subsets: the "signal" versus the "noise," with an a priori specifiable genome-wide error rate. These tests are demonstrated for the Haseman-Elston approach, are applied to real data, and are contrasted with traditional fixed-sampling tests in Monte Carlo simulations of repeated genome-wide scans. The method allows efficient identification of the true signals in a genome scan, uses the smallest possible sample sizes, saves the excess to confirm those findings, controls both types of error, and provides one elegant solution to the debate over the best way to balance between false positives and negatives in genome scans.

Dopamine beta-Hydroxylase↗