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At least 811 records · Page 45Linked to original sources
PubMed1999

Changing incidence of Achilles tendon rupture in Scotland: a 15-year study.

OBJECTIVE: To determine the incidence of Achilles tendon rupture in Scotland from 1980 to 1995. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Data were obtained from the National Health Service Information and Statistics Division and analyzed in terms of age- and gender-specific incidence rates and time trends by age group. PARTICIPANTS: A total of 4,201 patients with Achilles tendon ruptures occurring during the study period. MAIN OUTCOME MEASURES: Calculation of incidence and of seasonality. RESULTS: The overall incidence of Achilles tendon rupture increased from 4.7/100,000 in 1981 to 6/100,000 in 1994, with a peak in 1986. In men, the incidence rose from 6.3/100,000 to 7.3/100,000. In women, the increase in incidence was more pronounced, from 3/100,000 to 4.7/100,000. In men, peak incidence rate occurred in the 30- to 39-year age group, whereas in women, the peak age-specific incidence occurred in those aged 80 years and older, with a steady increase after age 60. There was no evidence of a seasonality effect in the rate of occurrence of Achilles tendon rupture. A bimodal distribution of age at time of Achilles tendon rupture was noted. CONCLUSION: There was a significant increase in the incidence of Achilles tendon rupture during the period from 1980 to 1995. This reflects the increased incidence of the injury noted in other Northern European countries.

Achilles Tendon↗
PubMed1996

Patients' complaints as a management tool for continuous quality improvement.

Continuous quality improvement focuses on the customer and, therefore, requires attention to customers' feedback as a vital input. Customers' feedback in general hospitals includes utilization statistics of various services, patient satisfaction surveys and patients' complaints. The role of complaint data as a management tool, and particularly as applied to quality improvement, has received little attention in the literature. As a quality control tool, complaints are investigated on the individual, unit and organizational levels. Repeated complaints about the same units, procedures or individuals, are especially important for quality review. The role of the hospital administration is to draw on the human, technological and procedural resources at its disposal, along a solution time interval (immediate, short and long term), in designing its policy for quality improvement. Presents three examples of policy changes. The aggregate of complaint data serves, in addition, for follow-up of the effect of changes introduced by policy decisions.

Health Care Surveys↗
PubMed2003

Catching up on health outcomes: the Texas Medication Algorithm Project.

OBJECTIVE: To develop a statistic measuring the impact of algorithm-driven disease management programs on outcomes for patients with chronic mental illness that allowed for treatment-as-usual controls to "catch up" to early gains of treated patients. DATA SOURCES/STUDY SETTING: Statistical power was estimated from simulated samples representing effect sizes that grew, remained constant, or declined following an initial improvement. Estimates were based on the Texas Medication Algorithm Project on adult patients (age > or = 18) with bipolar disorder (n = 267) who received care between 1998 and 2000 at 1 of 11 clinics across Texas. STUDY DESIGN: Study patients were assessed at baseline and three-month follow-up for a minimum of one year. Program tracks were assigned by clinic. DATA COLLECTION/EXTRACTION METHODS: Hierarchical linear modeling was modified to account for declining-effects. Outcomes were based on 30-item Inventory for Depression Symptomatology-Clinician Version. PRINCIPAL FINDINGS: Declining-effect analyses had significantly greater power detecting program differences than traditional growth models in constant and declining-effects cases. Bipolar patients with severe depressive symptoms in an algorithm-driven, disease management program reported fewer symptoms after three months, with treatment-as-usual controls "catching up" within one year. CONCLUSIONS: In addition to psychometric properties, data collection design, and power, investigators should consider how outcomes unfold over time when selecting an appropriate statistic to evaluate service interventions. Declining-effect analyses may be applicable to a wide range of treatment and intervention trials.

Adult↗
PubMed1992

Quantitative indicators for a healthy city--the Rotterdam local health information system.

STUDY OBJECTIVE: The aim was to develop a local health information system for monitoring health status and for contributing to the development of local health policy. DESIGN: At district or even at neighbourhood level, data are collected on health status and factors related to health, including lifestyle, social and physical and environment, and the health care system. Data are collected from central and municipal Bureaus of Statistics, health care services, regional and municipal institutions, and by means of regularly performed local health surveys. SETTING: The 84 neighbourhoods of the Rotterdam Municipality. MAIN RESULTS: In the local health information system three sorts of data are collected: data on health status, data on health risk factors, and socioeconomic and demographic data. Two examples of data on health status are given (mortality and mental health) which were analysed. These data show differences in health status between several districts in Rotterdam, which can be related to differences in socioeconomic status between these districts. Examples are given of the influence of the project on local health policy in Rotterdam. CONCLUSIONS: The main conclusion is that the local health information system has great promise as an information system to give direction to local health policy. However if this promise is to be fulfilled, it will be necessary to obtain data from more varied sources.

Female↗
PubMed2003

Under-ascertainment of multiple myeloma among participants in UK atmospheric atomic and nuclear weapons tests.

An inter-comparison of cases of multiple myeloma among UK participants in the UK's atmospheric atomic and nuclear weapons tests ascertained by direct follow up methods detected at least a third more cases than a strategy relying solely on data linkage between the Office of National Statistics and the Service Records Offices. These finding have implications for the conduct and robustness of follow up studies of long term health effects among participants in nuclear weapons tests.

Air Pollutants, Radioactive↗
PubMed2005

Determinants of service use among young Canadians with mental disorders.

OBJECTIVE: To identify the determinants of service use by young Canadians with mental health problems. METHODS: Data were drawn from a recent large Canadian mental health survey. The analyses were conducted on a subsample of 1092 Canadians aged 15 to 24 years and identified as presenting a mood disorder, an anxiety disorder, or a substance-related disorder in the 12 months preceding the survey. We classified variables potentially associated with any type of service use for a mental health problem over a 12-month period according to predisposing, enabling, and need factors. We conducted weighted multivariate logistic regressions to determine the association of each factor with service use. RESULTS: In the final model, being female and living alone were the predisposing factors associated with service use. None of the enabling factors predicted help seeking. In regard to the perceived need factors, those who had difficulties with social situations were more likely to use services. Having a mood disorder and (or) having a diagnosed chronic illness were the evaluated need factors associated with service use. CONCLUSION: Certain groups of young Canadians are less likely to seek help for mental health problems and could be the target of interventions aimed at increasing service use.

Adolescent↗
PubMed2007

Development and confirmatory factor analysis of the community norms of child neglect scale.

This article describes the development of the Community Norms of Child Neglect Scale (CNCNS), a new measure of perceptions of child neglect, for use in community samples. The CNCNS differentiates among four subtypes of neglect (failure to provide for basic needs, lack of supervision, emotional neglect, and educational neglect). Scenarios ranging in seriousness for each subtype were presented to a large community sample (N = 3,809). Confirmatory factor analyses indicated that a four-factor model provided a better fit to the data than did a model specifying only one overall neglect factor, suggesting this sample distinguished among the four subtypes of neglect. The authors tested measurement equivalence across individuals who work with children and lay community respondents and across rural and urban respondents, with results indicating a very similar structure across these groups. These initial reliability and validity data suggest that the CNCNS may be of use in comparing perceptions of child neglect among individuals and across communities.

Adolescent↗
PubMed2006

Assessment of home-based behavior modification programs for autistic children: reliability and validity of the behavioral summarized evaluation.

Since the publication of Lovaas' (1987) impressive findings, there has been a proliferation of home-based behavior modification programs for autistic children. Parents and other paraprofessionals often play key roles in the implementation and monitoring of these programs. The Behavioral Summarized Evaluation (BSE) was developed for professionals and paraprofessionals to use in assessing the severity of autistic symptoms over the course of treatment. This paper examined the psychometric properties of the BSE (inter-item consistency, factorial composition, convergent validity, and sensitivity to parents' perceptions of symptom change over time) when used by parents of autistic youngsters undergoing home-based intervention. Recommendations for future research are presented.

Autistic Disorder↗
PubMed1994

Older consumers' perceptions of health care information sources: the effect on search behavior.

Substantial evidence has been developed regarding the identity of health care information sources preferred by the elderly. However, this research has not empirically investigated why a given source might be more or less important to this segment. To address this gap, this research investigates OTC-health care information sources in terms of their credibility, expertise and associated risk. Differences in perceptions of these characteristics across the derived information source types are then examined across heavy and light users of OTC medications.

Aged↗
PubMed1998

Coroners' records of rural and non-rural cases of youth suicide in New South Wales.

OBJECTIVE: The aim of this study is to compare the frequency of certain putative risk factors for youth suicide in New South Wales (especially use of alcohol, social class, unemployment, and internal migration) in metropolitan and rural settings. METHOD: A review of 137 files for 10-19-year-old subjects judged by the Coroner to have committed suicide in 1988-1990 was carried out. RESULTS: One hundred and fifteen males and 21 females were identified (one subjects sex was unavailable). The male-female ratio was higher in rural (13.0) areas than non-rural (4.9 chi 2 = 12.14, p < 0.01). Of 27 subjects migrating within Australia, most migrated in a rural direction, and most to rural shires. Unemployment was somewhat more common among rural (38.5%) than non-rural (28.9%) subjects (chi 2 = 0.75, p = 0.39). Eleven of 50 non-rural parents of the deceased, but none of the 11 rural parents, were ranked as being in social classes 2 or 3. Alcohol consumption appeared more common in rural shires (44%) than metropolitan areas (32.9%), but this was not statistically significant. Medical services were less utilised prior to death in rural (15%) than non-rural (25%) areas (chi 2 = 1.69, p = 0.19), and a psychiatric diagnosis was recorded more commonly in non-rural areas. CONCLUSIONS: Incomplete coronial file data and relatively small numbers limit this study's conclusions. Male suicides, principally by firearms, predominated in rural areas. Youth firearm access remains highly relevant to rural communities. Possible trends among rural subjects toward rural migration, higher unemployment, lower social class and lower medical attendance may point to resource deprivation among this group; these matters require further investigation.

Adolescent↗
PubMed1999

Trichinellosis in the United States, 1991-1996: declining but not gone.

Since the U.S. Public Health Service began recording statistics on trichinellosis in 1947, the number of cases reported by state health departments has decreased steadily. In the late 1940s, health departments reported an average of 400 cases and 10-15 deaths each year. From 1991 to 1996, the period covered in this report, three deaths in 230 cases were reported to the Centers for Disease Control and Prevention (an average of 38 cases per year), including 14 multiple case outbreaks from 31 states and Washington, DC. Information on the suspected food item was available for 134 (58%) of the 230 reported cases. Pork was implicated in 80 (60%) cases, bear meat in 31 (23%), walrus meat in 13 (10%), and cougar meat in 10 (7%). Sausage was the most frequently implicated pork product (i.e., 57 of the 64 cases for which the form of the pork product was identified). The proportion of trichinellosis cases attributable to consumption of commercial pork continued to decrease; this decrease was probably due to a combination of factors, including the continued reduction in the prevalence of Trichinella spiralis in domestic swine, the increased use of home freezers, and the practice of thoroughly cooking pork. As a proportion of all cases reported, those associated with wild game meat products has increased; however, the absolute numbers of such cases have remained similar at approximately 9-12 per year. The continued multiple case outbreaks and the identification of nonpork sources of infection indicate the need for further education and control measures.

Adolescent↗
PubMedDate not supplied

Discontinuity in the Health Care Financing Administration's published standardized mortality ratios due to underestimation bias across multiple admissions case selection methods.

Case counts below 50 can compromise the careful use of disease- or procedure-specific standardized mortality ratio comparisons across small hospitals in predominantly rural areas. Linking data series where data are of the same quality and are continuous across the series is one way of handling the problem of small case sizes. Examination of three different annual reports of Health Care Financing Administration (HCFA) mortality findings for 1987 of one state's providers showed significantly lower actual and predicted mortality rates reported in 1989, compared with the same mortality rates reported about 1987 published in 1988 and 1987. One hypothesis for the downward trend is the change in case selection method used for constructing the mortality model from last discharge (used in 1987 and 1988 reports) to random selection of cases with multiple admissions (initiated in 1989). A test of both case selection methods is presented and shows the consequences of mortality model changes that create discontinuities with previously reported findings, changes that limit or at least need to be taken into account when linking current HCFA mortality data series with historic series.

Bias↗
PubMedDate not supplied

Creation of hospital peer groups.

Hospital characteristics vary greatly across a geographic area such as a state. Hospital peer groups internally exhibit similar characteristics and can be used as a basis for the analysis of data, the dissemination of information, and the adoption of continuous quality improvement project results. This paper reflects the efforts made toward the identification of hospital peer groups within the state of Michigan. Hospital characteristics data for fiscal year 1992 were obtained from the American Hospital Association's Annual Survey of Hospitals and the Health Care Financing Administration's MEDPRO database. Thirteen peer group clusters have been identified, reviewed, and commented on by the state's hospital association and have met general approval by hospital administrators across the state. The established peer groups are being used to identify the differences in patterns of care among hospitals in the state. The peer groups also are being used for the feedback of comparable data and the identification of hospitals for participation in continuous quality improvement projects. The next research objective is to experiment with other clustering techniques and other inpatient populations. The consistency of the peer groupings across all clustering techniques and across both Medicare and total inpatient populations will be studied.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1998

Are pharmacists and pharmaceutical care having an impact on diabetes?

This study sought to identify pharmacy services offered to patients with diabetes and demonstrate patients receiving pharmaceutical care services had better glucose control as measured by laboratory values and medication compliance. Two hundred randomly selected patients with diabetes were identified from a pharmacy benefits manager's database. Their pharmacists were mailed a survey requesting information concerning morbidity risk factors, concomitant disease states, concomitant medications, diabetes pharmacotherapy, blood glucose concentrations, and percent hemoglobin A1c values. Information concerning diabetes cognitive services offered was also requested. A statistically significant correlation between diabetes cognitive services and improved disease control was not demonstrated secondarily to the small number of responses returned with glucose control information. Our results indicate pharmacists must improve documentation of their services and the impact these interventions have on disease control in order to prepare for reimbursement for cognitive services.

Blood Glucose↗