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PubMed1995

[Future need of eye care for patients with diabetes mellitus, costs and effectiveness].

OBJECTIVE: To determine how much vision loss caused by diabetic retinopathy can be prevented in the Netherlands until 2020, and what resources will be needed to do so. DESIGN: Computer simulation study. METHODS: The population forecasts of the Dutch Central Bureau of Statistics constituted the starting points. The literature provided data on the disease progression and the effectiveness of screening and treatment. A new continuous computer simulation assessed one scenario without eye care and four scenarios with different screening frequencies. Effects were measured in sight gain, costs were based on official charges, benefits included savings on disability facilities and reductions in production losses. RESULTS: The number of diabetic patients was estimated to increase form 287,000 in 1993 to 406,000 in 2020. Compared with a setting without ophthalmic care, full compliance with official screening guidelines would reduce the prevalence of blindness in 2020 by 45% among type I patients, and by 20% among type II patients. Financial benefits would exceed costs for type I, but not for type II diabetes. While the intensity of eye care would rise, the number of eye examinations would increase approximately in the same proportion, but the number of laser treatments would increase at a much slower rate. 30% more ophthalmologists were estimated to be required in 2020. CONCLUSIONS: The sharp increase in the number of diabetic patients plus the proven effectiveness of photocoagulation will inevitably cause a major rise in the need for ophthalmic care.

Adult↗
PubMed1994

The economic implications of tobacco product sales in a nontobacco state.

OBJECTIVE: The tobacco industry claims that tobacco makes a significant economic contribution to each of the states in the United States. We sought to determine whether Michigan, a nontobacco state, would reap more economic benefits from the presence or absence of tobacco product sales. DESIGN: Computer simulation of the Michigan economy, with and without tobacco product sales, for the years 1992 through 2005. INTERVENTION: We simulated Michigan's economy with tobacco expenditures eliminated or reduced and the equivalent spending redistributed to other goods and services, according to consumers' normal spending patterns. We compare these results with baseline forecasts of the economy. MAIN OUTCOME MEASURES: Numbers of jobs and tax revenues. RESULTS: Michigan would have had 5600 more jobs in 1992 had there been no expenditure on tobacco products, with equivalent spending redistributed to other goods and services (and to other taxes, to replace half of lost cigarette excise tax revenues). By the year 2005, a tobacco-free Michigan would still have almost 1500 more jobs than it will have if sales trends for tobacco products continue (ie, gradually declining over time). If, instead of tobacco expenditures ceasing, the contemporary rate of decline in tobacco consumption had doubled, the state would have had over 300 more jobs in 1992 and would have nearly 800 more in 2005. With cigarette excise tax revenues not replaced, the elimination of spending on tobacco products would have decreased Michigan's tax revenues by $254 million in 1992. The more realistic doubling of the expected decline in smoking would have decreased revenues by $14 million that year. CONCLUSIONS: Reducing or eliminating tobacco product spending in Michigan will increase employment in the state, as well as health.

Commerce↗
PubMed1993

A simple empirical calibration of energy dispersive X-ray analysis (EDXA) on the cornea.

Monitoring of the corneal electrolyte content is important for the study of chemical eye burns. This paper describes quantitative measurements on gelatin standards, corneas and a cornea homogenate with an energy dispersive X-ray analyzer (EDX) in the scanning electron microscope (SEM). Ten micrometers thick cryosections were freeze-dried and mounted on solid carbon supports. The applied quantification procedure was a local peak background analysis with a specifically designed computer program. Similar chemical and physical properties of gelatin, cornea homogenate, and cornea were proven by EDX-analysis and wet chemical analysis. Gelatin standards with known concentrations of different added salts showed linear correlations with a correlation coefficient higher than 0.95 for all considered elements. The local background generation on carbon supports was the same for gelatin standards and corneal tissue. The results demonstrate that quantitative EDX analysis of semi-thin samples, mounted on neutral carbon supports, can be reliably used for the assessment of the corneal mineral composition.

Animals↗
PubMed1994

Postural sway patterns of normal men and women and men with mental retardation during a two-legged stance test.

Previous research has shown that in healthy subjects during a quiet two-legged stance, sagittal postural sway is greater than lateral postural sway with a ratio approximating 1.5. The purpose of this study was to examine the postural sway profiles of healthy men and women, and men with mental retardation (MR). Subjects consisted of 22 men (M), 22 women (W) and 22 men with MR. Postural sway characteristics were examined using a Kistler force platform. Each subject performed six trials, three with vision and three with vision occluded. Each trial was 15sec in duration, and the subject was instructed to stand motionless on the force platform. A custom-designed computer program sampled the lateral and sagittal sway characteristics for each trial, at a sample rate of 50Hz. Results indicated that the MR group exhibited significantly more lateral sway than the other two groups, and that the sagittal/lateral sway ratio was significantly lower in this group. Moreover, the MR group showed a greater amount of sway in the no-vision condition than either the M or W groups. Using the sagittal/lateral sway ratio, discriminant analyses indicated that group membership could be predicted in 75% to 82% of the cases in the vision condition, and 64% to 73% of the cases in the no-vision condition. It is concluded that the sagittal/lateral sway ratio provides a valid and objective assessment measure to determine the postural control/balance capacities of persons with MR. In addition, it is hypothesized that this ratio may prove useful in quantifying the effectiveness of therapeutic intervention programs on balance performance.

Adult↗
PubMed1993

An in vitro study of parameters related to marginal and internal seal of bonded restorations.

The wall-to-wall contraction of the cementing layer of bonded restorations is compensated for mainly by elastic and plastic tooth substrate-cement deformation but may result in adhesive fracture. Occlusally flattened teeth and corresponding computer-designed onlays, both positioned in a special device, were used to study marginal and internal seal of the adhesive interface with respect to four variables: rigidity of the restoration-substrate setup, cement thickness, adhesive configuration (enamel-dentin ratio and bonding agent), and luting agent. The results of dye infiltration tests revealed the significant influence of the adhesive configuration and rigidity of the setup. A high enamel-dentin ratio, use of a dentinal adhesive on dentinal margins and relative restoration-substrate "mobility" are required to preserve satisfactory marginal seal. However, in the present experimental conditions, no statistically significant differences were found among the diverse cement thicknesses or the luting agents evaluated.

Composite Resins↗
PubMed1993

A clinical comparison of plaque removal performance of three manual toothbrushes.

A clinical study was performed to evaluate and compare the plaque-removal performance of a recently introduced, computer-designed manual toothbrush with that of two commercially available products; the Oral-B 40 and the Reach Full-Head soft toothbrushes. Seventy-five adult male and female subjects participated, each refraining from toothbrushing for twenty-four hours. Plaque was scored according to the Rustogi, et al. refinement of the Modified Navy Plaque Index. Following screening, the subjects were divided into three balanced groups on the basis of initial plaque scores. Each group, in an alternate weekly cross-over design, used each of the three toothbrushes. At Visit 1, each group, having refrained from toothbrushing for twenty-four hours, was evaluated for plaque before brushing for sixty seconds with the assigned toothbrush, after which plaque was again scored. At Visit 2 one week later, the same procedure was followed except for the assignment of a different toothbrush. The same procedure was employed for Visit 3. On completion of the study, the data were subjected to statistical analyses which indicated that the Colgate Precision Full Head soft toothbrush removed significantly more plaque than either of the other two toothbrushes.

Adult↗
PubMed1993

Dietary approaches for reducing fat intake of preschool-age children.

STUDY OBJECTIVE: The present study was conducted to determine the effects of applying different fat reduction strategies to the overall nutrient profile of diets for preschool-age children. DESIGN: Computer modeling techniques were used to modify the diets of children (ages 2 through 3 and 4 through 5 years old) to meet contemporary dietary recommendations (< 30% of calories from total fat, < 10% from saturated fatty acids, and < 300 mg of cholesterol daily). Fat reduction strategies were applied to a 1-week menu that included preschoolers' favorite foods. Strategies applied were replacing high-fat meat exchanges with lean meat exchanges (+/- three high-fat meat exchanges per week), replacing higher fat milks with skim milk, replacing high-fat meat exchanges with medium-fat meat exchanges, using fat-modified products, using low-fat preparation techniques, and added fat. All diets were made isocaloric after modifications were applied. RESULTS: It is more difficult to meet all recommendations for the 2- and 3-year-old children. Use of skim milk is the simplest strategy to use for the 4- and 5-year-old children, although other single strategies are effective. CONCLUSIONS: When multiple strategies are effected. Some diets are very low in fat (< 20% of calories) and potentially inadequate in energy and nutrients. It is important that caregivers know the appropriate foods to choose when modifying fat in children's diets to ensure meeting energy and nutrient requirements.

Child Nutritional Physiological Phenomena↗
PubMed1996

Employment implications of declining tobacco product sales for the regional economies of the United States.

OBJECTIVE: To determine whether declines in tobacco product sales significantly reduce employment in the United States, as the tobacco industry claims. DESIGN: Computer simulation of the economies of the Southeast Tobacco region and 8 nontobacco regions of the United States, with domestic tobacco expenditures eliminated or reduced and the equivalent spending redistributed, according to consumers' normal spending patterns. We compared these results with baseline forecasts of the regional economies that include normal tobacco expenditures. MAIN OUTCOME MEASURE: Number of jobs. RESULTS: Had there been no spending on tobacco products in the United States in 1993, the Southeast Tobacco region would have had 303 000 fewer jobs. Collectively, however, the 8 nontobacco regions would have gained enough employment to completely offset losses in the Southeast Tobacco region, with every nontobacco region gaining jobs. By the year 2000, the absence of tobacco spending would mean a loss of 222 000 jobs in the Southeast Tobacco region, but a gain of 355 000 throughout the rest of the country. In the more realistic scenario of doubling the downward trend in tobacco consumption, the Southeast Tobacco region would lose 6300 jobs in 1993 (0.03% of regional employment) and 36 600 jobs by 2000 (0.2%). The 8 nontobacco regions would gain 6400 jobs in 1993 and 56 300 jobs in 2000, with each of the nontobacco regions gaining employment in every year. CONCLUSIONS: Contrary to the tobacco industry's claims, reductions in spending on tobacco products will boost employment in every one of the 8 nontobacco regions and will not diminish employment in the Southeast Tobacco region by as much as the industry estimates. The primary concern about tobacco should be the enormity of its toll on health and not its impact on employment.

Commerce↗
PubMed1996

Cervical cytology screening. How can we improve rates among First Nations women in urban British Columbia?

OBJECTIVE: To determine Pap smear screening rates among urban First Nations women in British Columbia; to identify facilitators and barriers; and to develop, implement, and evaluate specific interventions to improve Pap smear screening in Vancouver. DESIGN: Computer records of band membership lists and the Cervical Cytology Screening Program registry were compared to determine screening rates; personal interviews and community meetings identified facilitators and barriers to urban screening programs. A community advisory committee and the project team collaborated on developing specific interventions. SETTING AND PARTICIPANTS: Purposive sample of British Columbia First Nations women, focusing on women living in Vancouver. INTERVENTIONS: Poster, art card, and follow-up pamphlet campaign; articles in First Nations community papers; community meetings; and Pap smear screening clinics for First Nations women. MAIN OUTCOME MEASURES: Pap smear screening rates among BC First Nations women according to residence and reasons for not receiving Pap smears. RESULTS: Pap smear screening rates were substantially lower among First Nations women than among other British Columbia women; older women had even lower rates. No clear differences were found among First Nations women residing on reserves, residing in Vancouver, or residing off reserves elsewhere in British Columbia. Facilitators and barriers to screening were similar among women residing on reserves and in Vancouver. Many First Nations women are greatly affected by health care providers' attitudes, abilities to provide clear information, and abilities to establish trusting relationships. CONCLUSIONS: Family physicians are an important source of information and motivation for Pap smear screening among First Nations women.

Adolescent↗
PubMed1996

The Chief Scientist reports... Behavioural risk factors for coronary heart disease and cancers among adults in Edinburgh and Glasgow: assessing change 1988-1995.

OBJECTIVE: To assess change over time in selected behavioural risk factors for coronary heart disease and cancers and to assess progress towards government-defined health targets. DESIGN: Computer assisted telephone interview survey, randomly selected sample. SETTING: Edinburgh and Glasgow. SUBJECTS: 34,247 aged 18-60 years; 43.2% male and 56.8% female. MAIN OUTCOME MEASURES: Changes in cigarette smoking, diet, alcohol use and exercise among adults between 1988 and 1995. RESULTS: A majority of the variables under study showed significant change over the time period under review. On the positive side, the percentage of female smokers decreased significantly, whilst the number of female ex-smokers increased; the use of salt and butter declined significantly for men, and butter use declined significantly for women; and increasing numbers of men ate fruit in the last 24 hours and daily. On the negative side, there was no significant decrease in smoking prevalence among men; no significant increase in reported participation in physical activity for exercise for men or women, and a significant decrease in frequency of exercise for women; and the frequency of "drinking heavily on occasion' increased for both men and women. CONCLUSIONS: Significant positive changes in key health behaviours have taken place among adults resident in Edinburgh and Glasgow since 1988, particularly in relation to smoking among women and diet among men, but progress is slow and patchy.

Adult↗
PubMed1996

Introduction to telehealth home care.

Technologic advances in telecommunications and computer design will provide new tools for home health nurses to improve patient care and nurse efficiency. Participating in interactive electronic home visits, capturing vital sign data without visiting the home, scheduling daily events, teaching patients, and remotely managing the care plan all can be accomplished by using telehealth in home care.

Aged↗
PubMed1996

Interventions for coronary stenosis--a Canadian experience of 30 revolutionary years.

OBJECTIVE: To report 2324 coronary stenosis interventions (Vineberg procedures [VbP], coronary artery bypass graft operations [CABG] and percutaneous transluminal coronary angioplasties [PTCA]), in 1711 patients of a Canadian military hospital between 1965 and 1995 and to report their evolution and interaction in a historical context. DESIGN: Retrospective examination of clinical and angiographic findings in hard records, collected from the beginning for long term follow-up and later embedded in a custom-designed computer database. PATIENTS: Most were male, mean ages 43.2 and 43.3 years for first and second VbPs; 48.9 and 58.2 years for first and repeat CABGs; and 53.4 and 59.9 years for first and repeat PTCAs, respectively; 12% of all patients were 39 years old or younger at the first intervention. INTERVENTIONS: There were 160 VbPs, 1637 CABGs and 527 PTCAs. Of 1711 subjects, 74% had only one procedure, 15% had more than one of the same kind, and 11% had more than one of different kinds. MAIN RESULTS: Perioperative mortality for VbPs was 4.4%; for 'isolated' first CABGs it was 1.4% and 6.6% for reoperations, when other concurrent major cardiac procedures, excepting ventricular aneurysm repair, were excluded. It was 0.4% for PTCAs. Perioperative mortality for all 1761 'isolated' coronary interventions necessitating thoracotomy, during 30 years, was 2.4%. Angiographic follow-up rates were high and some findings are reported, including early postoperative patency rates for 5065 coronary bypass grafts, and long term follow-up data on graft patency and disease. CONCLUSIONS: Each intervention was used to circumvent or relieve coronary stenosis, in the early years when it became available and, later, as was most appropriate for dealing with specific clinical problems. The impact of advances in the evolution of these interventions on therapeutic decision-making is discussed. Finally, tributes are paid to those responsible for making these procedures possible, including a Canadian surgeon whose role was pivotal.

Adult↗
PubMed1997

Neuropathology: art and science.

So many examples of computer-designed (rather than human-designed) displays occurred at a recent meeting of the American Association of Neuropathologists that we were stimulated to develop simple guides to help improve presentation. Various color combinations provide examples of the best (and worst) contrast between the message and the medium (background).

Art↗
PubMed1997

Functional morphology of the spinal canal after endplate, wedge, and burst fractures.

Changes in the canal diameter during physiological motions are important considerations in the treatment of patients who have a burst fracture with the presence of bony fragments, but without neurologic deficit. In this in vitro study, the changes in the soft-canal diameter of the thoracolumbar region, when intact and after different fractures, was investigated under several different loading conditions. The soft-canal diameter was clearly identified on the lateral radiographs by attaching a series of steel balls to the posterior longitudinal ligament and ligamentum flavum in the midsagittal plane. Endplate, wedge, and burst fractures were produced incrementally in 19 three-vertebrae human cadaveric spine specimens by high-speed impacts. After each injury, a series of functional lateral radiographs were taken. The minimal canal diameter (MCD) was obtained by digitizing the images of the steel balls on radiographs using a custom-designed computer program. In the intact specimens, the MCD at the disc level changed significantly in flexion, extension, and compression, when compared with the MCD in the unloaded neutral position. However, the changes were small. The MCD after endplate and wedge fractures changed in a similar way. However, after the burst fracture, the MCD at the bone fragment level increased remarkably by a distraction force. It also significantly improved by an anterior shear force in comparison to the corresponding MCD in the neutral position. However, this change was smaller than the change due to the distraction force.

Biomechanical Phenomena↗
PubMed1998

[Continuous quality improvement in anesthesia].

Slow continuous quality improvement (SCQI) in anesthesia is a process that allows identification of problems and their causes. Implementing measures to correct them and continuous monitoring to ensure that the problems have been eliminated are necessary. The basic assumption of CQI is that the employees of an organization are competent and working to the best of their abilities. If problems occur they are the consequences of inadequacies in the process rather that in the individual. The CQI program is a dynamic but gradual system that invokes a slower rate of response in comparison with other quality methods, like quality assurance. Spectacular results following a system change are not to be expected an the ideal is slow and continuous improvement. A SCQI program was adapted by our department in May 1994, according to the recommendations of the American Society of Anesthesiologists. Problem identification was based on 65 clinical indicators, reflecting negative events related to anesthesia. Data were collected using a specially designed computer database. 4 events were identified as crossing previously established thresholds (hypertension, hypotension, hypoxia and inadequate nerve block). Statistical process control was used to establish stability of the system and whether negative events were influenced only by the common causes. The causes responsible for these negative events were identified using specific SCQI tools, such as control-charts, cause-effect diagrams and Pareto diagrams. Hypertension and inadequate nerve block were successfully managed. The implementation of corrective measures for the other events that cross the threshold is still in evolution. This program requires considerable dedication on the part of the staff, and it is hoped that it will improve our clinical performance.

Anesthesia↗
PubMed1998

Economic evaluation of neonatal health protection programs for cattle.

OBJECTIVE: To develop an economic tool that can be used to help cattle producers evaluate benefits of neonatal health programs. DESIGN: Computer simulation of a multiple-year spreadsheet model, using economic and production variables. SAMPLE POPULATION: Records for a university research farm beef herd. PROCEDURE: Data from the university research farm beef herd for each year from 1990 to 1995 were evaluated to determine economic benefits for the cow-calf enterprise that would result from a decrease in morbidity and mortality. A baseline economic evaluation of returns to variable costs was performed, using actual production and marketing information. Actual economic performance was contrasted with a projected simulation in which morbidity and mortality were decreased. Sensitivity analysis for the simulation model assessment of a neonatal health program was also performed. RESULTS: Mean-per-cow increase in net income for the herd during the 6-year period for morbidity and mortality reductions of 20, 40, and 60% was $7.44, $14.93, and $22.42, respectively. Sensitivity analysis revealed that net income per cow was not sensitive to errors in projections of morbidity and mortality. CLINICAL IMPLICATIONS: Identifying potential economic benefits for implementing a neonatal health plan and quantifying the costs to implement each component of the plan can be used by veterinarians and their clients when formulating a proactive strategy to provide the greatest potential for economic reward.

Animals↗
PubMed1998

Is brain cancer an occupational disease of cardiologists?

OBJECTIVE: To assess the plausibility of radiation as a cause of the statistically unusual event of two cardiologists in Toronto, Ontario who were diagnosed with brain tumours in 1997. DESIGN: Computation of the expected occurrence of brain cancer in Ontario cardiologists and review of the epidemiological literature pertaining to radiation and brain cancer. DATA SYNTHESIS: The occurrence of these two cases is a statistically unusual event--a 'cluster'. There are several plausible explanations for this cluster. First, this may be a chance occurrence, and the tumours may have no causative factors in common. Second, the cause may be radiation exposure. A connection to occupational radiation exposure is biologically plausible, but risk assessment suggests that it is unlikely that this effect would have been observable in the small population of Ontario cardiologists. CONCLUSIONS: Initiation of brain tumours during cardiac fluoroscopic procedures is plausible. Physicians are reminded to practise radiation safety methods during fluoroscopic procedures. The diagnosis of two additional brain tumours in Canadian interventional cardiologists during the past 10 years would confirm the occupational causation theory. The author invites physicians to report knowledge of the diagnosis of brain tumours in Canadian cardiologists to the author or to the editors.

Aged↗