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PubMed1998

[Tuberculosis in HIV-positive and HIV-negative drug users in Amsterdam].

OBJECTIVE: To determine and to compare the incidences of active tuberculosis in HIV positive and HIV negative drug users and to describe the main characteristics of the tuberculosis cases. DESIGN: Prospective. SETTING: Municipal Health Service, Amsterdam, the Netherlands. METHOD: Data of the ongoing cohort study of HIV infection in Amsterdam drug users, including HIV serostatus and CD4 cell counts, from 1986 until 1996 were completed with data from the tuberculosis registration of the tuberculosis department of the Amsterdam Municipal Health Service and analysed statistically. RESULTS: Of 872 participants 24 persons developed culture confirmed tuberculosis during a total follow-up period of 4000 person years (py) (0.6 per 100 py). Nineteen persons were HIV positive (1.54 per 100 py) and 5 HIV negative (0.18 per 100 py). Multivariately, HIV infection and higher age increased the risk of tuberculosis substantially (relative risks 12.9; 95% confidence interval (CI): 3.4-48.8 and 6.8: 95% CI: 1.3-35.0 respectively). Thirteen of 22 pulmonary tuberculosis cases (59%) were detected by half-yearly X-ray screening of the chest. Tuberculosis occurred relatively early in the course of HIV infection at a mean CD4 cell number of 390/microliter. All but one patient completed the tuberculosis treatment. CONCLUSION: HIV infection increases the risk of active tuberculosis in Amsterdam drug users 13-fold. The incidence of tuberculosis in HIV negative drug users in 6 times higher than that in the overall Amsterdam population. Periodic chest X-ray screening contributes substantially to case-finding of active tuberculosis in Amsterdam drug users.

AIDS-Related Opportunistic Infections↗
PubMed2005

South African Red Cross Flying Doctors Service quality and safety in the rural and remote South African environment.

CONTEXT: The South African Red Cross Air Mercy Service and its Flying Doctors Service provides health care to far flung and disadvantaged communities in South Africa. PURPOSE: The purpose of this article is to highlight the importance and effectiveness of the service in providing health care to a range of people who have poor or no access to certain health services in South Africa. METHODS: Data and information was collected from records and statistical data of our service. Data was evaluated and compiled into a report highlighting the achievements of this organisation from its infancy to the present day. FINDINGS: The Flying Doctor and Health Outreach Programme has made a difference in improving health care by providing specialist services, transport of patients and training of medical personnel in outlying areas of South Africa that have poor access to health care. Emergency Air Ambulance and Rescue Services have proven to be supportive in providing rapid advanced life support and rescue services to patients in emergency situations. Many lives have been saved through this service. CONCLUSION: The South African Red Cross Air Mercy Service plays a crucial role in delivering specialised health care to disadvantaged communities in South Africa.

Air Ambulances↗
PubMed2003

Fertility of dairy cows after resynchronization of ovulation at three intervals following first timed insemination.

Lactating Holstein cows (n = 711) on a commercial dairy farm in Wisconsin received a hormonal synchronization protocol to initiate first timed artificial insemination (TAI) on the following postpartum schedule: two injections of 25 mg PGF2alpha at 32 +/- 3 d and 46 +/- 3 d (Presynch); 100 microg GnRH at 60 +/- 3 d; 25 mg PGF2alpha at 67 +/- 3 d; and 100 microg GnRH + TAI at 69 +/- 3 d (Ovsynch). At first TAI, cows were randomly assigned to initiate the first GnRH injection of a hormonal protocol for resynchronization of ovulation (Resynch; 100 microg GnRH, d 0, 25 mg PGF2alpha, d 7, 100 microg GnRH + TAI, d 9) at 19 (D19), 26 (D26), or 33 d (D33) after first TAI to set up a second TAI service for cows failing to conceive to Ovsynch. Overall pregnancy rate per artificial insemination (PR/AI) to Ovsynch assessed 68 d after TAI was 31% and did not differ among treatment groups. For Resynch, PR/AI was assessed 26 d after TAI for D19 and D26 cows and 33 d after TAI for D33 cows. Overall PR/AI to Resynch was 32%. However, the PR/AI for D26 (34%) and D33 (38%) cows to Resynch was greater than for D19 cows (23%). Cows with a CL at the PGF2alpha injection (D19 cows) or at the first GnRH injection (D26 + D33 cows) of Resynch exhibited greater PR/AI to Resynch compared with cows without a CL. Survival analysis (failure time) of cows in the D26 and D33 treatment groups across the first three TAI services did not differ statistically. Although administration of GnRH to pregnant cows 19 d after first TAI service did not appear to induce iatrogenic embryonic loss, initiation of Resynch 19 d after first TAI service resulted in a lower PR/AI compared with initiation of Resynch 26 or 33 d after first TAI service.

Animals↗
PubMed1997

Application of the Mantel-Haenszel odds ratio in validation of hospital episode statistics data.

The National Health Service reforms have led to a growing need to determine the efficiency and cost effectiveness of health care provision. Resource utilization and the factors that influence it form a vital part of the information procured by commissioners of health care. Currently the most comprehensive source of routinely collected data is the Hospital Episode Statistics database. This database provides the most complete coverage of all areas of hospital inpatient services; these services account for up to 70% of the health care budget. Several studies have investigated the integrity of these data, but they have been concerned only with a subset of the data or with particular hospitals. This paper derives a method of data validation that can be applied either regionally or nationally to two key fields within the database: in this instance, consultant specialty and principal diagnosis. The process uses the Mantel-Haenszel odds ratio estimate to reveal large anomalies within either specialty of diagnostic coding. Within the West Midlands, it was generally observed that diagnosis codes are coded more consistently than consultant codes. However, problems occur due to incomplete or incorrect diagnostic entries and these anomalies are irregular across provider units. In contrast, anomalies within Korner specialty codes are associated predominantly with maternity, obstetrics, geriatric and general medicine. A large number of these anomalies are well understood within the context of local practice variation. Nevertheless, many anomalies remain within a wide range of other specialties where further investigation is warranted. Where systematic error is found, provider units should be notified in order to improve data consistency and enhance quality for future data users and health care planners.

Cost-Benefit Analysis↗
PubMed2005

The administrative control system of substance abuse managed care.

OBJECTIVE: This article searches for the dimensions of the administrative structures in outpatient substance abuse managed care that control the behavior of agency providers. It also ascertains how these dimensions, and several financial mechanisms, affect key aspects of the providers services: the average number of sessions of care that are delivered, the rate of completion of care, and the (estimated) rate at which clients control their substance use. DATA SOURCES: The data were collected in 1999 for this investigation. STUDY DESIGN: These data come from a nationally representative, cross-sectional sample of individual contracts between outpatient drug treatment providers and the Behavioral Health Managed Care Organizations (BHMCOs) that are empowered to regulate the delivery of services. Provider responses are analyzed here. DATA COLLECTION METHODS: Factor analyses at a contract level examine the structural dimensions of the control system. Multivariate analyses at the same level rely on generalized linear models to predict the dependent variables by the structural dimensions and financial mechanisms. FINDINGS: The factor analyses suggest that there are six multiple variable structural dimensions. The multivariate analyses suggest that the dimension that mandates follow-up of discharged clients tends to relate to more sessions of care and perhaps a higher rate of service completion. Most other dimensions are found to relate to fewer sessions of care, lower rates of service completion, or lower rates of control of substance abuse. No structural dimension relates to all dependent variables. Financial mechanisms evince varying relations to the sessions of care. They rarely relate to the other dependent variables. CONCLUSION: The results generally suggest that providers, payers, or policymakers might affect service provision by selecting BHMCOs that stress particular structural dimensions and financial mechanisms. However, managed care contracts most heavily rely on structural dimensions that restrict treatment sessions and fail to predict superior client outcomes.

Ambulatory Care↗
PubMed1990

[A single year birth cohort analysis of mortality in Japan, 1950 to 1984, statistical method and all cause mortality].

Mortality of single birth year cohort were calculated using the data tape of Information Service on World Health Statistics, WHO, 1950-1984. The data tape gave population and number of deaths for each year of age under 5 years of age and by 5 years of age for ages from 5 to 84 years. Population and number of deaths by age for each year of age in each calendar year were estimated by interpolation. Populations for each year of age were interpolated by B-spline interpolation. Number of deaths for each year of age were calculated by application of "two dimensional semi-Hermite method" after estimation of number of deaths for age 80, 81,......84, using Sprague interpolation factors. Age-specific cohort mortality curves were lower for each successive cohort, demonstrating the so-called "cohort phenomenon", clearly. Ratios of mortalities at the same age, for each successive 5 year interval cohort, which indicate cohort-by-cohort changes of mortalities, were thus less than 1.0 in almost all age groups. In recent years the ratios have gradually been leveling off at 0.8-0.9. Cohorts born in the early Showa Era (around 1930) showed higher ratios than all other cohorts, indicating relatively poor improvement in mortalities compared to the other cohorts. Ratios of cohort mortalities for successive ages within the same cohort, which indicates mortalities increase with advance of age, were greater than 1.0 after adulthood. These particular results showed that the increase in mortality with age accelerated after 30 years of age and that a difference in trend was observed between male and female after age 50. This new method of cohort analysis, single birth year cohort, gives clearer results than those obtained by methods heretofore utilized in cohort studies and is useful for more detailed analysis of cohort mortality.

Adolescent↗
PubMed1992

Organization of perinatal care within the European community.

A survey on the infrastructure and organization of maternity and neonatal services in the European Community has been conducted within the framework of the European Community Concerted Action Project 'New Methods for Perinatal Surveillance'. Objectives were to provide a basis for comparative evaluation of perinatal studies, to achieve a better understanding of differences in national perinatal services and to identify problem areas in provision of perinatal care. Data concern general maternal statistics, structure of maternity services and organization of maternity and neonatal services. Similarities between the perinatal services of the countries surveyed outweigh local deficiencies in some aspects of care and organization. Information tabulated in this survey can serve as a stimulant to reach a better understanding of current health care for pregnant mothers and their newborns within the European Community.

Europe↗
PubMed2000

Item response theory and health outcomes measurement in the 21st century.

Item response theory (IRT) has a number of potential advantages over classical test theory in assessing self-reported health outcomes. IRT models yield invariant item and latent trait estimates (within a linear transformation), standard errors conditional on trait level, and trait estimates anchored to item content. IRT also facilitates evaluation of differential item functioning, inclusion of items with different response formats in the same scale, and assessment of person fit and is ideally suited for implementing computer adaptive testing. Finally, IRT methods can be helpful in developing better health outcome measures and in assessing change over time. These issues are reviewed, along with a discussion of some of the methodological and practical challenges in applying IRT methods.

Activities of Daily Living↗
PubMed2005

Is the statistical association between sex and the use of services for mental health reasons confounded or modified by social anchorage?

OBJECTIVE: Confounding and interaction have differing implications for the interpretation of findings and the design of research, mental health services, and policy. This study aimed to verify whether the association between sex and the use of services for mental health reasons is confounded or modified by social anchorage. METHODS: We undertook a case-control study nested in Cycle 1.2 of the Canadian Community Health Survey. Cases were defined as users of general medical services for mental health reasons in the previous 12 months, and control subjects were defined as never-users of any services for mental health reasons. The pattern of social anchorage was described by the roles of parent, spouse, worker, and their combination. RESULTS: Overall, women are 2.9 times more likely than men to use general services for mental health reasons. However, this inequality between women and men decreases substantially or subsides in individuals who are less anchored to Canadian society. For instance, in single parents and in unemployed parents, the odds of using general services for mental health reasons are similar in women and in men. The pattern of social anchorage tends to modify, but not to confound, the association between sex and the use of services. CONCLUSIONS: Ignoring the interaction between sex and the pattern of social anchorage distorts the interpretation of the inequality between women and men in the use of general medical services for mental health reasons and may affect the design of comprehensive mental health services and policy.

Adolescent↗
PubMed1992

Criteria for designation of mental health professional shortage areas--PHS. Final rule.

This final rule amends the existing regulations governing the criteria for designation of health manpower shortage areas, or HMSAs (now health professional shortage areas, or HPSAs; name changed by Public Law 101-597, the National Health Service Corps Revitalization Amendments of 1990) under section 332 of the Public Health Service Act. Specifically, this amendment revises the existing criteria for designation of HMSAs having shortages of psychiatric manpower, transforming them into criteria for designation of HPSAs having shortages of mental health professionals, to take into account not only psychiatrists but also mental health service providers other than psychiatrists. The intended effect of this amendment is to more accurately assess the supply of mental health service providers when making shortage area determinations. This notice also summarizes the comments received by the Department on the Notice of Proposed Rulemaking published on August 8, 1989, which set forth the proposed methodology for making this and other changes to the HMSA criteria. It also formally changes "HMSA" to "HPSA" throughout the regulation, to conform with Public Law 101-597.

Catchment Area, Health↗
PubMed1993

Waiting in the emergency room: how to improve patient satisfaction.

The authors conducted a field experiment in which emergency-room patients of a metropolitan hospital were either given or not given an expected waiting time to see a physician. Patients were then surveyed through the mail on their satisfaction and perceptions of service quality. The results revealed that satisfaction levels were higher when patients believed that they had received information on expected waiting time. Regression analysis revealed that service quality dimensions of trust, responsiveness, and staff service were significant predictors of patient satisfaction. In addition, satisfaction was independently influenced by whether patients' prior timeliness expectations were confirmed. The authors discuss the results in terms of the concept that the situational context of the service may influence the quality dimensions that most affect consumer satisfaction.

Chi-Square Distribution↗
PubMed1994

What's wrong with this picture?

According to Mr. Hage, when the government tries to measure economic output, "the 1930's mentality sticks like bubble gum to the sole of a shoe." He is alarmed that the current debate about healthcare reform is based on economic data derived from antiquated methods of analysis and that we are "rocketing into the 21st century with our eyes firmly fixed on the rear-view mirror."

Data Interpretation, Statistical↗