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At least 973 records · Page 54Linked to original sources
PubMed2005

Geographic and socioeconomic variation in the treatment of prostate cancer.

PURPOSE: Within a framework of quality assessment, primary treatment choice constitutes an indicator of quality of care. This study examines geographic and socioeconomic variation in the primary treatment of men with prostate cancer during the era of prostate-specific antigen testing. METHODS: Using the National Cancer Institute's Surveillance, Epidemiology, and End Results public use data files, we identified men with localized/regional prostate cancer who underwent surgery, radiation therapy, or watchful waiting. We used the year 2000 US Census information to ascribe education and income levels to these men based on their county of residence and ethnicity. RESULTS: Among the 96,769 men with localized/regional prostate cancer (during 1995 to 1999) who had sufficient information for analysis, we observed significant geographic variation nationwide in surgical, radiation, and watchful waiting treatment rates (P <.0015). Patterns noted 10 years ago, such as higher surgical rates in western regions, persisted. Ethnicity, income, and grade were all independently associated with primary treatment, or lack thereof. Blacks and low-income patients had the lowest rates of surgery and radiation. Grade was the best predictor of aggressive treatment. CONCLUSION: Nonclinical factors, such as ethnicity and income, were associated with the use of watchful waiting rather than surgery or radiation in men with early-stage prostate cancer. These findings have implications for quality of care.

Aged↗
PubMed2005

Not working 3 years after breast cancer: predictors in a population-based study.

PURPOSE: Little is known about factors increasing likelihood of not working among breast cancer survivors compared with women in the general population. PATIENTS AND METHODS: A population-based retrospective cohort study was conducted in Quebec, Canada, based on the consecutive series of working women aged younger than 60 years when first treated for breast cancer (identified through the Quebec Tumor Registry), and on a group of randomly selected similar women, living in Quebec, who were working at the time of survivors' diagnoses, but who were without cancer (identified through provincial health care files). Data came from a telephone interview, 3 years after diagnosis for 646 survivors (73% of those eligible) or during a similar period for 890 comparison women (51%). RESULTS: Slightly more survivors were not working 3 years after diagnosis compared with women never diagnosed with cancer (21% and 15%, respectively). Older age (for survivors and comparison women, relative risk [RR] = 4.62, P < .0001 and RR = 4.98, P < .0001, respectively) and union membership (RR = 1.88, P = .0003 and RR = 1.40, P = .06, respectively) increased the likelihood of not working at the end of follow-up. In addition, income less than 20,000 dollars compared with > or = 50,000 dollars was associated with not working only among survivors (RR = 3.18; P = .0008). Adjuvant treatments did not predict work cessation, but any new cancer event during follow-up did (RR = 2.14; P < .0001). CONCLUSION: Although reassuring that adjuvant treatments did not appear to play a role in survivors' not working, other aspects of the cancer experience might nonetheless have influenced the decision to reduce work effort after breast cancer.

Adolescent↗
PubMed2004

Mortality in epilepsy: driving fatalities vs other causes of death in patients with epilepsy.

OBJECTIVES: To estimate the risk to public safety posed by drivers with epilepsy, the authors compared annual totals and disease-specific risk for fatal crashes associated with seizures and other medical conditions. They compared individual risks for fatal crashes due to seizures and other causes of mortality in patients with epilepsy. METHODS: The authors analyzed Multiple-Cause of Mortality data files from death certificates provided by the National Center for Health Statistics (NCHS) for the years 1995-97. They analyzed International Classification of Diseases-9 codes for underlying causes of death and other major conditions and determined disease-specific rates of fatal crashes associated with seizures and other medical conditions. RESULTS: An average of 44,027 US drivers died annually as a result of motor vehicle crashes during 1995-97; however, only 86 (0.2%, range 82 to 97) of these deaths were associated with seizures in mortality reports. The incidence rate of fatal crashes for patients with seizures was 2.3 times the rate for patients with cardiovascular and hypertensive diseases and 4.6 times the rate for patients with diabetes. The proportionate mortality ratio for motor vehicle crashes in patients with seizures was low (0.2); most patients with epilepsy died of common cardiovascular and systemic disorders. CONCLUSION: Fatal driver crashes due to seizures are uncommon. This finding supports the current public policy of permitting patients whose seizures are controlled to drive.

Accidents, Traffic↗
PubMed1997

Risk of serious cutaneous disorders after initiation of use of phenytoin, carbamazepine, or sodium valproate: a record linkage study.

Clinical and epidemiologic evidence suggest serious cutaneous reactions to antiepileptic drugs are more likely to occur during the first few months of use. However, studies have quantified risk for these reactions by including all users and their entire duration of use in denominator estimates possibly underestimating the risk. The objective of this study was to measure risk of serious cutaneous reactions in new users of phenytoin, carbamazepine, or valproic acid. We identified serious cutaneous reactions that included hospitalization and occurred within 60 days of the first or second prescription for new users of each study drug in the Saskatchewan Health data files. To classify outcome diagnoses, a dermatologist reviewed hospital discharge summaries. In 8,888 new phenytoin users there were eight serious cutaneous reactions. These included two probable and two possible cases of hypersensitivity syndrome, yielding a risk of 2.3 to 4.5 per 10,000 for this syndrome. There were six serious cutaneous reactions in 9,738 new carbamazepine users. These included one probable case and four possible cases of hypersensitivity syndrome, yielding a risk of 1 to 4.1 per 10,000 for this syndrome. There were no confirmed serious cutaneous diagnoses in 1,504 new valproate users. During the first few weeks of initiating therapy with phenytoin or carbamazepine, the clinician should be aware of the uncommon but not rare possibility that a cutaneous eruption could evolve into a significantly more serious reaction.

Adolescent↗
PubMed1986

The performance of medical malpractice review panels.

In this paper we present the results of an empirical study of Arizona's medical malpractice review panels. We compare insurance company claim files data from before and after the implementation of panels to analyze the effects of the panel system. The data indicate that although the frequency and average amount of recovery are not affected by the panel system, the system leads to an increase in the number of disputes seeking formal adjudication, an increase in the cost of the process, and a lengthening of the time within which disputes are resolved.

Arizona↗
PubMed2001

What, when and how to back up your data.

This article defines and describes the process of backing up data files, which should be undertaken by anyone who routinely uses a computer. The important points to be considered when developing a backup strategy are explained and a résumé given of the backup devices currently available.

Compact Disks↗
PubMed2001

Gender differences in response to auditory-verbal intervention in children who are deaf or hard of hearing.

Recent research has questioned the role of gender in language development and in special education outcomes, yet neither issue has been addressed in literature on students who are deaf or hard of hearing. To determine if language and placement outcomes differ by gender, the present study considered the behavior of children who attended a clinical program subscribing to an auditory-verbal philosophy. Parents of 28 boys and 42 girls with hearing losses evaluated their children using the Parent Rating Scale of the Leiter International Performance Scale--Revised (Roid & Miller, 1997) and the Parental View of Therapy Scale (developed for the present study). Also, clinical file data were surveyed. The boys were found to be more likely than the girls to be rated by their parents as having basic features of temperament nonconducive to traditional clinical language intervention. The girls' language and placement outcomes surpassed the boys', although both groups' outcomes were positive. A possible limitation of the study was that the population was atypical of students with hearing losses in general.

Child↗
PubMedDate not supplied

Comparing Medicare and private insurers: growth rates in spending over three decades.

Over the past three decades both Medicare and private insurers have initiated cost containment mechanisms to control the growth of spending on personal health care. To compare spending growth between these two payers, we present four measurement principles that should be implemented when drawing such comparisons, and we apply them to the National Health Accounts data files. We attribute Medicare's ability to equal--and using our measures, actually exceed-the private sector in controllingthe rate of health spending growth to Medicare's ability to price aggressively for the services it covers.

Health Care Surveys↗
PubMed1991

Great vein and right atrial thrombosis in critically ill infants and children with central venous lines.

We performed a retrospective review of echocardiographic data files of infants and children hospitalized in the Newborn and Pediatric Intensive Care Units. Echocardiograms were examined to detect the presence and evolution of great vein and right atrial thrombosis in patients with central venous lines. Thirty-seven patients were identified over a five-year period. Echocardiograms were performed, not routinely, but in response to specific indications including catheter malfunction, thrombocytopenia, persistent chylothorax, bacterial or fungal sepsis, and superior vena cava syndrome. Fifteen of 37 patients died, 13 of them during the hospitalization in which the thrombus was discovered. Thrombolytic agents and surgery were used to treat selected patients, with mixed results. Two of the 22 survivors have significant disability related to the thrombus or complications arising from it. We conclude that great vein and/or right atrial thrombosis is a common complication of central venous catheterization in small infants and children; moreover, the morbidity and mortality relating to this complication is substantial.

Catheterization, Central Venous↗
PubMed2004

Flow cytometry: an introduction.

A flow cytometer is an instrument that illuminates cells (or other particles) as they flow individually in front of a light source and then detects and correlates the signals from those cells that result from the illumination. In this chapter, each of the aspects of that definition will be described: the characteristics of cells suitable for flow cytometry, methods to illuminate cells, the use of fluidics to guide the cells individually past the illuminating beam, the types of signals emitted by the cells and the detection of those signals, the conversion of light signals to digital data, and the use of computers to correlate and analyze the data after they are stored in a data file. The final section of the chapter will discuss the use of a flow cytometer to sort cells. This chapter can be read as a brief, self-contained survey. It can also be read as a gateway with signposts into the field. Other chapters in this book will provide more details, more references, and even some controversy about specific topics.

Animals↗
PubMed2002

Economic burden of obesity in youths aged 6 to 17 years: 1979-1999.

OBJECTIVE: To examine the trend of obesity-associated diseases in youths and related economic costs. METHODS: Using a multiyear data file of the National Hospital Discharge Survey, 1979-1999, we analyzed the changes in obesity-associated diseases and economic costs in youths (6-17 years of age) over time. Diabetes, obesity, sleep apnea, and gallbladder disease were examined to explore the trend of the disease burden. Other obesity-associated diseases for which obesity was listed as a secondary diagnosis were also analyzed. Obesity-associated hospital costs were estimated from the discharges with obesity listed as a principal or secondary diagnosis. RESULTS: From 1979-1981 to 1997-1999, the percentage of discharges with obesity-associated diseases increased. The discharges of diabetes nearly doubled (from 1.43% to 2.36%), obesity and gallbladder diseases tripled (0.36% to 1.07% and 0.18% to 0.59%, respectively), and sleep apnea increased fivefold (0.14% to 0.75%). Ninety-six percent of discharges with a diagnosis of obesity listed obesity as a secondary diagnosis. Asthma and some mental disorders were the most common principal diagnoses when obesity was listed as a secondary diagnosis. Obesity-associated annual hospital costs (based on 2001 constant US dollar value) increased more than threefold; from $35 million (0.43% of total hospital costs) during 1979-1981 to $127 million (1.70% of total hospital costs) during 1997-1999. CONCLUSIONS: Among all hospital discharges, the proportion of discharges with obesity-associated diseases has increased dramatically in the past 20 years. This increase has led to a significant growth in economic costs. These findings may reflect the impact of increasing prevalence and severity of obesity. Diet and physical activity interventions should be developed for weight loss and prevention of weight gain in youths.

Adolescent↗
PubMed2002

Black-white differences in health care utilization among US children with frequent ear infections.

OBJECTIVE: To examine differences in patterns of and barriers to health care utilization between black and white children who have frequent ear infections (FEI). METHODS: Analysis was conducted using the 1997 and 1998 National Health Interview Survey-Sample Child Files. Data on 25 497 children under 18 years of age and 1985 who were reported by the parent/guardian to have had "3 or more ear infections during the past 12 months" were analyzed. The data were weighted and analyzed to represent all black and white children nationwide, accounting for the complex survey design. RESULTS: Of white and black children under 18 years of age in the United States, 8.0 and 6.6%, respectively, had FEI in the past year. Among those with FEI, whites and blacks exhibited significantly different patterns in the type of health insurance they had and in the usual source of care. After accounting for sociodemographic factors, health insurance, and usual source of care, there were still significant differences in health care use between whites and blacks. The affected black children had an increased risk of getting delayed care because of transportation problems (odds ratio [OR]: 2.32) and a reduced likelihood of seeing a medical specialist (OR: 0.49) and having surgery (OR: 0.39) in comparison to white children. CONCLUSION: Although black children with FEI were as likely as white children to be covered by health insurance and have a usual place of health care, they were significantly more likely to face barriers in obtaining the care, especially the more specialized care.

Adolescent↗
PubMed2004

Health status and health services utilization among US Chinese, Asian Indian, Filipino, and other Asian/Pacific Islander Children.

OBJECTIVE: This study examines the health status and health services access and utilization characteristics of US Chinese, Asian Indian, Filipino, other Asian/Pacific Islander (API), and non-Hispanic white children by using nationally representative data. METHODS: We analyzed the aggregated data file from the National Health Interview Survey from 1997 to 2000 including 334 Chinese, 287 Asian Indian, 292 Filipino, 696 "other API," and 29,016 non-Hispanic white children <18 years old. Bivariate and multivariate analyses were conducted to examine the relationship between Asian ethnicities and dependent variables including components of health status, health services access, and utilization. RESULTS: Logistic regression reveals that all Asian American children were less likely to miss school because of illness or injury or have learning disabilities compared with non-Hispanic whites. Other APIs were less likely to be taking prescription medication for at least 3 months, and Asian Indian children were half as likely to have chronic conditions. Chinese, Filipino, and other API children were more likely to be without contact with a health professional within the past 12 months. Citizenship/nativity status, maternal education attainment, and poverty status were all significant independent risk factors for health care access and utilization. CONCLUSIONS: Asian ethnicities and being foreign-born are generally associated with more favorable health status measures such as school absence, learning disability, use of prescription medications, and chronic conditions. However, these attributes are negatively associated with health care access and utilization, suggesting the need for outreach to Asian immigrant populations to educate them on accessing the US health care system.

Adolescent↗
PubMed2000

[Female mortality in reproductive age in the State of Sao Paulo, Brazil, 1991-1995: underlying causes of death and maternal mortality].

OBJECTIVE: To describe female mortality in the reproductive age (15 to 49 years old) in the State of S. Paulo, Brazil, from 1991 to 1995, according to the age and underlying causes of death. METHODS: Underlying causes of death, according to the International Classification of Diseases, 9th Revision, were determined in the program Automated Classification of Medical Entities (ACME), developed by "Fundação Seade", which provided us data files and estimated women population by age groups and numbers of live births during the 1991 - 1995 period. Specific rates were calculated per 100,000 women and maternal mortality rates were given per 100,000 live births. Percentages of death were calculated for sub-groups. The median of the rates for a five-year-period was calculated to allow the comparison among the leading underlying causes of death. RESULTS: "Cellular immunity deficiency" increased from 1991 to 1995 in women aged 25 or more which seems to be concomitant to the spreading of the AIDS epidemic among women. Lesions and poisonings were the leading causes of death in younger women, but after the age of 35 cardiovascular diseases and neoplasms became the chief causes. Infectious and parasitic diseases were rated in the 7th or 8th positions in all ages. Accidents and homicides were high. Maternal mortality rates ranged from 43.7 to 49.6 per 100,000 live births, their leading causes were presented and discussed. CONCLUSIONS: Women in the reproductive age were exposed to external factors, chronic diseases and AIDS. The majority of maternal causes of death are preventable diseases. There is a lack of adequate and extensive antenatal care as well as in delivery and postpartum care.

Adolescent↗
PubMed1999

Persistence with estrogen therapy in a postmenopausal Medicaid population.

We evaluated rates of persistence with estrogen replacement therapy in postmenopausal Georgia Medicaid recipients adjusted for age and race. Data files for 1992-1994 were examined to estimate 3-year conditional survival probabilities using the Kaplan-Meier model, and 3800 subjects were identified. Over 54% of women remained compliant over 29 months, and 17% continued therapy for the entire 35 months of observation. Kaplan-Meier predictors indicated that white women have a 70% chance of being compliant for 3 years, whereas black women have a 60% chance. Monthly discontinuation rates ranged from 1-1.5% after the second month of therapy. Younger, white women were the most likely to maintain and comply with therapy.

Black or African American↗
PubMed2005

beta-Blocker therapy in veterans with asthma or chronic obstructive pulmonary disease.

STUDY OBJECTIVES: To determine whether an association exists between health care resource use and beta-blocker therapy in patients with asthma or chronic obstructive pulmonary disease (COPD), and to determine whether any significant differences exist between type of beta-blocker agent administered and resource use. DESIGN: Retrospective cohort study. DATA SOURCE: Three Veterans Administration (VA) databases with information from hospitals and clinics in Iowa and Nebraska. Patients. A total of 8390 veterans with a diagnosis of asthma or COPD receiving treatment with a beta-blocker or another cardiovascular agent. MEASUREMENTS AND MAIN RESULTS: Clinic visits and hospital admissions for asthma or COPD that occurred in 2000-2001 were identified using electronic administrative data files. Analyses were adjusted for comorbidity and patient demographics. Mean patient age was 67 years, and 97% of the patients were men. In unadjusted analyses, patients taking beta-blockers had more hospital admissions, similar inpatient length of stay (LOS), and fewer outpatient clinic visits for asthma or COPD. In adjusted analyses, however, no difference was noted in the odds of hospital admission or in LOS, and patients had fewer clinic visits related to asthma or COPD. The hazard ratio for hospital admission for asthma or COPD during the observation year was similar for patients taking and not taking beta-blockers, and no difference was noted with selective versus nonselective beta-blockers. However, the hospital admission rate was lower with atenolol than metoprolol. CONCLUSION: Patients taking beta-blockers did not have more hospital admissions or clinic visits for their asthma or COPD than patients not taking these agents. When clinically indicated, beta-blockers-especially atenolol-should be considered for patients with asthma or COPD.

Adrenergic beta-Antagonists↗
PubMed1993

Risk analysis of low cardiac output syndrome after valve replacement.

In order to obtain a better understanding of the pathogenesis of the postoperative low cardiac output syndrome (LOS), a multivariate regression analysis was performed, evaluating predictive risk factors quantitatively as a function of plural preoperative variables. A total of 145 cases including 76 MVR (MS 36 MR 40), 42 AVR and 27 DVR were analyzed in this study. Ten historical, 10 hemodynamic and 4 operative risk factors were collected to compose the data file with corresponding status of postoperative cardiac function which was classified as follows. Patients who were not associated with postoperative LOS (Score 1), associated with the LOS which required and responded to ordinal dosage of a catecholamine (Score 2) associated with the LOS which required and responded to maximal dosage of the catecholamine and/or mechanical circulatory support (Score 3), and died of LOS (Score 4). Variables with significant relationships to postoperative LOS, regression equation to LOS score and their multiple correlation coefficients (R) of each group were as follows. MVR group: technical trouble (TT), extracorporeal circulation time (ECCT), change of myocardial preservation methods, delta LVSWI/delta LVEDP, diseased duration, aortic cross clamping time, CTR, Y = -1.16 + 1.01 (TT) + 0.05(ECCT) + 0.16(delta LVSWI/delta LVEDP) + 0.02(CTR), R = 0.76. AVR group: LVMMI, ECCT, cardiac failure, NYHA, Y = -0.71 + 0.03(LVMMI) + 0.004 (ECCT) + 0.22(NYHA), R = 0.78. DVR group: delta LVWI/delta LVEDP, LVMMI, NYHA, LV diastolic eccentricity ratio, ECCT, Y = -0.50 + 0.60 (delta LVWI/delta LVEDP) + 0.003(LVMMI) + 1.18(NYHA) + 0.38(delta LVSWI/delta LVEDP) + 0.003(ECCT), R = 0.87. It was demonstrated that preoperative ergometer exercise study during cardiac catheterization was useful in prediction of postoperative outcomes, especially in the MVR (MS) group.

Adult↗
PubMed2004

Hierarchical planning for a surface mounting machine placement.

For a surface mounting machine (SMM) in printed circuit board (PCB) assembly line, there are four problems, e.g. CAD data conversion, nozzle selection, feeder assignment and placement sequence determination. A hierarchical planning for them to maximize the throughput rate of an SMM is presented here. To minimize set-up time, a CAD data conversion system was first applied that could automatically generate the data for machine placement from CAD design data files. Then an effective nozzle selection approach implemented to minimize the time of nozzle changing. And then, to minimize picking time, an algorithm for feeder assignment was used to make picking multiple components simultaneously as much as possible. Finally, in order to shorten pick-and-place time, a heuristic algorithm was used to determine optimal component placement sequence according to the decided feeder positions. Experiments were conducted on a four head SMM. The experimental results were used to analyse the assembly line performance.

Algorithms↗