SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Data File: In this two-part column, take a look at 1999 and 2000 base capitation rates for several counties in Florida, a growing market for Medicare HMOs, and review Medicare HMO patient satisfaction survey results.
Data File: Are provider organizations taking over Medicaid risk? The answer depends on the market, as demonstrated in these three analyses of enrollment trends in New York, Florida, and Ohio.
The overall incidence of self-reported occupational hand injuries in a Danish population was estimated to 4.7%, with the highest incidence among the youngest, men and employees in the production and building industries. The life-time risk were 93% for men and 73% for women. Age and gender were found to be independent risk factors for the occupational hand injuries. The proportion treated in the casualty department was 0.28, for injuries with disability and time off work the proportions were 0.46 and 0.69 respectively. No age, gender or occupation specific selection for attending the hospital was found. Prevention-trials against hand injuries should therefore have a high priority, and it is recommended that hospital data files are used increasingly in future prevention programs.
Data File: Some Medicaid managed care challenges and trends appear universal. A baseline study of the county-organized health system and two-plan managed Medicaid models in California reveals the unique models haven't escaped some of the problems and trends faced by more traditional managed Medicaid plans and providers across the country.
BACKGROUND: Screening by cytology is a potentially highly effective procedure for preventing carcinoma of the uterine cervix. To elucidate any weaknesses in the screening procedure in a Swedish county where screening started many years ago, the detection of invasive cervical squamous cell carcinoma was compared to the prior cytological screening. METHODS: On the basis of the complete Pathology data files, including cytology and histology, all 112 women with invasive cervical squamous carcinoma were compared to 112 matched controls from the Swedish Population Register, regarding attendance rate and results of Pap-smears prior to the date of discovery of an invasive carcinoma in the case. RESULTS: Almost as many cases as controls had a history of pap-smear testing, but the cases had significantly more prior atypias registered. Only 16% of women with cervical carcinoma and younger than 60 years were lacking Pap-smear tests prior to the carcinoma diagnosis, but 46% had former atypias registered. More than half of them presented, however, a negative Pap-smear test less than three years before the diagnosis. Among the controls, 10% were lacking prior Pap-smears and only 9% had former atypias registered. CONCLUSION: The policy for follow-up and treatment of cervical dysplasias has to be improved in order to achieve a further reduction of the incidence of invasive carcinoma.
SETTING: Norwegian patients with pulmonary tuberculosis notified to the National Tuberculosis Register in 1975, 1985 and 1995. OBJECTIVE: To assess the proportion of cases attributable to endogenous reactivation, exogenous re-infection and primary infection. DESIGN: We reviewed patients notified with sputum smear and/or culture confirmed pulmonary tuberculosis in 1975 (50% random sample, 95 cases), 1985 (133 cases) and 1995 (70 cases). Information on previous chest X-ray, tuberculin and BCG status was collected from mass screening data files. Strains from 54 patients in 1995 were analysed by IS6110 restriction fragment length polymorphism (RFLP) typing and compared with culture-positive patients notified between 1994 and 1997. RESULTS: Most patients had previously had tuberculosis (65% in 1975, 53% in 1985 and 61% in 1995), either notified with tuberculosis or with X-ray findings indicating previous tuberculosis. Another 10% had a prior infection, but normal X-rays. No previous tuberculosis infection or disease was found in 10% in 1975, 19% in 1985, and 16% in 1995. Of 54 patients with RFLP results, three were caused by laboratory contamination. Of the remaining 51, eight (16%) belonged to a cluster. Among 45 patients with results of both RFLP typing and mass screening, 37 (82.2%) were probably caused by reactivation, six (13.3%) by re-infection and two (4.4%) by primary infection. CONCLUSION: Pulmonary tuberculosis in Norwegian patients can mainly be attributed to reactivation, predominantly in persons with previous changes on chest X-ray.
BACKGROUND: Few studies have reported population-based information on the treatment trends and outcomes of patients who have had an acute myocardial infarction (AMI). We therefore examined patterns of care and outcomes for AMI patients in Quebec, Canada, between 1988 and 1995. METHODS: Longitudinal data files of hospital admissions in Quebec (Med-Echo database) and inpatient and outpatient services (Régie de l'Assurance Maladie du Québec database) were used to construct cohorts of all AMI patients in the province between 1988 and 1995. Temporal trends in the use of cardiac procedures after an AMI, discharge prescriptions and mortality rates were examined. RESULTS: Between 1988 and 1995 the age- and sex-adjusted rates of AMI in the Quebec population declined (148 per 100,000 in 1988 to 137 per 100,000 in 1995). The use of intensive cardiac procedures increased in the same period; the 1-year cumulative incidence rate of catheterization increased from 28% in 1988 to 31% in 1994, that of angioplasty rose from 8% to 15% and that of coronary artery bypass surgery from 6% to 8%. Prescriptions for ASA, beta-blockers, lipid-lowering agents and angiotensin-converting enzyme inhibitors increased, and prescriptions for nitrates and calcium antagonists decreased. These temporal changes were paralleled by a decrease in mortality rates post-AMI. All-cause 1-year cumulative incidence mortality rates decreased from 23% in 1988 to 19% in 1994. INTERPRETATION: The decrease in AMI-related mortality in Quebec between 1988 and 1995 may be linked to changes in treatment strategies (i.e., increased use of cardiac surgical procedures and medications shown to increase survival).
Triploidy is constituted by an extra haploid set of chromosomes for a total of 69 chromosomes in humans. A "parent-of-origin" effect has been demonstrated by analysis of cytogenetic polymorphisms of triploidy pregnancies. Two distinct phenotypes of human triploid fetuses have been recognized according to the parental origin of the extra haploid set. The first one or triploidy of diandric type occurs when the extra haploid set of chromosomes arises from the father, the second one or triploidy of digynic type occurs when the extra haploid set of chromosomes arises from the mother. Diandric fetuses appear relatively well grown with a large placenta, while digynic fetuses show intrauterine growth retardation with a small placenta. Autopsy archive data files (1982-1998) of the Institute of Pathology, University of Heidelberg (Germany) were examined for fetuses with triploidy. We found 12 well-studied triploid fetuses (gestational age: 20 to 32 weeks). Eleven fetuses corresponded to the digynic type of triploidy and one fetus corresponded to the diandric type of triploidy. The spectrum of external malformations included a dysmorphic face (broad root of the nose, exophthalmos, low-set ears, micro-/retrognathia, microgenia, median cleft lip and/or palate, gnathoschisis, macroglossia), encephalocele, spina bifida, syndactyly, club or rocker-bottom feet, pes equino-valgus. More common internal malformations included ventricular septum defect of the heart, abnormal lobation of the lungs, and renal disease (agenesis, cysts).
The study aimed to examine the relationship between the total score on Hare's revised Psychopathy Checklist (PCL-R) and aspects of outcome for a nonrandom sample (n = 89) of male mentally disordered offenders treated in an English high security hospital. The subjects were all legally classified as suffering from "psychopathic disorder" and the majority were followed-up in the community. The methodology was retrospective, using existing case-file data, with follow-up lasting until discharge from statutory supervision. PCL-R scores were dichotomized and related to various outcome factors, including recidivism and aspects of social behavior. The results showed, in contrast to previous North American research, that the PCL-R did not predict any of the outcome factors. Because the PCL-R was able to identify psychopaths in this population but failed to predict their prognosis, it is possible that their outcome may have been improved by the treatment they received in hospital.
OBJECTIVE: Uncontrolled intracranial hypertension after traumatic brain injury (TBI) contributes significantly to the death rate and to poor functional outcome. There is no evidence that intracranial pressure (ICP) monitoring alters the outcome of TBI. The objective of this study was to test the hypothesis that insertion of ICP monitors in patients who have TBI is not associated with a decrease in the death rate. DESIGN: Study of case records. METHODS: The data files from the Ontario Trauma Registry from 1989 to 1995 were examined. Included were all cases with an Injury Severity Score (ISS) greater than 12 from the 14 trauma centres in Ontario. Cases identifying a Maximum Abbreviated Injury Scale score in the head region (MAIS head) greater than 3 were selected for further analysis. Logistic regression analyses were conducted to investigate the relationship between ICP and death. RESULTS: Of 9001 registered cases of TBI, an MAIS head greater than 3 was recorded in 5507. Of these patients, 541 (66.8% male, mean age 34.1 years) had an ICP monitor inserted. Their average ISS was 33.4 and 71.7% survived. There was wide variation among the institutions in the rate of insertion of ICP monitors in these patients (ranging from 0.4% to over 20%). Univariate logistic regression indicated that increased MAIS head, ISS, penetrating trauma and the insertion of an ICP monitor were each associated with an increased death rate. However, multivariate analyses controlling for MAIS head, ISS and injury mechanism indicated that ICP monitoring was associated with significantly improved survival (p < 0.015). CONCLUSIONS: ICP monitor insertion rates vary widely in Ontario's trauma hospitals. The insertion of an ICP monitor is associated with a statistically significant decrease in death rate among patients with severe TBI. This finding strongly supports the need for a prospective randomized trial of management protocols, including ICP monitoring, in patients with severe TBI.
By now most, if not all, of us are familiar with the Internet. We can use it to send messages to our friends and business associates. We can send attached data files to those who need the information. We can download updates to our software or get new programs. We also can search the Web for information on an endless array of topics. The objective of this presentation is to familiarize you with the broad spectrum of business functions that can be significantly enhanced by the use of Internet technology. This is certainly one way to build your knowledge chain for success. This article is meant to stimulate your thinking about what this tool might be used for in your environment but will leave the technical issues of how to do that to other experts.
BACKGROUND: The importance of pilot error in aviation crashes has long been recognized. However, understanding and preventing pilot error remains the foremost challenge in aviation safety. OBJECTIVE: This study aims to identify pilot characteristics and crash circumstances that are associated with the presence of pilot error in a large sample of aviation crashes. METHODS: Different data files compiled by the National Transportation Safety Board for 329 major airline crashes, 1,627 commuter/air taxi crashes, and 27,935 general aviation crashes for the years 1983-96 were merged; and the presence of pilot error was analyzed in relation to variables indicating the characteristics of the pilot-in-command, crash circumstance, and aircraft. Multivariate logistic regression modeling was performed to assess the associations of individual variables with the likelihood of pilot error given a crash. RESULTS: Pilot error was a probable cause in 38% of the major airline crashes, 74% of the commuter/air taxi crashes, and 85% of the general aviation crashes. Among the factors examined, instrument meteorological condition and on-airport location were each associated with a significantly increased odds of pilot error. The likelihood of pilot error decreased as pilot certificate rating increased in commuter/air taxi and general aviation crashes. Neither pilot age nor gender was independently associated with the odds of pilot error. With adjustment for pilot characteristics and crash circumstances, flight experience as measured in total flight time showed a significant protective effect on pilot error in general aviation crashes. CONCLUSIONS: The prevalence and correlates of pilot error in aviation crashes vary with the type of flight operations. Adverse weather is consistently associated with a significantly elevated likelihood of pilot error, possibly due to increased performance demand.
AIMS: Our aim was to determine the significance in Maori of injury in relation to other health problems, to describe the leading causes of injury, and to determine age specific rates for major classes of injury. METHODS: We used New Zealand Health Information Services mortality data files. The New Zealand Census classification of 'Sole-Maori' was used to determine injury mortality rates. RESULTS: For more than three contiguous decades of life (1-34 yrs) injuries were the leading cause of death. For all age groups combined, unintentional injury accounted for 75% of injury deaths, suicide 17%, and assault 7%. The leading mechanism of death was motor vehicle traffic crashes (49%). Occupants of motor vehicles accounted for the majority of the victims. The occupant fatality rate remained relatively constant for all age groups from 15-24 years. The second most common mechanism of death was suffocation (13%), 76% of which were self-inflicted, all of these being hangings. CONCLUSIONS: There is a need for government agencies with a mandate for injury prevention to develop specific injury prevention goals for Maori.
AIMS: To determine the significance of serious injury in Maori relative to other health problems, to describe the leading causes, and to determine age specific rates for major classes of injury. METHOD: We used New Zealand Health Information Services' public hospital inpatient data files. The New Zealand Census classification of 'Sole-Maori' was used to determine injury mortality rates. RESULTS: On average, one in every eight admissions in Maori, was for injury. Injury was the leading reason for admission for those 5-44 years old. Unintentional injury accounted for 85% of injuries, with those ages 1-14 and 15-24 years having the highest numbers and rates. Falls, followed closely by motor vehicle traffic crashes, were the leading causes, accounting for 23% and 20% respectively. CONCLUSIONS: In order to address the priorities identified here, appropriate partnerships between crown agencies and social agencies, both Iwi and/or community based, must be established.
OBJECTIVE: To estimate the prevalence and correlates of influenza vaccination in a Home Care population. METHODS: This was a cross-sectional investigation involving linkage of three population-based databases from a rural Alberta Regional Health Authority, i.e., the Regional immunization and the Regional home oxygen information systems to the Regional home care information system. The sample comprised 649 persons who had been admitted or discharged from the Regional Home Care Program in the period Oct. 1-Dec. 31, 1998. An anonymous data file was released to the investigators. We estimated the proportion ever vaccinated against influenza, the proportion vaccinated in the period Oct. 1-Dec. 31, 1998 ("currently vaccinated"); and explored sociodemographic and program correlates of current vaccination. RESULTS: 67% had ever been vaccinated against influenza; 60.7% were currently vaccinated. Factors associated with current vaccination (multivariate analysis) include older age, being married, not receiving nursing services, district of residence and program status. CONCLUSIONS: Influenza vaccination rates were suboptimal. The correlates of vaccination suggest systems-level impediments to influenza vaccination.
Along with the rapid development of information technology, computers play an increasingly prominent and important role. One current trend is to use computers as instruments for physical rehabilitation. In this study, we introduce a new hand motion assessment and rehabilitation system. This system assesses a user's grip strength and records the sudden changes in air pressure through a circuit and A/D adapter. A PC interface transforms and saves the data in a data record file. The data is then compiled and combined with a patient's case history and keyed into a database as reference for clinical use. The system is highly efficient, cheap and convenient to use. Doctors can use it to monitor and analyze the progress of a rehabilitation program.
AIMS: To determine the number and rates of work-related fatal injuries by employment status, occupation, industry, age and gender in New Zealand 1985-1994. METHODS: Potential cases of work-related injury deaths of persons aged 15-84 years were identified from the national electronic mortality data files. Main exclusions were deaths due to suicide and deaths due to motor vehicle crashes. The circumstances of the deaths of each fatal incident meeting inclusion criteria were then reviewed directly from coronial files to determine work-relatedness. RESULTS: The rate of work-related fatal injury in New Zealand was 5.03/100000 workers per year for the study period. There was a significant decline in crude rate over the study period. However, this was in substantial part accounted for by changes in occupation and industry mix. Older workers, male workers, self-employed workers, and particular occupational groups, all had substantially elevated rates. Agricultural and helicopter pilots, forestry workers and fishery workers had the highest rates. Farmers, forestry workers, and fishery workers also had high numbers of deaths, together accounting for nearly 40% of all deaths. CONCLUSIONS: This study has demonstrated that work-related fatal injury remains a pressing problem for New Zealand. Several areas in urgent need of prevention efforts were highlighted.
BACKGROUND: Despite the existing evidence of the effectiveness of secondary prevention by modifying lifestyles or using the different drugs which have shown themselves to be clinically beneficial for heart patients, there is little, not highly accurate information available regarding the handling of the treatment of these patients within the scope of primary care in our country. The purpose of this study is that of ascertaining the current status of secondary prevention of heart disease as far as lipid control is concerned. METHODS: A review was made of the clinical records of all of the patients diagnosed at some point in time of their life as having ischemic heart disease, including those under the heading of acute myocardial infarction and angina pectoris within the 11 groups of patients assigned to three urban Health Care Centers in Area II in Zaragoza. The population in question totaled 19,692 patients, 388 cases of ischemic heart disease having been found in the record files data. RESULTS: Based on a study of the lipid control data, 60.8% of the cases analyzed in this study showed a complete lipid profile for the last year. Solely 4.7% of these patients had LDL < 100, the control objective having to be limited to c-LDL < 130 to find a 31.3% of patients with a lower than optimum control of this parameter. CONCLUSIONS: The results of our study reveal that the diagnosis of dyslipemias as well as the control of all other heart disease risk factors in secondary care have not been in keeping, for the most part, with the quality criteria of this health care procedure and therefore reveal the existence of a major degree of room for improvement.