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At least 1,063 records · Page 59Linked to original sources
PubMed1999

Screening blood spots for argininosuccinase deficiency by electrospray tandem mass spectrometry.

Argininosuccinase deficiency is relatively more common in Saudi Arabia than other urea cycle detects (UCD) and its presentation is usually acute and virtually identical to the clinical presentation of other UCD. We developed a rapid, sensitive, and specific screening method for the diagnosis of argininosuccinase deficiency from blood spots. using electrospray tandem mass spectrometry. A 96-well microplate batch process is used for extraction of argininosuccinic acid (ASA), other amino acids and acylcarnitines (Rashed et al. 1995). ASA and other metabolites are derivatized to the corresponding butyl derivatives. The tris-butyl ester of ASA (MH = 459.3) yields two major fragments at m/z 70 and m/z 144 under mild collision induced collision. montitored in the product ion spectrum using a narrow mass range (65-150 kDa). A processing algorithm "CAMPA" is used to automatically calculate the height ratios of selected masses and flags data files as "abnormal" when certain threshold is exceeded. The method is integrated with our existing 2-minute MS/MS method for profiling amino acids and acylcarnitines (Rashed et al. 1997). Using this approach for two years we diagnosed 16 ALD cases from 14 hyperammonemic infants, one high-risk newborn, and one from a regular newborn screening blood spot.

Amino Acid Metabolism, Inborn Errors↗
PubMed2001

[Comorbidity indexes: review of the literature and application to studies of elderly population].

BACKGROUND: Older patients often suffer concomitant chronic diseases in addition to various health disorders. When attempting to study one of these diseases, it is necessary to consider the complexity of the patient's health status. Comorbidity is a cause of confusion, especially for elderly patients with multiple diseases. Comorbidity indexes have been developed in order to measure this complexity. METHODS: We focused this article on a review of the literature in order to identify and examine the validity of comorbidity indexes applied to the elderly population. RESULTS: Five indexes have been used to measure comorbidity in patient populations with complex health situations: the Cumulative Illness Rating Scale (CIRS), the Kaplan-Feinstein index, the Charlson index, the Index of Coexistent Disease (ICED), and the Total Illness Burden Index (TIBI). Each of these indexes included a series of domains which vary according to the authors'view of comorbidity. These indexes were validated under different conditions with similar targets. Their validation fields limited their use and extrapolation of results. Only the CIRS, the Charlson index, the Kaplan-Feinstein index and the ICED were validated and applied to old patients. However, the Charlson index was found to be limited in recording the entirety of the old patients'pathologies, and in patients with cognitive deficits, only CIRS appeared to be sufficiently trustworthy because it allows a comprehensive recording of all the comorbid disease from clinical examination and medical file data. CONCLUSION: When studying chronic disease states in frail elderly patients, it is essential to consider comorbidity using standard validated indexes in order to get a comprehensive assessment of the patient's situation and avoid neglecting diseases and handicaps. Further studies are necessary to develop and validate tools specifically adapted to the elderly population.

Activities of Daily Living↗
PubMed2001

The epidemiology of mental disorders in the U.S. Navy: the neuroses.

As part of a series of investigations into the occurrence and outcome of mental disorders in the U.S. Navy, this study was designed to determine first hospitalization incidence rates for neurotic disorders in an initially healthy young adult population and to determine the duration of acute illness, severity, and posthospital outcomes in terms of military performance and premature personnel losses. Data on first hospitalizations for neurotic disorders were extracted from automated medical record data files for all active duty Navy personnel admitted between 1980 and 1988. Incidence rates were calculated for major demographic subgroups, and career history records provided a 4-year follow-up of service-related outcomes. Overall incidence ranged from a low of 3 per 100,000 for obsessive-compulsive disorders to a high of 58 per 100,000 for other neurotic disorders/neurotic disorders not otherwise specified (NOS). The phobia and depressive groups had the poorest prognoses for continued service, and the NOS and anxiety groups had the best prognoses.

Adolescent↗
PubMed2001

The critical dimension of ethnicity in liver cirrhosis mortality statistics.

BACKGROUND: In 1997, liver cirrhosis was the 10th leading cause of death in the United States. Beginning in the 1950s, liver cirrhosis mortality rates have been consistently higher for black than for white men and women. There has been a gradual adoption of the recommendation that all death certificates include information on the Hispanic origin of decedents, with universal adoption in the 1997 data year. It is the purpose of this study to examine the extent to which relative risks for cirrhosis mortality might shift for different demographic groups when Hispanic origin is considered along with the race and sex of the decedent. METHODS: Age-adjusted death rates were calculated for liver cirrhosis by using public-use data files produced by the National Center for Health Statistics. Trends in cirrhosis mortality rates from 1991 through 1997 are shown for white Hispanic, white non-Hispanic, black Hispanic, and black non-Hispanic men and women. RESULTS: In 1997, white Hispanic men show the highest cirrhosis mortality rates over the period examined, followed by black non-Hispanic and white non-Hispanic men, white Hispanic women, and black non-Hispanic and white non-Hispanic women. Among Hispanic decedents, the largest group was of Mexican ancestry, with large numbers being born outside the United States and having low education levels. CONCLUSIONS: The findings of higher risk for cirrhosis mortality among white men and women of Hispanic origin serve to focus new attention on these demographic groups. Collateral analyses of other causes of death do not support alternate explanations of these findings as artifacts of demographic misclassification. Future studies of amounts and patterns of alcohol consumption should include Hispanic origin among demographic factors examined.

Black or African American↗
PubMed2001

A randomized intervention to improve ongoing participation in mammography.

OBJECTIVE: To test the effectiveness of interventions intended to increase rates of regular breast cancer screening, according to recommended guidelines. STUDY DESIGN: A randomized controlled trial of 2 outreach interventions (a mail reminder and a telephone reminder plus appointment scheduling) compared with a routine publicity campaign to encourage continued participation in mammography screening. PARTICIPANTS AND METHODS: Participants were 1908 women aged 50 to 75 years continuously enrolled in a large group-model HMO during the study who underwent a bilateral mammogram during the first quarter of 1994 and no subsequent mammogram during the next 18 to 21 months. Data were obtained from health plan administrative data files supplemented by medical chart review. Women were randomly assigned to receive (1) a mail reminder, (2) a telephone reminder, or (3) routine publicity on mammography for all women. The outcome measure was a mammogram received after the intervention period and within 2 years of the initial mammogram date. RESULTS: Bivariate and multivariate statistical analyses showed that participation was significantly higher for women contacted by telephone than through routine publicity. Mail reminders were no more effective than a routine publicity campaign. Primary care physician and gynecologist visits increased the likelihood of a subsequent mammogram for women in all intervention groups. CONCLUSIONS: Telephone contact by regular health plan staff was more successful than publicity in encouraging continued participation in mammography screening in women enrolled in a group-model managed health care plan. Because mailings did not influence participation in mammography screening, health plans should be cautious about investing in member mailings without first evaluating their effectiveness in the context of existing outreach efforts.

Aged↗
PubMed2001

Fall history is an independent predictor of adverse health outcomes and utilization in the elderly.

OBJECTIVE: To determine whether a history of falls predicts functional decline, adverse health events, and hospitalization. STUDY DESIGN: Twelve-month prospective cohort study. PATIENTS AND METHODS: Participants were members of a Medicare managed care program. Outcomes were assessed each quarter and included functional status, healthcare utilization (hospitalization), and adverse events (hospitalizations, nursing home placement, or death). Subject healthcare utilization diaries were corroborated with health system data files. RESULTS: At baseline, 70% reported no falls (NF), 18% had 1 fall (F), and 12% reported 2 or more falls (RF). Fall status predicted functional decline; new ADL deficits were seen in 18% of NF, 28% of F, and 55% of RF (P < or = .0001). Following adjustment for baseline function, this association remained predictive (adjusted odds ratio [OR] for new ADL deficits: 3.5, P = .007; and for new ADL and IADL deficits: 12.0, P= .0001). Fall frequency was a univariate predictor of adverse events (hospitalizations, nursing home placement, or death) and of hospital utilization alone. One or more adverse event(s) occurred in 18% of NF, 22% of F, and 38% of RF (P = .049). Hospitalization occurred in 16% of NF, 22% in F, and 35% of RF (P = .03). Following adjustment for likelihood of future hospitalization (P(ra)), these associations remained predictive for RF (adjusted OR for one or more adverse event[s]: 2.4, P = .05; OR for hospitalization 2.4, P = .06). CONCLUSIONS: Fall history predicts decline in function, hospitalization, and adverse events among a Medicare managed care population and remains independently predictive of poor outcomes after controlling for baseline function and likelihood of future hospitalization.

Accidental Falls↗
PubMed2001

Medical care expenditures under gatekeeper and point-of-service arrangements.

OBJECTIVE: To compare expenditures for medical care in a closed-panel gatekeeper HMO and an open-panel point-of-service (POS) plan that share the same provider network. DATA SOURCE/STUDY SETTING: The two study HMOs are distinct product lines of a single managed care organization; both plans are commercial products. We used administrative data files from the study plans for 1994-95 to assess differences in total medical care expenditures and spending for five categories of services: physician services, inpatient hospital services, outpatient hospital services, prescription drugs, and other services. STUDY DESIGN: Multivariate analyses were based on the two-part model of the demand for medical care. The dependent variables in these models were expenditures in each of the five categories of services, and the independent variables were indicator variables for plan type and visit copayments, prescription drug copayment, distance to the nearest primary care physician (PCP), demographic characteristics, chronic conditions, area characteristics, and entry/exit indicator variables. PRINCIPAL FINDINGS: Total expenditures for medical care ranged from equal in both plans to 7 percent higher in the gatekeeper HMO (p < .10), depending on the copayments for physician visits. Expenditures were not higher in the POS plan for any of the five categories of services. These findings were robust to a wide range of sensitivity analyses. CONCLUSIONS: Direct patient access to specialists in POS plans does not necessarily result in higher medical care expenditures. When POS enrollees are required to choose PCPs, patient cost sharing, physician financial incentives, and utilization review may control expenditures without constraining direct patient access to providers.

Adolescent↗
PubMed2002

Study of the visual evoked magnetic field with the m-sequence technique.

PURPOSE: Multifocally stimulated visual evoked magnetic field (VEF) examination with an m-sequence technique (multifocal VEF; mVEF) was studied, and the neural generators at peaks of mVEF were estimated in the visual cortex. METHODS: Visual field stimulation was generated by a multifocal testing system with use of the m-sequence technique. The stimulation pattern covered a central area extending from 0.6 degrees to 10 degrees in radius outward from the center of four visual-field quadrants. The stimulation pattern was projected onto a screen by a liquid crystal projector. VEFs of 14 healthy adults were recorded with a 160-channel, whole-head-type magnetoencephalography (MEG) system. The output signals of 16 selected MEG sensors covering the occipital region were recorded for each subject with the multifocal testing system, and the second-order responses were calculated. The analyzed response data files were transferred to the MEG system, a single equivalent current dipole (ECD) was estimated to locate the neural generator, and the localization was superimposed onto the corresponding brain magnetic resonance image of the subject. RESULTS: mVEFs showed three peak waves (N75m, P100m, N145m) in 75% of the subjects and two peak waves (N75m, N145m) in 25%. (N, P and m denote negative, positive, and magnetic fields, respectively.) Latencies of the first and the last peak were similar between the two kinds of peak waves. ECD examination showed more than 97% of goodness of fit at all peaks, and the relation between EDCs and the stimulated visual field coincided with a retinotopic organization that fit a cruciform model in all subjects. ECD depths from the occipital pole were similar to the depth expected from the human linear cortical magnification factor model in all subjects. Main neural generators of all mVEF components (N75m, P100m, N145m) were shown in the striate cortex (V1). CONCLUSIONS: Testing the VEF with an m-sequence technique showed stable responses to simultaneous stimulation of four visual-field quadrants. Consistency of correlation of the estimated ECD with the known cortical organization of the primary visual cortex confirmed the reliability of this examination. The three mVEF peaks were thought to derive mainly from V1 activity.

Adult↗
PubMedDate not supplied

Risk of postpartum induced abortion in Finland: a register-based study.

CONTEXT: Half of Finnish abortion patients already have children, and one in 10 pregnancies ending in abortions started within 12 months of a birth. Thus, many women may not practice contraception effectively during the postpartum period. METHODS: Data from national registers were used to create ajoint data file on pregnancies occurring in Finland over the period 1987-1998. The abortion risk (the risk of a conception that leads to an induced abortion) and abortion ratio (the number of conceptions leading to abortions divided by the number leading to deliveries) were analyzed in follow-up periods after all live births to women younger than 45 (684,922), using hazard regression and logistic regression. RESULTS: Pregnancies starting within eight months postpartum were more likely to end in abortion than were those starting later. Within the first eight months, the shorter the interval to the next pregnancy, the more likely the pregnancy was to end in abortion. Abortion risk was higher 6-18 months postpartum than at later periods and was highest at 6-8 months postpartum, particularly among unmarried women and teenagers. Between 1987-1988 and 1995-1996, the abortion risk within the first eight months postpartum rose significantly among women aged 25-29 and 30-34 (relative risks, 1.5 and 1.2, respectively). The abortion risk and abortion ratio were higher among teenagers than among women in other age-groups. CONCLUSIONS: The findings are consistent with the hypothesis that contraceptive practice is less effective postpartum, suggesting room for improvement in postpartum contraceptive counseling in Finland.

Abortion, Induced↗
PubMedDate not supplied

An information system for analyzing census data on microcomputers.

The authors describe a software program called CeDAR, for Census Data Analysis and Retrieval System, which is "a microcomputer-based census information system that can be used to retrieve, display, manipulate and analyze published data from the 1980 U.S. Census and other geographic databases." General characteristics, sequence of operation, and availability of CeDAR are discussed.

Americas↗
PubMed1991

The sample of anonymised records.

The author describes the purchase of two samples of anonymized records from the 1991 United Kingdom census and the creation of a center at the University of Manchester to act both as distributor of these data to the academic community and as a focus for research on substantive and methodological topics connected with census microdata. She "describes the legal problems and public sensitivities involved, makes comparisons with other countries' handling of census data, [and] describes the information to be released and the broad types of usage envisaged."

Censuses↗
PubMed1993

Beware the passenger card] Australian and New Zealand data on population movement between the two countries.

"This article reports on idiosyncrasies of two official national migration databases, most of which became apparent when trying to account for marked differences in their estimates of both migratory and more short-term population movement between the two countries, and for variation over time in the pattern of differences. It is shown that the use of apparently similar broad classification principles, by different countries and through time within a country, can create impressions of comparability and continuity that may be quite misleading." Data are for Australia and New Zealand.

Australia↗
PubMed1992

The ESRC/UFC-ISC 1991 census of population initiative: delivering the data of the decade.

"This article describes the programme of data purchase, dissemination, training and development support which the Economic and Social Research Council (ESRC) in collaboration with the Information Systems Committee of the Universities Funding Council (UFC-ISC) has put in place to...[inform users about] new products derived from the Census [of the United Kingdom]. As a preliminary some background to the census itself and to the Census Initiative are provided." Topics covered include census outputs, new features of the census, linked datasets, linked software, and Census Initiative datasets, training and development programs, and organization.

Censuses↗
PubMed1994

[Demographic statistics after the GBA Law is passed].

"The Dutch Ministry of Internal Affairs plans to replace the old written population systems on paper with a new system of decentralized automated population registers (in Dutch this system is called: GBA) on 1 October 1994.... In the summer of 1993 Statistics Netherlands carried out a test to find out whether the GBA messages are appropriate for making population statistics. To do this such messages were forwarded to Statistics Netherlands by five municipalities for three months. The conclusion of the test results was that the GBA system is technically adequate for making population statistics." (SUMMARY IN ENG)

Data Collection↗
PubMed1998

Recent population trends in nonmetropolitan cities and villages: from the turnaround, through reversal, to the rebound.

"The purpose of this study is to track and contrast the patterns of local concentration and deconcentration in nonmetropolitan America between 1950 and 1996. We consider the growth of places by initial size as well as the growth of population living in the countryside or in unincorporated hamlets.... To determine how widespread and consistent the trends are, we compare patterns of growth by nearness to metropolitan areas, and by region of the country. We also examine differences among a subset of nonmetropolitan places distinguished by the primary socioeconomic character of their county. Using a detailed data file from the 1990 census, we are able to give some consideration to commuting."

Americas↗