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Dental health of Louisiana residents based on the ten-state nutrition survey.
The dental health status of 4,006 residents of Louisiana was analyzed, based on data in the 1968-70 Ten-State Nutrition Survey funded by the U.S. Government. These data were based on examinations of census districts in which the average per capita income was in the lowest quartile for the nation. A considerable variation in the prevalence of dental diseases was found among the Louisiana residents according to age. The females examined had a slightly higher DMF (decayed, missing, and filled permanent teeth) score, a lower OHI (oral hygiene index) score, and a slightly lower PI (periodontal index) score than did the males. The dental caries attack rate did not vary much by race, but the whites examined had received a much greater amount of dental care than had their black counterparts. The OHI scores of the blacks were higher than those for the whites in both the debris and calculus components. The PI scores were higher for the blacks than for the whites. More white persons than blacks were edentulous; this result, however, tends to confirm the observation of increased dental care in white persons. The percentages of persons with periodontal disease and periodontal pockets were considerably higher among persons with incomes below the poverty level, and a greater percentage of blacks had incomes below that level. The data thus apparently indicate that the major determinants of dental health status in Lousiana are age and level of income; race appears to be the major determinant of the amount of dental care received.
Adolescent↗
Integrated NHANES: uses in national policy.
The National Nutrition Monitoring and Related Research Program (NNMRRP) arose from Congressional concern about lack of information regarding the occurrence in the American population of undernutrition and diet-related risk factors for chronic diseases. Congressional appropriations and executive branch decisions about budget priorities have been the major determinants of the scope and number of nutrition monitoring surveys and surveillance activities fielded and therefore the information available for policy and research uses. The nutrition data collected in the NNMRRP are used by federal agencies, the private sector and academia for a variety of purposes, including public policy (e.g., development and evaluation of monitoring and surveillance, regulatory and nutrition programs), normative standards (e.g., growth charts, reference data for hematological and biochemical indicators of nutritional status or Dietary Reference Intakes) and research (e.g., cross-sectional, longitudinal and time-trends studies of dietary and nutritional status, health status, disease morbidity and mortality). Although the importance of the NNMRRP to national policy is difficult to quantify, in a 5-y period 97 proposed and final regulations citing NNMRRP data were published in the Federal Register by federal agencies responsible for nutrition and food safety programs. The NNMRRP-derived dietary and nutritional status data are essential information for quantitative risk assessments increasingly relied on by regulatory agencies as the basis for programmatic decisions and regulations development. Users of NNMRRP data in government agencies, academic institutions and the private sector have come to recognize the value of data from the surveys and surveillance systems for a wide variety of programmatic and research purposes.
Child↗
Electronic health record meets digital library: a new environment for achieving an old goal.
Linking the electronic health record to the digital library is a Web-era reformulation of the long-standing informatics goal of seamless integration of automated clinical data and relevant knowledge-based information to support informed decisions. The spread of the Internet, the development of the World Wide Web, and converging format standards for electronic health data and digital publications make effective linking increasingly feasible. Some existing systems link electronic health data and knowledge-based information in limited settings or limited ways. Yet many challenging informatics research problems remain to be solved before flexible and seamless linking becomes a reality and before systems become capable of delivering the specific piece of information needed at the time and place a decision must be made. Connecting the electronic health record to the digital library also requires positive resolution of important policy issues, including health data privacy, government encouragement of high-speed communications, electronic intellectual property rights, and standards for health data and for digital libraries. Both the research problems and the policy issues should be important priorities for the field of medical informatics.
Internet↗
Hormone replacement therapy: assessment of present use, costs, and trends.
BACKGROUND: Hormone replacement therapy (HRT) is probably unprecedented as a drug in widespread preventive use by a predominantly well population, but there is little direct data on current trends in use. AIM: To estimate trends in the use and cost of HRT in Britain. METHOD: Government prescription data and therapy cost data were analysed to provide trends in costs and point prevalence of the use of HRT since 1980. Projections were estimated to the year 2000. RESULTS: In 1987, HRT was used by an estimated 2.2% of women aged 40 to 64 years in England, and by 1.0% in Scotland. By 1994 this had risen to 21.7% in England, 20.4% in Scotland, and 21.3% in Wales. Between 1980 and 1986, costs remained steady at approximately 11 million Pounds per annum for England and 1 million Pounds for Scotland (1994 values). Between 1987 and 1994 they rose to 87 million Pounds for England, 10 million Pounds for Scotland, and 46 million Pounds for Wales (1994 values). Projections suggest that, by the year 2000, 25.4% of women aged 40 to 64 years (95% CI = 20.1-30.7%) will be taking HRT at any one time, at a cost of 150 million Pounds (95% CI = 142 m Pounds-157 m Pounds: 1994 values). This implies an 'ever' user prevalence of at least two-thirds of women in this age group. CONCLUSION: Use of HRT for long-term therapy is widespread and rising. It is estimated that prevalence has increased tenfold since 1987. Average individual costs of therapy have fallen by one third. The level of reduced risk of osteoporosis and cardiovascular disease, and the balance with cost and potential increased risk of breast cancer, are not yet established and are in need of clarification.
Adult↗
Health care governance: are we keeping pace?
This article reviews current activity of AUPHA programs in the areas of teaching, continuing education, and research in health care governance. Survey data from a sample of 61 AUPHA programs are used to relate these activities to trends in the practice of institutional governance and changes in the health care environment that affect such practices. Areas of concern are identified and recommendations for improvement made.
Community-Institutional Relations↗
The expanded criteria donor dilemma in cadaveric renal transplantation.
BACKGROUND: Outcomes of expanded criteria donor (ECD) kidney transplants are known to be superior to dialysis but inferior to transplant with a standard donor. Because of recent policy changes, ECD kidneys will be offered only to patients who have agreed to consider such an organ in advance. There is wide variation in opinion concerning the composition of ECD wait lists. However, the relative benefits of accepting an ECD versus waiting for a standard donor have not been quantified. METHODS: A Markov model was developed to determine when an individual patient should accept or reject an offer of an ECD kidney to optimize their personal expected quality-adjusted life years (QALY). Input variables were estimated from the United States Renal Data System (USRDS) database using a sample of 35,030 recipients. RESULTS: Recipients of ECD kidneys waited 77 days longer for transplant than recipients of standard donors. The average patient could wait 3.2 years longer, in addition to the time they have already waited, for a standard donor than an ECD and expect equivalent QALYs. Selected subsets revealed differences in wait times that equated QALYs for ECD and standard donors: African American, 4.4 years; age under 30, 4.0 years; age over 60, 11 months. CONCLUSIONS: Existing policy is likely to be in the best interests of only certain sets of patients awaiting cadaveric kidney transplantation unless ECDs dramatically reduce expected waiting for transplantation. This is most possible in elderly patients because of the short wait-time reduction required to make ECDs beneficial. Data reported here have been supplied by the USRDS. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US Government. The data and analyses reported in the 2001 Annual Report of the United States Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients have been supplied by the United Network for Organ Sharing and University Renal Research and Education Association under contract with Health and Human Services. The authors alone are responsible for reporting and interpreting of these data.
Databases, Factual↗
[Draft bill for the regulation of DNA bases].
With regard to the possible setting up in our country of a DNA data base for criminal identification purposes, the author undertakes a series of reflections--with constant reference to Comparative Law--on the draft Bill governing DNA data bases and underlines the timeliness and positive contribution of this legislative initiative. However, he also draws attention to several aspects of the proposed legislation which are clearly in need of improvement.
DNA↗
Implications of the National Practitioner Data Bank for nurse practitioners.
The National Practitioner Data Bank is a new federal repository of data on malpractice payments and adverse actions taken against the clinical privileges and licenses of all health care practitioners. This article summarizes the law governing the data bank and its implications for nurse practitioners. Specific reporting requirements are discussed, as well as guidelines for those who must and those who can access the data bank. This article also explains how NPs are notified when reports are made and gives methods for correcting errors in reports.
Data Collection↗
The role of government agencies in the development of cancer policy.
OBJECTIVES: To provide a review of federal government agencies that most directly affect cancer care and research and how cancer policy can be indirectly shaped or affected by federal and state programs. DATA SOURCES: Government reports and internet sources. CONCLUSIONS: The US government's role in cancer policy has grown substantially and involves ongoing dialogue among Congress, government agencies, and stakeholders in the cancer community. The government can be a powerful catalyst for progress or a seeming insurmountable barrier to high-quality cancer care and research. Working together can make a significant difference in the outcome of cancer policy. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses are an important voice in the development of legislation, regulation, and other national policies for cancer care. It is important for cancer care professionals to be aware of these federal programs and participate in deliberations.
Advisory Committees↗
The importance of human exposure information: a need for exposure-related data bases to protect and promote public health.
As a subfield of public health, environmental health is concerned with evaluating and ameliorating the effects of people on the environment and the effects of the environment on people. Separating hazards from risks, and characterizing the magnitude, likelihood, and uncertainty of risks is at the heart of environmental health in the 1990s. To this end, a full range of data is needed, including data that characterize the distribution of hazards, the population potentially at risk, and the contact between people and pollution that creates the risk. Several government-sponsored data systems contain information on a range of exposure estimators. The challenge is to develop meaningful, properly validated models to identify public health needs and evaluate public health programs.
Data Collection↗
Use of the Omaha System data to validate Medicare required outcomes in home care.
Millions of dollars have been spent developing standardized terminologies for nursing. However, many nurses are unaware of them, because vendors have not incorporated them into electronic health records (EHRs), and quality assurance staff and researchers have not benefited from reuse of the data to examine practice. Government regulations require the use of particular data sets, such as OASIS in home care. Most staff and agencies are focused on government-mandated data without realizing how the nationally recognized terminologies for nursing can benefit an agency. This article seeks to demonstrate the value of using the Omaha System in an EHR for documenting care and conducting Medicare's required Outcome-Based Quality Improvement process in one home care agency.
Certification↗
Aortic aneurysm repair in a peripheral setting: audit 100 consecutive cases.
BACKGROUND: Subspecialization of vascular surgery and the advent of endovascular techniques for aortic aneurysm repair have had a large impact on the approach to aortic surgery in main centres. Centralization of vascular surgery has been proposed to lower mortality and morbidity rates. More recently, clinical governance standards have been set by professional bodies for acceptable adverse outcome rates in aortic surgery. A peripheral general surgeon's experience with aortic surgery is reviewed in the present report in order to identify the local adverse outcome rates, and to relate them to case data and governance recommendations. METHODS: A retrospective audit of 100 cases of elective and emergency aortic aneurysm repair (performed by the senior author over a 10-year period) was undergone for the present review. Demographic and outcome data were recorded, and a data analysis was performed to identify factors related to mortality. Significance was tested using chi-squared analysis. RESULTS: Postoperative mortality rates were 1.7% for elective cases and 21% for acute cases. Mortality was related to rupture of the aneurysm, blood loss and American Society of Anesthetists score > 3. CONCLUSION: Morbidity and mortality rates from this audit compare favourably with those from larger vascular units. They are well within the accepted clinical governance rates, although the latter do not account for any case mix variation which may exist between peripheral and tertiary referral centres. These results support the continuation of aortic aneurysm surgery in peripheral centres.
Aged↗
[Climate and the superimposed distribution of Aedes aegypti and Aedes albopictus on infestation of São Paulo State, Brazil].
OBJECTIVE: To study the influence of climatic factors and superimposed distribution of Aedes aegypti and Aedes albopictus populations on their geographic dispersal in the state of São Paulo. METHODS: Data from government agencies on Ae. aegypti and Ae. albopictus foci and their distribution throughout counties of the state of São Paulo year by year, from 1985 to 1995, were obtained. Temperatures and rainfall data were also collected. Two indicators were used: infestation and rate. RESULTS AND CONCLUSIONS: The analysis indicated that the lower the temperature, the slower the geographic dispersal of Ae. aegypti population. This factor predominantly influenced the macro regional dispersal patterns of the species in the state of São Paulo. There was no clear influence of temperature on the dispersal of Ae. albopictus. The influence of rainfall on dispersal patterns was seen only for Ae. aegypti in a state area. No influence was detected on the prior presence of Ae. albopictus on the establishment of Ae. aegypti.
Aedes↗
Global government applications of analogues, SARs and QSARs to predict aquatic toxicity, chemical or physical properties, environmental fate parameters and health effects of organic chemicals.
Faced with the need to predict physical and chemical properties, environmental fate, ecological effects and health effects of organic chemicals in the absence of experimental data, several Government organizations have been applying analogues, Structure Activity Relationships (SARs) and Quantitative Structure Activity Relationships (QSARs) to develop those predictions. To establish some benchmarks for monitoring future increases in applications of analogues, SARs and QSARs by global Government organizations, this paper describes the current applications of analogues, SARs and QSARs by Australian, Canadian, Danish, European, German, Japanese, Netherlands, and United States Government organizations to predict physical and chemical properties, environmental fate, ecological effects and health effects of organic chemicals.
Animals↗
Quadrennial review of a paediatric emergency assessment unit.
The primary aim of this article is to report on one aspect of a quadrennial study designed to explore the appropriateness and impact of the development of a paediatric emergency assessment unit (PEAU) as a response to increases in paediatric emergencies presenting to a south-western regional child health unit. In particular, this article will present the findings of a prospective audit of admissions to the PEAU over a 1-month period during the latter part of 2002. The primary method of data collection utilized a structured survey instrument developed using a design and automatic data computer software package, completed by the nursing staff. Anonymized descriptive data were obtained from 223 children admitted to the PEAU during one calendar moth and authorized by the appropriate clinical directorate audit committee as part of its ongoing commitment to the full implementation of clinical governance. The data presented primarily relate to children admitted during the official opening times of the PEAU, and those presenting out of hours. The data analysis demonstrates a reduction in the number of children staying overnight in hospital since the opening of the PEAU, with the majority of children being referred by their own family doctor. Only one child in the sample was readmitted to the PEAU within 24 hours, and two within 24 hours of discharge as inpatients. Although thought to be pertinent, only one child admitted after official closing of the PEAU and out of hours was described as being admitted for social reasons. The International Classification of Diagnosis (ICD) 10 (World Health Organization (WHO), 1994) classifications of the children admitted to the PEAU reflect those found in other similar studies. Overall, the results of this investigation demonstrate that a PEAU can offer an efficient service to GPs, families and others as a route of referral, thus mitigating unnecessary overnight stays for individual children.
Child↗
A method of analyzing density-dependent vital rates with an application to the Gainj of Papua New Guinea.
A method of estimating age-specific coefficients of density-dependent variation in fertility and mortality is developed; the method is applicable to longitudinal data on population size and the number of births and deaths classified by age. Given a sufficiently large data set, it is possible to estimate both the sensitivity of each age class to density-dependent damping and the density effect of each age class on every age class in the population. Application of the method to government census data on the Gainj, a small tribal population from highland Papua New Guinea, shows that fertility is density-independent, but that mortality is at least partially density-dependent. This finding suggests that the size of the population is regulated by mortality rather than fertility. Individuals aged less than five years and greater than 50 years are particularly sensitive to density-dependent survival damping; individuals of adolescent and early reproductive age are not themselves damped, but appear to be responsible for the observed damping.
Adolescent↗
A model to control data flow in multicenter clinical trials.
A model for the data management procedures of multicenter clinical trials is proposed. Focus will be restricted to those trials in which data are collected over time depending on therapy and follow-up schedules. The requirements for the model are structured data collection forms and a theoretical data flow governing the submission of materials by the participating institutions. The existence of a coordinating center is assumed, but the model presented here can be applied irrespective of the organizational set up of the research environment. It is suggested that each data collection form (or any other piece of documentation) is seen as an independent information holder, irrespective of the actual data it contains. The status of each form, from when it is expected by the coordinating center to when it is accepted for statistical analysis, can be summarized by a single variable, maintained by the data manager. Depending on its value, certain activities can be initiated, such as requesting missing forms or corrections. The implementation of the described model within a database system as well as its relation to the requirements for reliable statistical evaluation of the study are discussed with reference to a real example.
Clinical Trials as Topic↗