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Comprehensive and human capital crash costs by maximum police-reported injury severity within selected crash types.

This paper presents estimates for both the economic and comprehensive costs per crash for three police-coded severity groupings within 16 selected crash types and within two speed limit categories ( or=50 mph). The economic costs are hard dollar costs. The comprehensive costs include economic costs and quality of life losses. We merged previously developed costs per victim keyed on the Abbreviated Injury Scale (AIS) into US crash data files that scored injuries in both the AIS and police-coded severity scales to produce per crash estimates. The most costly crashes were non-intersection fatal/disabling injury crashes on a road with a speed limit of 50 miles per hour or higher where multiple vehicles crashed head-on or a single vehicle struck a human (over 1.69 and $1.16 million per crash, respectively). The annual cost of police-reported run-off-road collisions, which include both rollovers and object impacts, represented 34% of total costs.

Abbreviated Injury Scale↗

The role of XML in medical informatics in Hungary.

Reforms in healthcare means frequent changes. The author focusing on flexible information systems and data structures in healthcare, that gives the chance to avoid costly deadlocks, incompatibilities and data chaos--keeping the financial and administrative burden of provider and reimbursement information systems at low level. He describes data and document exchange among health care providers (hospitals, GPs etc.) and the reimbursing insurance institute introducing XML (eXtensible Markup Language) technology and it's multimedia extension called SMIL (Synchronized Multimedia Integration Language) that well supports large textual and multimedia nature of data in healthcare. He presents the most frequent XML datasets for reimbursement in Hungary, the validation schemas (Data Type Definitions) and procedures, comparing the new and old data file sizes with different compressions. The comparison includes different schema file sizes, and validation times.

Humans↗

[Impact of posttraumatic stress disorder symptoms and their intensity on patients working ability].

After the war in Croatia, many people are suffering from posttraumatic stress disorder (PTSD). The aim of this research was to analyse the impact of symptoms of PTSD and their intensity on working ability of those patients. Two groups of patients with PTSD hospitalized at Psychiatric Department of osijek Clinical Hospital were interviewed. The first one consisted of 80 patients who were (by psychiatrist) estimated as able to work, and the second of 80 patients who were estimated as unable to work. In this research we used ICD-10 classification for diagnosis of PTSD, self-estimate scale for evaluation of intensity of simptoms of PTSD, Brief psychiatric ratin scale (BPRS) and medical files. Data were statistically arranged by SAS. Working status is correlated to values on Brief psychiatric rating scale (BPRS) and self-estimate scale for evaluation of symptoms intensity of PTSD. Work disability was statistically significantly correlated to: earlier appearance of symptoms of PTSD, more frequent reminding of stressor by live memories, and symptoms intensity. The intensity of symptoms was statistically more significantly correlated to work ability than their form, and the number of stressors lived through the war (through more severe illness) had more influence on work ability than characteristics or durability of a stressor.

Croatia↗

The influence of age and exercise on the mobility of hand joints: 1: Metacarpophalangeal joints of the three-phalangeal fingers.

Mobility of metacarpophalangeal joints (MP) of the three-phalangeal fingers was measured in university students (52 males and 49 females), senior citizens (30 males and 30 females), and pianists (21 males and 31 females). We consider the student data file to be a control group with hand mobility unchanged by external influence. Extension, flexion, and total abduction in this group are greater in the left than the right hand. Only extensions were greater in females compared to males. In seniors, all types of studied movements are, with the exception of total abduction in females, lesser that in the control group. The difference is more apparent in males than in females. Intersexual difference showing better MP joint mobility in females than males is thus greater in seniors than in students; however, greater mobility of MP joints in left compared to right hand is less noticeable. Compared to students, pianists show greater finger abduction, and--less markedly--also passive and active extensions, while we did not notice difference in finger flexion. Intersexual difference in MP joint mobility in pianists were not recorded, and better mobility on the left hand compared to the right hand was evident only in dorso-palmar movements in males (the exception was total finger abduction, which is greater for the left hand in males as well as in females). In the three studied series we did not register differences in interfinger abduction between the left and right hand or between sexes. Active dorso-palmar MP joint range of motion is greatest in the little finger and smallest in the index finger, smallest in seniors and greatest in pianists. In all three groups, the range is greater in the left than the right hand and in females compared to males.

Adolescent↗

[A computerized anesthesia record system: four years' experience].

A computerized anesthesia record system is in routine use for cardiovascular procedures in our operating rooms. This system is implemented on an NEC PC-9801 personal computer and automatically collects hemodynamic variables from a polygraph as well as from intraoperative laboratory reports via RS-232C ports. Events such as intubation can be entered manually using a standard keyboard. Since the introduction of the system in 1987, the system has been used in 90 percent of the total cases performed and 2941 electronic data files were recorded in a four-year period. Excluding some short procedures for which the system was not used, failure to store records on disks resulted from system errors due to power-line troubles in the operating rooms as well as users' omission to command the system. User-acceptance of event entry was poor. In 74 percent of the cases, not a single event was entered. Advantage of an automated anesthesia record system over a hand-written record is being recognized. Wide-spread use of such a system will require ergonomic design of the system and man-machine interfaces suitable for use in an operating room.

Anesthesiology↗

'Did everybody get that?' The challenges of international teleconferencing.

Countless hours and dollars are frittered away during teleconferences. This situation is greatly magnified when spread across international boundaries. Some simple steps can reduce this waste. Careful attention should be paid to such issues as time zones, appropriate telephone etiquette and equipment, sensible meeting management, careful use of additional data files and restrained use of new technology in some areas. Based on our group's extensive experience, we have collected some useful tips and resources on how to reduce your costs and frustrations.

Humans↗

[Experience in labor and delivery care in university centers].

Some considerations about an individual experience of labour and delivery care by means of three different partograms at the university departments of Obstetrics and Gynecology of Genova, Trieste and Verona are reported. The value of partography in management of labour was stressed in connection with a better delivery care, with a systematic recording of cervicometric data and fetal maternal monitoring and in the prevention of the use of unsuitable medical and surgical treatments. The partogram is also essential for the correct communication and makes both tracking and data filing easier. By means of partography the return concept of personalized care of woman in labour is possible without that safety and technology of new obstetrics are lost.

Adult↗

Routine screening for diabetic eye complications in a population based cohort of 4.438 persons with type 2 diabetes in a Danish county.

OBJECTIVES: This study aims to describe the use of routine screening for diabetic eye complications in a large population based cohort of type 2 diabetic patients in the County of Vejle, Denmark. Furthermore, it aims to identify characteristics of patients and general practitioners related to the frequency of eye examinations. METHODS: The type 2 diabetic population alive and resident in the County of Vejle on 1st January 1997. Data concerning eye examinations were collected from public data files for the period of January 1993 to December 1997. RESULTS: In a population of 4438 type 2 diabetic patients, 46% had had one annual eye examination in 1997 and 26% had not had a single eye examination within the last five years. Patient characteristics related to an eye examination included: treatment with insulin or oral hypoglycaemic agents, females and long duration of diabetes. The number of diabetic patients who had had an eye examination varied substantially between the general practices. The characteristics of general practitioners were not related to this variation. CONCLUSIONS: The results of this study indicate a great need for quality improvement of ophthalmologic service in diabetes care. To achieve this improvement, more focus should be given to cooperation between the general practitioners and the ophthalmologists.

Adult↗

Trends in birth across high-parity groups by race/ethnicity and maternal age.

BACKGROUND: The changing racial and ethnic diversity of the U.S. population along with delayed childbearing suggest that shifts in the demographic composition of gravidas are likely. It is unclear whether trends in the proportion of births to parous women in the United States have changed over the decades by race and ethnicity, reflecting parallel changes in population demographics. METHODS: Singleton deliveries > or = 20 weeks of gestation in the United States from 1989 through 2000 were analyzed using data from the "Natality data files" assembled by the National Center for Health Statistics (NCHS). We classified maternal age into three categories; younger mothers (aged < 30 years), mature mothers (30-39 years) and older mothers (> or = 40 years) and maternal race/ethnicity into three groups: blacks (non-Hispanic), Hispanics and whites (non-Hispanic). We computed birth rates by period of delivery across the entire population and repeated the analysis stratified by age and maternal race. Chi-squared statistics for linear trend were utilized to assess linear trend across three four-year phases: 1989-1992, 1993-1996 and 1997-2000. In estimating the association between race/ethnicity and parity status, the direct method of standardization was employed to adjust for maternal age. RESULTS: Over the study period, the total number of births to blacks and whites diminished consistently (p for trend < 0.001), whereas among Hispanics a progressive increase in the total number of deliveries was evident (p for trend < 0.001). Black and white women experienced a reduction in total deliveries equivalent to 10% and 9.3%, respectively, while Hispanic women showed a substantial increment in total births (25%). Regardless of race or ethnicity, birth rate was associated with increase in maternal age in a dose-effect fashion among the high (5-9 previous live births), very high (10-14 previous live births) and extremely high (> or = 15 previous live births) parity groups (p for trend < 0.001). After maternal age standardization, black and Hispanic women were more likely to have higher parity as compared to whites. CONCLUSIONS: Our findings demonstrate substantial variation in parity patterns among the main racial and ethnic populations in the United States. These results may help in formulating strategies that will serve as templates for optimizing resource allocation across the different racial/ethnic subpopulations in the United States.

Adult↗

Assisted automated peritoneal dialysis (AAPD) for the functionally dependent and elderly patient.

OBJECTIVE: To describe basic demographics and clinical outcomes among elderly end-stage renal disease (ESRD) patients physically dependent on a caregiver and maintained on an assisted automated peritoneal dialysis (AAPD) program. DESIGN: Retrospective single-center study based on patient records and data files. SETTING: University Hospital. PATIENTS: 64 physically dependent AAPD patients followed for 1.012 treatment months. Assistance and care was delivered by 52 briefly trained teams of visiting nurses or nursing home staff. RESULT: Crude 1-year survival was 58% and 2-year survival was 48%. Crude 1- and 2-year survivals, excluding deaths within 90 days, were 66% and 54% respectively. We found no significant effect on survival by main causes of ESRD, gender, age, late referral, need for acute start, social isolation, physical dependency on help at inclusion, or residence in a nursing home. 10% of patient-days on AAPD were spent in hospital. 13 (20%) of the patients were converted permanently to hemodialysis due to PD technique failure. The incidence of peritonitis was 1 in every 25.3 treatment-months. CONCLUSIONS: AAPD may be a feasible and safe option for renal replacement therapy for frail, elderly, and physically dependent patients with ESRD. Despite the special patient selection for this AAPD program, we achieved results of international standards for patient survival, PD technique survival, and incidence of acute peritonitis. These results do notjustify withholding dialysis from this group of patients.

Age Factors↗

[So-called complex ego-functions, psychic cross findings and valuation of efficiency in medical expert assessment of psychogenic diseases].

Medical expert assessment of a disease-induced disability requires the integrative examination of own and outside anamnestic data, file content and psychic cross-findings received in the assessment interview, if necessary completed by results of psychologic testing. The measure of disability with regard to psychogenic diseases is the impairment of the so-called complex ego-functions because they make it possible to judge someone's will which is available to overcome his inhibitions concerning achievement. This case report describes how to determine and present an impairment of complex ego-functions on the finding level. It is the author's view that it is desirable to operationalise this way of receiving findings with the aim of achieving obligatory criteria for granting payment to every insured person.

Activities of Daily Living↗

[The physiology of natural parturition in cows].

In the year 1990 free parturitions of 339 cows were followed on three farms; these parturitions were compared with the last parturitions of these cows when the tender's assistance was available. The spontaneous free parturitions were followed in the open air in litter boxes which were located outside the barns where the groups of about twenty highly pregnant cows and heifers were housed for two months before their parturitions all the year round irrespective of the weather conditions. In addition to direct continuous observations, a host of zooveterinary data filed for these groups of animals were evaluated, concerning particularly those animals which could not be directly followed for the time reasons. Through direct observations the time schedule of the given parturition was evaluated and recorded above all, including all changes in the behaviour of the cow itself, and also behavioural changes in the group of animals or the behaviour of particular groups of animals toward each other. Applying the same criteria, the behaviour of born calves toward the mother, behaviour of calves toward each other and their behaviour toward other breeding cows was evaluated. The method of disinterested observation was used, this means the principle of noninterference with the most actions observed, with the exception of such situations that could result in the calf death. Another principle was to minimize through these observations all negative effects that could influence the behaviour of individual animals and also the behaviour of the whole group.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Changes in clinical characteristics and drug treatment of hypertension over 40 years at the Dunedin Hypertension Clinic.

The clinical characteristics of the 4,170 hypertensive patients referred to the Dunedin Clinic from 1950 to 1989 have been compared for eight successive 5-year periods. A gradual decrease in the severity of referred hypertension and an increase in the proportion of patients already on treatment at the time of referral (currently 50%) were noted. For male patients, mean +/- SD initial lying blood pressure was 179 +/- 27/116 +/- 19 mm Hg in 1950-1954 and 158 +/- 25/91 +/- 14 mm Hg in 1985-1989. Corresponding prevalence data for target organ damage among male patients were retinal grade 3 or 4, 49% and 3%; cardiomegaly on chest radiograph, 60% and 26%; electrocardiogram left ventricle strain pattern, 28% and 3%; and serum urea levels greater than 10 mmol/L, 16% and 5%, respectively. For women there was a similar trend. The number of patients on drugs in each of nine categories and the percent use of each drug category for each year during 1950-1989 was recovered from computerized data files. The percentage peak usage of ganglion blockers was in 1950-1958, adrenergic neuron blockers in 1963-1970, centrally acting drugs in 1965-1968, diuretics in 1960-1982, beta-blockers in 1974-1987, alpha-blockers in 1980-1987, and angiotensin converting enzyme inhibitors and calcium antagonists in 1989. The diuretics have been the most enduring drugs, followed by the beta-blockers.

Ambulatory Care Facilities↗

Class endogamy, inbreeding and migration during the Argentinean colonial period: analysis based on individuals of European ancestry.

During the Spanish colonial period, Córdoba was an important town due to its location suitable for controlling communication throughout a wide region of Argentina. As a typical colonial society, where individuals belonged to a well established social class, marriages among Whites were the result of strict norms and prejudices founded on nets of kinship, friendship and neighbouring. The objective of this paper is to determine, whether the elevated class endogamy among Whites during the colonial period resulted in high consanguinity and whether a process of selection of surnames was present in 1813. In both cases the interaction with the migratory flow was taken into account. It is concluded that (a) Although an endogamy of "class" existed among Whites, there is no evidence of the consequences on the biological structure of the population through preferential mating between relatives, as deduced from the low level of inbreeding from isonymy. (b) There was no differential reproduction reflecting the selection of families carrying certain surnames; therefore surnames followed a "neutral" model. (c) The diversity of surnames and the gene flow deduced from them were of a magnitude similar to present populations; this fact could have balanced the effect of the "class" endogamy. (d) Finally, the congruence between information derived from the population age distribution and historic data and the quantification of migration from surnames allowed the detection of mistakes in the census data file regarding the number of foreigners, thus validating the use of surnames as biological markers of the population structure.

Adolescent↗

[Direct positive DDP 111 as a possible means of documentation for electrophoresis].

The positivepaper DDP 111 manufactured in the Fotopapierwerk Dresden is presented. It allows to make copies (1:1) of electrophoreses. Independently of the used staining procedure it is a simple, quickly and cameraless possibly to obtain reproductions with a high quality. The DDP 111 allows to resolve the problem of documentation of electropherograms (especially of wet flat gels) and to build up collections and data files respectively.

Electrophoresis↗

[ALEE-AO: epidemiologic and economic atlas of hospital activities in Lombardy].

This paper describes the main characteristics of a data processing system that is available through the Internet and that is used to process epidemiological and economic data, predominantly from a geographical viewpoint, starting from the hospital discharge abstracts of the Lombardy Region. Technical aspects of the system are briefly reviewed, including epidemiological-statistical aspects (incidence, prevalence, variety of diagnoses, indicators, controlling for statistical variability, etc.) and aspects relating to information systems (hardware platform, software environment, Internet access and security problems, original database, etc). The system introduces several methodological innovations in the processing of hospital discharge abstracts (such as links between data files, evaluation of activity of each individual GP, and analysis of patient mobility), proposes three successive levels of case selection (time, geography, nosology) prior to statistical analysis which is performed starting from the information on each individual discharge abstract. Finally, several examples are given and critical aspects, as well as prospects of the system, are discussed.

Epidemiologic Studies↗

Digital cell image analysis of Ewing's sarcoma.

We analyzed the lesional tissue in Ewing's sarcoma by means of a cell image processor computing 15 nuclear parameters in order to quantify the morphologic variability of the tumor cell nuclei. To this end we combined 32 cases (350-400 Feulgen-stained nuclei analyzed per case) in a data file, which was then subjected to principal component and canonical analyses. We found considerable heterogeneity within the cell nucleus population of Ewing's sarcomas. Indeed, after the arbitrary subdivision of the file into two cell classifiers (CC1 and CC2 cell types) on the basis of the first canonical function, the 32 Ewing's sarcomas showed a great deal of variability in the proportion of CC1 and CC2 cell nucleus types. The nuclei of the CC1 type had a more finely textured chromatin when compared to the CC2 type, the nuclei of which exhibited a more granular chromatin pattern. Additionally, these 32 Ewing's sarcomas were characterized by three distinct DNA histogram types. Eight tumors displayed a diploid nonproliferating DNA histogram pattern (type A), 11 a diploid proliferating (type B) and 13 an aneuploid (type C) DNA histogram profile. We found a highly significant relationship between these DNA histogram types and the CC1:CC2 cell type percentage ratio. The eight Ewing's sarcomas with a type A DNA histogram contained a significantly higher proportion of CC1 cell type nuclei as compared to the 13 tumors with a type C DNA histogram, which contained a great proportion of CC2 cell type nuclei.

Cell Nucleus↗

[A computerized method for studying contractility of isolated cardiac myocytes].

In recent years methods for the isolation of cardiac myocytes have gained increasing interest. Single cardiac cells represent an effective model for the study of cardiac contractility thanks to their features of simplified preparation. This improves the understanding of cardiac contractile properties and the effects of cardio-active substances. Moreover, it has been demonstrated that the isolation procedure does not alter the basic characteristics of the original tissue. The contractility indices in multicellular models are derived from the direct measurement of mechanical parameters (pressure and tension). These are difficult to perform in the case of isolated cardiac myocytes for which optical techniques of measurement proved particularly suitable. A system based on the video motion detector technique has been used to measure the extent of shortening. The cell is observed using a video camera connected with a phase contrast microscope. The video dimension analyser receives the cell image from the video camera and its output is a voltage proportional to the cell length. This signal is sent to a personal computer for acquisition and analysis. The signal is then digitalized by an analog to digital conversion board and subsequently elaborated to calculate the contraction parameters. Then these values are visualized on the computer screen, printed and stored with other pertinent information typed by the user. The result is the creation of a data file, available for further processing.

Animals↗