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PubMed1998

[Computer technology for genogenographic study of the gene pool. V. Evaluation of the reliability of maps].

An important aspect of gene geography, the estimation of the reliability of interpolation maps, is considered. The introduced quantitative parameter, map reliability, was estimated as the probability of predicted character values in interpolated map regions. The obtained estimates characterize the statistic significance of the mapped values of the character. The estimation algorithm is based on concepts and mathematical methods of the reliability theory. The proposed approach involved the estimation of the reliability at each point of the mapped area and resulted in a new map (a reliability map) expressing the reliability of gene geographic mapping in probability terms. Approaches to estimate the reliability of mapping, as dependent on various parameters of the initial data, were proposed, a general computer-based technology was elaborated, and a standardized reliability scale was proposed. Reliability maps are considered necessary for the correct interpretation of gene geographic maps. The estimation of reliability as dependent on the number and distribution of initially tested populations was illustrated by the example of frequency maps of individual genes (HP*1, HLA*A1) and synthetic maps (100 alleles of 34 polymorphic loci) of Eastern Europe.

Algorithms↗
PubMed1998

2001 Census output areas: from concept to prototype.

This article describes the development of a prototype output area production system for the 2001 Census. A number of outstanding design issues concerning 2001 output areas are explained, and the implications of using a geographical information system for the management of census geography are explored.

Censuses↗
PubMed2005

Polio eradication: mobilizing and managing the human resources.

Between 1988 and 2004, the Global Polio Eradication Initiative grew to become the largest international health effort in history, operating in every country of the world. An estimated 10 million health workers and volunteers have been engaged in implementing the necessary polio supplementary immunization activities (SIAs) on a recurring basis, and at least 35,000 well-trained workers have been conducting polio surveillance. A combination of task simplification, technological innovations and adaptation of strategies to fit local circumstances has allowed the Initiative to use a wide range of workers and volunteers, from both inside and outside the health sector, to deliver the polio vaccine during SIAs and to monitor progress in virtually every area of every country, regardless of the health infrastructure, conflict, geography and/or culture. This approach has required sustained political advocacy and mass community mobilization, together with strong management and supervisory processes. Non-monetary incentives, reimbursement of costs and substantial technical assistance have been essential. Given the unique features of eradication programmes in general, and polio eradication in particular, the implications of this approach for the broader health system must continue to be studied if it is to be replicated for the delivery and monitoring of other interventions.

Community Health Planning↗
PubMed2002

Primary care quality in the Medicare Program: comparing the performance of Medicare health maintenance organizations and traditional fee-for-service medicare.

BACKGROUND: Since 1972, Medicare beneficiaries have had the option of enrolling in a Medicare-qualified health maintenance organization (HMO). Little information exists to inform beneficiaries' choices between the traditional fee-for-service (FFS) Medicare program and an HMO. OBJECTIVES: To compare the primary care received by seniors in Medicare HMOs with that of seniors in the traditional FFS Medicare program, and among HMOs, and to examine performance differences associated with HMO model-type and profit status. METHODS: Data were derived from a cross-sectional observational survey of Medicare beneficiaries 65 years or older in the 13 states with mature, substantial Medicare HMO markets. Only beneficiaries continuously enrolled for 12 months or more in traditional FFS Medicare or a qualified Medicare HMO were eligible. Data were obtained using a 5-stage protocol involving mail and telephone (64% response rate). Analyses included respondents who identified a primary physician and had all required data elements (N = 8828). We compared FFS and HMO performance on 11 summary scales measuring 7 defining characteristics of primary care: (1) access, (2) continuity, (3) integration, (4) comprehensiveness, (5) "whole-person" orientation, (6) clinical interaction, and (7) sustained clinician-patient partnership. RESULTS: For 9 of 11 indicators, performance favored traditional FFS Medicare over HMOs (P<.001). Financial access favored HMOs (P<.001). Preventive counseling did not differ by system. Network-model HMOs performed more favorably than staff/group-model HMOs on 9 of 11 indicators (P<.001). Few differences were associated with HMO profit status. CONCLUSIONS: The findings are consistent with previous comparisons of indemnity insurance and network-model and staff/group-model HMOs in elderly and nonelderly populations. The stability of results across time, geography, and populations suggests that the relative strengths and weaknesses of each system are enduring attributes of their care. Medicare enrollees seem to face the perennial cost-quality trade-off: that is, deciding whether the advantages of primary care under traditional FFS Medicare are worth the higher out-of-pocket costs.

Aged↗
PubMed2000

Surgery in Hungary.

After providing data on the geography and demographics of Hungary, the 1100 years of Hungarian history are briefly surveyed. The introduction, development, and present state of medical education and, in particular, surgical education, including specialty training, are discussed. Attention is devoted to the organization of the surgical community and of surgical manpower in the country. Various disease patterns and their influence on surgical practice are discussed. Attention is also devoted to health care provision and research activity. Finally, the future of surgery, especially general surgery, is outlined.

Curriculum↗
PubMed2004

Racial disparities in rectal cancer treatment: a population-based analysis.

HYPOTHESIS: We hypothesized that there are significant racial disparities in delivery of care to rectal cancer patients. We examined differential surgical and radiation treatment for these patients and determined whether blacks were less likely than whites to undergo sphincter-sparing procedures, which are associated with a higher quality of life than sphincter-ablating procedures. DESIGN: Cross-sectional cohort study. PATIENTS AND SETTING: The Surveillance Epidemiology and End Results database provided population-based data for rectal cancer patients who were diagnosed between 1988 and 1999, were older than 35 years, and had no prior colorectal or other pelvic cancer. MAIN OUTCOME MEASURES: Using logistic regression, we compared receipt and type of surgical therapy and radiation therapy, controlling for age, sex, year, geography, stage, and anatomic location. RESULTS: Among 52 864 patients, 3851 were black and 44 010 were white. Blacks were younger than whites and had more advanced disease (P<.001). Among patients who underwent operation, rates of sphincter-ablating procedure were 37% for whites and 43% for blacks (adjusted odds ratio [AOR], 1.42; 95% confidence interval [CI], 1.23-1.65). Moreover, 53% of whites and 56% of blacks received no radiation therapy for stage II to III disease (AOR, 1.30; 95% CI, 1.15-1.47). CONCLUSIONS: Blacks with rectal cancer were diagnosed at a younger age and more advanced disease stage than whites, implying a need for more aggressive screening. After adjusting for stage and other covariates, surgical and radiation treatment also differed along racial lines. Our data suggest that treatment disparities may contribute to differences in outcome among racial/ethnic groups with rectal cancer, and they highlight the need for improving access to state-of-the-art surgical care for minority patients with rectal cancer.

Adult↗
PubMed1991

No-smoking laws in the United States. An analysis of state and city actions to limit smoking in public places and workplaces.

OBJECTIVE: To assess the prevalence, content, and growth of state and city laws restricting smoking in public places and workplaces in the United States and to identify factors associated with their passage. DESIGN: A mailed survey of city clerks in US cities with a population of 25,000 or greater (N = 980) and review of existing data sources confirmed the status of smoking restrictions in 902 (92%) of the cities in the sample. State laws were identified by contacting each state's Legislative Reference Bureau (100% response). Content of laws was coded using previously developed categories. MAIN OUTCOME MEASURES: Prevalence, comprehensiveness, and cumulative incidence of no-smoking laws in states and in cities with a population of 25,000 or greater. RESULTS: By July 1989, 44 states and 500 (51%) of the cities in our sample had adopted some smoking restriction, but content varied widely. While 42% of cities limited smoking in government buildings, 27% in public places, 24% in restaurants, and 18% in private workplaces, only 17% of cities and 20% of states had comprehensive laws restricting smoking in all four of these sites. The number of city no-smoking laws increased tenfold from 1980 to 1989. City no-smoking laws were independently associated with population size, geography, state tobacco production, and adult smoking prevalence. Laws were more common in larger cities, Western cities, and states with fewer adult smokers. Laws were less common in tobacco-producing states and in the South. CONCLUSIONS: No-smoking laws are more widespread than previously appreciated, especially at the local level, reflecting a rapid pace of city government action in the 1980s. Nonetheless, comprehensive laws, which are most likely to provide meaningful protection from environmental tobacco smoke exposure, remain uncommon and represent a major gap in smoking control policy. Laws are most needed in smaller and non-Western cities and in states that produce tobacco and have a higher proportion of smokers.

Humans↗
PubMed2001

Relation between pediatric experience and treatment recommendations for children and adolescents with kidney failure.

CONTEXT: Children and adolescent patients with renal failure are frequently cared for by adult subspecialists. While peritoneal dialysis is used in less than 17% of adults with kidney failure, it is the preferred dialysis treatment for children. National data show that 45% of children receiving dialysis are treated with peritoneal dialysis and pediatric nephrologists report its use in 65% of patients receiving dialysis. Whether differences in peritoneal dialysis use among children are due to the pediatric experience of the clinician has not been examined. OBJECTIVE: To assess whether the pediatric experience of nephrologists directly affects treatment recommendations for children with kidney failure. DESIGN: Cross-sectional survey using 10 case vignettes per survey based on random combinations of 8 patient characteristics (age, sex, race, distance from facility, cause of renal failure, family structure, education, and compliance). SETTING AND PARTICIPANTS: National random sample of office-, hospital-, and academic medical center-based adult and pediatric nephrologists, stratified by geographic region and conducted June to November 1999. Of 519 eligible physicians, 316 (61%) responded, including 191 adult and 125 pediatric nephrologists. MAIN OUTCOME MEASURE: Treatment recommendations for peritoneal dialysis vs hemodialysis, compared based on nephrologists' pediatric experience. RESULTS: After controlling for patient characteristics, pediatric nephrologists were 60% more likely than adult nephrologists to recommend peritoneal dialysis for identical patients (odds ratio, 1.61; 95% confidence interval, 1.35-1.92). This was true regardless of dialysis training, years in practice, practice setting, geography, or patient characteristics. CONCLUSIONS: Our data indicate that pediatric specialization of clinicians influences treatment recommendations for children and adolescents with end-stage renal disease. Referring children to adult subspecialists may lead to differences in treatment choices and processes of care.

Adolescent↗
PubMed1997

Genetic variability in two Brazilian ethnic groups: a comparison of mitochondrial and protein data.

Sequence data from the first hypervariable segment of the mitochondrial DNA control region of 124 subjects belonging to three African-Brazilian and three Brazilian Indian populations were compared with information related to 12 protein genetic loci from 601 persons living in the same localities. There is high diversity among the mtDNA sites, and the most variable in one ethnic group are not the most variable in the other. No differences in gene diversity between populations within ethnic groups were observed, but the Indians showed a reduced variability. Much more interpopulation variation was observed in the mtDNA data than in the protein set. The relationships obtained for the six populations, however, are the same regardless whether mtDNA or protein loci are considered. African-Brazilians from Porto Alegre and Salvador, situated 3,000 km apart, are more similar to each other than both are to Paredão, despite the geographical proximity between Porto Alegre and Paredão, which are just 50 km apart. The tree topology in relation to the three Indians groups, on the other hand, is that expected when languages, culture, and geography are considered.

Africa↗
PubMed1996

Practical community screening for diabetic retinopathy using the mobile retinal camera: report of a 12 centre study. British Diabetic Association Mobile Retinal Screening Group.

OBJECTIVE: To document the performance of 12 diabetes eye screening units in different health districts which were financed by a single charitable donation. DESIGN: Each location was equipped with a retinal camera and screening vehicle, and the lead clinician developed the screening service configuration to suit local conditions. SETTINGS: Districts were chosen on the basis of interest in developing effective diabetes eye screening services. Characteristics of districts varied from largely rural to exclusively urban. SUBJECTS: People with diabetes who attended either general practice or hospital diabetes services were screened. MAIN OUTCOME MEASURES: Referral for ophthalmological opinion and use of laser therapy for new vessel formation or exudative maculopathy. RESULTS: A total of 64,905 screening episodes were recorded. Full data were available on 42,803 episodes which led to 2400 referrals (5.6%) and 516 of which resulted in laser therapy (1.2% of those screened or 21.5% of those referred). Where sequential data were available a year by year fall in sight threatening retinopathy incidence was demonstrated as the screening programmes detected incipient problems in the initial cycles of screening. The average cost of screening was Pounds13.11 per patient and the average cost of identifying a person requiring laser therapy was Pounds1110. Financial responsibility for running the service has been taken on by 10 of the 12 health districts. CONCLUSIONS: Diabetes eye screening using a mobile retinal camera is effective, efficient and robust. It is important that the service specification is designed to suit the geography and existing diabetes services in each district.

Costs and Cost Analysis↗
PubMed1998

Randomness of spatial distributions of two proteins in the cell nucleus involved in mRNA synthesis and their relationship.

Randomness and relation between point positions play an important role in archeology, cosmology, geography, and biology. An often-discarded effect is the edge effect, the effect that points are bound to a certain region. Without an appropriate correction, the outcome will be wrong. We studied the problem of randomness by comparing the distribution of interpoint distances with what can be expected for randomly distributed points (pair correlation function in statistics), and applied this to two sets of nuclear proteins inside the cell nucleus. The technique comprised labelling the proteins with a fluorescent dye, recording the fluorescent distribution with a 3D confocal microscope, and detecting the positions of the individual fluorescent spots. Results showed that, apart from studying randomness, the method is well equipped to quantitatively analyze a spot detection procedure, as the resolving power and the subvoxel accuracy were clearly visible. Given the results of assessing the randomness of the general transcription factor BRG1 and the RNA synthesizing protein RNA polymerase II (polII) in the cell nucleus, we concluded that the high intensity spots of the BRG1 protein are regularly spaced. The low intensity spots of the BRG1 protein and the low- and high-intensity spots of the polII protein showed more random behavior. The BRG1 and polII proteins showed correlation; unexpectedly, the relation was also found for the low-intensity spots, which were expected to have a more random behavior.

Animals↗
PubMed1996

Use of a commercial consumer panel to recruit a comparator cohort for a pharmacoepidemiologic study.

The Upjohn Consumer Health Survey (UCHS) was a prospective, observational study designed to comply with the US FDA's request that 10,000 users of ROGAINE (REGAINE in international markets) Topical Solution 2% (2% minoxidil solution) be systematically studied in the first year following the product's approval. Members of the Drug cohort were recruited at the time they filled prescriptions for 2% minoxidil solution at cooperating retail pharmacies in the United States. To meet the need for rapid identification of a cooperative comparison group, the Comparator cohort was selected by stratified random sampling from members of a commercial consumer panel. Group matching of Comparators to the Drug cohort on four variables--age, sex, race, and geography of residence--was accomplished prior to recruitment on the basis of information available from the consumer panel records; education was obtained via consent procedures and was also used as a group matching variable. Data collection was accomplished by participant interviews and confirmation of participant-reported medical events. Interviewing costs averaged 18.88 US dollars/completed interview. A commercial consumer panel offers a pool of rapidly identifiable subjects with known demographic characteristics and established willingness to participate in research for efficient cohort recruitment.

Journal Article↗
PubMed2001

Isonymy structure of USA population.

The isonymy structure of the 48 states of the continental United States of America was studied using the surname distributions of 18 million telephone users, distributed in 247 towns. The shortest linear distance between nearest neighbor towns included in the sample was 12.0 km. The largest distance was 4,577 km. The number of different surnames found in the whole analysis was 899,585. Lasker's distance was found to be significantly but weakly correlated with the geographic distance, with r = 0.21 +/- 0.01. A dendrogram of the 48 states was built from the matrix of isonymy distances: it divides the US into several clusters, in general correlated with geography. A notable exception is California and New Jersey, which cluster together. Wisconsin is separated from all other states. An important cluster is formed by Texas, Colorado, New Mexico, Nevada, and Arizona, together with Illinois and Florida. It was observed that Hispanic surnames are among the most frequent in Illinois, as they are in New Jersey and California. No main distinction among the states clearly attributable to surnames of French origin was detected; however, New Hampshire, Vermont, and Maine which have a considerable number of these surnames belong to the same northeastern cluster. From the present analysis, the great mobility of the US population emerges clearly, and it seems relevant that the practical absence of isolation by distance is seen also considering only small towns. It appears that groups of different origin are well-mixed over the whole area of the United States. The values of isonymy indicate that the south-central area of the USA has the highest level of inbreeding. In fact, the heterogeneity in surname composition is greater in the coastal areas, particularly on the East Coast, than anywhere else in the USA.

Emigration and Immigration↗
PubMed2000

Mapping of architectonic subdivisions in the macaque monkey, with emphasis on parieto-occipital cortex.

The intraparietal sulcus (IPS) of the macaque monkey contains numerous areas associated with different aspects of cortical function, including motor control as well as visual, somatosensory, vestibular, and possibly auditory processing. This study focuses largely on the architectonic organization of areas within and near the IPS, but also examines remaining portions of the hemisphere with which the IPS is interconnected. We charted the location of up to 72 architectonically distinct areas plus numerous architectonic zones in individuals over a region covering most of the cortical hemisphere. Identified cortical subdivisions (areas plus zones) were represented on computationally generated flat maps in relation to gyral and sulcal geography, thereby facilitating the analysis of consistent as well as variable aspects of the sizes and relative positions of subdivisions across animals. Using myelin and Nissl stains, plus immunohistochemical staining with the SMI-32 antibody, 17 architectonic subdivisions were identified that are largely or entirely contained in the intraparietal and parieto-occipital sulci. This includes four newly identified zones: a heavily myelinated lateral occipitoparietal zone, termed LOP; a strongly SMI-32 immunoreactive zone termed 7t (near the tip of the IPS); plus medial and lateral subdivisions (VIPm and VIPl) of ventral intraparietal area (VIP), which was previously regarded as an anatomically homogeneous area. Within the superior temporal sulcus, we identified a densely myelinated zone termed the dorso-posterior subdivision of the medial superior temporal area (MSTdp) that bordered middle temporal area (MT). We charted the extent of numerous other architectonically defined subdivisions throughout the cortical hemisphere by using criteria largely based on previous studies, but in some instances involving revised or expanded identification criteria.

Animals↗
PubMed1977

The epidemiology of colorectal polyps: prevalence in New Orleans and international comparisons.

Based on a study of the prevalence of intestinal polyps in New Orleans and on international comparisons, the following conclusions are reached. 1) There is a close parallelism in the epidemiology of colon cancer and adenomatous polyps. Both conditions are statistically associated with respect to geography, anatomic localization, socioeconomic class, migration experience and time trends. 2) The strength of the association favors the notion of a direct, positive correlation between multiplicity, size and atypia of polyps, and cancer risk, equivalent to "dose-effect". 3) The epidemiologic findings are coherent with other biologic facts derived from clinical, morphological and experimental studies. 4) Adenomatous polyps are a good epidemiologic indicator of colon cancer risk and their presence should be helpful in advancing from studies of the epidemiology of colon cancer to the epidemiology of precursor lesions.

Adult↗
PubMed1981

Epidemiology of pancreas cancer in Los Angeles.

The characteristics of the 3614 Los Angeles County residents in whom cancer of the exocrine pancreas was diagnosed during the period 1972-1977 were compared with those of all county residents and patients in whom any cancer was diagnosed during the same period. Seventy-nine percent of the diagnoses had been pathologically verified. This disease still preferentially afflicts the old, the black, and men, although the differences in risk with factors other than age are modest. The disease is not evenly distributed by social class, or over time, although it is not clear that the observed differences reflect etiology. The distributions with respect to important categories of occupation and industry, religion, marital status, geography of residence, and birthplace were rather uniform. Although there is no obvious explanation for any of several unexpected minor inequities in the pattern of incidence, there is no compelling evidence to support any specific environmental cause. There is substantial evidence which is inconsistent with those environmental hypotheses that have been proposed previously.

Age Factors↗
PubMed1991

Primary neoplasms of the central nervous system in children.

Modern diagnostic imaging techniques are able to detect primary neoplasms of the central nervous system (CNS) in children safely and accurately but with less specificity as to cell type or degree of malignancy. These neoplasms, often peculiar in cell type and size, mediated by hydrocephalus in their clinical presentation, demand careful and often extensive imaging techniques best to evaluate their geography and character. Added to these basic observations, determination of the neoplasm from surrounding edema, detection of possible spread, and evaluation of residual or recurrent neoplasm are prime responsibilities of the pediatric neuroradiologist toward the child, neurosurgeon, and oncologist.

Angiography↗
PubMed1988

The Fargo Map Test: a standardized method for assessing remote memory for visuospatial information.

At present, there is no standardized method for assessing remote memory (RM) for visuospatial information in humans. The Fargo Map Test (FMT) uses knowledge of the locations of geographical features in regions of the country in which subjects currently live and formerly resided to provide a measure of this aspect of RM. Two different formats of the FMT have been developed, which differ in their demands for fine motor skill, ease of scoring, and in the amount and nature of geographical knowledge that can be measured. Preliminary findings suggest that both formats are equally sensitive to the influences of gender and age in normal subjects. Furthermore, knowledge of the geography of regions of prior residence appears to be stable over a period of at least 15 years.

Adult↗