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At least 1,171 records · Page 65Linked to original sources
PubMed2006

Ecological time-trend analysis of caries experience at 12 years of age and caries incidence from age 12 to 18 years: Norway 1985-2004.

OBJECTIVES: The purpose of the present investigation was to report on caries experience among Norwegian 12-year-olds from 1985 to 2004 and to assess caries incidence from 12 to 18 years of age for birth cohorts 1973 to 1986. MATERIAL AND METHODS: Aggregated data from the Norwegian Public Dental Services and from official statistics were employed. Information was available about the number of subjects, the proportion receiving treatment, sales of fluoride tablets, socio-demographics, caries prevalence, and the number of decayed, missing, and filled teeth (DMFT). RESULTS: An almost linear decline in caries prevalence and mean D3MFT (dentine level) occurred among 12-year-old children from 1985 until the year 2000, but from 2000 to 2004 an increasing trend was observed. The highest mean 6-year D3MFT increment (age 12-18 years) was 4.1 (cohort 1976), while the lowest was 3.2 (cohorts 1982 and 1983). In multiple linear regression analyses of trend, baseline D3MFT accounted for more than 91% of total explained variance in D3MFT increment (Models I and III). Without baseline D3MFT as predictor (Models II and IV), there was a significant association between education, social assistance, mobility, infant mortality, percentage examined, and the additive interaction terms year + income and year + education and D3MFT increment after controlling for confounding and multicollinearity. CONCLUSIONS: Four consecutive years of increase in caries experience among 12-year-old children after 15 years of decline and evidence of stability or increase of the caries increment from 12 to 18 years of age among Norwegian teenagers give cause for concern.

Adolescent↗
PubMed2000

Multivariate modeling of missing data within and across assessment waves.

Missing data constitute a common but widely underappreciated problem in both cross-sectional and longitudinal research. Furthermore, both the gravity of the problems associated with missing data and the availability of the applicable solutions are greatly increased by the use of multivariate analysis. The most common approaches to dealing with missing data are reviewed, such as data deletion and data imputation, and their relative merits and limitations are discussed. One particular form of data imputation based on latent variable modeling, which we call Multivariate Imputation, is highlighted as holding great promise for dealing with missing data in the context of multivariate analysis. The recent theoretical extension of latent variable modeling to growth curve analysis also permitted us to extend the same kind of solution to the problem of missing data in longitudinal studies. Data simulations are used to compare the results of multivariate imputation to other common approaches to missing data.

Bias↗
PubMedDate not supplied

Indices of social risk among first attenders of an emergency mental health service in post-conflict East Timor: an exploratory investigation.

OBJECTIVE: Little is known about the profile of patients treated in mental health services in low-income, post-conflict countries, especially in the post-emergency phase. We postulated that patients attending the first community mental health service in East Timor would be characterized not only by mental disturbance but by high levels of social vulnerability. METHOD: Drawing on existing methods and on consultations with East Timorese mental health staff, five social indicators were identified: dangerousness; inability to undertake life-sustaining self-care; bizarre behaviour; incapacitating distress; and social unmanageability. Adequate levels of interrater reliability (65-91%) were achieved in identifying these indicators from case notes. Forty-eight randomly selected case notes were analyzed to ascertain the prevalence of social risk factors as well as the referral source and broad diagnostic groupings. RESULTS: Major referral sources were the family, humanitarian agencies and the police. Twenty-nine percent met criteria for dangerousness; 42% for inability to undertake self-care; 58% for bizarre behaviour; 75% for distress; and 19% for unmanageability. Ninety-eight percent fulfilled at least one social indicator, with the modal score being 2. CONCLUSIONS: Although the approach to documentation and analysis was preliminary, the data suggest that a focus on social risk indicators may assist in determining those mentally disturbed persons in need of priority care in resource-poor post-conflict countries.

Adult↗
PubMed2000

Inadequate stocking of antidotes in Taiwan: is it a serious problem?

OBJECTIVE: Insufficient hospital stock of a variety of poisoning antidotes is a worldwide problem. In an attempt to establish an antidote storage and distribution system for the response of the various poisoning accidents, we conducted a nationwide survey to characterize the current availability of selected antidotes and their anticipated need in Taiwan. MATERIALS AND METHODS: A questionnaire was mailed to 834 hospitals to gather information on the availability, anticipated need, and preferred purchase policy of 20 selected antidotes. A survey on the availability of cyanide antidote in 523 cyanide-handling facilities and their neighboring hospitals was also conducted. RESULTS: Hospitals of different size and service levels had a statistically significant difference in response rates. Except for pyridoxine, the availability and anticipated need for antidotes also varied significantly among different hospital groups. We found that physostigmine, cyanide antidote kit, BAL, EDTA, methylene blue, Vipera Russell formosensis antivenin, and botulism antitoxin were not available in most (>90%) hospitals. Interestingly, these antidotes are also among the most needed antidotes. Most hospitals preferred a government-ordered purchase of antidotes. In the survey of cyanide-processing facilities, a response rate of 24.1% was obtained and only 9.3% of these 107 facilities that both replied to the questionnaire and continued handling cyanide products had stocked cyanide antidote. It is noteworthy that cyanide antidote was also frequently lacking in the neighboring hospitals. CONCLUSIONS: The appropriate storage of antidotes in hospitals or workplaces in rural areas is instrumental in the timely treatment of certain poisonings, while nationwide unavailability is the critical problem. Raising awareness of the importance of antidotes by education, regular review of antidote storage, distribution plans, and appropriate legislation might provide solutions.

Antidotes↗
PubMed2003

Estimating the relative risk in cohort studies and clinical trials of common outcomes.

Logistic regression yields an adjusted odds ratio that approximates the adjusted relative risk when disease incidence is rare (<10%), while adjusting for potential confounders. For more common outcomes, the odds ratio always overstates the relative risk, sometimes dramatically. The purpose of this paper is to discuss the incorrect application of a proposed method to estimate an adjusted relative risk from an adjusted odds ratio, which has quickly gained popularity in medical and public health research, and to describe alternative statistical methods for estimating an adjusted relative risk when the outcome is common. Hypothetical data are used to illustrate statistical methods with readily accessible computer software.

Clinical Trials as Topic↗
PubMed1995

Comparison of adverse drug reactions detected by pharmacy and medical records departments.

Adverse drug reactions (ADRs) detected by the pharmacy and medical records departments of a multispecialty teaching hospital were studied. The charts of all adult patients who were identified by the pharmacy or medical records departments as having had an ADR and who were discharged from the hospital between July and September 1990 were reviewed. Data on patient demographics and the characteristics of the ADRs were collected, and the causality and severity of each ADR were assessed by two pharmacists and one physician. A total of 110 charts representing 117 ADRs were reviewed. Twenty-five (21%) of the ADRs were identified by the pharmacy department and 101 (86%) by the medical records department; 9 (8%) were reported by both departments. The pharmacy and medical records groups of patients were demographically similar, except that the percentage of patients admitted through the emergency room was significantly smaller for the pharmacy department group. ADRs identified by the pharmacy were most commonly cutaneous, and those identified by medical records were most commonly neurologic. For the pharmacy department, hypersensitivity reactions accounted for the largest number of ADRs, while for medical records the largest number involved abnormal laboratory test values. Anti-infectives were involved in two thirds of the pharmacy-identified ADRs, compared with only a fifth of the ADRs identified by medical records. Mean causality and severity scores did not differ significantly between the groups. The medical records department identified four times as many ADRs as the pharmacy department. Observed differences in the number and types of reactions, manifestations, patient locations, and suspected drugs probably reflect the different surveillance methods and ADR definitions used by the two departments.

Adult↗
PubMed2005

Longitudinal profiling of health care units based on continuous and discrete patient outcomes.

Monitoring health care quality involves combining continuous and discrete outcomes measured on subjects across health care units over time. This article describes a Bayesian approach to jointly modeling multilevel multidimensional continuous and discrete outcomes with serial dependence. The overall goal is to characterize trajectories of traits of each unit. Underlying normal regression models for each outcome are used and dependence among different outcomes is induced through latent variables. Serial dependence is accommodated through modeling the pairwise correlations of the latent variables. Methods are illustrated to assess trends in quality of health care units using continuous and discrete outcomes from a sample of adult veterans discharged from 1 of 22 Veterans Integrated Service Networks with a psychiatric diagnosis between 1993 and 1998.

Bayes Theorem↗
PubMed2001

What prevents GPs from using outside resources for women experiencing depression? A New Zealand study.

BACKGROUND: GPs, often the 'gatekeepers' to mental health and related support services, have been found to refer on less often than seems desirable. OBJECTIVES: The aim of this study was to explore what issues GPs would discuss with, and which treatments and support services they would consider for, depressed women; and to investigate barriers to referrals to other resources. METHODS: All (217) GPs in one region of Auckland received questionnaires with a vignette and quantitative and qualitative questions concerning their responses to women experiencing depression. Twelve of the 86 respondents were interviewed. RESULTS: GPs wanted to know about a range of medical, psychological and social issues. The solutions valued were biological and psychological, with some also favouring social interventions, such as assistance with childcare. However, the GPs reported limited referrals to outside resources, and frequent use of medication, because of the high cost and limited availability of psychological treatment, and difficulties accessing practical help. CONCLUSIONS: This sample of GPs support improved accessibility, availability and affordability of psychological treatments and support services.

Depression↗
PubMed1995

The design and analysis of hospital utilization studies.

The reports of hospital utilization review (UR) studies that appear in this issue employ a range of design strategies, and much of the variation seems accidental--arising because there are many acceptable strategies--rather than functional. This paper is about general design strategy: the value of explicit protocols for sampling and data collection, of analyses appropriate to the sampling, of generating reports managers can use. More coordination is strongly encouraged, to reduce unnecessary variation and to facilitate comparisons across studies. While individual groups may still opt for different strategies, techniques for increasing the comparability of reported findings are discussed. This will increase the value of each study, individually, as well as the value of the collective effort.

Bias↗
PubMed2004

Do health plans influence quality of care?

OBJECTIVE: To investigate the relative impact of physician groups and health plans on quality of care measures. DESIGN: Secondary data analysis of receipt of preventive care services included in the Health Plan Employer Data and Information Set (HEDIS) among 10 758 patients representing 21 health maintenance organizations and 22 large provider groups in the San Francisco and Los Angeles, California, areas in 1997. Each patient was eligible for (at least) one of six HEDIS-measured services. Data identify whether or not the service was provided, the patient's health plan, and the provider group responsible for the care. We used logistic regression to examine variations across plans in HEDIS rates, and whether variations persist after controls for provider groups are included. SETTING: Patients from 21 health maintenance organizations serving San Francisco and Los Angeles, California, in 1997. MAIN OUTCOME MEASURES: Breast cancer screening, childhood immunizations, cervical cancer screening, diabetic retinal exam, prenatal care in the first trimester, and check-ups after delivery among patients for whom these services are appropriate. RESULTS: There are statistically significant differences across health plans in utilization rates for the six services examined. These differences are not substantially affected when we control for the provider group that cared for the patient. That is, controlling for provider group does not explain variations across plans, consistent with the view that health plans have an impact on HEDIS quality measures independent of the providers that they contract with. CONCLUSIONS: There are activities that plans can undertake which influence their HEDIS scores. On the face of it, these results suggest that plans can independently improve quality, in contrast to hypotheses that plans would be "too far" from patients to have an influence. Continued attention to collecting plan-level data is warranted. Further work should address other possible sources of variations in HEDIS scores, such as variability in the quality of plan administrative databases.

California↗
PubMed1990

Geographic variations in US asthma mortality: small-area analyses of excess mortality, 1981-1985.

US asthma mortality rates have been increasing during the past 10 years. Little is known about the geographic variation of this infrequent health event. Using US vital records for the 1981-1985 period, small-area variation of excess asthma mortality of young adults was studied. Several geopolitical definitions were used to define populations. A total of 22 single counties, 12 metropolitan statistical areas, 11 health service areas, and 29 state economic areas were identified as having mortality significantly in excess of that expected, based on US race/sex-specific rates. Significant variation in asthma mortality was found at several levels of geopolitical classification of the data. Elevated areas included the central plains states and three large urban metropolitan areas--Chicago, Illinois, New York, New York, and Phoenix, Arizona--as well as a few mostly suburban populations. Areas with excess mortality may provide a useful population base for further epidemiologic investigation into the risk factors associated with the more frequent morbid events of this disease, such as emergency room and hospital utilization.

Adolescent↗
PubMed1988

Integrated reporting of quality and length of life--a statistician's perspective.

The reporting of trials has been dominated by a concentration on single measures of response, such as survival or extent of side-effects, perhaps selected as giving an impressive P value for treatment comparisons. Relevant questions about trade-offs are seldom answered or even envisaged in the trial design. Cardiovascular trials should provide evidence on quality of life after myocardial infarction or during antihypertensive therapy. Examples from oncology are used to illustrate how the robustness of treatment recommendation can be explored through a grid of quality adjustments, ranging from complete intolerance of side-effects to absolute acceptance of them. Treatment recommendations may need to be specific to patients unless they are independent of the system of quality adjustment used.

Aged↗
PubMed1997

Analyzing intensive care unit length of stay data: problems and possible solutions.

OBJECTIVES: To explore methods of evaluating the length of stay patterns of intensive care unit (ICU) patients. It was hypothesized that the mean does not adequately describe the typical length of stay (central tendency) because distribution patterns are often markedly skewed by patients with extended stays. Therefore, other descriptors are needed. In addition, ways are needed to identify outliers-patients with stays longer or shorter than the bulk of the data. DESIGN: Review of retrospective data. SETTING: University hospital surgical ICU. PATIENTS: Representative data included all (4,499) patients admitted over a 6-yr period. Each was assigned to a diagnostic group that represented either a frequently performed surgical procedure (e.g., thymectomy) or in cases where there was no predominant procedure, a surgical discipline (e.g., otolaryngology). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The frequency distributions were usually skewed to the right and included two populations of interest: The portion with the majority of observations ("body"), which described "typical" behavior, and the "tail", which provided information on outliers. The average of the mean lengths of stay of all diagnostic groups was higher than the average of the medians (3.9 +/- 1.8 [SD] vs. 2.7 +/- 1.1 days, p < .001) and modes (2.1 +/- 1.2 days, p < .001), reflecting the rightward skewness of the length of stay frequency distributions. The median +/- 1 day included 75 +/- 13% of the patients, thus confirming that the median was the most useful descriptor of central tendency. Various methods were used to identify outliers. Histograms of the frequency distributions were examined and outliers visually identified. Conventional outlier analysis labeled as outliers patients staying greater than two standard deviations from the mean stay. This method underestimated the number of outliers when the distributions were skewed to the right. Another method involved designating a specific length of stay (e.g., 7 or 10 days) or percentage of patients as the outlier threshold. Each method designated different numbers of patients as outliers. CONCLUSIONS: When analyzing length of stay data it is important to visually examine the frequency distribution because it is often skewed to the right. This skewness renders traditional parameters such as the mean and standard deviation less useful for describing the typical length of stay. Instead, the median, mode, and harmonic mean should be used. When reporting length of stay, some indication of the characteristics of the data should be presented. A graph of the frequency distribution rapidly allows the reader to determine its shape. A simple method is to report the mean, median, and range.

Bias↗