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The incidence of symptomatic intracranial hemorrhage in term appropriate-for-gestation-age infants.

Symptomatic intracranial hemorrhage in term infants is rare. In over 23,000 deliveries the authors were only able to find 12 diagnosed cases for an incidence of 5.9/10,000 livebirths (greater than or equal to 2,500 g and greater than or equal to 37 weeks' gestation). No consistent clinical patterns were identified. However, the obstetrical risk factors were a precipitate delivery, a second stage of more than 2 hours, the use of pitocin, and a forceps delivery. The number of cases of asymptomatic ICH was unknown because routine surveillance was not done. Furthermore, some infants may have become symptomatic following discharge, which may have resulted in an undercounting of the incidence of ICH. Most infants, however, became symptomatic by the second day.

Cerebral Hemorrhage↗

Cancer mortality in Italy, 1998.

This short report provides data and statistics of cancer mortality in Italy in 1998, updating previous work on the issue. The material and methods of this report are similar to those previously described. Briefly, cancer death certification numbers by cause and estimates of the resident population in 1998, stratified by sex and quinquennia of age, were abstracted from data provided by the Istituto Nazionale di Statistica (ISTAT). All cancers or groups of cancers, classified according to the standard International Classification of Diseases (ICD), Ninth Revision, were grouped in 31 categories, besides total cancer mortality and other and unspecified sites. We grouped together all intestinal sites, melanomas and non-melanomatous skin neoplasms, all uterine neoplasms (cervix and corpus), all neoplasms of the brain and nerves (benign and malignant), all leukemias, and all non-Hodgkin's lymphomas. Eight tables were produced, including the following statistics: 1) number of deaths, crude and age-standardized death certification rates, and percentages of all cancer deaths for population at all ages and truncated 35-64 years (Table 1 for males and Table 2 for females). Two different standards were used: i) the 1971 Italian census population, corrected for census undercount and subdivided into 16 quinquennia of age from 0-4 to 75-79, plus 80 and over, and ii) the world standard population, for purposes of comparison with other countries; 2) age-specific death certification rates for each sex and quinquennium of age from 0-4 to 75-79, plus 80 and over (Table 3 for males and Table 4 for females); 3) total number of registered deaths for each cancer or group of cancers, sex and age group (Table 5 for males and Table 6 for females); 4) percentage of all cancer deaths for each sex and age group (Table 7 for males and Table 8 for females). A few comments are included, mainly in order to assist reading and interpretation of data for major cancer sites, and to recall underlying long-term tendencies. Any inference should in any case be based on age-standardized rates, and, essentially, on detailed inspection of age-specific rates.

Adolescent↗

Socioeconomic, cultural, and behavioral factors affecting Hispanic health outcomes.

Evidence suggests that social and economic factors are important determinants of health. Yet, despite higher porverty rates, less education, and worse access to health care, health outcomes of many Hispanics living in the United States today are equal to, or better than, those of non-Hispanic whites. This paradox is described in the literature as the epidemiological paradox or Hispanic health paradox. In this paper, the authors selectively review data and research supporting the existence of the epidemiological paradox. They find substantial support for the existence of the epidemiological paradox, particularly among Mexican Americans. Census undercounts of Hispanics, misclassification of Hispanic deaths, and emigration of Hispanics do not fully account for the epidemiological paradox. Identifying protective factors underlying the epidemiological paradox, while improving access to care and the economic conditions among Hispanics, are important research and policy implications of this review.

Adult↗

A histochemical ATPase method for the demonstration of the muscle capillary network.

A histochemical method for demonstration of the capillaries in skeletal muscle of birds is proposed. The present method, which is a modification of a previously reported myosin ATPase technique used for simultaneous staining of capillaries and fiber types, provides an accurate count of capillaries associated with different fiber types in avian skeletal muscles. We have applied the original and the modified method to serial adjacent sections of certain skeletal muscles and our results show that after the application of the original technique: (a) in muscles having dark Type II fibers, these fibers produce a masking effect on their adjacent capillaries; (b) a consistent and significant undercounting in capillary densities can be seen even in muscles having no dark Type II fibers; and (c) the staining quality and capillary count are substantially improved with the use of the modified method. We attribute the better results obtained with our modification to differences in thermosensitivity of ATPase activity from the capillary endothelium and of the myofibers. A mathematical treatment is therefore proposed to correct the values of capillary count obtained with the original method.

Analysis of Variance↗

An evaluation of completeness of tuberculosis notification in the United Kingdom.

BACKGROUND: There has been a resurgence of tuberculosis worldwide, mainly in developing countries but also affecting the United Kingdom (UK), and other Western countries. The control of tuberculosis is dependent on early identification of cases and timely notification to public health departments to ensure appropriate treatment of cases and screening of contacts. Tuberculosis is compulsorily notifiable in the UK, and the doctor making or suspecting the diagnosis is legally responsible for notification. There is evidence of under-reporting of tuberculosis. This has implications for the control of tuberculosis as a disproportionate number of people who become infected are the most vulnerable in society, and are less likely to be identified and notified to the public health system. These include the poor, the homeless, refugees and ethnic minorities. METHOD: This study was a critical literature review on completeness of tuberculosis notification within the UK National Health Service (NHS) context. The review also identified data sources associated with reporting completeness and assessed whether studies corrected for undercount using capture-recapture (CR) methodology. Studies were included if they assessed completeness of tuberculosis notification quantitatively. The outcome measure used was notification completeness expressed between 0% and 100% of a defined denominator, or in numbers not notified where the denominator was unknown. RESULTS: Seven studies that met the inclusion and exclusion criteria were identified through electronic and manual search of published and unpublished literature. One study used CR methodology. Analysis of the seven studies showed that undernotification varied from 7% to 27% in studies that had a denominator; and 38%-49% extra cases were identified in studies which examined specific data sources like pathology reports or prescriptions for anti-tuberculosis drugs. Cases notified were more likely to have positive microbiology than cases not notified which were more likely to have positive histopathology or be surgical in-patients. Collation of prescription data of two or more anti-tuberculosis drugs increases case ascertainment of tuberculosis. CONCLUSION: The reporting of tuberculosis is incomplete in the UK, although notification is a statutory requirement. Undernotification leads to an underestimation of the disease burden and hinders implementation of appropriate prevention and control strategies. The notification system needs to be strengthened to include education and training of all sub-specialities involved in diagnosis and treatment of tuberculosis.

Disease Notification↗

The multistage model of cancer development: some implications.

The multistage model, introduced by Armitage and Doll, was very successful at describing many features of cancer development. Doll and Peto noted a significant departure below the prediction of the model and suggested that this could be due to undercounting of cases at older ages, or to the 'biology of extreme old age.' Moolgavkar pointed out that it could also be due to the approximation used. The recent observation that cancer incidence falls rapidly above age 80 has stimulated new modelling investigations, such as the Pompei-Wilson beta model (which does reproduce the rapid fall). In the present paper, we argue that Moolgavkar's criticisms, while mathematically correct, do not affect the conclusions, particularly the constancy of the number of stages across different cancer registries (Cook, Doll and Fellingham. 1969: A mathematical model for the age distribution of cancer in man. International Journal of Cancer 4, 93-112). We discuss several exact solutions, compare them with the most recent data, and prove rigorously that the standard Armitage-Doll multistage model can never reproduce the sharp turnaround in cancer incidence at old age seen in the data. We discuss in detail multistage processes which have a property observed in many laboratory studies, namely that some stages progress much faster than the others. We verify mathematically the intuition that sufficiently fast stages do not appreciably affect the incidence rate of cancer, and discuss implications of this fact for cancer treatment strategies. We also show that the simplest possible modification of the Armitage-Doll model to incorporate cellular senescence just leads to the Pompei-Wilson beta model.

Aged↗

Mental ill-health in adults with intellectual disabilities: prevalence and associated factors.

BACKGROUND: Reported prevalence of mental ill-health among adults with intellectual disabilities ranges from 7 to 97%, owing to methodological limitations. Little is known about associations. AIMS: To determine the prevalence of mental ill-health in adults with intellectual disabilities and to investigate factors independently associated with it. METHOD: Population-based study (n=1023) with comprehensive individual assessments modelled using regression analyses. RESULTS: Point prevalence of mental ill-health was 40.9% (clinical diagnoses), 35.2% (DC-LD), 16.6% (ICD-10-DCR) and 15.7% (DSM-IV-TR). The most prevalent type was problem behaviours. Mental ill-health was associated with more life events, female gender, type of support, lower ability, more consultations, smoking, incontinence, not having severe physical disabilities and not having immobility; it was not associated with deprived areas, no occupation, communication impairment, epilepsy, hearing impairment or previous institutional residence. CONCLUSIONS: This investigation informs further longitudinal study, and development of appropriate interventions, public health strategy and policy. ICD-10-DCR and DSM-IV-TR undercount mental ill-health in this population compared with DC-LD.

Adolescent↗

A comparison of multiple data sources to identify vaccinations for veterans with spinal cord injuries and disorders.

Monitoring vaccination activity requires regular access to information about patient vaccination status. This report describes our experience using multiple Department of Veterans Affairs (VA) data sources to determine availability and completeness of vaccination information for veterans with spinal cord injuries and disorders (SCI&D). Administrative and clinical databases were limited to coding vaccine administration, undercounted vaccinations, and were unable to account for whether the vaccine was offered and the reasons for nonreceipt. Medical record review provided more detail but was labor intensive and costly. Patient surveys provided the richest information but were costly, time-consuming, and based on a sample of patients. Agreement was poor between data sources. This report suggests that while VA is well positioned to use national databases for clinical care decisions and to inform policy, vaccination data were incomplete. Electronic records must include data that are consistently entered and validated before they can be useful for care management and decision making.

Data Collection↗

New African American life tables from 1935-1940 to 1985-1990.

New life tables for African Americans are presented from 1935 through 1990. They are based on a historical series of vital statistics data on deaths that have been corrected for age misreporting, on reconstructed population counts that have been adjusted for census underenumeration, and on births that have been corrected for underregistration. The new life tables show rapid mortality declines for both African American males and females from 1935 to 1950, and relatively steady reductions thereafter for females. The smaller declines in male mortality in young adulthood and middle age since the 1950s have led to exceptionally high ratios of male to female mortality at these ages. Corrections for census undercounts lead to higher values of life expectancy than in official life tables, but to less improvement over time. Official estimates of life expectancy at age 65 appear to be about 10% too high around 1940 but only about 1.5% too high in the late 1980s.

Adolescent↗

Can we trust population surveys to count Medicaid enrollees and the uninsured?

Health foundations, such as the Robert Wood Johnson Foundation (RWJF), make multimillion-dollar investments in programs to expand insurance coverage. These efforts are driven largely by estimates of the number of uninsured people derived from population surveys, which might overestimate the number of uninsured people if they under-count people enrolled in Medicaid. This paper reports the results of the RWJF-funded California Medicaid Undercount Experiment (CMUE) to estimate the extent of underreporting of Medicaid in the California Health Interview Survey (CHIS) and its effect on estimates of uninsurance. Although some over- and underreporting occurs, overall CHIS Medicaid estimates match administrative counts for adults.

Adolescent↗

Insect infestation of stored oats in Florida and field evaluation of a device for counting insects electronically.

Automated methods of monitoring stored grain for insect pests will contribute to early detection and aid in management of pest problems. An insect population infesting stored oats at a seed processing plant in north-central Florida was studied to test a device for counting insects electronically (Electronic Grain Probe Insect Counter, EGPIC), and to characterize the storage environment. The device counts insects as they fall through an infrared beam incorporated into a modified grain probe (pitfall) trap and transmits the counts to a computer for accumulation and storage. Eight traps were inserted into the surface of the grain bulk, and the insects trapped were identified and counted manually at weekly intervals. Grain temperature and moisture content also were recorded for each trap location. Manual and automatic counts were compared to estimate error in the EGPIC system. Both over- and undercounting occurred, and errors ranged from -79.4 to 82.4%. The mean absolute value of error (+/- SE) was 31.7% (+/- 4.3). At least 31 species, or higher taxa, were detected, but the psocid Liposcelis entomophila (Enderlein) and the foreign grain beetle, Ahasverus advena (Waltl), accounted for 88% of the captured insects. Species diversity, phenology, and spatial distribution are presented, as well as temporal and spatial distribution of grain temperature and moisture content. The data sets generated will find application in population modeling and development of integrated pest management systems for stored grain.

Animals↗

Cancer screening and risk factor rates among American Indians.

OBJECTIVES: We examined cancer screening and risk factor patterns in California using 4 different statistical tabulations of American Indian and Alaska Native (AIAN) populations. METHODS: We used the 2001 California Health Interview Survey to compare cancer screening and risk factor data across 4 different tabulation approaches. We calculated weighted prevalence estimates by gender and race/ethnicity for cancer screening and risk factors, sociodemographic characteristics, and access to care variables. We compared AIAN men and women with members of other racial groups and examined outcomes among AIAN men and women using the 4 tabulation methods. RESULTS: Although some differences were small, in general, screening and risk factor rates among American Indians/Alaska Natives were most similar to rates among Whites when the most inclusive multiracial tabulation approach was used and least similar when the more exclusive US census "single-race" approach was used. CONCLUSIONS: Racial misclassification and undercounting are among the most difficult obstacles to obtaining accurate and informative data on the AIAN population. Our analysis suggests some guidelines for overcoming these obstacles.

California↗

Comparison of two methodologies to measure agricultural occupational fatalities.

Agricultural occupational fatalities in Pennsylvania for the years 1985-87 were followed up. Supplemental data concerning the occupation of the deceased and circumstances of the fatal accident were obtained from a family member. The number of fatalities designated as agriculturally and occupationally related by the National Traumatic Occupational Fatality (NTOF) system was compared with the number of fatalities identified by using alternative criteria for classification of agriculturally and occupationally related fatalities. There may be nearly a 30 percent error in the NTOF method resulting in a 20 percent undercount.

Accidents, Occupational↗

Race/ethnicity and socioeconomic status: measurement and methodological issues.

This article considers the ways in which race/ethnicity and socioeconomic status (SES) relate to each other and combine to affect racial variations in health status. The author reviews a number of methodological issues concerning the assessment of race in the United States that importantly affect the quality of the available data on racial differences in health. These issues include the discrepancy between self-identification and observer-reported race, changing racial classification categories and racial identification, the difficulties in categorizing persons of mixed racial parentage, and census undercount. In discussing the complex interactions between race and SES, the author first describes the relationship between race and SES and assesses the role of SES in accounting for racial differences in health, then shows how the failure of SES to completely account for racial variations in health status emphasizes the need for health researchers to give more systematic attention to the unique factors linked to race that affect health. These factors include racism, migration, acculturation, and the comprehensive assessment of SES.

Bias↗

Familial clustering of diabetic nephropathy in Brazilian type 2 diabetic patients.

There is evidence for genetic predisposition to diabetic nephropathy in type 1 diabetic patients. However, there are few studies on type 2 diabetic patients, and most of those have been conducted on ethnic minorities or Caucasian individuals. The aim of this study was to ascertain the presence of an inherited predisposition to diabetic nephropathy in a sample of Brazilian type 2 diabetic patients. Families with two or more type 2 diabetic siblings were identified. Subjects with the longest duration of known diabetes were considered probands. Some 90 probands and their 107 diabetic siblings were studied. Urinary albumin excretion rate was measured in a sterile 24-h urine sample on at least three different occasions. Probands and siblings were classified according to urinary albumin excretion rate as normo- (<20 microg/min), micro- (20-200 microg/min), or macroalbuminuric (>200 microg/min). Patients with end-stage renal disease were included in the macroalbuminuric group. Macroalbuminuria was identified in 5.2% of the siblings of normoalbuminuric probands and in 24.1% of the siblings of macroalbuminuric probands (P = 0.024). In multiple logistic regression, the presence of diabetic nephropathy in probands (micro- or macroalbuminuria and end-stage renal disease) was significantly associated with the presence of sibling diabetic nephropathy (odds ratio = 3.75, 95% CI = 1.36-10.40, P = 0.011) adjusted for proband fasting plasma glucose and diabetes duration. Interpretation of these results should take into account the possibility that the families including siblings with diabetic nephropathy may have been overcounted and, on the other hand, that the siblings without diabetic nephropathy may have been undercounted. In conclusion, there is a familial aggregation of diabetic nephropathy in this sample of type 2 diabetic patients.

Adult↗

Factors in mortality by drug dependence among Puerto Ricans in New York City.

This paper presents data on mortality by drug dependence among Puerto Rican residents aged 15-44 of New York City. While men show death rates for drug dependence several times those of women, when deaths by drug dependence are calculated as a proportion of all deaths, the ratios are nearly the same for both sexes. Factors relevant to analyzing mortality statistics on drug dependence in this population are an undercount of Puerto Rican males and competing causes of death, particularly homicide among men. Factors influencing deaths by drugs are gender roles as they influence patterns of drug use and types of chronic use: regular and intermittent.

Adolescent↗

Mortality associated with drug misuse among blacks in New York City, 1979-1981.

A comparison of age-specific death rates from "drug dependence" (ICD 304) among Blacks and Whites in New York City for 1979-1981 found two distinct patterns of mortality. Blacks have higher levels of mortality which extend from the central adult years into middle age while deaths among Whites are confined largely to the younger years (below 35). Among both racial groups, mortality is much higher for males than for females. When male undercount is "corrected," the ratios between male and female deaths are smaller. The difference in economic opportunities for Whites and Blacks is suggested as a reason why Whites "age out" of the years of highest risk before Blacks.

Adolescent↗

Population estimates of intravenous drug users and HIV infection in Los Angeles County.

This study applies multiple-capture models to drug treatment data and the synthetic estimation method to arrestee data to provide estimates of the number of IVDUs in Los Angeles County in 1989. Based on the 5% HIV-prevalence rate currently found in IVDUs in Los Angeles, it is estimated that there could be as many as 9,500 HIV-infected IVDUs. The estimates of IVDUs are generally higher than those obtained by back-calculation methods which often undercount IVDU-related AIDS cases and do not consider deaths for causes other than HIV infection.

Adolescent↗