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Analysis of Q-fever morbidity and serological studies of representative extracts of population, agricultural and wild animals permitted to reveal the importance of inner-herd foci in epidemiology of this infection. It is shown that the level of registered morbidity mainly depends on the state of Q-fever laboratory diagnostics.
Analysis was made of spike activity of nerve cells in the parietal cortex of alert Macaca mulatta when the animal performed the task of delayed alternative choice. The parietal cortex neurones (at the boundary between fields 5 and 7) were divided into two groups by the mean background frequency of their spike activity and by their functional properties. Cells with relatively low frequency (up to 10 imp/s) resemble by their functional properties prefrontal cortex neurones, whereas neurones with a background frequency over 10 imp/s reveal a similarity with motor cortex cells.
Analysis of late results of operations performed in 160 patients to remove excessive skin and wrinkles on the forehead showed that good results were attained in only 40% cases. This was because surgical interventions to remove skin excess on the forehead and to repair the eyebrows in ptosis did not include resection of the muscles which created folds in the glabella. Resection of the muscles moving the eyebrows together helped appreciably improve the remote results of surgery.
STUDY OBJECTIVE: To study whether hospitals of different levels are equally safe places to give birth in a regionalised system of care. DESIGN: This was a population based, cross sectional survey comparing birth outcomes in nationwide catchment areas of different levels of hospital care. All women and low risk women were examined separately. SETTING AND SUBJECTS: The study population comprised all women who gave birth in Finland in 1987-88. The data were obtained from the Finnish Medical Registry, complemented by official data. MAIN RESULTS: No statistically significant differences were found in crude or birthweight specific perinatal mortality rates between the catchment areas, nor did the other outcomes studied favour tertiary care compared with other levels of care in the area based analysis. CONCLUSIONS: In a regionalised system of birth care with a proper referral system, small local hospitals are as safe places to give birth as tertiary care hospitals.
Using Bayesian statistical models, the authors investigated spatial and temporal variations in small-area malaria incidence rates for the period mid-1986 to mid-1999 for two districts in northern KwaZulu Natal, South Africa. Maps of spatially smoothed incidence rates at different time points and spatially smoothed time trends in incidence gave a visual impression of the highest increase in incidence occurring where incidence rates previously had been lowest. This was confirmed by conditional autoregressive models, which showed that there was a significant negative association between time trends and smoothed baseline incidence before the steady rise in caseloads began. Growth rates also appeared to be higher in the areas close to the Mozambican border. The main findings of this analysis were that: 1) the spatial distribution of the rise in malaria incidence is uneven and strongly suggests a geographic expansion of high-malaria-risk areas; 2) there is evidence of a stabilization of incidence in areas that had the highest rates before the current escalation of rates began; and 3) areas immediately adjoining the Mozambican border appear to have undergone larger increases in incidence, in contrast to the general pattern of low growth in the more northern, high-baseline-incidence areas, but this was not confirmed by modeling. Smoothing of small-area maps of incidence and growth in incidence (trend) is important for interpretation of the spatial distribution of disease incidence and the spatial distribution of rapid changes in disease incidence.
Glottal area waveform (GAW) is the plot of relative glottal area versus time through 1 representative glottal cycle. It is derived from the quantitative analysis of the videostroboscopic image. A GAW analysis was performed on 24 patients before and after microlaryngeal phonosurgery. Patients with vocal fold polyps, polypoid degeneration, cysts, sulcus vocalis, and Reinke's edema were included. From each GAW, 5 parameters were determined and compared: maximum normalized glottal area, maximum opening rate, maximum closing rate, percent open time at 50% glottal opening, and glottal gap size. Statistically significant differences in postoperative states included an increased maximum glottal area, an increased maximum opening rate, and an increased maximum closing rate. Glottal opening and closing rate are objective measures of vocal fold pliability that have clinical relevance. The GAW may be used to quantitate vocal fold vibratory capability.
This article reports the findings of a study to develop a new method for allocating resources to family and child care services within Northern Ireland. Downloads from financial and client databases, together with a survey of social worker case activity, were used to estimate utilization costs across 500 local areas. Regression techniques were then used to account for variations in these costs in terms of local socioeconomic conditions. The resultant needs index represents a fair and equitable means of allocating central family and child care budgets to local units of management and service delivery.
BACKGROUND: The description of patient travel patterns and variations in health care utilization may guide a sound health care planning process. In order to accurately describe these differences across regions with homogeneous populations, small area analysis (SAA) has proved as a valuable tool to create appropriate area models. This paper presents the methodology to create and characterize population-based hospital service areas (HSAs) for Switzerland. METHODS: We employed federal hospital discharge data to perform a patient origin study using small area analysis. Each of 605 residential regions was assigned to one of 215 hospital provider regions where the most frequent number of discharges took place. HSAs were characterized geographically, demographically, and through health utilization indices and rates that describe hospital use. We introduced novel planning variables extracted from the patient origin study and investigated relationships among health utilization indices and rates to understand patient travel patterns for hospital use. Results were visualized as maps in a geographic information system (GIS). RESULTS: We obtained 100 HSAs using a patient origin matrix containing over four million discharges. HSAs had diverse demographic and geographic characteristics. Urban HSAs had above average population sizes, while mountainous HSAs were scarcely populated but larger in size. We found higher localization of care in urban HSAs and in mountainous HSAs. Half of the Swiss population lives in service areas where 65% of hospital care is provided by local hospitals. CONCLUSION: Health utilization indices and rates demonstrated patient travel patterns that merit more detailed analyses in light of political, infrastructural and developmental determinants. HSAs and health utilization indices provide valuable information for health care planning. They will be used to study variation phenomena in Swiss health care.
"This study considers the utility of parameterised life tables derived by survival analysis for comparing mortality between areas, using death registration records and accompanying information on the social characteristics for each individual deceased. Such methods enable a comparison of summary measures of mortality experience such as life expectancy and median age at death before and after adjustment for socio-economic variables. In the absence of comparable information on the survivor population an approximate life table method is investigated as a means of comparing mortality profiles and the effects of social factors. Such factors may pertain both to the individuals (e.g. their birthplace) or to their small area of residence (e.g. measures of area deprivation). These methods also permit a comparison of the impact of socio-economic factors on different causes of death. The application is to mortality in London over the period 1990-92 and to its constituent boroughs and electoral wards."
The paper first summarises the main aspects of the ARIPAR methodology whose steps can be applied to quantify the impact on a territory of major accident risks due to processing, storing and transporting dangerous substances. Then the capabilities of the new decision support tool ARIPAR-GIS, implementing the mentioned procedure, are described, together with its main features and types of results. These are clearly shown through a short description of the updated ARIPAR study (reference year 1994), in which the impact of changes due to industrial and transportation dynamics on the Ravenna territory in Italy were evaluated. The brief explanation of how results have been used by local administrations offers the opportunity to discuss about advantages of the quantitative area risk analysis tool in supporting activities of risk management, risk control and land-use planning.
Previous small area analysis studies have shown that hospital admission rates (total, medical and surgical) vary among hospital service areas. Using 1983 Michigan hospital inpatient data from 53 nonmetropolitan Detroit lower peninsula hospital service areas, one physician characteristic and 13 hospital characteristics (in the categories of resource supply, services offered and organization) were tested for their association with and explanation of 14 hospital use rates. Registered nurses per bed and the weighted proportion of board certified physicians to total physicians were inversely related to and offered significant contribution to the explanation of the variation in total use rates and in four medical causes for admission rates (circulatory, respiratory, digestive and genito-urinary). Physician and hospital variables provided significant explanation for six of the seven surgical procedure rates tested (appendectomy, hemorrhoidectomy, cholecystectomy, inguinal hernia repair, prostatectomy and hysterectomy). Four causative factors derived from the characteristics studied were postulated to influence the hospital use rates. The first factor was the small rural nature of the average high use hospital service area. High use areas had a lower proportion of board certified physicians and fewer RNs per bed, beds per hospital, and house staff per 10,000 population than did low use areas. Another factor was the inequality in the distribution of high technology diagnostic services. High use hospital service areas had fewer diagnostic services than did low use areas. The third factor was the inequality in the rural hospital environment produced by the presence or absence of medical education programs. The fourth factor was the impact of the definition and size of a hospital service area. Current small area analysis methodology assigns every small area to a hospital service area, no matter what the probability of the population using the hospital(s) within the service area. This research questions that methodology, suggests the need for hospital service area definitions based upon the specific diagnosis or procedure being studied and postulates that some rural hospital distance decay curves may turn upward at farther distances when the immediate availability of treatment is too critical to allow patients to return to distant residences.
It is widely held that color and motion are processed by separate parallel pathways in the visual system, but this view is difficult to reconcile with the fact that motion can be detected in equiluminant stimuli that are defined by color alone. To examine the relationship between color and motion, we tested three patients who had lost their color vision following cortical damage (central achromatopsia). Despite their profound loss in the subjective experience of color and their inability to detect the motion of faint colors, all three subjects showed surprisingly strong responses to high-contrast, moving color stimuli--equal in all respects to the performance of subjects with normal color vision. The pathway from opponent-color detectors in the retina to the motion analysis areas must therefore be independent of the damaged color centers in the occipitotemporal area. It is probably also independent of the motion analysis area MT/V5, because the contribution of color to motion detection in these patients is much stronger than the color response of monkey area MT.
This study explores the potential of health care service areas (HCSAs) developed from claims data as the geopolitical units for the assessment of health professional needs in rural areas. HCSAs reflect consumer shopping patterns for health care and alter traditional health professional needs estimates.
Small area analysis is a widely used approach for identifying variations in the delivery of health services across geographically defined populations. There is growing consensus that, to a significant degree, these variations reflect the practice style of different physicians at area hospitals. However, to date, small area analysis has not been appropriate for studying the practice style of physicians at individual urban hospitals. This occurs, at least in part, because urban residents have easy geographic access to several hospitals, and no clear method of assigning small geographic areas to a single hospital is available. This study addresses this issue by taking a new approach to defining urban hospital service areas. As gate keepers to hospitals, physicians tend to admit their patients to one or two institutions. Therefore, urban hospital service areas are defined by ignoring geographic boundaries and linking patients to a single hospital on the basis of the admitting patterns of the physicians the patient contacts. The sensitivity of the assignment rules is tested; the results of the proposed technique are compared with those using a traditional geographic approach. The findings of the study reported here suggest that this is a feasible method, which yields stable sensitivity results and is generalizable to a variety of urban settings.
Quantitative evaluation of scalp hair requires techniques that are reproducible. The unit area trichogram is such a method but is unsuitable for large-scale clinical trials. An alternative may be the phototrichogram--a non-plucking, non-invasive method. Hair variables were evaluated in 12 Caucasian subjects employing both methods. The mean value for total hair density was significantly underestimated by the phototrichogram (181 versus 237 hairs/cm2); however, no significant difference was found between this phototrichogram value and the number of non-vellus hairs/cm2. Estimates for the percentage of anagen hairs were similar with both methods. Hair diameters from the phototrichogram were too unreliable to be of any practical use. Analysis of the individual hair data revealed that light hair was much more difficult to evaluate than dark hair. Consequently, Caucasian subjects with light hair or dark skin subjects with dark hair should be excluded from studies employing phototrichograms.
Imaging time-of-flight secondary ion mass spectrometry (TOF-SIMS) was used for characterization and subcellular localization of organic ions in leucocytes adhering to glass surfaces. The cells were fixed by freeze drying in 0.15 m ammonium formate buffer at pH 7.2-7.4. The freeze-dried cells were sputter-coated with silver, and the silver surface was analysed with imaging TOF-SIMS. TOF-SIMS spectra were recorded by scanning the primary ion beam over the analysis area and acquiring positive mass spectra of the ions leaving the surface. The relative brightness of each pixel within the analysis area reflects the signal intensity of a selected ion in that pixel. Data were collected separately at high mass resolution m/delta m > 7000 and at high lateral resolution (= 0.5 micro m). The images were analysed by principal component analysis (PCA). The glass-adhering cells showed a well defined attachment area with a diameter of up to 20 micro m, and an equally well defined cell body, containing the nucleus, with a diameter of 8-10 micro m. On the raw data images, the obtained cholesterol distributions were consistent with a higher cholesterol content of the cell membrane in the attachment area than in the cell body. Using PCA analysis, silver-cationized molecular cholesterol was found localized mainly in the attachment area of the cells. Cholesterol was also seen at higher concentration in circular spots of </= 1 micro m in diameter, probably representing caveolae.
INTRODUCTION: Much effort has been devoted to educating the public about diabetes. However, the impact of such efforts has yet to be formally evaluated. OBJECTIVES: To identify areas of knowledge that might require additional educational efforts. METHODOLOGY: A cross-sectional survey was conducted to evaluate the general public's knowledge of diabetes. The respondents were required to answer 45 questions from a pre-tested questionnaire divided into five main sections, namely, general knowledge, risk factors, symptoms and complications, treatment and management, monitoring and other miscellaneous questions. A point was awarded for each correct response and zero for wrong or unsure responses. The maximum total score was 41. The miscellaneous questions were not scored. RESULTS: A total of 1337 subjects were interviewed. The mean score obtained by the respondents was 66.1% of the maximum possible total score (i.e. 27.1 points out of 41). The "correct answer" percentages for the individual questions from each section ranges from 22 to 83% (General knowledge), 31 to 91% (Risk factors), 48 to 81% (Symptoms and complications), 35 to 87% (Treatment and management), and 58 to 93% (Monitoring of condition).With respect to the source of medical information, health care professionals did not feature prominently (20.7%). CONCLUSION: The public as represented by the samples in this survey is generally well informed about diabetes except for a few areas. Analysis of these areas would have a significant implication for future public education programme. Health care professionals should be more proactive in disseminating health information about diabetes to the public.
Plantwide analyses of the mortality experience of 8147 foundrymen revealed excesses for several diseases including lung cancer. Using indirect measures of smoking, it appeared that most, if not all, of the excess of lung cancer deaths could be explained by smoking habits. To explore further the possible association between these mortality excesses and foundry exposures, jobs were grouped into six work areas on the basis of similarities in production processes. The findings of analyses by work areas support the inferences from plantwide observations. No evidence was found of a relationship between lung cancer and foundry exposures. The pattern of mortality from emphysema and cerebrovascular disease in the different work areas paralleled that of lung cancer, suggesting that mortality from these diseases may have been influenced by a common etiologic agent, probably tobacco smoke. The data also reveal possible associations between metal pattern-making and colon cancer, silica or metal dust and stomach cancer, and carbon monoxide and ischemic heart disease.