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PubMed2003

Association between falls in elderly women and chronic diseases and drug use: cross sectional study.

OBJECTIVE: To assess the associations between having had a fall and chronic diseases and drug use in elderly women. DESIGN: Cross sectional survey, using data from the British women's heart and health study. SETTING: General practices in 23 towns in Great Britain. PARTICIPANTS: 4050 women aged 60-79 years. MAIN OUTCOME MEASURE: Whether women had had falls in the previous 12 months. RESULTS: The prevalence of falling increased with increasing numbers of simultaneously occurring chronic diseases. However, no such relation with falling was found in the fully adjusted data for the number of drugs used. Circulatory disease, chronic obstructive pulmonary disease, depression, and arthritis were all associated with an increased odds of falling. The fully adjusted, population attributable risk of falling associated with having at least one chronic disease was 32.2% (95% confidence interval 19.6% to 42.8%). Only two classes of drugs (hypnotics and anxiolytics, and antidepressants) were independently associated with an increased odds of falling. Each class was associated with an increase of about 50% in the odds of falling, and each had a population attributable risk of < 5%. CONCLUSION: Chronic diseases and multiple pathology are more important predictors of falling than polypharmacy.

Accidental Falls↗
PubMed1995

Genetic and environmental sources of fibrinogen variability in Israeli families: the Kibbutzim Family Study.

Genetic and environmental determinants of plasma fibrinogen were investigated in a sample of 82 kindreds residing in kibbutz settlements in Israel. The sample included 223 males and 229 females ages 15-97 years. Fibrinogen levels were first adjusted for variability in sex and age. There was a significant familial aggregation of adjusted fibrinogen levels, as indicated by inter- and intraclass correlation coefficients significantly different from zero. Commingling analysis implied that in this population a mixture of two normal distributions fit the adjusted fibrinogen levels better than did a single normal distribution. Complex segregation analysis was first applied to these sex- and age-adjusted data. Heterogeneous etiologies for individual differences were suggested. There was evidence for a nontransmitted environmental major factor in addition to polygenic genes that explained the mixture of distributions. In parallel, a single recessive locus with a major effect that explained the adjusted variation in fibrinogen could not be rejected. However, when the regression model for sex and age allowed coefficients to be ousiotype (class)-specific, the recessive genetic model was rejected and the mixed environmental one was not. These results suggested that particular ousiotypes determined by the major environmental factor are associated with a steeper increase of fibrinogen with age. While at the age of 20 years, the major environmental factor contributed 10% to fibrinogen variability, and 48% was explained by polygenic loci, at 80 years of age, the major factor explained 64% and only approximately 20% was explained by polygenic factors.

Adolescent↗
PubMedDate not supplied

Re-examination of the ED01 study - adjusting for time on study.

Gaylor (1980) describes conclusions drawn from the initial analysis of the ED01 study. These conclusions failed to take adequate account of differences in time on study for animals at different doses. Several consequences of this are discussed. Two conclusions of Gaylor's are identified that are open to question. The ED01 liver and bladder tumor data, adjusted for time-on-study, are used to firmly reject several mathematical models that have been proposed for low-dose extrapolation. The complexities that arise from differences in time-on-study are shown to cast serious doubt on the general concept of low-dose extrapolation, when it is attempted independent of time to tumor. It is pointed out that the problems of statistical analysis that arise when dosed animals live longer than controls (as occurred in the ED01 study) raise questions about the design of lifetime feeding studies in general.

2-Acetylaminofluorene↗
PubMed1991

Evaluating quality, cost-effective health care. Vascular database predicated on hospital discharge abstracts.

This population-based study examines all carotid endarterectomies (CE) performed by all surgeons in a single state over a 10-year period. The methodology is designed to determine morbidity rate, mortality rate, cost, and length of stay, as well as to understand the effect of pre-existing chronic disease, physician, and hospital volume on these outcome variables. The data source consisted of hospital discharge abstract data uniformly collected on all admissions (N = 5.9 million) to acute care hospitals in the state. In the decade 1979 to 1988, 11,199 patients underwent CE. Mortality rate from CE was 2.1%, and the postoperative stroke rate was 3.7% over this period. High physician volume decreased the mortality rate (p less than 0.05) and stroke rate (p less than 0.01) by 50% and significantly (p less than 0.001) reduced hospital cost and length of stay independent of patient complexity. Examination of cost data, adjusted for inflation, showed a decrease in mean cost for CE over the decade. Thus physicians are providing better care for less hospital dollars. Both patient and payor outcome is improved by concentrating CE patients in the hands of high-volume surgeons. Although the data suggests this trend is already evolving, the pace of this evolution can be expected to increase as payors recognize that regionalization of this procedure lowers costs.

Arteriosclerosis↗
PubMed2005

[Comparison on energy values of matching food items in food compositon table of four northeast Asian countries or region].

OBJECTIVE: To evaluate the consistency and compatibility of the energy values in present applied Food Composition Tables or Databases (FCTs or FCDs) of NeasiaFoods members. METHODS: A total 101 matching food items (N = 101 x 4) were selected from the FCTs or FCD of Japan, Korea, Taiwan and China. Statistical comparisons were conducted before and after water adjustment. Data profile plots, means and relative differences were provided. The significance of differences were examined by the block designed ANOVA (alpha = 0.05). RESULTS: The population mean of Chinese food items is significantly low than that of other three. Relative difference (mean and 95% CI) of water adjusted estimation indicate that energy of China is totally less 7.7% (-0.6% - 15.9%), 11.7% (3.5 % - 20.1 %) and 2.6% (-5.2% - 10.3%) than that of Japan, Taiwan, and Korea respectively. Major bias occurred in Nuts & seeds and Fungi & Algae, Japan and Taiwan higher 22% to 68% than China. CONCLUSIONS: The energy values in FCTs of these NEASIAFOODS members lack consistency, especially between China and other three members. Differences of food energy conversion systems are the main effect that producing discrepancies. The effect of bias in energy contributing nutrients (e.g. fat) are considerable; analytical errors, sampling errors, food processing effects, different of food species, and accumulation of them only can be estimated through interlaboratory comparison studies on the basis of totally same food samples.

Asia↗
PubMed1994

A case study in APR-DRGs: the Greater Southeast Community Hospital experience.

The need for accurate, valid, and reliable severity data has taken on increasing importance over the last several years. The impact of managed care has been particularly significant, with many conditions once treated on an inpatient basis now being managed in the outpatient setting or admitted to the hospital only after the condition has progressed to a more advanced stage. The results has been an increasingly sicker inpatient population. Both hospitals and managed care organizations need data that will measure the impact of case mix complexity and severity on outcomes. This case study reviews one health care system's experience in finding a severity system that would have the acceptance of its medical staff. The study also reviews the analytic methodology by which severity-adjusted data are used to improve utilization and quality.

Cost of Illness↗
PubMed2005

Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review.

CONTEXT: Duration of untreated psychosis (DUP) is the time from manifestation of the first psychotic symptom to initiation of adequate treatment. It has been postulated that a longer DUP leads to a poorer prognosis. If so, outcome might be improved through earlier detection and treatment. OBJECTIVES: To establish whether DUP is associated with prognosis and to determine whether any association is explained by confounding with premorbid adjustment. DATA SOURCES: The CINAHL (Cumulative Index to Nursing and Allied Health), EMBASE, MEDLINE, and PsychLIT databases were searched from their inception dates to May 2004. STUDY SELECTION: Eligible studies reported the relationship between DUP and outcome in prospective cohorts recruited during their first episode of psychosis. Twenty-six eligible studies involving 4490 participants were identified from 11 458 abstracts, each screened by 2 reviewers. DATA EXTRACTION: Data were extracted independently and were checked by double entry. Sensitivity analyses were conducted excluding studies that had follow-up rates of less than 80%, included affective psychoses, or did not use a standardized assessment of DUP. DATA SYNTHESIS: Independent meta-analyses were conducted of correlational data and of data derived from comparisons of long and short DUP groups. Most data were correlational, and these showed a significant association between DUP and several outcomes at 6 and 12 months (including total symptoms, depression/anxiety, negative symptoms, overall functioning, positive symptoms, and social functioning). Long vs short DUP data showed an association between longer DUP and worse outcome at 6 months in terms of total symptoms, overall functioning, positive symptoms, and quality of life. Patients with a long DUP were significantly less likely to achieve remission. The observed association between DUP and outcome was not explained by premorbid adjustment. CONCLUSIONS: There is convincing evidence of a modest association between DUP and outcome, which supports the case for clinical trials that examine the effect of reducing DUP.

Adaptation, Psychological↗
PubMed1996

The use of administrative data as the first step in the continuous quality improvement process.

Billing or claims data, commonly referred to as administrative data, can be a valuable tool as the first step in a continuous quality improvement process. It is an inexpensive source of information which allows providers to identify opportunities for improvement in the process and the outcomes of health care delivery. The All Patient Refined/Diagnosis-Related Group case mix or severity-adjusted data represents one tool. The Practice Review System of Value Health Sciences is another. Comparative information is the first step, and the first step only in the quality improvement process. As such, to meet the needs of all continuous quality improvement customers, it is necessary to make this first step as reliable, yet inexpensive, as possible. Completing all the steps requires the use of a several measures over time.

Comorbidity↗
PubMed2006

Surveillance for World Trade Center disaster health effects among survivors of collapsed and damaged buildings.

PROBLEM/CONDITION: Survivors of collapsed or damaged buildings from the attack on the World Trade Center (WTC) were among those most exposed to injury hazards, air pollution, and traumatic events. REPORTING PERIOD: This report summarizes data from health outcomes collected during interviews conducted from September 5, 2003, to the close of the World Trade Center Health Registry (WTCHR) enrollment on November 20, 2004. DESCRIPTION OF SYSTEM: WTCHR will be used to monitor periodically the mental and physical health of 71,437 enrollees for 20 years. The analysis is limited to 8,418 adult survivors of collapsed buildings (n = 5,095) and buildings with major or moderate damage (n = 3,323), excluding those who were involved in rescue and recovery. RESULTS: A total of 62.4% of survivors of collapsed or damaged buildings were caught in the dust and debris cloud that resulted from the collapse of the WTC towers, and 63.8% experienced three or more potentially psychologically traumatizing events. Injuries were common (43.6%), but few survivors reported injuries that would have required extensive treatment. More than half (56.6%) of survivors reported experiencing new or worsening respiratory symptoms after the attacks, 23.9% had heartburn/reflux, and 21.0% had severe headaches. At the time of the interview, 10.7% of building survivors screened positive for serious psychological distress (SPD) using the K6 instrument. After multiple adjustments, data indicated that survivors caught in the dust and debris cloud were more likely to report any injuries (adjusted odds ratio [AOR] = 3.9; p< or =0.05); any respiratory symptom (AOR = 2.7; p< or =0.05); severe headaches (AOR = 2.0; p< or =0.05); skin rash/irritation (AOR = 1.7; p< or =0.05); hearing problems or loss (AOR = 1.7; p< or =0.05); heartburn (AOR = 1.7; p< or =0.05); diagnosed stroke (AOR = 5.6; p< or =0.05); self-reported depression, anxiety, or other emotional problem (AOR = 1.4; p< or =0.05); and current SPD (AOR = 2.2; p< or =0.05). Adjustment for SPD did not diminish the observed associations between dust cloud exposure and physical health outcomes. Building type and time of evacuation were associated with injuries on September 11, 2001 and reported symptoms; building type (collapsed versus damaged) also was associated with mental distress. INTERPRETATION: Two to three years after September 11, survivors of buildings that collapsed or that were damaged as a result of the WTC attack reported substantial physical and mental health problems. The long-term ramifications of these effects are unknown. Many survivors were caught directly in the dust and debris of collapsing towers, a dense cloud of particulate matter that might have produced or exacerbated these health effects. PUBLIC HEALTH ACTION RECOMMENDED: Long-term follow-up of building survivors and all other persons enrolled in WTCHR should be maintained, with particular attention to those persons exposed to the dust cloud. Some of these findings might lead to building designs that can minimize injury hazards.

Adult↗
PubMed2004

Brain growth, life history, and cognition in primate and human evolution.

This study investigates brain size ontogeny in a sample of seven anthropoid primate species (including humans) in order to evaluate longstanding ideas about the relations between brain size, brain ontogeny, life history, and cognition. First, this analysis tests the hypothesis that primate brain growth patterns vary across species. Second, the relations between the duration of the brain growth period and the duration of the pre-adult period are evaluated. Brain growth data, derived from a number of sources, are analyzed through parametric and nonparametric regressions. The results indicate that primates are characterized by significant variation in patterns of brain growth. In addition, the degree to which brain growth is allocated to either the pre- or the postnatal period varies substantially. Analyses of phylogenetically adjusted data show no correlation between the lengths of the brain growth period and the juvenile period, but there are correlations with other life-history variables. These results are explained in terms of maternal metabolic adaptations. Specifically, primates appear to present at least two major metabolic adaptations. In the first, brain growth occurs mainly during the prenatal period, reflecting heavy maternal investment. In the second, brain growth occupies large portions of the postnatal period. These differing patterns have important implications for maturation age, necessitating late maternal maturation in the first case and enabling relatively early maternal maturation in the second. Overall, these adaptations represent components of distinctive life-history adaptations, with potentially important implications for the evolution of primate cognition.

Adaptation, Physiological↗
PubMed2002

The National Surgical Quality Improvement Program in non-veterans administration hospitals: initial demonstration of feasibility.

OBJECTIVE: To assess the feasibility of implementing the National Surgical Quality Improvement Program (NSQIP) methodology in non-VA hospitals. SUMMARY BACKGROUND DATA: Using data adjusted for patient preoperative risk, the NSQIP compares the performance of all VA hospitals performing major surgery and anonymously compares these hospitals using the ratio of observed to expected adverse events. These results are provided to each hospital and used to identify areas for improvement. Since the NSQIP's inception in 1994, the VA has reported consistent improvements in all surgery performance measures. Given the success of the NSQIP within the VA, as well as the lack of a comparable system in non-VA hospitals, this pilot study was undertaken to test the applicability of the NSQIP models and methodology in the nonfederal sector. METHODS: Beginning in 1999, three academic medical centers (Emory University, Atlanta, GA; University of Michigan, Ann Arbor, MI; University of Kentucky, Lexington, KY) volunteered the time of a dedicated surgical nurse reviewer who was trained in NSQIP methodology. At each academic center, these nurse reviewers used NSQIP protocols to abstract clinical data from general surgery and vascular surgery patients. Data were manually collected and then transmitted via the Internet to a secure web site developed by the NSQIP. These data were compared to the data for general and vascular surgery patients collected during a concurrent time period (10/99 to 9/00) within the VA by the NSQIP. Logistic regression models were developed for both non-VA and VA hospital data. To assess the models' predictive values, C-indices (0.5 = no prediction; 1.0 = perfect prediction) were calculated after applying the models to the non-VA as well as the VA databases. RESULTS: Data from 2,747 (general surgery 2,251; vascular surgery 496) non-VA hospital cases were compared to data from 41,360 (general surgery 31,393; vascular surgery 9,967) VA cases. The bivariate relationships between individual risk factors and 30-day mortality or morbidity were similar in the non-VA and VA patient populations for over 66% of the risk variables. C-indices of 0.942 (general surgery), 0.915 (vascular surgery), and 0.934 (general plus vascular surgery) were obtained following application of the VA NSQIP mortality model to the non-VA patient data. Lower C-indices (0.778, general surgery; 0.638, vascular surgery; 0.760, general plus vascular surgery) were obtained following application of the VA NSQIP morbidity model to the non-VA patient data. Although the non-VA sample size was smaller than the VA, preliminary analysis suggested no differences in risk-adjusted mortality between the non-VA and VA cohorts. CONCLUSIONS With some adjustments, the NSQIP methodology can be implemented and generates reasonable predictive models within non-VA hospitals.

Feasibility Studies↗
PubMed2005

Separation-individuation revisited: on the interplay of parent-adolescent relations, identity and emotional adjustment in adolescence.

The objective of this study was to test our alternative interpretation of the separation-individuation hypothesis. This interpretation states that separation from the parents is not a precondition for individuation, but rather separation and individuation are two parallel processes of development during adolescence. We investigated our interpretation in two ways. Firstly, we looked at descriptive age differences in parental support and development of relational and societal identity. Secondly, we investigated the variation with age of the associations between parental support and emotional adjustment, and identity and emotional adjustment. Data of a representative Dutch sample of 2814 adolescents, aged 12-24 were used. In both cases, the findings supported our interpretation of the separation-individuation hypothesis and similar results were found in the descriptive analyses and the structural equation models. Parental support decreased with age, and so too did its association with emotional adjustment. In other words, as adolescents become older, they experience less parental support, while its importance for their emotional adjustment also declines. The opposite pattern was observed with respect to identity development: as adolescents become older, their relational and societal identity commitments develop, and the degree to which these commitments are developed also becomes more important for their emotional adjustment.

Adaptation, Psychological↗
PubMed2005

[Genetic effects on physical growth items of child twins in Han nationality].

OBJECTIVE: To analyse the heritabilities of physical growth items of body and its related factors. METHODS: An 116 twin pairs of Han nationality, 67 monozygotic (MZ) and 49 like-sex dizygotic (DZ) aged 6 to 12 years, were investigated from June to October in 2004. The measurements included height, weight, sitting height, chest circumference, biacromial breadth and biiliac breadth, and BMI index calculated by the former two measurements. The heritabilities were estimated by using intraclass correlation coefficient method from the adjusted data for age. RESULTS: The intraclass correlation coefficient was greater in the MZ twins than in the DZ twins. The estimated heritabilities of height, weight, BMI, sitting height, chest circumference, biacromial breadth and biiliac breadth were 0.89, 0.88, 0.73, 0.87, 0.78, 0.78, 0.73 in boys and 0.87, 0.74, 0.72, 0.86, 0.62, 0.56, 0.59 in girls adjusted for age. Therefore, there were no sex difference for the heritabilities of height, sitting height and BMI, but the male heritabilities of weight, chest circumference, biacromial breadth and biiliac breadth were higher than the female's respectively. CONCLUSION: Physical growth items should be mainly determined by the genetic factors. There are sex differences for the heritabilities of weight, chest circumference, biacromial breadth and biiliac breadth, i.e., the girls might be affected more easily by environmental factors than the boys in these items.

Asian People↗
PubMed2006

Coracohumeral interval imaging in subcoracoid impingement syndrome on MRI.

OBJECTIVE: The coracohumeral interval previously has been described as predictive of subcoracoid impingement on dynamic screening. The purpose of this study was to determine whether a coracohumeral interval acquired from routinely performed MRI can reliably diagnose subcoracoid impingement. MATERIALS AND METHODS: Preoperative MRI examinations of 19 patients (16 males, three females) with subsequent surgical confirmation of subcoracoid impingement were reviewed retrospectively and compared with MRI studies of 41 control subjects (22 males, 19 females). Axial and oblique sagittal coracohumeral interval measurements were taken. The morphology of the coracoid process and lesser tuberosity was assessed. Postanalysis application of the data to two smaller groups of patients was performed. The first group consisted of nine subjects (three males, six females) for whom subcoracoid impingement was diagnosed prospectively on the basis of abnormalities found by MRI. The second group consisted of seven patients (two males, five females) who were referred for MRI evaluation because of clinically suspected subcoracoid impingement. RESULTS: The average coracohumeral interval for females was 3 mm smaller than that for males. Using sex-adjusted data, we found a statistically significant difference between individuals with or without subcoracoid impingement in the axial coracohumeral interval (p = 0.01). This value, however, was poorly predictive (area under the receiver operating characteristic curve, 0.73). An 11.5-mm axial coracohumeral interval had 84% sensitivity but only 44% specificity. A 10.5-mm axial coracohumeral interval had 79% sensitivity and 59% specificity. The shoulder morphologic features assessed and intraarticular contrast use were not statistically significantly related to the coracohumeral interval. In postanalysis application of data, in the group of nine subjects without clinical diagnosis of subcoracoid impingement, all prospective MRI subcoracoid impingement diagnoses were falsely positive. However, if subcoracoid impingement was the referring diagnosis, prospective MRI evaluation more often was correct (n = 7 [three true-negatives, two true-positives, two false-negatives]). CONCLUSION: A sex-adjusted coracohumeral interval of 10.5-11.5 mm, although statistically significantly related to subcoracoid impingement, is poorly predictive of this diagnosis when acquired via routinely performed MRI. Subcoracoid impingement is primarily a clinical diagnosis that may be supported, but not established, by this means.

Adolescent↗
PubMedDate not supplied

Adult adjustment among high school graduates with mild disabilities.

This study investigated the adult adjustment of a statewide random sample of 737 young adults with learning disabilities, 59 labeled behaviorally disordered, and 142 labeled mentally disabled, all graduates of special education resource teacher programs. Results are reported in terms of (a) general status information, such as marital status and living arrangements; (b) information about those competitively employed, such as wages, hours worked per week, and percentage of living expenses paid; and (c) comparison of competitively employed versus unemployed individuals, in terms of high school vocational training and work experiences. Information is also provided on postsecondary education and overall "successful" adult adjustment. Data are compared across disability groups and across gender, where relevant.

Adult↗
PubMed1991

Interpretation of "cost-effective" and soundness of economic evaluations in the pharmacy literature.

The varied interpretations of the term "cost-effective" in the pharmacy literature are discussed and the soundness of pharmacoeconomic analyses is assessed. Sixty-five studies concerning cost issues, which were published by six pharmacy journals from January 1985 to December 1990, were evaluated according to 10 methodological criteria. Two investigators independently reviewed each study and completed a data collection form; differences were discussed and resolved to ensure consistency of evaluation. In 36 (55%) of 65 articles, cost-effectiveness was misinterpreted as cost saving. Only 3 of the 10 criteria were fulfilled by 50% or more of the studies evaluated. Problem areas included the following: (1) identification of relevant costs and consequences of each strategy, (2) discounting--adjusting data to reflect the differential timing of costs and consequences, (3) incremental analysis--examining extra costs of a program relative to additional effects provided, and (4) sensitivity analysis. Many pharmacoeconomic studies inappropriately used the term "cost-effective" and inadequately addressed basic methodological components of an economic evaluation.

Cost Savings↗
PubMed1988

Differential adjustment of Ashkenazi versus Sephardi Jews to a forced relocation: the Israeli withdrawal from the Sinai.

This report focuses on a set of findings regarding differential adjustment patterns of Ashkenazi (Western) versus Sephardi (Oriental) Jews when faced with a stressful life event. The event in question was the wholesale evacuation of the Israeli Sinai community of Ophira (Sharm-el-Sheik in Arabic) when the Sinai was handed over to Egyptian control in March 1982. Immediately prior to the evacuation, the authors went down to Ophira to carry out a study of patterns of psychosocial adjustment of community residents designed to assess the relationships between individual coping styles, personal network characteristics, levels of psychological distress, and adequacy of social adjustment. Data were collected from a sample of 66 adult civilian community residents (31 men; 35 women), a sample that by coincidence was composed of two reputedly quite different ethnic subgroups: Israeli-born Jews whose parents were of European origin; and "Oriental" Jews, i.e., immigrants from Moslem countries. This fortuitous mix allowed us to carry out the analyses exploring ethnic differences in adjustment and their possible causes that are to be presented in this paper.

Adaptation, Psychological↗
PubMed2004

Mortality risk among new onset injection drug users.

AIMS: To characterize mortality experience among those who only recently started injection. DESIGN: Prospective study. SETTING: Independent study clinic within high drug use neighborhoods. PARTICIPANTS: In 1988-1989, we enrolled 256 adult injection drug users (IDUs) recruited through street outreach who had initiated injection within the prior 2 years. MEASUREMENTS: Consenting participants underwent venipuncture for HIV antibody testing and interviews. We prospectively ascertained date and cause of death through follow-up contact and registry linkages. Analyses included standardized mortality ratios (SMRs) with local, state and national mortality data, adjusted for age, gender and race. FINDINGS: Baseline median age was 30 years, 70% were male, 95% were African-American and 90% injected within the prior 6 months. We identified 69 deaths through October 2000; mortality rate was 3.3/100 person-years. The adjusted SMR with the USA (and Baltimore) as the reference for IDUs was 4.40 (2.43) for 1991-1992, which increased to 8.12 (4.13) by 1993-1994, decreased to 4.43 (2.13) by 1997-1998 and increased slightly to 5.35 (2.79) during 1999-2000. Excluding HIV-related mortality, SMRs remained elevated. Decline in SMRs was not linked to drug abuse treatment. CONCLUSIONS: These data demonstrate excess mortality among new-onset IDUs compared with demographically similar peers in the general population, indicating the need for interventions to prevent premature death among young IDUs.

Adult↗