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Impact of MR imaging on nationwide health care costs and comparison with other imaging procedures.

OBJECTIVE: We wished to determine the extent to which MR imaging contributes to the overall costs of imaging in the United States and to compare MR imaging costs with other imaging techniques. MATERIALS AND METHODS: All 23 current procedural terminology, version 4 (CPT-4) codes for MR imaging were extracted from the national 1993 Part B Medicare annual data reimbursement file. For each code, we calculated total Medicare physician reimbursements. Aggregate reimbursement for all MR imaging was compared with aggregate reimbursement for all 659 imaging-related current procedural terminology, version 4 codes and also with comparable figures for echocardiography and other categories of cardiovascular imaging. RESULTS: Within the 23 MR imaging codes, 1,449,911 examinations were performed on Medicare patients in 1993, for which physicians were reimbursed $370 million. Medicare reimbursement of physicians for all 659 imaging-related procedures was $5.3 billion. Thus, MR imaging accounted for only 7% of all imaging costs. By comparison, a group of just 10 imaging codes, which are primarily cardiovascular in nature, accounted for $1.67 billion, or 32% of the entire Part B costs for imaging. Reimbursements for echocardiography alone are more than twice those for MR imaging. CONCLUSION: From the national perspective, MR imaging does not appear to warrant its reputation as a costly procedure. The costs of echocardiography and other imaging related to the cardiovascular system are considerably higher.

Diagnostic Imaging↗

Suicide in Hong Kong.

Coroners' statistics indicated there were 684 suicides for the whole of Hong Kong in 1981. This gave a crude suicide rate of 18.1 per 100,000 population aged 15 years and over and constituted 2.7% of all deaths reported in that year. Only a few data were recorded in all coroners' files but additional data were obtained from police records on 168 of these suicides. The age and sex distribution among the suicides as well as the effect of marital and employment status on suicide rates were found to be similar to western countries. Jumping from a height was the most common method of suicide (47.2%) followed by hanging (30.8%). Psychiatric illness and chronic physical disability were two most important precipitating causes of suicide (39.8% and 35.7% respectively). Twenty per cent had a history of previous attempts with one-third occurring within six months of their completed suicide. Over 40% had communicated their suicide intention to others, while 19% left a note. 'Psychiatric' cases as a group had special features: there were more in the younger age groups, more with records of previous suicide attempts and more chose readily available methods.

Adolescent↗

Sex, ethnicity, age and education effects on the Trail Making test in a sample of cocaine abusers.

Sex, ethnicity, age and education effects on the Trail Making test (TMT), a test often used to for screen for cognitive impairment, were examined in a sample of cocaine abusers in drug abuse treatment programs. A mixed race sample of 5116 males and 2614 females was drawn from electronic files of data from the Drug Abuse Treatment Outcome Study (DATOS). The DATOS was a naturalistic, prospective cohort study that collected data from 1991-1993 in 96 programs in 11 cities in the United States. The number of cocaine/crack abuser scores available for analysis was 4306. Data were analyzed to determine the effects of sex, ethnicity, age and education variables on the two parts of the TMT in this large treatment sample of cocaine abusers. The variables of sex age, ethnicity and education were statistically significant for both parts A and B of the TMT. In addition, R-Square values for overall models were quite weak (A = .08, B = .11) suggesting that sex, ethnicity, age and education effects on the TMT, while clearly present, account for relatively little overall variance in terms of cocaine users TMT performance. These results are consistent with earlier research using a more heterogenous drug abuse treatment sample.

Adolescent↗

Using the Trail Making test to screen for cognitive impairment in a drug abuse treatment sample.

The Trail Making test (TMT) is a brief paper and pencil neuropsychological test often used for screening for cognitive impairment. The value of the TMT is examined in a sample of 5619 males and 2902 females was drawn from electronic files of data from the Drug Abuse Treatment outcome Study (DATOS), a naturalistic, prospective cohort study that collected data from 1991-1993 in 96 programs in 11 cities in the United States. Data were analyzed to determine the effects of specific drugs of abuse on parts A and B of the TMT in this large sample of patients in drug abuse treatment programs. Most subjects, regardless of type of drug abused, on TMT parts A and B appeared to fall within normal limits relative to commonly accepted cutoff scores. These results suggest that the TMT parts A and B would have great value as screening measures for cognitive impairment in a drug abuse treatment population.

Adult↗

Demographic effects on the Trail Making test in alcohol abusers.

Demographic effects on the Trail Making Test (TMT), a test often used for screening for cognitive impairment, are examined in a sample of alcohol abusers in drug abuse treatment programs. A sample was drawn from electronic files of data from the Drug Abuse Treatment outcome Study (DATOS). The DATOS was a naturalistic, prospective cohort study that collected data from 1991-1993 in 96 programs in 11 cities in the United States. The number of alcohol abuser's scores available for analysis was 1000. Data were analyzed to determine the effects of gender, ethnicity, age and education variables on the two parts of the TMT in this large treatment sample of alcohol abusers. The variables of age, ethnicity and education were statistically significant for both parts A and B of the TMT. R-Square values for overall models were quite weak (A = .12, B = .14) suggesting that demographic effects on the TMT, while clearly present, account for relatively little overall variance in terms of alcohol abuser's TMT performance. These results are consistent with earlier research using a more heterogenous drug abuse treatment sample.

Adult↗

Demographic effects on the Trail Making Test in marijuana abusers.

Demographic effects on the Trail Making Test (TMT), a test often used for screening for cognitive impairment, were examined in a sample of marijuana abusers in drug abuse treatment programs. A sample was drawn from electronic files of data from the Drug Abuse Treatment outcome Study (DATOS). The DATOS was a naturalistic, prospective cohort study that collected data from 1991-1993 in 96 programs in 11 cities in the United States. The number of marijuana abusers' scores available for analysis were 259. Data were analyzed to determine the effects of sex, ethnicity, age, and education variables on the two parts of the TMT in this large treatment sample of marijuana abusers. The variables of age and education level were statistically significantly related to TMT parts A and B, and ethnicity was statistically significant for part B of the TMT. R-Square values for overall models were moderate (A = .15, B = .18) suggesting that demographic effects on the TMT are weak.

Adolescent↗

Demographic effects on the Trail Making Test in amphetamine abusers.

Demographic effects on the Trail Making Test (TMT), a test often used for screening for cognitive impairment, were examined in a sample of amphetamine abusers in drug abuse treatment programs. A sample was drawn from electronic files of data from the Drug Abuse Treatment Outcome Study (DATOS). The DATOS was a naturalistic, prospective cohort study that collected data from 1991-1993, in 96 programs in 11 cities in the United States. The number of amphetamine abusers scores available for analysis were 185. Data were analyzed to determine the effects of sex, ethnicity, age, and education variables on the two parts of the TMT in this large treatment sample of amphetamine abusers. No variables were statistically significant for either parts A and B of the TMT. R-square values for overall models were also negligible (A = .03, B = .08) suggesting that demographic effects on the TMT account for a minuscule amount of overall variance in terms of amphetamine abusers' TMT performance.

Adolescent↗

Demographic effects on the Trail Making Test in sedatives abusers.

Demographic effects on the Trail Making test (TMT), a test often used to screen for cognitive impairment, were examined in a sample of sedatives abusers in drug abuse treatment programs. A sample was drawn from electronic files of data from the Drug Abuse Treatment Outcome Study (DATOS). The DATOS was a naturalistic, prospective cohort study that collected data from 1991-1993 in 96 programs in 11 cities in the United States. The number of sedatives abusers' scores available for analysis were 72. Data were analyzed to determine the effects of sex, ethnicity, age, and education variables on the two parts of the TMT in this large treatment sample of sedatives abusers. None of the demographic variables were statistically significantly related to TMT parts A and B, when considered as single variables. In addition, R-Square values for overall models were low (A = .15, B = .18), suggesting that demographic effects on the TMT in a sample of sedative abusers are very weak.

Adolescent↗

Derived trail making test indices in a sample of substance abusers: demographic effects.

Derived indices on the Trail Making Test (TMT), a test often used to screen for cognitive impairments, were examined in a sample of substance abusers in drug abuse treatment programs. A mixed race sample was drawn from electronic files of data from the Drug Abuse Treatment Outcome Study (DATOS). The DATOS was a naturalistic, prospective cohort study that collected data from 1991 through 1993 within 96 programs in 11 cities in the United States. Data were analyzed to determine the effects of demographic variables on derived indices created by adding, subtracting, multiplying, and dividing parts A and B of the TMT in this large treatment sample of substance abusers. The variables of sex, age, ethnicity, and education were statistically significant for selected derived indices of the TMT.

Adult↗

Demographic effects on the Trail Making Test in hallucinogen abusers.

Demographic effects on the Trail Making test (TMT), a test often used for screening for cognitive impairment, were reexamined in a sample of hallucinogen abusers in drug abuse treatment programs. A sample was drawn from electronic files of data from the Drug Abuse Treatment outcome Study (DATOS). The DATOS was a naturalistic, prospective cohort study that collected data from 1991-1993 in 96 programs in 11 cities in the United States. The number of hallucinogen abusers' scores available for analysis were 128. Data were analyzed to determine the effects of sex, ethnicity, age and education variables on the two parts of the TMT in this large treatment sample of hallucinogen abusers. The variable of ethnicity was statistically significant for both parts A and B of the TMT and just at the edge of significance for age for part A. R-Square values for overall models were moderate (A = .30, B = .29) suggesting that demographic effects on the TMT account for a minority of overall variance in terms of hallucinogen abusers' TMT performance.

Adolescent↗

Sex, ethnicity, age and education effects on the Trail Making Test in a sample of heroin abusers.

Sex, ethnicity, age and education effects on the Trail Making test (TMT), a test often used for screening for cognitive impairment, are examined in a sample of heroin abusers in drug abuse treatment programs. A mixed race sample was drawn from electronic files of data from the Drug Abuse Treatment outcome Study (DATOS). The DATOS was a naturalistic, prospective cohort study that collected data from 1991-1993 in 96 programs in 11 cities in the United States. The number of heroin abusers with TMT scores available for analysis was 1548. Data were analyzed to determine the effects of sex, ethnicity, age and education variables on the two parts of the TMT in this large treatment sample of heroin abusers. The variables of sex, age, ethnicity and education were statistically significant for both parts A and B of the TMT. Nonetheless, R-Square values for overall models were quite weak (A = .08, B = .13) suggesting that sex, ethnicity, age and education effects on the TMT, while clearly present, account for relatively little overall variance in terms of heroin users' TMT performance. These results are consistent with earlier research using a more heterogenous drug abuse treatment sample.

Adult↗

Lethal injuries among the members of the 4th Guardian Brigade of Croatian Army during the 1991-1995 war.

OBJECTIVE: We analyzed the causes of deaths among the members of the 4th Guardian Brigade (GB) of the Croatian Army during the war in Croatia from 1991 to 1995: the site of the lethal injuries, the type of wounds, and estimated the severity of injuries with lethal outcome according to the Abbreviated Injury Scale. METHODS: This was a retrospective study using the files and data obtained from 4th GB, Croatian Ministry of Defense, and Croatian Ministry of War Veterans. RESULTS: During the War in Croatia from 1991 to 1995, 182 members of 4th GB were killed. One hundred fifteen (63.2%) suffered lethal injuries caused by shell fragments, 47 (25.8%) soldiers had gunshot wounds, and 20 ( 11.0%) died in traffic accidents. Mean Abbreviated Injury Scale for killed soldiers was 7.61 +/- 1.27. CONCLUSION: During the war in Croatia, the leading causes of death were mines and explosions, and, in a minor proportion, gunshot wounds.

Blast Injuries↗

Privacy. Are there any guarantees?

Many health plan members worry that their medical records no longer are kept securely in paper medical files. Electronic data, they argue, is too easy to access. But healthcare administrators often need to use personal medical information to follow trends in outcomes, quality management and utilization review. Is there a balance? Kathleen O'Connor reports that Donna Shalala, secretary of the Department of Health and Human Services, recently provided some suggestions for safeguarding medical privacy in the information age.

Computer Communication Networks↗

Population planning program management: the role of health administration programs.

An international survey of educators, program managers, and donors was undertaken to assess the current status of education for population planning (P/P) program management. Most respondents perceived a high level of need for management training in the population field. This perception was less likely to be held by health administration program directors, however, whose programs for the most part had only limited experience or interest in addressing this need. P/P program directors indicated that regional training institutes and the local P/P program itself were the most frequent source of management training, although the sample as a whole perceived that training to be of lower quality than what would be offered by U.S. and Canadian universities. The major improvement desired in such training related to the appropriateness and effectiveness of teaching methods and content. Planning, needs assessment, and goal setting was seen to be the area of greatest training need.

Data Collection↗

Pulmonary embolism in Veterans Affairs Medical Centers: is vena cava interruption underutilized?

Veterans with venous thrombosis or pulmonary embolism (PE) were evaluated using Veterans Affairs patient treatment file (PTF) data from fiscal years 1990-1995, inclusive, to define outcomes for those with PE. The specific aims of the study were to define how often those with PE underwent vena cava interruption (VCI) and whether VCI affected in-hospital mortality rates. Outcomes were defined using PTF data and Patient Management Category (PMC) software for 26,132 veterans discharged from all Veterans Affairs Medical Centers (VAMCs) with venous thromboembolism, which included a subset of 4,882 patients identified by both PTF data and PMC software to have PE. PMC software also generated measures of illness severity, patient complexity (PMC count), and resource utilization (called resource intensity scale) for each hospital admission. The in-hospital mortality rate for those with PE was 15.9 per cent (775 of 4882). Only 157 VCIs were performed in those with PE which constituted 3.2 per cent of the latter group. Those with PE who had VCI experienced a 13.4 per cent unadjusted in-hospital mortality rate (21 of 157) versus a 16 per cent unadjusted mortality rate without VCI (754/4725; not significant). In a logistic regression model of in-hospital mortality in those with PE, increasing age and illness severity were directly related to mortality, whereas VCI was independently associated with reduced mortality. The odds of death were reduced by 0.482 (0.287-0.807, 95% limits) for patients with PE who underwent VCI (P<0.005). Utilization of VCI varied among VAMCs: the hospital rates that VCI were performed in those with PE ranged from 0 to 16.7 per cent. Mortality associated with PE was substantial in VAMCs, and VCI was independently associated with reduced in-hospital mortality. The low percentage of veterans with pulmonary embolism who underwent VCI was surprising. VCI may be underutilized in veterans with PE.

Age Factors↗

[The analysis of the selected epidemiological aspects in patients with inhalant allergy treated at the Allergology Outpatient Clinic in Zabrze].

The study was designed to analyse the selected epidemiological aspects in patients with inhalant allergy treated at the Allergology Outpatient Clinic in Zabrze from 1989 till 1994. The analysis was based on the data from the files of 11,540 patients. The data of the pollinotic patients (1571 subjects) and of those with bronchial asthma (521 subjects) were analysed with regard to frequency of the diseases, place of residence (urban or country area), sex, date of birth, age when the illness had occurred, hereditary factors, type of allergens and the coexistence of other atopic diseases. Additionally, a group of 317 patients (183 men and 134 women) with inhalant allergy in period studied was randomly chosen to estimate the concentration of IgE. In the group of 28 patients with pollinosis the serum level of specific IgE antibodies against grass (g5, g6), trees (t3, t4) and weeds (w6, w9) was evaluated as well. The relationship between the concentration of IgE and sex, age, the month of birth, family history was estimated.

Adolescent↗

[Malignant mesothelioma in the industrial area of Colleferro].

The study describes the occurrence of pleural and peritoneal malignant mesothelioma in the Colleferro industrial area (Province of Rome, 9 municipalities, population 63,000, period 1993-98) which is the site of a large chemical plant (BPD) producing organic chemicals, acid mixtures, insecticides, explosives and dynamite, and was involved in manufacturing/maintenance of railroad rolling stock. Asbestos was extensively used in these plants in the past. Mesothelioma cases were actively searched from data in files of pathology archives, hospital admission and discharge (records), and death certificates recorded at local health authority register. 23 potential cases were identified for whom clinical charts and pathological slides were reviewed. A multidisciplinary evaluation of all collected information confirmed 18 cases of cyto-histologically proven malignant mesothelioma (pleural/peritoneal ratio of 2.75:1) among residents and/or workers at BPD. The remaining 5 cases were defined as not mesothelioma; however, two were cases of lung cancer (both occupationally exposed to asbestos). All subjects with malignant mesothelioma had been occupationally exposed to asbestos (14 males and 3 females), except one (1 female with domestic exposure). No mesothelioma case was attributable to environmental exposure. Of the 17 cases with occupational asbestos exposure, 15 occurred in BPD workers employed in manufacturing/maintenance of railroad rolling stock (3 cases), general maintenance services (5 cases), or in the armaments sector (7 cases) and 2 in residents but not BPD workers (1 baker, 1 pipefitter). The incidence rate in residents of the 9 municipalities was 5.5 in males and 1.3 in females (standardized on the Italian population x100,000, census 1981). For Colleferro municipality only, the incidence was 10.1 in males and 4.1 in females, which are the highest rates reported so far in Italy. Besides confirming the risk of mesothelioma risk in railroad rolling stock manufacturing and asbestos-insulated pipe maintenance workers, this study identifies a cluster of malignant mesothelioma in explosives production workers.

Aged↗