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PubMed1991

Parallel line bioassay in a coagulation laboratory. A program for personal computer use and an example application to Ristocetin Cofactor assay.

The authors review the statistical principles of parallel line bioassay and describe a computer program written to facilitate a correct approach to most coagulation assays. This program should be especially useful for those assays in which linearization of dose-response curves may prove difficult, or in which careful analysis of assay validity is required. How the knowledge of bioassay theory can be applied to von Willebrand factor Ristocetin Cofactor activity measurement is shown as a general example.

Biological Assay↗
PubMed2004

Cost shifting to jails after a change to managed mental health care.

OBJECTIVE: To determine whether managed mental health care for Medicaid enrollees in King County, Washington, has led to indirect cost-shifting to substitute treatments, such as jails and state mental hospitals that are free goods to providers. DATA SOURCES: Complete service records for 47,300 adults who used at least one of the following systems from 1993 to 1998: King County jail system, Medicaid, or the King County mental health system. Data were also obtained from the Washington State Hospital System. STUDY DESIGN: A quasi-experimental analysis that compares the difference in outcomes between the pre- and post-managed care periods for Medicaid enrollees compared to non-Medicaid enrollees. The outcomes-jail costs, state hospital costs, and county outpatient mental health costs-were estimated with two-part difference-in-differences models. The regressions control for person-level fixed effects on up to 66 months of data per person. DATA COLLECTION METHODS: Administrative data were collected from the jail, Medicaid, and mental health systems, then merged and cleaned. Additional data on costs were obtained in interviews. PRINCIPAL FINDINGS: There is a striking increase in the probability of jail use for persons on Medicaid following the introduction of managed care. There was a significant decrease in expenditures in the county mental health system for outpatient care. CONCLUSIONS: Managed care led to indirect cost-shifting, probably through poor access to services, which may have led to an increased probability of jail detention.

Adult↗
PubMed1997

Injury prevention programmes in primary care: a high risk group or a whole population approach?

OBJECTIVE: To examine the relationship between risk factors for childhood unintentional injury and injury outcome and to assess the feasibility of using risk factors to identify children at high risk of injury. SETTING: One general practice in Nottingham, UK. METHOD: A postal questionnaire survey to all parents of children registered with the practice (n = 771) to obtain data on risk and sociodemographic factors. All children still registered with the practice one year later were followed up for occurrence of a medically attended injury. RESULTS: The response rate was 78%. The injury rate over the follow up year was 246 injuries per 1000 children. Previous medically attended injury was associated with each of the injury outcomes (odds ratio (confidence interval) for all attendances, 2.33 (1.37 to 4.05); for accident and emergency attendances, 2.27 (1.15 to 4.4); and for primary health care team attendances, 2.58 (1.33 to 5.0)). Male sex was associated only with accident and emergency department attendance (odds ratio 2.13 (1.06 to 4.2)). Maternal age and previous injury were associated with a higher number of injuries in the subsequent year on univariate and multivariate analyses. The sensitivity and positive predictive value of the risk factors were low, except for previous injury and male sex. The number of children needing an injury prevention intervention to prevent one injury as identified by the risk factors was not significantly different from that required if a whole population approach were to be used. CONCLUSION: Primary care based injury prevention programmes, at present, should not be targeted at children identified as being at 'high risk' of injury. Nevertheless, a larger study using a wider cross section of the population is needed to address this issue further.

Adolescent↗
PubMed2005

Laparoscopic Roux-en-Y gastric bypass with 2-metre long biliopancreatic limb for morbid obesity: technique and experience with the first 150 patients.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (RYGBP) is being performed widely as a treatment of choice for morbid obesity. We present our method and experience with the first 150 consecutive cases of laparoscopic RYGBP with a 2-m long biliopancreatic limb (BP-limb). METHODS: Between November 2001 and November 2003, a prospective analysis of 150 patients was performed identifying technical success and complications. Before surgery, patients underwent a strict multidisciplinary behavioral program. At operation the stomach was transected proximally with a linear stapler (60-mm, Endo-GIA) to create a prolongation of the esophagus (gastric tube) along the lesser curvature, resulting in a 40-50 ml pouch. Two meters of the proximal jejunum were bypassed (BP-limb), creating an antecolic Roux-en-Y gastro-jejunostomy to the posterior wall of the gastric tube using a 45-mm linear Endo-GIA stapler. The entero-anastomosis was created 50 cm below the gastro-jejunostomy, also with a 45-mm linear Endo-GIA. RESULTS: Mean BMI was 50.0, and 78% of patients were females. With 100% follow-up, we found an EWL of 50% 6 months after surgery, gradually rising to 80% after 18 months. The mean operating time was 116 min for the first 50 cases and decreased to 82 min for the last 50 cases. Intestinal leakage occurred in 5 patients (3%) and bleeding in 5 (3%). Most of these complications occurred in the first 50 cases, and all but one were treated successfully with an early laparoscopic re-operation. Marginal ulcers were found in 16.6% of patients. No internal hernias have occurred. CONCLUSION: The operation demands advanced laparoscopic skills, but technically it is relatively simple and has an acceptable complication rate. Short-term results regarding excess weight loss are at least comparable to the RYGBP with a long alimentary limb.

Adolescent↗
PubMed2002

Panoramic and cephalometric extraoral dental radiograph systems.

The basic unit is the Orthopantomograph OP100, which is a computer-controlled extraoral imaging system capable of producing panoramic radiographs using either film or digital technology. This unit has automatic exposure control, automatic spine compensation, a patented V-shaped X-ray beam and a built-in quality assurance program. The OP100 is available with cephalometrics (the OC100 model), linear tomography (the Ortho Trans model), identification film marking (the Ortho ID model) and imaging software (the Ortho Zone and Ortho TMJ models). The addition of a cephalometric arm to the Orthopantomograph makes the unit an Orthoceph. The image receptor sizes are as follows: Panorama OP100: cassette 15 x 30 centimeters; Cephalometric image receptor OC100: 24 x 30 cm, 18 x 24 cm, 8 x 10 inches; Panoramic image receptor OP100D: CCD camera, image pixel size 90 x 90 micrometers; Cephalometric image receptor OC100D: CCD camera, image pixel size 90 x 90 microm.

Cephalometry↗
PubMed2004

Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users.

BACKGROUND: North America's first medically supervised safer injecting facility for illicit injection drug users was opened in Vancouver on Sept. 22, 2003. Although similar facilities exist in a number of European cities and in Sydney, Australia, no standardized evaluations of their impact have been presented in the scientific literature. METHODS: Using a standardized prospective data collection protocol, we measured injection-related public order problems during the 6 weeks before and the 12 weeks after the opening of the safer injecting facility in Vancouver. We measured changes in the number of drug users injecting in public, publicly discarded syringes and injection-related litter. We used Poisson log-linear regression models to evaluate changes in these public order indicators while considering potential confounding variables such as police presence and rainfall. RESULTS: In stratified linear regression models, the 12-week period after the facility's opening was independently associated with reductions in the number of drug users injecting in public (p < 0.001), publicly discarded syringes (p < 0.001) and injection-related litter (p < 0.001). The predicted mean daily number of drug users injecting in public was 4.3 (95% confidence interval [CI] 3.5-5.4) during the period before the facility's opening and 2.4 (95% CI 1.9-3.0) after the opening; the corresponding predicted mean daily numbers of publicly discarded syringes were 11.5 (95% CI 10.0-13.2) and 5.4 (95% CI 4.7-6.2). Externally compiled statistics from the city of Vancouver on the number of syringes discarded in outdoor safe disposal boxes were consistent with our findings. INTERPRETATION: The opening of the safer injecting facility was independently associated with improvements in several measures of public order, including reduced public injection drug use and public syringe disposal.

British Columbia↗
PubMed2002

Fluticasone is associated with lower asthma-related costs than leukotriene modifiers in a real-world analysis.

STUDY OBJECTIVE: To compare the impact of fluticasone propionate versus three leukotriene modifiers-montelukast, zafirlukast, and zileuton-on the cost of asthma within a managed care organization. DESIGN: Retrospective quasi-experimental comparison. SETTING: Managed care organization with approximately 350,000 enrollees. PATIENTS: Three hundred forty-seven patients with asthma who received at least two prescriptions for either fluticasone or a leukotriene modifier. Patients receiving both fluticasone and a leukotriene modifier were excluded. MEASUREMENTS AND MAIN RESULTS: Multivariate analysis was used to compare total asthma-related costs between treatment groups. A significant difference in total asthma-related costs was found between patients receiving fluticasone (adjusted mean cost $511) compared with those receiving a leukotriene modifier ($1,092; p=0.0001). Other significant predictors of postindex asthma-related costs were pre-index asthma-related costs, a severity adjustment score, and the diagnosis of chronic obstructive pulmonary disease. Patients taking a leukotriene modifier obtained more short-acting beta-agonists than patients receiving fluticasone (6.49 +/- 4.05 vs 4.30 +/- 3.41, p < 0.0001). A survival analysis of time to receive any additional controller therapy revealed that patients receiving fluticasone were significantly less likely to receive another controller than were those receiving a leukotriene modifier (p=0.0014). CONCLUSION: These results suggest that fluticasone is associated with lower asthma-related costs than leukotriene modifiers.

Adult↗
PubMed2005

Spectrophotometric titration of cobalt(II) with CaCl2 in mixed solvents of 2-propanol and water for the analysis of the extraction mechanism of cobalt(II) by salting-out in the presence of CaCl2.

The spectrophotometric titration of cobalt(II) with CaCl2 was carried out in mixed solvents of 2-propanol and water at different solvent compositions of 2-propannol, water and CaCl2 to analyze the salting-out extraction mechanism of Co(II) by the addition of CaCl2 from the mixed solvents. The formation constants of betaCoCl4(2-) = [CoCl4(2-)][Co2+](-1)[Cl-](-4) in both the organic and aqueous phases were determined thorough non-linear regression of the spectrophotometric titration data by a computer program SPECFIT/32. The values of log betaCoCl4(2-) in the aqueous phases were -4.26 +/- 0.03, -4.03 +/- 0.07, -3.83 +/- 0.04, -3.69 +/- 0.03 and -3.46 +/- 0.01 at mole fractions of 2-propanol of 0.026, 0.023, 0.017, 0.014 and 0.012, respectively, and at [CaCl2]/mol dm(-3) values of 3.555 (I = 10.6), 4.276 (I = 12.8), 4.916 (I = 14.7) and 5.444 (I = 16.3), respectively. The formation constants of [CoCl4(2-)] in the organic phase were 5.70 +/- 0.06, 5.44 +/- 0.03, 5.36 +/- 0.06, 5.10 +/- 0.04 and 4.84 +/- 0.05 at mole fractions of water of 0.431, 0.441, 0.444, 0.447 and 0.451, respectively, and at [CaCl2]/mol dm(-3) of 0.941 (I = 2.8), 0.943 (I = 2.8), 1.013 (I = 3.0), 1.090 (I = 3.3) and 1.165 (I = 3.5), respectively. These results suggest the formation of [CoCl4(2-)] of 23-90% in the aqueous phase at the above mole fractions and the quantitative formation of [CoCl4(2-)] in the organic phase. The extraction percentage of [CoCl4(2-)] increased with an increase in [CaCl2]. The distribution constant, KD (= [CoCl4(2-)]org/[CoCl4(2-)]aq), however, decreased and became constant with [CaCl2]. The detailed extraction mechanism of Co(II) is discussed.

2-Propanol↗
PubMed1998

Patterns of expenditures and use of services among older adults with diabetes. Implications for the transition to capitated managed care.

OBJECTIVE: To examine health care use and expenditures among older adults with diabetes, investigate factors that are associated with higher expenditures, and describe the policy implications of caring for this population under managed care. RESEARCH DESIGN AND METHODS: A cross-sectional analysis of expenditures for individuals with diabetes over age 65 years from a nationwide 5% random sample of Medicare beneficiaries was conducted during 1992. All components of medical care covered under Medicare were examined. Multivariate analysis was used to assess the contribution of age, race, sex, number of diabetic complications, and comorbidity (Charlson Index) on total expenditures. RESULTS: On average, individuals with diabetes (n = 188,470) were 1.5 times (P < 0.0001) as expensive as all Medicare beneficiaries (n = 1,371,960). However, there were wide variations, with the most expensive 10% of beneficiaries with diabetes accounting for 56% of expenditures for individuals with diabetes and the least expensive 50% accounting for 4%. Acute care hospitalizations accounted for the majority (60%) of total expenditures, whereas outpatient and physician services accounted for 7 and 33%, respectively. There were no differences in the number of complications for all older adults with diabetes compared with those with the highest expenditures. However, the average number of hospitalizations was 1.6 times (0.53 vs. 0.34; P < 0.0001) higher, and the average length of stay was 2 days longer, among older adults with diabetes (P < 0.0001). In the regression model, age and male sex (factors currently used to set payment rates for Medicare managed care enrollees), and number of diabetic complications, but not race, were positively related to expenditures, yet had minimal predictive power (R2 = 0.0006). The addition of the Charlson Index, also positively related to expenditures, was able to explain up to 20% of the variation in total expenditures (R2 = 0.196). CONCLUSIONS: There are large variations in expenditures among older adults with diabetes. Because elderly beneficiaries with diabetes are more expensive than the average older adult, current Medicare capitation rates may be inadequate. To avoid selection bias and under-treatment of this vulnerable population under managed care, methods to construct fair payment rates and safeguard quality of care are desirable.

Age Factors↗
PubMed1978

Physical activity, motor development and self-concept: race and age differences.

To investigate the effect of organized physical activity on the development of specific motor skills (body coordination and self-concept) of elementary age children, 344 children from the ethnic origins, black and white, were administered the Schilling Body Coordination Test and the Martinek-Zaichkowsky Self-concept Scale for Children. Motor development (body coordination) and self-concept scores were significantly higher for the group who participated in the physical activity program than for controls who did not. There was a linear trend in motor skill improvement, with Grades 2, 3, 4, and 5 showing significantly higher gains than Grade 1. The self-concept scores indicated a significant decline for Grades 3, 4, and 5. There were no significant differences between blacks and whites. A two-way interaction was found between grade and race in motor development, with blacks demonstrating lower mean scores than whites in Grade 2 but higher mean scores in Grade 5. Correlations between self-concept and motor development were non-significant.

Black or African American↗
PubMed1996

The impact of Haemophilus influenzae type b vaccination in Sweden.

The number of patients with meningitis and bacteremia due to Haemophilus influenzae was studied in Sweden over the period 1987-1994. Conjugated H. influenzae type b vaccines were introduced in Sweden in 1992, and all children born after December 31, 1992, were offered vaccination free of charge. A rapid decline of H. influenzae meningitis and bacteraemia was observed in the autumn of 1993, when the expected peak incidence failed to appear. In the prevaccination period 1987-1991, the average annual incidence (cases/100,000) was 34.4 in children aged 0-4 years. In 1994, the annual incidence fell to 3.5. No significant decline was observed in older children or adults. There was a 92% reduction in the number of meningitis cases and an 83% reduction in cases of bacteraemia. A similar decline was noted in 2 regions which followed different strategies for the introduction of the vaccination programme.

Adult↗
PubMed1986

Purification of monkey prolactin from culture medium: biochemical and immunological characterization.

Serum-free culture medium, previously incubated with dispersed monkey pituitary cells, provided a relatively uncontaminated source for extraction and purification of 15 mg of monkey prolactin. N-terminal group analysis of this preparation, M21GB, produced predominantly leucine. The amino acid composition closely resembles that of both human and sheep prolactin. M21GB monkey prolactin migrates in 10% polyacrylamide with sodium dodecyl sulfate (SDS) as a single band with a molecular weight of about 23,000. Multiple bands typical of prolactins are seen with nondenaturing polyacrylamide disc electrophoresis. M21GB contains less than 1% growth hormone, incorporates radioactive iodine with a specific activity of 15 microCi/micrograms and specifically binds to the anti-human prolactin serum-3 provided by the National Hormone and Pituitary Program (B spec/total = 23%). M21GB does not compete in a linear fashion with iodinated human prolactin-16 for the human prolactin antiserum, but M21GB does compete in a linear fashion with iodinated M21GB with the same antiserum. Monkey serum, pituitary homogenate, and culture medium containing unknown levels of monkey prolactin are not parallel with NIAMDD-HPrl-RP1 in the human prolactin assay, but are parallel when M21GB is used as the reference preparation and for iodination. Finally, antisera to M21GB were generated in rabbits which are specific for monkey and human prolactin and which can be used for radioimmunoassay or immunocytochemistry. In summary, serum-free medium from primary cultures of dispersed monkey pituitaries provided a quantitity of monkey prolactin which promoted biochemical analysis and production of a specific antiserum. This culture system may be a unique and ongoing source for extraction of significant quantities of monkey prolactin suitable for investigative use.

Amino Acids↗
PubMedDate not supplied

[Synchronous automated analysis of a spirogram and cardiac intervalogram].

The paper deals with the functional diagnosis based on the synchronous analysis of a spirogram and a cardiac intervalogram (CIG) by evaluating respiratory sinus arrhythmia (RSA). A method based on the calculation of R-R interval differences in separate breathing cycles is used for automated reckoning of RSA. A band-pass filter is employed to separate out a respiratory constituent of CIG. The programmed algorithmic use of the method is based on a linear selective transformation that is a general procedure for morphological analysis of cardiac signals in real time.

Algorithms↗
PubMed1999

[The trend in pregnancies terminated by a cesarean operation in Mexico during 1991-1995].

In the last decades has been a worldwide trend to increase the number of cesarean sections as an alternative of obstetric resolution, phenomenon for which it was proposed a variety of explanation, this fact remains practically unknown in the institutions of the National Health System (NHS) in Mexico. To identify the trend of the pregnancy to end for cesarean sections during the years of 1991-1995 in the 32 states of de country, as well as of all the institutions of the National Health System. Descriptive, cross sectional and retrospective. We use the data of the Bureau of Statistics and Informatics of de Health Ministry of each one of the 32 states of the country, of the years 1991 to 1995, and of the number of cesarean sections made in the hospitals of the different institutions of the NHS. We started off with a data-base, to calculate frequency tables, and the specific rate of the cesarean section for each year, for each one of the states and institutions of the NHS. We calculate the secular trends using the annual rates of cesarean section, for each one of the states and institutions of the NHS. We also made bivariate analysis and estimated the odds ratio (OR) and 95% Confidence Interval (95% IC); and the statistic X2 for trend, setting the two tailed statistic significance level of 0.05. During the study period, there was 7,503,817 births in all hospitals of the NHS, of these births 1,929,865 (25.72%) was resolved by cesarean section. For the whole period it there was a clear trend to increment of the cesarean section, the rate for 1991 was 20.44%, and by 1995 was 28.58%, the raise for the period was 39.82%, with values of the OR for trend of 1.56; 95% IC (1.55-1.57). "P" < 0.05. The rate for institutions attending open population had an increment of 35.08% [OR trend 1.45; 95% IC (1.43-1.46), "p" < 0.05], of them the highest rate was for the State System of Health in 1995 with 29.78%, the rates for the remaining institutions varied from 16.57% for the IMSS/SOLIDARIDAD and 21.7% for the Health Ministry, all trends were statistically significant. In relation to the institutes attending closed population the raise was of 53.27% [OR trend 1.82; 95% IC (1.81-1.83), "p" < 0.05], with the highest rate for the National Defense Ministry which had a rate of 51-15%, the rates for the remaining institutions varied from 33.52% for the Mexican Institute of Social Security (IMSS) to 43.89% for the Institute of Safety and Social Services for the State Workers (ISSSTE), with exception of the Management of the Medical Services of the Mexican Oils (PEMEX) and the Marine Ministry (SECMAR), all trends were statistically significant. When the analysis of the cesarean section rates for the 32 states of the Mexican Republic was carried out, we found that in 1995, the national average rate was 28.58%, the lowest rate corresponded to the state of Zacatecas with 19.82% and the highest to the state of Nuevo León with 42.14%. There was a tendency to increment for all states which varied from 23.55% for the state Chiapas and 67.97% for the states of Querétaro, all increments were statistically significant. We conclude, that rates of cesarean section for both, institutions of NHS and states of the Mexican Republic, are of the highest in the world, no matter what big the interinstitutional and interstate variation are. The highest rates occurred in institutions attending closed population, and the states with a higher degree of socioeconomic development.

Cesarean Section↗
PubMed2001

Financial risk, plan types, and authorizations for managed alcohol treatment services.

OBJECTIVE: To estimate the effects of a managed behavioral healthcare organization's (MBHO's) products/plans and financial risk on levels and amount of care authorized for patients with alcohol-related problems. STUDY DESIGN: Secondary analysis of 1995-1998 MBHO authorization files. PATIENTS: Individuals diagnosed as having an alcohol-related problem without comorbidities. METHODS: Episodes (n = 10,872) were constructed with 60-day clear zones. Multinomial regression equations were used to analyze the proportional distribution of care authorized within episodes at 5 levels: inpatient, residential, partial hospitalization, intensive outpatient, and traditional outpatient. Care equivalency hours were calculated to combine data across outpatient sessions and inpatient days. A linear regression equation analyzed quantity of care within episodes. Product/plan types, financial risk, state of residence, and participation in the MBHO's network were explanatory variables. Age, sex, diagnosis, and episode number were control variables. RESULTS: Most utilization management care hours authorized are inpatient and residential. Relative to other products/plans for managing care, utilization management leads to 50% more authorized hours. More financial risk does not predict fewer care units authorized but shifts hospitalizations toward residential treatment. Increasing age and higher-severity diagnoses predict more overnight care authorizations. Pennsylvania, which mandates minimum levels of care and follows American Society of Addiction Medicine criteria, has significantly more care authorized compared with 8 other states with data. CONCLUSIONS: Other than in utilization management, MBHO financial risk does not predict less care authorization. The MBHO authorizes higher-level care for older adults, for those with more severe diagnoses, and for those with episodes of care beyond the second. Authorization data do not necessarily reflect utilization but can provide a useful, partial view of management strategies.

Adult↗
PubMed1992

Correction of emission spectra in microspectrofluorimetry using a reference lamp: computations.

Accurate correction of emission spectra in microspectrofluorimetry, using a reference lamp, may require that a factor for the emissivity of tungsten be introduced. This is only possible provided that the true temperature of the lamp filament is known. A method is given for obtaining the true temperature from the knowledge of the colour temperature. Also, the values of the spectral concentration of the radiance of the black body, either computed according to Planck's equation or taken from available published tables, have to be converted from energetic units to units of quanta since the photomultiplier is linear not to absorbed power but to units of quanta. When the fluorescence spectra to be corrected extend into the far red it is preferable to use a lower temperature (by lowering the supply voltage) than that for which the lamp is certified. It is possible to determine the new temperature (and then the corresponding spectral distribution) by taking a few pairs of measurements at different wavelengths both at the lower voltage and at the voltage for which the lamp is certified and then introducing these values in a non-linear regression soluble on a PC with a curve fitting program. The microscope tungsten halogen lamp can conveniently be used as a reference, thanks to its small size and its steady spectral characteristics. When high accuracy is required, however, the halogen lamp should be calibrated against a certified ribbon filament lamp.

Flow Cytometry↗
PubMed2004

Effect of static stretch on fatigue of lumbar muscles induced by prolonged contraction.

Low back pain (LBP) is believed to be the result of fatigue of the back extensor muscles induced by prolonged contraction. Although static stretch has been considered to promote recovery from such muscle fatigue by relaxation, little is known about the effect of stretch on muscle fatigue, especially in the back extensor muscles. The purpose of this study was to investigate the effect of static stretch on prolonged contraction-inducedfatigue of the back extensor muscles using electromyographic (EMG) spectral analysis in ten healthy volunteers. Bipolar surface electrodes were placed on the longissimus and the multifidus muscles. EMG signals were collected during two trials of a Sorensen trunk-holding test for two minutes, with a five-minute rest period between the two trials (control test). All subjects were asked to perform the same trials, with one-minute of static stretch and a four-minute rest period (stretch test). Maintaining the knees toward the chest in supine position resulted in static stretch. The median frequency (MF) was calculated using a spectrum analysis program, and the MF slope over time was computed by linear regression analysis, and normalized with the y-intercept. The decreasing rate of the normalized MF slope between two trials in two tests was compared. The decreasing rate of the normalized MF slope of the second trial was larger than that of the first trial in the control test (p < 0.05), but no significant difference was observed in the stretch test. The results indicated that static stretch had a significant effect on the recovery from fatigue of the back extensor muscles, since it influenced the decreasing rate of the normalized MF slope.

Adult↗