Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Data Adjustment”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 163 records · Page 9Linked to original sources
PubMed1995

MOMs (multiples of the median) and DADs (discriminant aneuploidy detection): improved specificity and cost-effectiveness of biochemical screening for aneuploidy with DADs.

OBJECTIVE: Our purpose was to assess the efficacy of double- and triple-screening paradigms for Down syndrome and to develop a more logical, statistical approach to risk prediction that will decrease the cost of screening and allow the incorporation of new parameters appropriately weighted for their contribution. STUDY DESIGN: Data from 24,504 patients who had biochemical screening for Down syndrome by single (alpha-fetoprotein), double (alpha-fetoprotein, beta-human chorionic gonadotropin), or triple screening (alpha-fetoprotein, beta-human chorionic gonadotropin, unconjugated estriol) who had complete outcome information were analyzed by (1) existing gaussian-based methods, (2) the Glasgow ratio method, and (3) a new statistical approach (i.e., directly adjusted data sets for discriminant aneuploidy detection [DADs]) RESULTS: By use of individual risk-based thresholds for "at risk" status, both double and triple screening performed far better than single screening, but the percentages of patients at risk varied widely. When the percentages at risk were held constant, the sensitivity of double and triple screenings was similar, suggesting that there are no benefits of using estriol as a third marker. For 25,000 patients the use of only alpha-fetoprotein and beta-human chorionic gonadotropin would save about $500,000, with no decrease in sensitivity. With the DADs approach a statistically sound model giving more stable estimates was developed that permits each factor to be analyzed for its own explained proportion of variance and allows each parameter to have different weighting. For this data set the same sensitivity was seen with, conservatively, a 1% reduction in the percentage of patients at risk, which would reduce by 250 the number of amniocenteses, at a further savings of about $400,000. CONCLUSIONS: By use of existing methods, double screening is equally as effective as triple screening, so that the expense of estriol is unnecessary. The DADs approach, by allowing for variable weighting of parameters, lowers the at risk percentage and will permit a much more flexible approach as new parameters become available. Changing to DADs and eliminating estriol should achieve higher specificity for the same sensitivity and save, conservatively, about $900,000 in this series. Extrapolated nationally, if confirmed, the annual savings could approach $72,000,000.

Adolescent↗
PubMed2002

Outpatient encounter data for risk adjustment: strategic issues for Medicare and Medicaid.

Payers are increasingly using diagnostic data from outpatient encounter records to adjust the payment to health plans. Although much has been written about the ability of such data to predict health care costs, little has been written about the data itself--its quality and availability. Fee-for-service (FFS) data face several threats to their validity, including the possibility that they may seriously underreport diagnoses. Because the systems and incentives that yield FFS and managed care diagnosis data are quite different, they may not be comparable, depending on circumstances such as audit rules. The next generation of risk adjustment models should be designed around the capabilities and potentialities of plans' information systems.

Abstracting and Indexing↗
PubMed1995

Does recollection error threaten the validity of cross-sectional studies of effectiveness?

New cross-sectional studies have been designed to evaluate therapeutic effectiveness of medical and surgical treatments. The extent to which error in recollection may threaten the validity of conclusions reached in these studies has not been determined. The purpose of this research was to evaluate the impact of recollection error by comparing patients' prospectively acquired reports about their condition before total hip replacement with their recollections of their preoperative condition obtained several years after surgery. A total of 104 patients prospectively completed the Hip Rating Questionnaire (HRQ), a valid, reproducible, responsive, disease-specific scale composed of four domains (pain, walking, function, and impact of hip arthritis on overall health). These same patients then completed the HRQ several years after surgery by recalling their preoperative condition. Current postoperative condition was also obtained several years after surgery with the HRQ. Patient characteristics include: 55% were women, mean age was 67 years, 90% had osteoarthritis, 78% had no prognostically significant comorbid disease, and the mean time interval between surgery and recall was 2.5 years. Comparison of prospective and recalled responses with the weighted kappa and intraclass correlation coefficients showed poor to fair agreement in three domains, and moderate agreement in the fourth domain. Overall, the directions of the recollection errors were toward patients' recalling more pain, better walking, better function, and worse impact of hip arthritis on health than they reported before surgery. When the data were stratified to determine if there were systematic biases among major patient subgroups, there were discrepancies in the percentage of patients within each subgroup who had recollection error for the different domains, as well as differences in the magnitudes and directions of the recollection errors. These results indicate that relying on patients' recollections does not provide an accurate measure of preoperative state, and that attempting to adjust data is not feasible because the directions and magnitudes of recollection error vary for major subgroups of patients. In addition, when outcome was assessed using postoperative HRQ responses, the cross-sectional data overestimated the effectiveness of total hip replacement in 68% of patients. It is concluded that cross-sectional data do not accurately portray baseline preintervention condition and therefore can lead to overestimating, as in this instance, or to underestimating effectiveness.

Adult↗
PubMed1983

Estimates of birth prevalence rates of spina bifida in the United States from computer-generated maps.

A computer-generated mapping procedure was developed to estimate geographic and race-specific birth prevalence rates of open spina bifida. The estimates are based on birth certificate data adjusted for underascertainment. Separate maps were produced for white births and black births. For both races there is a general decreasing rate of spina bifida from east to west. The highest rates are eight per 10,000 total births for whites in Southern Appalachia, and the lowest rates are less than one per 10,000 for blacks in the Rocky Mountain states and the Pacific Northwest. Until more exact data are available, these maps represent the best current available data on racial and geographic birth prevalence rates in the United States. They are useful for program planning and as an aid in interpreting maternal serum alpha-fetoprotein levels to detect neural tube defects.

Black or African American↗
PubMed2001

Prevalence and correlates of smoking and sexual activity among Hong Kong adolescents.

PURPOSE: To report on the prevalence and correlates of smoking and sexual activity in a community sample of Hong Kong Chinese adolescents. METHODS: Participants (N = 4116) aged 13 to 18 years were surveyed regarding smoking and physical heterosexual activity, relationships with family members, family involvement, social support, school performance and emotional adjustment. Data were analyzed using logistic regression analyses. RESULTS: About 30% of participants reported ever smoking and 3.5% reported sexual intercourse. Current smoking was correlated with age, school performance and quality of relationship with mother. Sexual intercourse was correlated with age, gender, family involvement and social support. Smoking and sexual activity were significantly correlated with each other. Smoking and increasing levels of heterosexual physical contact were negatively correlated with emotional adjustment, even after controlling for common predictors to health-endangering behaviors and emotional adjustment. CONCLUSIONS: Smoking and sexual activity among adolescents are far less common in Hong Kong than in the West and their presence in a Hong Kong adolescent should alert the health practitioner to the possibility of significant psychosocial stress and maladjustment.

Adolescent↗
PubMed2003

Doxorubicin in combination with fluorouracil and cyclophosphamide (i.v. FAC regimen, day 1, 21) versus methotrexate in combination with fluorouracil and cyclophosphamide (i.v. CMF regimen, day 1, 21) as adjuvant chemotherapy for operable breast cancer: a study by the GEICAM group.

BACKGROUND: The purpose of this study was to determine the relative efficacy of doxorubicin versus methotrexate in combination with intravenous cyclophosphamide and 5-fluorouracil (FAC versus CMF) as adjuvant chemotherapy for operable breast cancer. PATIENTS AND METHODS: Over a 4-year period, 985 women undergoing curative surgery for breast cancer (T1-3 N0-2 M0, stage I-IIIA, UICC) from nine hospitals were stratified with respect to axillary node involvement (node positive versus node negative) and randomized to receive either FAC (500/50/500/m(2)) every 3 weeks for six cycles or CMF (600/60/600/m(2)) every 3 weeks for six cycles. RESULTS: The relative dose intensities of FAC and CMF were 87% and 85% of planned doses, respectively. Unadjusted data indicated a non-significant trend towards better results with FAC. In the prospectively formed subset of node-negative patients, disease-free survival and overall survival were statistically superior in the FAC treatment arm (P = 0.041 and 0.034, respectively), but this advantage was not seen in the subset of node-positive patients, probably because of a difference in the percentage of patients with four or more positive nodes. Adjusting data for size of treatment effect and potential interactions (number of positive nodes, tumor size, treatment center), the overall relative risk (RR) of disease recurrence and death were significantly lower with FAC treatment (RR 1.2, P = 0.03, and RR 1.3, P = 0.05, respectively). This result was mainly due to the difference observed in the node-negative patient population. Toxicity was mild: FAC induced more alopecia, emesis, mucositis and cardiotoxicity; this last was of clinical concern, but was infrequent and manageable. CMF induced more conjunctivitis and weight gain. There were no toxic deaths. CONCLUSIONS: Doxorubicin in combination with day 1 i.v. cyclophosphamide and 5-fluorouracil is superior to methotrexate in combination with day 1 i.v. cyclophosphamide and 5-fluorouracil as adjuvant chemotherapy for operable breast cancer. A treatment effect is particularly evident in the node-negative patients. Although the clinical toxicity of FAC is greater than that of CMF, the levels were manageable and clinically acceptable.

Adolescent↗
PubMedDate not supplied

Effect of treadmill exercise on circulating thyroid hormone measurements.

OBJECTIVES: Effects of exercise on circulating thyroid hormone (TH) values remain controversial. We sought to observe the effect of treadmill exercise on serum TH values in highly selected subjects. METHODS: Twenty-six healthy male military recruits aged 23-27 (mean, 25) years were studied. All had maintained identical diet and physical activity for a week before the test. Serum samples were drawn before (baseline) and immediately, 1, 4, 24, 24 and 48 h after maximal exercise (on a treadmill, Bruce protocol). All subjects completed the protocol with normal ECG results. Specimens were analyzed to measure 3,3',5-triiodothyronine (T(3)), thyroxine (T(4)), free T(4) (FT(4)), free T(3) and thyroid-stimulating hormone (TSH) in the same assays. To determine the possible effect of hemodynamic changes, hematocrit (Hct)-adjusted data were also compared. RESULTS: Hemoconcentration, as reflected by increased Hct, was found immediately after exercise. No significant changes of serum mean TH values before and after exercise were found except for TSH, which increased significantly immediately after exercise (1.72 vs. baseline 1.42 IU/l, p < 0.01). Values for T(3), T(4), and TSH increased significantly immediately after exercise, as compared to other postexercise values. However, the changes became insignificant after Hct adjustment. The FT(4) values showed a reciprocal increase after exercise that became significant after Hct correction. Significantly negative correlation was found between FT(4) and TSH values, but these values were still well within the normal range. CONCLUSIONS: Maximal treadmill exercise does not greatly affect the determination of concentrations of circulating THs.

Adult↗
PubMedDate not supplied

Lung function and methacholine responsiveness among adolescents in an air-polluted area.

BACKGROUND: Outdoor air pollution is hazardous to human pulmonary health. Airway inflammation is an important cause of bronchial hyperresponsiveness. Information is not univocal about the potential effects of prolonged exposure to environmental air pollutants on lung function. OBJECTIVES: A cross-sectional study was performed to assess bronchial responsiveness to methacholine in children living in an air-polluted area. Afterwards, the same study protocol was repeated in children of similar age living in mountain valleys with virtually no air pollution. METHODS: Every child underwent a lung function test, skin tests to common allergens, total serum levels of IgE, and a challenge to methacholine at increasing doses (PD20 FEV1). Subjects were 246 children 11-12 years old living in an air-polluted area, and 285 children 11-13 years old living in mountain valleys. Respectively, 156 and 161 were negative to skin tests and had serum total IgE<100 IU/ml, and had no asthma or other recurrent or ongoing respiratory symptoms. RESULTS: Lung function data, adjusted for the effect of potential confounders showed significantly lower FVC, and even more so FEV1, in the children from the polluted area. After the exclusion of subjects with positive skin tests and serum total IgE>100 IU/ml and those with history of asthma or respiratory disorders, there were higher percentages of positive responses in the challenge to methacholine in children from the polluted area (28.9 vs. 15.5%, p<0.001). CONCLUSIONS: These data may corroborate the possible importance of long exposure to air pollutants on the prevalence of bronchial aspecific hyperresponsiveness in otherwise normal children.

Adolescent↗
PubMedDate not supplied

The cost and efficiency of hospital care provided by primary care physicians and medical subspecialists.

There is a perceived excess of subspecialists compared with primary care doctors, but there are few severity-adjusted data that characterize the care provided by these physician groups. In a nationwide hospital network, we studied outcomes of 17,185 patients who were hospitalized for 1 of 9 common internal medicine illnesses. For 4 of 9 conditions, the subspecialists treated more severely ill (P < .001) patients. The raw total charges for their care were higher (P < .002) for 4 of 9 conditions and longer stays were required for 2 conditions. After adjusting for severity of illness, differences between the physician groups became minimal. In nine-severity adjusted medical illnesses, subspecialists and primary care physicians provide care that produces similar results for length of stay, charge, and mortality. Health care manpower projections should be re-evaluated in light of this information.

Adult↗
PubMed2001

DiasNet--a diabetes advisory system for communication and education via the internet.

Intensive diabetes treatment can lead to a substantial reduction of the rate of the complications associated with diabetes. However, a number of patients may have poor control despite specialist care, and this along with devolution of care to non-specialists suggests that alternative interventions should be developed. The present paper describes an Internet based system where more emphasis is put on patient empowerment, the keywords being education and communication. The DiasNet system is based on a well documented decision support system, Dias, designed for use by clinicians. The scope of DiasNet has been widened from being used by clinicians to give advice on insulin dose, to also being used by patients as a tool for education and communication. Patients can experiment with their own data, adjusting insulin doses or meal sizes. In this way different therapeutic and dietary alternatives can be tried out, allowing the patient to gain experience in achieving glycaemic control. DiasNet is implemented in JAVA according to the client/server principle, enabling a new way of communication between patient and clinician: in case of any problems, the patient simply phones the clinician, who immediately, using his or her office PC, can take a look at the data the patient has entered.

Blood Glucose↗
PubMed2006

Racial/ethnic differences in diabetes care for older veterans: accounting for dual health system use changes conclusions.

BACKGROUND: Veterans Health Administration (VHA) databases are used extensively to study racial/ethnic disparities; however, these databases may not capture all care received by VHA patients. OBJECTIVES: We examined the extent to which accounting for non-VHA care changed conclusions about racial/ethnic disparities for VHA patients with diabetes. METHODS: Using a cross-sectional observational study, we analyzed a national sample of noninstitutionalized Hispanic (n = 5931), black (n = 24,670), and white (n = 149,222) VHA patients with diabetes who were at least 65 years of age for receipt of annual HbA1c testing, low-density lipoprotein (LDL) cholesterol testing, or eye examination from VHA and Medicare administrative files. RESULTS: In VHA alone data, adjusting for patient characteristics, Hispanic and black patients were as likely as white patients to receive HbA1c testing (odds ratio 1.06 [95% confidence interval 0.99-1.13] and 1.04 [1.00-1.07], respectively), and more likely to receive eye examinations (1.31 [1.24-1.38] and 1.33 [1.29-1.37], respectively). Hispanic patients were equally likely (1.01 [0.95-1.07]) and black patients were less likely (0.81 [0.79-0.84]) to receive LDL testing versus white patients. In VHA plus Medicare data, Hispanic and black patients were less likely than white patients to receive HbA1c (0.76 [0.71-0.82] and 0.83 [0.80-0.87], respectively) and LDL testing (0.84 [0.79-0.90] and 0.70 [0.68-0.72], respectively), and equally likely to receive eye examinations (0.91 [0.86-0.96]) and 0.98 [0.95-1.01]), respectively). Accounting for VHA facility had little effect on results. CONCLUSIONS: Restricting to VHA data masks racial/ethnic disparities in care of VHA patients. VHA researchers must be aware and supplement VHA data with other sources whenever possible.

Black or African American↗
PubMedDate not supplied

Male breast cancer: Austrian experience.

Data were collected on 169 men treated for breast cancer at 36 surgical departments in Austria between 1970 and 1991. We report here several of their clinical features and assess the importance of established prognostic factors. After a median observation period of 51 months 60 patients (35%) suffered a recurrence. The estimated 5-year recurrence-free survival for the entire group was 55%, and the estimated 5-year overall survival was 62%. Although stage-adjusted data are comparable to those for female breast cancer, the outcome in this series may be attributed to a relatively high frequency of advanced tumor stages. Tumor size (recurrence-free survival p = 0.00001; overall survival p = 0.03) and axillary lymph node status (recurrence-free survival p = 0.0001; overall survival p = 0.0001) proved to have a prognostic impact. Using a multivariate analysis, axillary lymph node status (recurrence-free survival p = 0.001; overall survival p = 0.01) still had prognostic influence. The various procedures used had no effect on local recurrence.

Adult↗
PubMed1986

Relationship of angiographically defined coronary artery disease to serum lipoproteins and apolipoproteins in young survivors of myocardial infarction.

The relationship of serum lipoprotein and apolipoprotein concentrations to angiographically determined coronary artery disease was investigated in 105 consecutive male survivors of myocardial infarction under the age of 45. Concentrations and composition of lipoproteins, lipid indexes, and nonlipid risk factors (tobacco consumption, hypertension, reduced glucose tolerance, and obesity) were related to a recently developed scoring system for semiquantitative estimation of diffuse coronary atheromatosis, as well as to the number and severity of significant coronary artery stenoses. The concentrations of cholesterol in very low-density lipoprotein (VLDL), low-density lipoprotein (LDL), and high-density lipoprotein (HDL), in combination with serum triglyceride or VLDL triglyceride level, comprised the best set of independent discriminatory lipid variables between patients and control subjects. In the patients, LDL cholesterol and apolipoprotein B levels showed strong relationships to the extent and severity of coronary atheromatosis but not to the number and severity of distinct coronary stenoses. HDL2 cholesterol concentration correlated inversely with the coronary atheromatosis score, whereas other variables reflecting HDL concentration and composition or VLDL lipids were not independently related to any of the coronary scores. The LDL triglyceride level, an index of intermediate-density lipoprotein (IDL) accumulation, was significantly correlated to the coronary atheromatosis score in univariate analysis. Nonlipid risk factors were correlated neither to coronary atheromatosis nor to severity of stenoses. Stepwise multiple regression analyses of data adjusted for age, cumulative tobacco consumption, and weight indicated that 18% of the variation in the coronary atheromatosis score could be accounted for by levels of apolipoprotein B. Addition of other lipoprotein variables or the nonlipid variables hypertension and glucose tolerance did not significantly increase the value of R2. When ratios of lipoprotein lipids and apolipoproteins were included in the regression model, the highest multiple correlation coefficient was obtained with the LDL/HDL cholesterol ratio alone (R2 = .22). The present data demonstrate the importance of elevated LDL cholesterol and apolipoprotein B concentrations for the development of coronary atheromatosis in young male survivors of myocardial infarction. The lack of correlations between the levels of lipoprotein lipids and serum apolipoproteins and the severity of coronary stenoses suggests that mechanisms other than disturbances of lipoprotein metabolism may be involved in the progression of more advanced coronary lesions.

Adult↗
PubMed1984

Admixture analysis of plasma cholesterol levels in a Jewish population sample in Jerusalem.

The frequency distribution of total plasma cholesterol levels (TC) in 17-year-old Jerusalem youngsters and their parents (n = 6,170) was examined for evidence of admixture of normal distributions. Probability plots indicated bimodality of age-adjusted TC in both sexes. Using a maximum likelihood procedure, two normal distributions fitted the age- and sex-adjusted data significantly better than 1, with 0.9% males and 1.2% females coming from a lower distribution 2-3 standard deviations below the major mode and 0.2% males and 1.1% females belonging to the higher distribution. These results suggest that single genes may determine high as well as low cholesterol levels, but are open to other interpretations, and thus require confirmation by segregation analysis. Jews originating from Europe showed the highest TC levels followed by those from Israel, Asia, and Africa. Adjustment of TC for ethnicity did not alter the above estimates. Analysis of bimodality within countries of origin showed greater separation of the distributions in Asian and Israeli origin groups than in European and North African groups, in whom there was less evidence for admixture.

Adolescent↗
PubMedDate not supplied

Urinary cadmium and beta 2-microglobulin: normal values and concentration adjustment.

Approximately 1000 urine samples were collected from the general adult U.S. population and were analyzed for cadmium, beta 2-microglobulin, specific gravity, and creatinine. The distributions of urinary cadmium and beta 2-microglobulin levels were quantified for use as benchmarks against which the effects of environmental cadmium exposure may be measured. Urinary cadmium is significantly higher in females than males, and increases significantly with age. Urinary beta 2-microglobulin is significantly higher in males than females, is probably related to age, and does not significantly increase with increased urinary cadmium (at the levels found). Since urinary creatinine is lower in females than males and is a function of age, specific gravity is concluded to be the most straightforward and practical parameter to use in data adjustment for urine concentration.

Adult↗
PubMed2001

Improved antimicrobial interventions have benefits.

Studies have shown benefits to patients from improved interventions involving antimicrobial therapy. The purpose of the present study was to evaluate prospectively the impact of improved interventions by (i) the use of TheraTrac 2, a computer software program which electronically links susceptibility testing results immediately to the pharmacy and alerts pharmacists of potential interventions, and (ii) the education of pharmacists involving microbiologic topics. The study group had the new intervention program. The control group had interventions performed the way that they had previously been done by manually reviewing hard copies of susceptibility testing data. In a 5-month period, all inpatients whose last names began with A to K were the study group; inpatients whose last names began with L to Z were controls. Three analyses were done; one analysis (analysis A) involved only patients with interventions, one analysis (analysis B) involved all patients for whom antimicrobial testing was done and who were matched for diagnosis-related groups (DRGs), regardless of whether an intervention occurred, and one analysis (analysis C) involved these DRG-matched patients by using severity-adjusted data. In analysis A, the study group had a 4.8% decreased rate of mortality, an average of a 16.5-day decreased length of stay per patient, and $20,886 decreased variable direct costs per patient. None of these differences was statistically significant. In analysis B, the study patients had a 1.2% higher mortality rate (P = 0.741), an average of a 2.7-day decreased length of stay per patient (P = 0.035), and $2,626 decreased variable direct costs per patient (P = 0.008). In analysis C, the study patients had a 1.4% lower mortality rate, a 1.2-day decreased length of stay per patient, and $1,466 decreased variable direct costs per patient. In conclusion, the institution of this program caused substantial cost savings.

Aged↗
PubMed2003

A cohort study of health effects of human T-cell lymphotropic virus type I infection in Jamaican children.

OBJECTIVE: Human T-cell lymphotropic virus type I (HTLV-I) infection in childhood is believed to play an important role in risk for adult T-cell leukemia/lymphoma. Although HTLV-I is known to be associated with infective dermatitis in childhood, other HTLV-I-associated morbidity in children has not been well studied. We sought to determine the HTLV-I-associated health effects in Jamaican children. METHODS: We compared incidence rates of several health outcomes in 28 HTLV-I-infected and 280 uninfected children clinically followed from age 6 weeks to a maximum of 10 years. Cox proportional hazards regression analysis was used to analyze these prospectively collected data, adjusting for confounding effects of other variables as necessary. RESULTS: HTLV-I-infected children had significantly higher incidence rates of seborrheic dermatitis (rate ratio [RR] = 4.8, 95% confidence interval [CI] = 1.9-12.5), eczema (RR = 3.1, CI = 1.2-7.9) and persistent hyperreflexia (RR = 3.7, CI = 1.6-8.2). Additionally, HTLV-I infected children had increased rates of severe anemia (RR = 2.5, CI = 0.8-7.9) and abnormal lymphocytes (RR = 2.4, CI = 0.8-7.6) that were of borderline statistical significance. CONCLUSIONS: Our study suggests that HTLV-I-associated skin diseases of childhood may include seborrheic dermatitis and eczema. Additionally, these data suggest that persistent hyperreflexia of the lower limbs may be an early sign of HTLV-I-associated neurologic involvement in children. Expansion and continued clinical observation of this cohort would be valuable.

Anemia↗
PubMedDate not supplied

[Human immunodeficiency virus infection and AIDS in Aquitaine. 10 years' experience of a hospital information system, 1985-1995. Le Groupe d'Epidemiologie Clinique du SIDA en Aquitaine (GECSA)].

OBJECTIVES: To describe the hospital-based information system developed by the GESCA (Clinical epidemiology group on AIDS in Aquitaine) and evaluate the main results obtained over the last 10 years, specifically data related to epidemiological monitoring, medico-economic analysis and clinical research in HIV infection. METHODS: Inclusion criteria were HIV-1 seropositivity confirmed by Western blot, age over 13 years, consultation or hospitalization is one of the 18 participating units. Follow-up data were collected at each hospital visit. RESULTS: On December 31, 1995, 4268 subjects had been registered in the GECSA system, including 25.7% women. Contamination categories were homosexuals 33.4%, intravenous drug abusers 32.8%, heterosexuals 13.9%. A clear drop in the number of new cases in intravenous drug abusers and an increase in the number with heterosexual transmission was observed after 1988. The medico-economic analysis showed that patients followed in the system were in a more advanced stage at registry since 1992. More than half of the subjects are now taking antiretroviral therapy and prophylaxis for opportunistic infections. Clinically, after adjusting data for the major known prognosis factors, the risk of progression to AIDS is higher in homosexuals and intravenous drug abusers than in heterosexuals. Transmission route does not however have any significant effect on survival after development of AIDS. There is no significant difference in outcome of HIV infection between men and women and pregnancy is not associated with poorer outcome. CONCLUSION: This regional registry provides valuable data for epidemiological monitoring, medico-economic analysis, hospital management and clinical research.

Acquired Immunodeficiency Syndrome↗