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National Data (national + data)
Terms modified by National Data Selected AbstractsPsychological Aggression by American Parents: National Data on Prevalence, Chronicity, and SeverityJOURNAL OF MARRIAGE AND FAMILY, Issue 4 2003Murray A. Straus This article describes the prevalence of psychological aggression in a nationally representative sample of 991 parents. By child-age 2, 90% reported using one or more forms of psychological aggression during the previous 12 months and 98% by age 5. From ages 6 to 17, the rates continued in the 90% range. The rate of severe psychological aggression was lower: 10%,20% for toddlers and about 50% for teenagers. Prevalence rates greater than 90% and the absence of differences according to child or family characteristics suggests that psychological aggression is a near universal disciplinary tactic of American parents. Finally, this article discusses the implications of the findings for the conceptualization of psychological "abuse," and for understanding the origins of the high level of psychological aggression between intimate partners. [source] Potential Savings from an Evidence-Based Consumer-Oriented Public Education Campaign on Prescription DrugsHEALTH SERVICES RESEARCH, Issue 5p1 2008Julie M. Donohue Objective. To estimate potential savings associated with the Consumer Reports Best Buy Drugs program, a national educational program that provides consumers with price and effectiveness information on prescription drugs. Data Sources. National data on 2006 prescription sales and retail prices paid for angiotensin-converting enzyme inhibitors (ACEIs), ,-blockers, calcium channel blockers, and 3-hydroxy-3-methylglutaryl coenzyme A (HMG-coA) reductase inhibitors (statins). Study Design. We converted national data on aggregate unit sales of drugs in the four classes to defined daily doses (DDD) and estimated a range of potential savings from generic and therapeutic substitution. Principal Findings. We estimated that $2.76 billion, or 7.83 percent of sales, could be saved if use of the drugs recommended by the educational program was increased. The recommended drugs' prices were 15,65 percent lower per DDD than their therapeutic alternatives. The majority (57.4 percent) of potential savings would be achieved through therapeutic substitution. Conclusions. Substantial savings can be achieved through greater use of comparatively effective and lower cost drugs recommended by a national consumer education program. However, barriers to dissemination of consumer-oriented drug information must be addressed before savings can be realized. [source] Forensic nursing in secure environmentsJOURNAL OF FORENSIC NURSING, Issue 3 2009Deborah Shelton PhD Abstract There are few well-designed studies of corrections or prison nursing roles. This study seeks to describe the corrections or prison role of forensic nurses in the United States who provide care in secure environments. National data detailing the scope of practice in secure environments are limited. This pencil and paper survey describes the roles of 180 forensic nurses from 14 states who work in secure environments. Descriptive statistics are utilized. A repeated measures ANOVA with post hoc analyses was implemented. These nurses were older than average in age, but had 10 years or less experience in forensic nursing practice. Two significant roles emerged to "promote and implement principles that underpin effective quality and practice" and to "assess, develop, implement, and improve programs of care for individuals." Significant roles varied based upon the security classification of the unit or institution in which the nurses were employed. Access to information about these nurses and their nursing practice was difficult in these closed systems. Minimal data are available nationally, indicating a need for collection of additional data over time to examine changes in role. It is through such developments that forensic nursing provided in secure environments will define its specialization and attract the attention it deserves. [source] ECONOMIC DEPRIVATION AND CHANGES IN HOMICIDE ARREST RATES FOR WHITE AND BLACK YOUTHS, 1967,1998: A NATIONAL TIME-SERIES ANALYSIS,CRIMINOLOGY, Issue 3 2001STEVEN F. MESSNER Using time-series techniques with national data for 1967,98, we model the effects on changes in age-race-specific arrest rates of changes in indicators of economic deprivation. A measure of child poverty is positively related to juvenile arrest rates for both races, whereas changing unemployment (lagged) yields a surprising negative effect on youth offending. Measures of intraracial income inequality are also associated with changes in juvenile arrest rates, but the effects differ by race. Between-race inequality is unrelated to changes in arrest rates for both races. Our general conclusion is that fluctuations in juvenile homicide offending over recent decades can be understood, at least in part, with reference to the macro-economic environment confronting young people and their families. [source] The Rationale for Developing Public Health Surveillance Systems Based on Emergency Department DataACADEMIC EMERGENCY MEDICINE, Issue 12 2000Jon Mark Hirshon MD Abstract. Emergency departments (EDs) are well positioned to provide national data on several aspects of public health. The large volume of patients seen annually, improving medical record technology, and emergency uniform data sets make the development of public health surveillance systems a realistic opportunity for emergency medicine. Such data could identify public health concerns and suggest interventions to improve the health of the nation. This article describes current concepts and status of ED surveillance systems, their advantages and disadvantages, the rationale for their existence, and recommendations to allow their continued consideration and development. [source] Carers and the digital divide: factors affecting Internet use among carers in the UKHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 3 2005Clare Blackburn BA (Hons) DipHE RHV RGN Abstract This paper presents data from a cross-sectional survey of 3014 adult carers, examining use of the Internet and factors associated with it. Carers recruited from the databases of three local authorities and other carer organisations within their geographical boundaries and that of Carers UK, a national carers organisation, were sent a postal questionnaire (response rate: 40%). A comparison of our data with national data on carers suggests some under-representation of men and younger adult carers and some over-representation of those who had been caring for long periods and those with substantial caring responsibilities. Two measures of Internet use were used and are presented in this analysis: previous use (ever used vs never previously used) and frequency (less than once a week vs once a week or more). Bivariate analyses identified patterns of Internet use and socio-demographic and socio-economic factors and caring circumstances associated with them. Factors significantly associated with each measure of Internet use were entered into direct logistic regression analyses to identify factors significantly associated with each measure. Half (50%) of all carers had previously used the Internet. Of this group, 61% had used it once a week or more frequently. Factors significantly associated with having previously used the Internet were carer's age, employment status, housing tenure and number of hours per week they spent caring. Frequency of Internet use was significantly associated with carer's age, sex, employment status and number of hours spent caring. Our study suggests that a significant number of carers may not currently be Internet users and that age, gender, socio-economic status and caring responsibilities shape Internet use in particular ways. Given the targets set by government for the development of online services, it is important to address the digital divide among carers and to continue to develop other services and information systems to meet the needs of those who do not access the Internet. [source] Potential Savings from an Evidence-Based Consumer-Oriented Public Education Campaign on Prescription DrugsHEALTH SERVICES RESEARCH, Issue 5p1 2008Julie M. Donohue Objective. To estimate potential savings associated with the Consumer Reports Best Buy Drugs program, a national educational program that provides consumers with price and effectiveness information on prescription drugs. Data Sources. National data on 2006 prescription sales and retail prices paid for angiotensin-converting enzyme inhibitors (ACEIs), ,-blockers, calcium channel blockers, and 3-hydroxy-3-methylglutaryl coenzyme A (HMG-coA) reductase inhibitors (statins). Study Design. We converted national data on aggregate unit sales of drugs in the four classes to defined daily doses (DDD) and estimated a range of potential savings from generic and therapeutic substitution. Principal Findings. We estimated that $2.76 billion, or 7.83 percent of sales, could be saved if use of the drugs recommended by the educational program was increased. The recommended drugs' prices were 15,65 percent lower per DDD than their therapeutic alternatives. The majority (57.4 percent) of potential savings would be achieved through therapeutic substitution. Conclusions. Substantial savings can be achieved through greater use of comparatively effective and lower cost drugs recommended by a national consumer education program. However, barriers to dissemination of consumer-oriented drug information must be addressed before savings can be realized. [source] Does Prospective Payment Really Contain Nursing Home Costs?HEALTH SERVICES RESEARCH, Issue 2 2002Li-Wu Chen Objective. To examine whether nursing homes would behave more efficiently, without compromising their quality of care, under prospective payment. Data Sources. Four data sets for 1994: the Skilled Nursing Facility Minimum Data Set, the Online Survey Certification and Reporting System file, the Area Resource File, and the Hospital Wage Indices File. A national sample of 4,635 nursing homes is included in the analysis. Study Design. Using a modified hybrid functional form to estimate nursing home costs, we distinguish our study from previous research by controlling for quality differences (related to both care and life) and addressing the issues of output and quality endogeneity, as well as using more recent national data. Factor analysis was used to operationalize quality variables. To address the endogeneity problems, instrumental measures were created for nursing home output and quality variables. Principal Findings. Nursing homes in states using prospective payment systems do not have lower costs than their counterpart facilities under retrospective cost-based payment systems, after quality differences among facilities are controlled for and the endogeneity problem of quality variables is addressed. Conclusions. The effects of prospective payment on nursing home cost reduction may be through quality cuts, rather than cost efficiency. If nursing home payments under prospective payment systems are not adjusted for quality, nursing homes may respond by cutting their quality levels, rather than controlling costs. Future outcomes research may provide useful insights into the adjustment of quality in the design of prospective payment for nursing home care. [source] Moral Cosmology, Religion, and Adult Values for ChildrenJOURNAL FOR THE SCIENTIFIC STUDY OF RELIGION, Issue 1 2007BRIAN STARKS We hypothesize that the religiously orthodox, who are theologically communitarian/authoritarian in seeing individuals as subsumed by a larger community of believers and as subject to timeless divine law, are more likely to value obedience in children over autonomy than are theological modernists, who are theologically individualistic in seeing individuals, not a deity, as the ultimate arbiters of right and wrong. We hypothesize further that differences in moral cosmology (orthodoxy vs. modernism) within faith traditions are more important for the values adults seek to instile in children than are differences between traditions. Through analyses of national data from the 1998 General Social Survey, we find strong confirmation of both hypotheses. Moral cosmology is the single-most important factor in valuations of obedience and autonomy in children. While evangelical Protestants differ from Catholics, mainline Protestants, and those with no religion in their values for children, moral cosmology is associated with differences in values for children within each of the faith traditions, including evangelical Protestants. We conclude that intra-faith differences in moral cosmology are key in explaining values for children, but have not completely supplanted interfaith differences. [source] Are News Reports of Suicide Contagious?JOURNAL OF COMMUNICATION, Issue 2 2006A Stringent Test in Six U.S. Cities Past evidence of suicidal contagion from news reports in the United States is based largely on national data prior to 1980 using proxies for suicide stories rather than local news sources. Our research examined more proximal effects of suicide news reporting for 4 months in 1993 in 6 U.S. cities controlling for a wide range of alternative sources of media and interpersonal influence. In addition, predictions for the effect based on suicide contagion theories were examined for 3 age groups (15,25, 25,44, and older than 44). Local television news was associated with increased incidence of deaths by suicide among persons younger than 25 years. Newspaper reports were associated with suicide deaths for both young persons and persons older than 44 years. An unexpected protective effect of television news reports was observed in the 25,44 age range; nevertheless, news reporting was associated with an aggregate increase in suicide deaths. The results support theories of media contagion but also suggest that media depiction can inhibit suicide among some audience members. [source] Calman,Hine reassessed: a survey of cancer network development in England, 1999,2000JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2002Beth Kewell BA PhD Abstract Rationale, aims and objectives,The paper assesses preliminary national data on the development of cancer care networks in England. Methods,In January 2000, a national postal survey was sent to lead clinicians at 36 cancer centres and associate centres. Respondents were asked to provide basic numerical data on the design of the network (i.e. its configuration), detailing how many units it encompassed, and whether the centre was a multiple or a single entity. Results,The survey highlighted national variations in the size and configuration of networks. The survey also highlighted tentative signs of shifts in clinical practice. The results showed that consultants at cancer centres and units were engaging in two forms of collaboration across centre,unit boundaries. Type 1 involved routine multidisciplinary team (MDT) outreach from centres to units, incorporating joint planning between clinicians at cancer centres and cancer units. Type 2 collaboration involved joint planning but also promoted joint centre and unit training and continuing professional development (CPD) programmes. Conclusions,In our estimation, both forms of collaboration represented early evidence of qualitative changes in medical working practices. Organizational changes within cancer services have moved swiftly since initial soundings were taken in 2000 and we update our initial commentary in the light of recent empirical data. The findings may be of wider significance to managers and health practitioners who are working towards the implementation of delivery network elsewhere in the UK National Health Service. [source] Reporting of adverse events following immunization in AustraliaJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 4 2005David Isaacs Abstract: It is an important component of any immunization programme that vaccine safety is monitored by carrying out surveillance for adverse events following immunization (AEFI). Such surveillance can be active or passive. Active surveillance will detect more AEFI, but the vast majority will be minor events. Passive surveillance is probably more appropriate for routine AEFI surveillance, while active surveillance can be used to monitor a new vaccine or to test whether a specific severe event is significantly associated with immunization. Australia has a predominantly passive surveillance system. The system has recently been centralized, providing useful national data on vaccine safety. [source] Students' Perceptions of Prosthodontics in a PBL Hybrid CurriculumJOURNAL OF PROSTHODONTICS, Issue 6 2008Cortino Sukotjo DDS Abstract Purpose: A survey was distributed to the Harvard School of Dental Medicine (HSDM) predoctoral student classes of 2005 and 2006 to assess their perceptions regarding preclinical prosthodontics laboratory exercises. Prosthodontics curriculum clock hours, prosthodontics teaching participation, and plans for specialization were also analyzed. We hypothesized that reduced hours and perceived stress in the prosthodontics curriculum might impact students' choice of specialty at HSDM Materials and Methods: HSDM preclinical prosthodontics clock hours were compared with national means from published data. A survey was distributed to the HSDM classes of 2005 and 2006 (n = 70) at the end of their preclinical prosthodontics laboratory exercises, prior to students seeing their first patient in the clinics. Results: A 100% response rate was achieved. Results from this study show that HSDM preclinical prosthodontics clock hours are on average shorter than other schools. The majority of the students felt stressed during the laboratory exercises, and they felt they did not gain adequate knowledge from the lectures, resulting in low self-esteem (confidence) in treating patients in the clinic. Despite this perception, HSDM students do just as well, if not better, than other students, as judged by external and internal outcome measures. Graduate prosthodontics specialization is still a specialty of choice among the graduates when compared to national data. Conclusions: The shortened preclinical didactic and laboratory exercises in prosthodontics at HSDM affect student anxiety, but not their didactic and clinical performances or their decisions in choosing their graduate program. Problem-based learning (PBL) tutorials help the students to integrate preclinical and clinical knowledge and skills in prosthodontics. [source] Assessing Effectiveness of National Flood Policy Through Spatiotemporal Monitoring of Socioeconomic Exposure,JOURNAL OF THE AMERICAN WATER RESOURCES ASSOCIATION, Issue 1 2009Lauren A. Patterson Abstract:, After a century of evolving flood policies, there has been a steady increase in flood losses, which has partly been driven by development in flood prone areas. National flood policy was revised in 1994 to focus on limiting and reducing the amount of development inside the 100-year floodplain, with the goal of decreasing flood losses, which can be measured and quantified in terms of population and property value inside the 100-year floodplain. Monitoring changes in these measurable indicators can inform where and how effective national floodplain management strategies have been. National flood policies are restricted to the spatial extent of the 100-year floodplain, thus there are no development regulations to protect against flooding adjacent to this boundary. No consistent monitoring has been undertaken to examine the effect of flood policy on development immediately outside the 100-year floodplain. We developed a standardized methodology, which leveraged national data to quantify changes in population and building tax value (exposure). We applied this approach to counties in North Carolina to assess (1) temporal changes, before and after the 1994 policy and (2) spatial changes, inside and adjacent to the 100-year floodplain. Temporal results indicate the Piedmont and Mountain Region had limited success at reducing exposure within the 100-year floodplain, while the Coastal Plain successfully reduced exposure. Spatially, there was a significant increase in exposure immediately outside the 100-year floodplain throughout North Carolina. The lack of consistent monitoring has resulted in the continuation of this unintended consequence, which could be a significant driver of increased flood losses as any flood even slightly higher than the 100-year floodplain will have a disproportionately large impact since development is outside the legal boundary of national flood policy. [source] Privatization and Equity in Brazil and RussiaKYKLOS INTERNATIONAL REVIEW OF SOCIAL SCIENCES, Issue 4 2002Werner Baer This paper uses cross,national data from happiness surveys, jointly with data on per capita income and pollution, to examine how self,reported well,being varies with prosperity and environmental conditions. This approach allows us to show that citizens care about prosperity and the environment, and to calculate the trade,off people are willing to make between them. The paper finds that the effect of urban air pollution on subjective well,being shows up as a considerable monetary valuation of improved air quality. For instance, a representative German citizen would need to be given more than 1900$ per year in order to accept the typical urban air pollution level prevailing in Japan. The subjective marginal valuation of air pollution is compared with marginal abatement costs from the literature. [source] Mothers' citizenship status and household food insecurity among low-income children of immigrantsNEW DIRECTIONS FOR CHILD & ADOLESCENT DEVELOPMENT, Issue 121 2008Ariel Kalil Recent data have shown that children of immigrant noncitizens experience more persistent and higher levels of food insecurity than the children of citizens following welfare reform. However, little is known about the range of factors that might explain different rates of food insecurity in the different populations. In this study, the authors used national data from the Early Childhood Longitudinal Study,Kindergarten cohort to assess this question, using multivariate probit regression analyses in a low-income sample. They found that households of children (foreign and U.S.-born) with noncitizen mothers are at substantially greater risk of food insecurity than their counterparts with citizen mothers and that demographic characteristics such as being Latina, levels of maternal education, and large household size explain about half of the difference in rates. © 2008 Wiley Periodicals, Inc. [source] Postmarketing surveillance of medications and pregnancy outcomes: Clarithromycin and birth malformations,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 7 2000Carol R. Drinkard MPh PhD Abstract Purpose This retrospective surveillance study used linked administrative claims data and medical records to determine the rate and types of birth malformations in infants born to women exposed to the antibiotic, clarithromycin (Biaxin®), during the first trimester of pregnancy. Methods Pharmacy and hospital claims from eight geographically diverse health plans were used to identify women who had a delivery claim within 270 days of a clarithromycin prescription over a 5-year period (1991,1995). Hospital delivery admission medical records for 143 mothers and their 149 infants were abstracted to identify birth malformations. Results Five infants were identified with major malformations, three with minor malformations, and four with undescended testicles likely to resolve with time. The observed rate of 3.4% (95% CI, 0.5, 6.3) for major malformations was not statistically significantly different compared to an expected rate of 2.8% based on earlier national data. There was no consistency across types of major malformations. Conclusions These results provide no evidence that clarithromycin is a likely major teratogen in humans. Use of claims data is one way to evaluate quickly and efficiently the safety of prescription medications in humans during pregnancy, especially when both exposure and outcome are rare. Copyright © 2000 John Wiley & Sons, Ltd. [source] Variation across the agricultural season in organophosphorus pesticide urinary metabolite levels for Latino farmworkers in eastern North Carolina: Project design and descriptive resultsAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 7 2009Thomas A. Arcury PhD Abstract Background Community Participatory Approach to Measuring Farmworker Pesticide Exposure, PACE3, used a longitudinal design to document pesticide biomarkers among farmworkers. This article presents an overview of PACE3 and provides a descriptive analysis of participant characteristics and one set of pesticide biomarkers, the dialkylphosphate (DAP) urinary metabolites of organophosphorus (OP) pesticides. Methods Two hundred eighty seven farmworkers were recruited during 2007 from 44 farmworker camps in 11 eastern North Carolina counties. Participants provided interviews, urine samples, blood samples, and saliva samples up to four times at monthly intervals beginning in May. A total of 939 data points were collected. Results Farmworkers were largely men (91.3%) from Mexico (94.8%) with a mean age of 33.7 years (SE 0.82); 23.3% spoke an indigenous language. Across all data points, frequencies of detection and median urinary concentrations were 41.3% and 0.96,µg/L for dimethylphosphate (DMP), 78.3% and 3.61,µg/L for dimethylthiophosphate (DMTP), 33.3% and 0.04,µg/L for dimethyldithiophosphate (DMDTP), 40.5% and 0.87,µg/L for diethylphosphate (DEP), 32.3% and 0.17,µg/L for diethylthiophosphate (DETP), and 8.09% and 0.00,µg/L for diethyldithiophosphate (DEDTP). The frequencies of detection and urinary concentrations of the DAP metabolites increased during the season. Conclusions More PACE3 participants were from Mexico, male, migrant workers, and spoke an indigenous language compared to national data. PACE3 participants had comparable frequencies of detection and urinary metabolite concentrations with participants in other studies. Variability in the frequencies of detection and urinary concentrations of the DAP metabolites indicates the importance of longitudinal studies of biomarkers of currently used pesticides in farmworker populations. Am. J. Ind. Med. 52:539,550, 2009. © 2009 Wiley-Liss, Inc. [source] Fiscal Coordination and Financial Dependence of State Governments in MexicoPUBLIC BUDGETING AND FINANCE, Issue 3 2010JORGE IBARRA-SALAZAR This paper presents evidence of the effects on subnational financial dependence of the intergovernmental fiscal agreement implemented in 1980. In contrast with a previous study that uses annual time series national data, we use a panel of annual time series (1975,1995) of 31 Mexican states. We propose and estimate three different empirical models using the fixed effects panel data approach. In concordance with previous literature, we find strong statistical evidence that the implementation of the agreement increased financial dependence. The main contribution of this paper is to distinguish the effect of the 1980 fiscal arrangement on every state's degree of financial dependence. [source] Is Pregnancy After Breast Cancer Safe?THE BREAST JOURNAL, Issue 4 2010Julie A. Kranick MA Abstract:, The impact of treatment on subsequent fertility and the safety of childbearing are major complicating factors for young women diagnosed with breast cancer. As national data indicate women are postponing first pregnancy to older ages; therefore, many young patients are seeking clinical guidance regarding the safety of conception and treatment options that may not prevent subsequent pregnancy. Newly developed chemotherapy protocols of brief duration have improved life expectancy enabling some women to consider childbearing. This study was conducted to compare prognosis among breast cancer patients with and without a subsequent pregnancy. Medical record review of female members of a Northern California prepaid health care plan enabled the identification of 107 women with one or more subsequent pregnancies and 344 cases without a pregnancy, who were diagnosed between 1968 and 1995. Sets were matched on age, year and stage at diagnosis, months of survival and recurrence status at conception. Among the matched sets, neither risk of recurrence nor death differed significantly by subsequent pregnancy history during an average 12 years of follow-up (adjusted hazard ratio [HR] recurrence: 1.2 [0.8, 2.0]; adjusted HR death: 1.0 [0.6, 1.9]). Women interested in preserving their fertility and considering pregnancy are a self-selected population; therefore, to reduce potential bias, cases were matched on recurrence status at time of conception. Although the number of cases was limited, subgroup analyzes indicated a small, nonsignificant adverse effect among women who conceived within 12 months of diagnosis. This analysis of carefully matched cases provides reassurance that long-term prognosis was not adversely affected by subsequent pregnancy. [source] Influence of a Rural Primary Care Clerkship on Medical Students' Intentions to Practice in a Rural CommunityTHE JOURNAL OF RURAL HEALTH, Issue 2 2000Alma R. Jones M.D., M.P.H. The Association of American Medical Colleges Medical School Graduation Questionnaire (GQ) for years 1988 through 1997 was examined to compare the career plans of students graduating from Morehouse School of Medicine (MSM) with those of all students graduating from United States medical schools before the period 1988 through 1992 and after the period 1993 through 1997, after the inception of the rural clerkship at MSM. Select GQ data items examined include student demographics, medical school experiences, and career plans. Statistical analyses were used to compare pre- and post-clerkship responses for MSM students and to compare their responses with the national trends. Results indicate that, following a transition period, MSM students showed an increased preference for a future career in a rural community. A smaller upward trend in the national data was observed. There appears to be an association between the rural clerkship experience at MSM and the stated preferred career choices of the students. [source] Influence of Recipient Race on the Outcome of Simultaneous Pancreas and Kidney TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2010F. L. Luan Racial differences on the outcome of simultaneous pancreas and kidney (SPK) transplantation have not been well studied. We compared mortality and graft survival of African Americans (AA) recipients to other racial/ethnic groups (non-AA) using the national data. We studied a total of 6585 adult SPK transplants performed in the United States between January 1, 2000 and December 31, 2007. We performed multivariate logistic regression analyses to determine risk factors associated with early graft failure and immune-mediated late graft loss. We used conditional Kaplan,Meier survival and multivariate Cox regression analyses to estimate late death-censored kidney and pancreas graft failure and death between the groups. Although there was no racial disparity in the first 90 days, AA patients had 38% and 47% higher risk for late death-censored kidney and pancreas graft failure, respectively (p = 0.006 and 0.001). AA patients were twice more likely to lose the kidney and pancreas graft due to rejection (OR 2.31 and 1.86, p = 0.002 and 0.008, respectively). Bladder pancreas drainage was associated with inferior patient survival (HR 1.42, 95% CI 1.15, 1.75, p = 0.001). In the era of modern immunosuppresion, AA SPK transplant patients continue to have inferior graft outcome. Additional studies to explore the mechanisms of such racial disparity are warranted. [source] Kidney Transplantation in Previous Heart or Lung RecipientsAMERICAN JOURNAL OF TRANSPLANTATION, Issue 3 2009B. E. Lonze Outcomes after heart and lung transplants have improved, and many recipients survive long enough to develop secondary renal failure, yet remain healthy enough to undergo kidney transplantation. We used national data reported to United Network for Organ Sharing (UNOS) to evaluate outcomes of 568 kidney after heart (KAH) and 210 kidney after lung (KAL) transplants performed between 1995 and 2008. Median time to kidney transplant was 100.3 months after heart, and 90.2 months after lung transplant. Renal failure was attributed to calcineurin inhibitor toxicity in most patients. Outcomes were compared with primary kidney recipients using matched controls (MC) to account for donor, recipient and graft characteristics. Although 5-year renal graft survival was lower than primary kidney recipients (61% KAH vs. 73.8% MC, p < 0.001; 62.6% KAL vs. 82.9% MC, p < 0.001), death-censored graft survival was comparable (84.9% KAH vs. 88.2% MC, p = 0.1; 87.6% KAL vs. 91.8% MC, p = 0.6). Furthermore, renal transplantation reduced the risk of death compared with dialysis by 43% for KAH and 54% for KAL recipients. Our findings that renal grafts function well and provide survival benefit in KAH and KAL recipients, but are limited in longevity by the general life expectancy of these recipients, might help inform clinical decision-making and allocation in this population. [source] Maternal and neonatal outcomes following diabetes in pregnancy in Far North Queensland, AustraliaAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2009Bronwyn DAVIS Background: Diabetes in pregnancy (DIP) is increasing and is associated with a number of adverse consequences for both the mother and the child. Aims: To compare local maternal and neonatal outcomes with state and national data. Methods: Chart audit of all DIP delivered during 2004 at a regional teaching hospital and compare outcomes with national benchmark, Queensland and national Indigenous data. Results: The local DIP frequency was 6.7%. The local compared to benchmark and state data demonstrated a higher frequency of Indigenous mothers (43.6% vs 6.8% vs 5.5%), caesarean sections (50.7% vs 26% vs 32.0%), hypoglycaemia (40.7% vs 19.5% vs 2.7%) and respiratory distress (16.6% vs 4.5% vs 2.3%) in infants, fewer normal birthweights (64.8% vs 82.6% vs 80.4%) and full-term deliveries. More local mothers compared to benchmark had type 2 diabetes mellitus (T2DM) (15.4% vs 8.7%) but fewer used insulin (31.0% vs 46.6%); compared to state data, fewer women had gestational diabetes (79.5% vs 91.2%), however, insulin use was higher (22.8%). Furthermore, Aborigines had fewer pregnancies compared to Torres Strait Islanders (3.0 vs 5.0) and less insulin use (21.9% vs 59.3%) (P = 0.008,0.024). In contrast, non-Indigenous versus Indigenous women showed fewer pregnancies, less T2DM (7.8% vs 23.7%), better glycaemic control, longer babies, more full-term deliveries and less severe neonatal hypoglycaemia. Comparing local and national Indigenous data, local showed poorer outcomes, however, only 11.8% had diabetes or hypertension nationally. Conclusion: The local cohort had poorer outcomes probably reflecting a more disadvantaged. Few differences were found between local Indigenous groups. [source] Prevalence of neural tube defects in Australia prior to mandatory fortification of bread-making flour with folic acidAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2010Samanthi Abeywardana Abstract Objective: To establish baseline prevalence of neural tube defects (NTDs) prior to mandatory folic acid fortification in Australia. Method: Retrospective population based study. Data from the Australian Congenital Anomalies Monitoring System, for 1998,2005 were used to calculate birth prevalence including live/stillbirths of at least 20 weeks gestation or 400 g birthweight. Total prevalence and trends of NTD including terminations of pregnancy (TOPs) before 20 weeks were established using data from South Australia, Victoria and Western Australia because of the incomplete ascertainment in other states. Results: The birth prevalence of NTDs from 1998,2005, was 5/10,000 births. The total prevalence including TOPs was 13/10,000 births. A 26% declining trend in total prevalence was seen from 1992,2005, but the main decline occurred prior to 1998. Women who were Indigenous, socially disadvantaged, young, living in remote areas and had multiple gestations were more likely to give birth to babies with NTDs. Conclusion: The prevalence of NTD has been stable since 1998. Reporting of the birth prevalence alone underestimates the actual prevalence of NTD. Implications: From a public health perspective, future monitoring of NTD following implementation of fortification of bread-making flour with folic acid should include a mixed methods approach; reporting birth prevalence on national data and total prevalence on tri-state data. [source] An estimate of the number of inmate separations from Australian prisons 2000/01 and 2005/06AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2010Kristy A. Martire Abstract Objective: To estimate the annual number of inmate separations from correctional centres in Australia in 2000/01 and 2005/06. Methods: Data on separations were obtained from the websites of each State and Territory government department responsible for prisons. Data on state and national prison population were obtained from the website of the Australian Bureau of Statistics. Three different methods of estimation (multiplier, multiplier adjusted for remand separations and back-projection) were applied to State, Territory and national data on prison population and separations in Australia. Results: The median estimate (to the nearest thousand) of the number of inmate separations was 42,000 in 2000/01 and 44,000 in 2005/06 Conclusions: While the precise figures ought to be interpreted with some caution, our estimates suggest that approximately 44,500 separations from prison occurred in Australia in 2005/06. Each of these separation episodes is accompanied by an elevated risk of mortality; therefore, these figures represent a substantial public health concern. [source] National Growth in Simulation Training within Emergency Medicine Residency Programs, 2003,2008ACADEMIC EMERGENCY MEDICINE, Issue 11 2008Yasuharu Okuda MD Abstract Objectives:, The use of medical simulation has grown dramatically over the past decade, yet national data on the prevalence and growth of use among individual specialty training programs are lacking. The objectives of this study were to describe the current role of simulation training in emergency medicine (EM) residency programs and to quantify growth in use of the technology over the past 5 years. Methods:, In follow-up of a 2006 study (2003 data), the authors distributed an updated survey to program directors (PDs) of all 179 EM residency programs operating in early 2008 (140 Accreditation Council on Graduate Medical Education [ACGME]-approved allopathic programs and 39 American Osteopathic Association [AOA]-accredited osteopathic programs). The brief survey borrowed from the prior instrument, was edited and revised, and then distributed at a national PDs meeting. Subsequent follow-up was conducted by e-mail and telephone. The survey concentrated on technology-enhanced simulation modalities beyond routine static trainers or standardized patient-actors (high-fidelity mannequin simulation, part-task/procedural simulation, and dynamic screen-based simulation). Results:, A total of 134 EM residency programs completed the updated survey, yielding an overall response rate of 75%. A total of 122 (91%) use some form of simulation in their residency training. One-hundred fourteen (85%) specifically use mannequin-simulators, compared to 33 (29%) in 2003 (p < 0.001). Mannequin-simulators are now owned by 58 (43%) of the programs, whereas only 9 (8%) had primary responsibility for such equipment in 2003 (p < 0.001). Fifty-eight (43%) of the programs reported that annual resident simulation use now averages more than 10 hours per year. Conclusions:, Use of medical simulation has grown significantly in EM residency programs in the past 5 years and is now widespread among training programs across the country. [source] Birth Centers in Australia: A National Population-Based Study of Perinatal Mortality Associated with Giving Birth in a Birth CenterBIRTH, Issue 3 2007Sally K Tracy DMid ABSTRACT: Background: Perinatal mortality is a rare outcome among babies born at term in developed countries after normal uncomplicated pregnancies; consequently, the numbers involved in large databases of routinely collected statistics provide a meaningful evaluation of these uncommon events. The National Perinatal Data Collection records the place of birth and information on the outcomes of pregnancy and childbirth for all women who give birth each year in Australia. Our objective was to describe the perinatal mortality associated with giving birth in "alongside hospital" birth centers in Australia during 1999 to 2002 using nationally collected data. Methods: This population-based study included all 1,001,249 women who gave birth in Australia during 1999 to 2002. Of these women, 21,800 (2.18%) gave birth in a birth center. Selected perinatal outcomes (including stillbirths and neonatal deaths) were described for the 4-year study period separately for first-time mothers and for women having a second or subsequent birth. A further comparison was made between deaths of low-risk term babies born in hospitals compared with deaths of term babies born in birth centers. Results: The total perinatal death rate attributed to birth centers was significantly lower than that attributed to hospitals (1.51/1,000 vs 10.03/1,000). The perinatal mortality rate among term births to primiparas in birth centers compared with term births among low-risk primiparas in hospitals was 1.4 versus 1.9 per 1,000; the perinatal mortality rate among term births to multiparas in birth centers compared with term births among low-risk multiparas in hospitals was 0.6 versus 1.6 per 1,000. Conclusions: This study using Australian national data showed that the overall rate of perinatal mortality was lower in alongside hospital birth centers than in hospitals irrespective of the mother's parity. (BIRTH 34:3 September 2007) [source] Inappropriate Use of Antibiotics for Acute Asthma in United States Emergency DepartmentsACADEMIC EMERGENCY MEDICINE, Issue 8 2008Stefan G. Vanderweil BA Abstract Objectives:, The aim was to examine the use of antibiotics to treat asthma patients in U.S. emergency departments (EDs). The authors sought to investigate inappropriate antibiotic prescriptions by identifying the frequency and predictors of antibiotics prescribed for asthma exacerbations using data from two sources, the National Hospital Ambulatory Medical Care Survey (NHAMCS) and the National Emergency Department Safety Study (NEDSS). Methods:, The authors used data from NHAMCS and NEDSS to identify the proportion of ED visits for asthma exacerbations that resulted in the prescription of an antibiotic. NHAMCS provided national data from 1993 through 2004, while NEDSS provided data from 63 primarily academic EDs from 2003 through 2006. Univariate analysis and multivariate logistic regression modeling were used to identify variables associated with antibiotic administration. Results:, Analysis of NHAMCS data revealed that 22% (95% confidence interval [CI] = 20% to 24%) of acute asthma visits resulted in an antibiotic prescription from 1993 through 2004, with no significant change in prescribing frequency over the 12-year period. NEDSS data from 2003 through 2006 showed that 18% (95% CI = 17% to 19%) of acute asthma cases in academic EDs received an antibiotic. Multivariate modeling of NHAMCS data revealed that African American patients (odds ratio [OR] = 0.8; 95% CI = 0.6 to 0.97) and patients in urban EDs (OR = 0.5; 95% CI = 0.4 to 0.7) were less likely to receive antibiotics for asthma exacerbations than white patients and patients in nonurban EDs, respectively. NHAMCS analysis also found that patients in the South were more likely to receive antibiotics than those in the Northeast (OR = 1.4; 95% CI = 1.1 to 1.9). A NEDSS multivariate model found a similar difference, with African Americans (OR = 0.6; 95% CI = 0.4 to 0.8) and Hispanics (OR = 0.6; 95% CI = 0.4 to 0.8) being less likely than whites to receive an antibiotic. Conclusions:, ED treatment of acute asthma with unnecessary antibiotics is likely to contribute to bacterial antibiotic resistance. Interventions are needed to reduce inappropriate antibiotic prescriptions and to address disparities in asthma care. [source] Mammography screening in African American womenCANCER, Issue S1 2003Evaluating the research Abstract BACKGROUND Notwithstanding some controversy regarding the benefits of screening mammography, it is generally assumed that the effects are the same for women of all race/ethnic groups. Yet evidence for its efficacy from clinical trial studies comes primarily from the study of white women. It is likely that mammography is equally efficacious in white and African American women when applied under relatively optimal clinical trial conditions, but in actual practice African Americans may not be receiving equal benefit, as reflected in their later stage at diagnosis and greater mortality. METHODS Initial searches of Medline using search terms related to screening mammography, race, and other selected topics were supplemented with national data that are routinely published for cancer surveillance. Factors that potentially compromise the benefits of mammography as it is delivered in the current health care system to African American women were examined. RESULTS While there have been significant improvements in mammography screening utilization, observational data suggest that African American women may still not be receiving the full benefit. Potential explanatory factors include low use of repeat screening, inadequate followup for abnormal exams, higher prevalence of obesity and, possibly, breast density, and other biologic factors that contribute to younger age at diagnosis. CONCLUSIONS Further study of biologic factors that may contribute to limited mammography efficacy and poorer breast cancer outcomes in African American women is needed. In addition, strategies to increase repeat mammography screening and to ensure that women obtain needed followup of abnormal mammograms may increase early detection and improve survival among African Americans. Notwithstanding earlier age at diagnosis for African American women, mammography screening before age 40 years is not recommended, but screening of women aged 40,49 years is particularly critical. Cancer 2003;97(1 Suppl):258,72. © 2003 American Cancer Society. DOI 10.1002/cncr.11022 An erratum to this article is published in Cancer (2003) 97(8) 2047. 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