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Selected AbstractsUrban-Rural Disparities in Injury Mortality in China, 2006THE JOURNAL OF RURAL HEALTH, Issue 1 2010Guoqing Hu PhD Abstract Context: Urban-rural disparity is an important issue for injury control in China. Details of the urban-rural disparities in fatal injuries have not been analyzed. Purpose: To target key injury causes that most contribute to the urban-rural disparity, we decomposed total urban-rural differences in 2006 injury mortality by gender, age, and cause. Methods: Mortality data came from the Chinese Vital Registration data, covering a sample of about 10% of the total population. The chi-square test was used to test the significance of urban-rural disparities. Findings: For all ages combined, the injury death rate for males was 60.1/100,000 in rural areas compared with 40.9 in urban areas; for females, the respective rates were 31.5 and 23.6/100,000. The greatest disparity was at age <1 year for both sexes, where the rate from unintentional suffocation in rural areas was more than twice the urban rate. The higher mortality from drowning among males of all ages and among females ages 1-24 and 35+ contributed substantially to the age-specific urban-rural disparities. For both sexes, transportation incidents and suicide were the most important contributors to higher rates among rural residents ages 15+. Conclusions: Unintentional suffocation, drowning, transportation incidents, and suicide not only are the major causes of injury death, but also play a key role in explaining the urban-rural disparities in fatal injuries. Further research is needed to identify factors leading to higher rural death rates and to explore economical and feasible interventions for reducing injuries and narrowing the urban-rural gap in injury mortality. [source] The effect of socioeconomic factors on voter turnout in Finland: A register-based study of 2.9 million votersEUROPEAN JOURNAL OF POLITICAL RESEARCH, Issue 5 2005PEKKA MARTIKAINEN The analyses are based on individual-level register data from electoral wards from the parliamentary elections of 1999 linked to population registration data on personal characteristics covering the whole 25 to 69 year-old Finnish electorate. The results show that income and housing tenure are more important determinants of turnout among older voters than among younger voters, whereas education has a dominant role in determining young people's turnout. Moreover, class has maintained its discriminatory power in determining turnout in all age groups even though working-class under-representation in participation can be partly attributable to previously obtained educational attainment. Furthermore, the lower turnout of younger voters remains unexplained even if socioeconomic factors are held constant. Lower turnout among lower social classes and among the young will affect the legitimacy of the prevalent model of party democracy. [source] Iloperidone for schizophrenia: a review of the efficacy and safety profile for this newly commercialised second-generation antipsychoticINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 8 2009L. Citrome Summary Objective:, The aim of the study was to describe the efficacy and safety of iloperidone for the treatment of schizophrenia. Data sources:, The pivotal registration trials were accessed by querying http://www.pubmed.gov, http://www.fda.gov and http://www.clinicaltrials.gov for the search term ,iloperidone'. Study selection:, Four published primary reports of phase III studies were identified as well as preclinical animal and receptor affinity studies that describe potential mechanisms of action and pharmacogenomic studies that identify potential genetic biomarkers for efficacy and tolerability. Product labelling provided additional data. Data extraction:, Descriptions of the principal results and calculation of number needed to treat (NNT) and number needed to harm (NNH) for relevant dichotomous outcomes were extracted from the study reports. Additional safety outcomes subject to NNH analysis were obtained from product labelling. Data synthesis:, Iloperidone is a second-generation antipsychotic agent indicated for the acute treatment of schizophrenia in adults. Iloperidone has been evaluated in several double-blind placebo-controlled clinical trials. The oral formulation has demonstrated efficacy in reducing the symptoms of acute schizophrenia at fixed daily doses ranging from 12 to 24 mg. Data reported for categorical definitions of response using the Positive and Negative Syndrome Scale were limited to one study and specifically to rates of achieving a , 20% decrease in the positive subscale from baseline; significantly more patients receiving iloperidone 24 mg/day (72%) than placebo (52%) met this criterion, yielding a NNT of five. Iloperidone should be titrated slowly to avoid orthostatic hypotension, potentially delaying the achievement of a therapeutic dose level. There appears to be a dose relationship for adverse events such as dizziness, somnolence and dry mouth; for example NNH vs. placebo for somnolence was 25 for iloperidone 10,16 mg/day and 10 for 20,24 mg/day. There is a possibility of a therapeutic dose response as well. Iloperidone is essentially free of extra-pyramidal side effects. Iloperidone is associated with weight gain comparable with risperidone. Long-term double-blind maintenance studies have demonstrated iloperidone's non-inferiority to haloperidol for relapse prevention. Product labelling includes a warning about the potential for QT interval prolongation. At present there are no efficacy studies available that are powered to directly compare iloperidone with other second-generation antipsychotics. The development of a depot formulation of iloperidone as well as efforts to identify genetic biomarkers for prediction of both efficacy and tolerability are in progress. Conclusions:, Aside from paliperidone, iloperidone is the first new second-generation antipsychotic to be commercialised in the USA since 2002. From the limited registration data, iloperidone appears to be relatively well tolerated once titrated to a therapeutic level and can be a useful option to consider. The development of a depot formulation and potential for genetic biomarkers may make this agent compelling. Further comparisons with other available agents among patients with schizophrenia in the ,real world' are needed. [source] Evaluation of the Personal Dental Services (Wave 1) for Lambeth, Southwark and Lewisham Primary Care Trusts , Part 1: Retrospective analyses of registration data and access issuesJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2005Helen Best BDS MDS PhD Abstract Aim/objective, The purpose of the study was to undertake analyses of registration data for the personal dental services (PDS) of Lambeth, Southwark and Lewisham primary care trusts and relate the analyses to the PDS goal ,of ,increasing ,uptake ,of ,dental services. Method, Secondary analyses of registration statistics provided by the Dental Practice Board were undertaken for both 1 years pre-PDS (October 1997 to September 1998) and post-PDS (October 1998 to March 2003) periods. Three sets of analyses were undertaken to consider different aspects of changing registrations: (1) Absolute numbers of patients registered at each time interval; (2) Rates of change in numbers of patients registered for the entire period after the introduction of PDS; and (3) Rates of change in numbers of patients registered ,for ,the ,most recent 3 years of available data. Results, There was a significant increase in the numbers of children registered under capitation, post-PDS as compared to the pre-PDS level (all ages and both genders combined). Post-PDS, the rate of increase for the children was approximately one additional child per practice per month (0.96, 95% CI 0.41,1.52). Similarly there was a significant trend for increasing adults registrations over time of about two and a half adults per practice per month (2.42, 95% CI 0.90,3.95). There was no evidence of a change in registrations for children or adults in total over the most recent period of 3 years. Conclusions, The analysis of the absolute numbers of registered patients each month indicated that the PDS practices had more children registered than before the implementation of the PDS scheme, but not adults. Overall post-implementation there was a trend for increasing registrations in both children and adults, but the most recent data indicated a plateau effect. Further consideration of facilitators to achieve PDS goals of improved uptake of services is required, particularly as they relate to local contexts. [source] A profile of invasive cutaneous malignant melanoma in Malta: 1993,2002JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 8 2006S Aquilina Abstract Background, The incidence of malignant melanoma of the skin has risen in every part of the world where reliable cancer registration data are found. Objective, Our study aims to describe the changing incidence of and survival from invasive cutaneous malignant melanoma in Malta, by analysing the data from the 211 cases that were registered at the Malta National Cancer Registry between 1993 and 2002. Results, The age standardized incidence rates for invasive cutaneous malignant melanoma rose from 3.7 per 100 000 population per year for males and 5.1 for females in the first 5-year period, to 8.0 per 100 000 population per year for males and 5.9 for females in the second 5-year period. In both sexes, numbers of thin (, 1.0 mm) invasive melanomas increased significantly between 1993 and 2002; males also registered a significant increase in intermediate-thickness (1.01,4.0 mm) melanomas. The increase in numbers of thin and intermediate-thickness melanomas between the two 5-year periods was greatest in patients aged 60 years and over. The overall absolute 5-year survival rate for the first period was 74% and for the second period 92%. Conclusion, Numbers of reported cases of invasive cutaneous malignant melanoma in Malta have more than doubled during the 10-year study period. This is mostly due to a marked rise in the diagnosis of thin melanomas in both sexes, occurring mainly in patients aged 60 years and over. As thin melanomas are of low metastasizing potential, this has resulted in an increase in survival between the two 5-year study periods. [source] Generalized linear models incorporating population level information: an empirical-likelihood-based approachJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES B (STATISTICAL METHODOLOGY), Issue 2 2008Sanjay Chaudhuri Summary., In many situations information from a sample of individuals can be supplemented by population level information on the relationship between a dependent variable and explanatory variables. Inclusion of the population level information can reduce bias and increase the efficiency of the parameter estimates. Population level information can be incorporated via constraints on functions of the model parameters. In general the constraints are non-linear, making the task of maximum likelihood estimation more difficult. We develop an alternative approach exploiting the notion of an empirical likelihood. It is shown that, within the framework of generalized linear models, the population level information corresponds to linear constraints, which are comparatively easy to handle. We provide a two-step algorithm that produces parameter estimates by using only unconstrained estimation. We also provide computable expressions for the standard errors. We give an application to demographic hazard modelling by combining panel survey data with birth registration data to estimate annual birth probabilities by parity. [source] Risk factors for worker injury and death from occupational light vehicles crashes in New South Wales (Australia),AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 9 2010Rwth Stuckey MPH Abstract Background/Aim To identify risk and protective factors for crash casualty outcomes in occupational light vehicles (OLV), a previously under-recognized work context for injuries and fatalities. Methods A register-based study was conducted using linked vehicle crash and registration data (n,=,13,491) for the Australian state of New South Wales. Univariate and multivariate analyses were undertaken to assess the relationship between casualty outcomes and variables drawn from four domains of potential determinants of severity: user, vehicle, road, and work organization factors. Results Nineteen percent of OLV crashes had OLV-user casualties (n,=,2,506) and 1% fatalities (n,=,34). Adjusted casualty risk factors included tired driver (OR 2.1, 95% CI 1.5,2.7), no seat belt use (OR 1.8, 95% CI 1.4,2.3), and excessive speed (OR 1.4, 95% CI 1.2,1.6). Adjusted fatality risk factors were no seat belt (OR 12.9, 95% CI 4.9,34.3) and high-speed zone crash (OR 5.0, 95% CI 2.1,12.3). Conclusions OLV users are at risk from both recognized road risks and hazards specific to OLV use. Findings suggest that risk reduction could be improved by the use of safer vehicles, fatigue management, and journey planning. Am. J. Ind. Med. 53:931,939, 2010. © 2010 Wiley-Liss, Inc. [source] Estimating fatality rates in occupational light vehicle users using vehicle registration and crash dataAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2010Rwth Stuckey Abstract Objective: To estimate occupational light vehicle (OLV) fatality numbers using vehicle registration and crash data and compare these with previous estimates based on workers' compensation data. Method: New South Wales (NSW) Roads and Traffic Authority (RTA) vehicle registration and crash data were obtained for 2004. NSW is the only Australian jurisdiction with mandatory work-use registration, which was used as a proxy for work-relatedness. OLV fatality rates based on registration data as the denominator were calculated and comparisons made with published 2003/04 fatalities based on workers' compensation data. Results: Thirty-four NSW RTA OLV-user fatalities were identified, a rate of 4.5 deaths per 100,000 organisationally registered OLV, whereas the Australian Safety and Compensation Council (ASCC), reported 28 OLV deaths Australia-wide. Conclusions: More OLV user fatalities were identified from vehicle registration-based data than those based on workers' compensation estimates and the data are likely to provide an improved estimate of fatalities specific to OLV use. Implications: OLV-use is an important cause of traumatic fatalities that would be better identified through the use of vehicle-registration data, which provides a stronger evidence base from which to develop policy responses. [source] Avoidable mortality trends in Aboriginal and non-Aboriginal populations in the Northern Territory, 1985-2004AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 6 2009Shu Qin Li Abstract Objectives: To analyse rates of avoidable mortality in Aboriginal and non-Aboriginal residents of the Northern Territory (NT) from 1985 to 2004, in order to assess the contribution of health care to life expectancy improvements. Methods: Australian Bureau of Statistics (ABS) death registration data for NT residents were used to identify ,avoidable' deaths, with further separation into three categories of conditions amenable to either medical care or health policy, and a category for ischaemic heart disease (IHD). A Poisson regression model was used to calculate the average annual change in avoidable mortality by sex and Aboriginality in the NT compared with Australia as a whole. Results: In the 20 years between 1985 and 2004, avoidable mortality rates fell 18.9% in NT Aboriginal people, 61.1% in NT non-Aboriginal people and 59.5% in Australians overall. NT Aboriginal people continued to experience higher avoidable mortality than other Australians and the disparity increased over time. Most of the decline in avoidable mortality for Aboriginal Territorians occurred for conditions amenable to medical care. Conclusion: Medical care has made a significant contribution to improvements in Aboriginal life expectancy in the NT, however, reductions in avoidable mortality from IHD and conditions amenable to health policy have been variable. Implications: The results highlight the need for ongoing investment in comprehensive programs incorporating appropriate health policy interventions and management of chronic diseases. [source] Trends in chronic disease mortality in the Northern Territory Aboriginal population, 1997-2004: using underlying and multiple causes of deathAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 6 2009Emily Fearnley Abstract Objective: To assess trends in chronic disease mortality in the Aboriginal population of the Northern Territory (NT), using both underlying and multiple causes of death. Method: Death registration data from 1997 to 2004, were used for the analysis of deaths from five chronic diseases; ischaemic heart disease (IHD), diabetes, chronic obstructive pulmonary disease (COPD), renal failure and stroke. Negative binomial regression models were used to estimate the average annual change in mortality rates for each of the five diseases. Chi squared tests were conducted to determine associations between the five diseases. Results: The five chronic diseases contributed to 49.3% of all Aboriginal deaths in the NT. The mortality rate ratio of NT Aboriginal to all Australian death rates from each of the diseases ranged from 4.3 to 13.0, with the lowest rate ratio for stroke and highest for diabetes. There were significant statistical associations between IHD, diabetes, renal failure and stroke. The mortality rates for diabetes, COPD and stroke declined at estimated annual rates for NT Aboriginal males of 3.6%, 1.0% and 11.7% and for Aboriginal females by 3.5%, 6.1% and 7.1% respectively. There were increases in mortality rates for Aboriginal males and females for IHD and a mixed result for renal failure. Conclusion: NT Aboriginal people experience high chronic disease mortality, however, mortality rates appear to be declining for diabetes, COPD and stroke. The impact of chronic disease on mortality is greater than previously reported by using a single underlying cause of death. The results highlight the importance of integrated chronic disease interventions. [source] Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital birthsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2009A De Jonge Objective, To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care. Design, A nationwide cohort study. Setting, The entire Netherlands. Population, A total of 529 688 low-risk women who were in primary midwife-led care at the onset of labour. Of these, 321 307 (60.7%) intended to give birth at home, 163 261 (30.8%) planned to give birth in hospital and for 45 120 (8.5%), the intended place of birth was unknown. Methods, Analysis of national perinatal and neonatal registration data, over a period of 7 years. Logistic regression analysis was used to control for differences in baseline characteristics. Main outcome measures, Intrapartum death, intrapartum and neonatal death within 24 hours after birth, intrapartum and neonatal death within 7 days and neonatal admission to an intensive care unit. Results, No significant differences were found between planned home and planned hospital birth (adjusted relative risks and 95% confidence intervals: intrapartum death 0.97 (0.69 to 1.37), intrapartum death and neonatal death during the first 24 hours 1.02 (0.77 to 1.36), intrapartum death and neonatal death up to 7 days 1.00 (0.78 to 1.27), admission to neonatal intensive care unit 1.00 (0.86 to 1.16). Conclusions, This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system. [source] | ||||||||||