Seat belt use among rear passengers: validity of self-reported versus observational measures

<p>Abstract</p> <p>Background</p> <p>The effects of seat belt laws and public education campaigns on seat belt use are assessed on the basis of observational or self-reported data on seat belt use.</p> <p>Previous studies focusing on front seat occupants have shown that self-reports indicate a greater seat belt usage than observational findings.</p> <p>Whether this over-reporting in self reports applies to rear seat belt usage, and to what extent, have yet to be investigated.</p> <p>We aimed to evaluate the over-reporting factor for rear seat passengers and whether this varies by gender and under different compulsory seat belt use conditions.</p> <p>Methods</p> <p>The study was conducted in the Veneto Region, an area in the North-East of Italy with a population of 4.7 million.</p> <p>The prevalence of seat belt use among rear seat passengers was determined by means of a cross-sectional self-report survey and an observational study.</p> <p>Both investigations were performed in two time periods: in 2003, when rear seat belt use was not enforced by primary legislation, and in 2005, after rear seat belt use had become compulsory (June 2003).</p> <p>Overall, 8138 observations and 7902 interviews were recorded.</p> <p>Gender differences in the prevalence of rear seat belt use were examined using the chi-square test. The over-reporting factor, defined as the ratio of the self-reported to the observed prevalence of rear seat belt use, was calculated by gender before and after the rear seat belt legislation came into effect.</p> <p>Results</p> <p>Among rear seat passengers, self-reported rates were always higher than the observational findings, with an overall over-reporting factor of 1.4.</p> <p>We registered no statistically significant changes over time in the over-reporting factor, nor any major differences between genders.</p> <p>Conclusion</p> <p>Self-reported seat belt usage by rear passengers represents an efficient alternative to observational studies for tracking changes in actual behavior, although the reported figures need to be adjusted using an appropriate over-reporting factor in order to gain an idea of genuine seat belt use.</p

Diffusion of good practices of care and decline of the association with case volume: the example of breast conserving surgery

<p>Abstract</p> <p>Background</p> <p>Several previous studies conducted on cancer registry data and hospital discharge records (HDR) have found an association between hospital volume and the recourse to breast conserving surgery (BCS) for breast cancer. The aim of the current study is to depict concurrent time trends in the recourse to BCS and its association with hospital volume.</p> <p>Methods</p> <p>Admissions of breast cancer patients for BCS or mastectomy in the period 2000–2004 were identified from the discharge database of the Veneto Region (Italy). The role of procedural volume (low < 50, medium 50–100, high > 100 breast cancer surgeries/year), and of individual risk factors obtainable from HDR was assessed through a hierarchical log-binomial regression.</p> <p>Results</p> <p>Overall, the recourse to BCS was higher in medium (risk ratio = 1.12, 95% confidence interval 1.07–1.18) and high-volume (1.09, 1.03–1.14) compared to low-volume hospitals. The proportion of patients treated in low-volume hospitals dropped from 22% to 12%, with a concurrent increase in the activity of medium-volume providers. The increase over time in breast conservation (globally from 56% to 67%) was steeper in the categories of low- and medium-volume hospitals with respect to high caseload.</p> <p>Conclusion</p> <p>The growth in the recourse to BCS was accompanied by a decline of the association with hospital volume; larger centers probably acted as early adopters of breast conservation strategies that subsequently spread to smaller providers.</p

Monitoring the occurrence of diabetes mellitus and its major complications: the combined use of different administrative databases

OBJECTIVE: Diabetes mellitus is a growing public health problem, for which efficient and timely surveillance is a key policy. Administrative databases offer relevant opportunities for this purpose. We aim to monitor the incidence of diabetes and its major complications using administrative data. STUDY DESIGN AND METHODS: We study a population of about 850000 inhabitants in the Veneto Region (Italy) from the end of year 2001 to the end of year 2004. We use four administrative databases with record linkage. Databases of drug prescriptions and of exemptions from medical charge were linked to identify diabetic subjects; hospital discharge records and mortality data were used for the assessment of macrovascular and renal complications and vital status. RESULTS: We identified 30230 and 34620 diabetic subjects at the start and at the end of the study respectively. The row prevalence increased from 38.3/1000 (95% CI 37.2 – 39.5) to 43.2/1000 (95% CI 42.3 – 44) for males and from 34.7/1000 (95% CI 33.9 – 35.5) to 38.1/1000 (95% CI 37.4 – 39) for females. The mean row incidence is 5.3/1000 (95% CI 5 – 5.6) person years for males and 4.8/1000 (95% CI 4.4 – 5.2) person years for females. The rate of hospitalisations for cardiovascular or kidney diseases is greatly increased in diabetic people with respect to non diabetics for both genders. The mortality relative risk is particularly important in younger age classes: diabetic males and females aged 45–64 years present relative risk for death of 1.7 (95% CI 1.58 – 1.88) and 2.6 (95% CI 2.29 – 2.97) respectively. CONCLUSION: This study provides a feasible and efficient method to determine and monitor the incidence and prevalence of diabetes and the occurrence of its complications along with indexes of morbidity and mortality

Blob motion and control in simple magnetized plasmas

Intermittent convective transport caused by coherent structures, or blobs, are universally observed in the edge of laboratory plasmas. Besides being of fundamental physics interest, the dynamics of these structures in fusion reactors influence the density scale-length in the scrape-off layer, its impurity screening characteristics, wall-recycling and possibly the overall confinement properties. In TORPEX simple magnetized plasmas, blobs are generated from interchange turbulence and, driven by gradB and curvature-induced charge separation, propagate radially outwards. The magnitude of their velocity depends on the current paths to damp charge separation. Regimes dominated by either parallel or cross-field currents are achieved by varying the ion mass. An analytical expression for the blob velocity including cross-field ion polarization currents, cross-field ion currents due to neutral friction and parallel currents to the sheath is derived and shows good quantitative agreement with the experimental data. To confirm this interpretation, direct measurements of the 2D structure of the blob-induced parallel currents have been obtained using magnetic probes. Parallel blob dynamics are further studied with a Mach probe, revealing the convection of parallel momentum by blobs. Methods to influence and control blob motion are also being explored, such as the variation of the connection length or the use of poloidal arrays of biased electrodes. This study is part of a more general project of code validation on TORPEX. Methodology and results of a comparison of 2D and global 3D fluid simulations with experiments will be presented

Pattern and determinants of hospitalization during heat waves: an ecologic study

<p>Abstract</p> <p>Background</p> <p>Numerous studies have investigated mortality during a heatwave, while few have quantified heat associated morbidity. Our aim was to investigate the relationship between hospital admissions and intensity, duration and timing of heatwave across the summer months.</p> <p>Methods</p> <p>The study area (Veneto Region, Italy) holds 4577408 inhabitants (on January 1^st, 2003), and is subdivided in seven provinces with 60 hospitals and about 20000 beds for acute care. Five consecutive heatwaves (three or more consecutive days with Humidex above 40°C) occurred during summer 2002 and 2003 in the region. From the regional computerized archive of hospital discharge records, we extracted the daily count of hospital admissions for people aged ≥75, from June 1 through August 31 in 2002 and 2003. Among people aged over 74 years, daily hospital admissions for disorders of fluid and electrolyte balance, acute renal failure, and heat stroke (grouped in a single nosologic entity, heat diseases, HD), respiratory diseases (RD), circulatory diseases (CD), and a reference category chosen a priori (fractures of the femur, FF) were independently analyzed by Generalized Estimating Equations.</p> <p>Results</p> <p>Heatwave duration, not intensity, increased the risk of hospital admissions for HD and RD by, respectively, 16% (p < .0001) and 5% (p < .0001) with each additional day of heatwave duration. At least four consecutive hot humid days were required to observe a major increase in hospital admissions, the excesses being more than twofold for HD (p < .0001) and about 50% for RD (p < .0001). Hospital admissions for HD peaked equally at the first heatwave (early June) and last heatwave (August) in 2004 as did RD. No correlation was found for FF or CD admissions.</p> <p>Conclusion</p> <p>The first four days of an heatwave had only minor effects, thus supporting heat health systems where alerts are based on duration of hot humid days. Although the finding is based on a single late summer heatwave, adaptations to extreme temperature in late summer seem to be unlikely.</p

Linguistic Structures and Economic Outcomes

Linguistic structures have recently started to attract attention from economists as determinants of economic phenomena. This paper provides the first comprehensive review of this nascent literature and its achievements so far. First, we explore the complex connections between language, culture, thought and behaviour. Then, we summarize the empirical evidence on the relationship between linguistic structures and economic and social outcomes. We follow up with a discussion of data, empirical design and identification. The paper concludes by discussing implications for future research and policy

Variability of adenoidectomy/tonsillectomy rates among children of the Veneto Region, Italy

<p>Abstract</p> <p>Background</p> <p>Despite national guidelines in 2003 aimed at limiting the recourse to tonsillectomy and/or adenoidectomy (A/T), the latter are among the most frequent pediatric surgeries performed in Italy. Aim of the study is to investigate variability of A/T rates among children of the Veneto Region, Italy.</p> <p>Methods</p> <p>All discharges of Veneto residents with Diagnosis-Related Groups 57–60 and ICD9-CM intervention codes 28.2 (tonsillectomy), 28.3 (adenotonsillectomy), 28.6 (adenoidectomy) were selected in the period 2000–2006 for a descriptive analysis. A multilevel Poisson regression model was applied to estimate Incidence Rate Ratios (IRR) with 95% Confidence Intervals (CI) for A/T surgery among children aged 2–9 years in 2004–2006, while taking into account clustering of interventions within the 21 Local Health Units.</p> <p>Results</p> <p>Through 2000–2006, the overall number of A/T surgeries decreased (-8%); there was a decline of adenoidectomies (-20%) and tonsillectomies (-8%), whereas adenotonsillectomies raised (+18%). Analyses on children aged 2–9 resulted in an overall rate of 14.4 surgeries per 1000 person-years (16.1 among males and 12.5 among females), with a wide heterogeneity across Local Health Units (range 8.1–27.6). At random intercept Poisson regression, while adjusting for sex and age, intervention rates were markedly lower among foreign than among Italian children (IRR = 0.57, CI 0.53–0.61). A/T rates in the 10–40 age group (mainly tonsillectomies) computed for each Local Health Unit and introduced in the regression model accounted for 40% of the variance at Local Health Unit level of pediatric rates (mainly adenoidectomies and adenotonsillectomies).</p> <p>Conclusion</p> <p>A/T rates in the Veneto Region, especially adenoidectomies among children aged 2–9 years, remain high notwithstanding a decrease through 2000–2006. A wide heterogeneity according to nationality and Local Health Units is evident. The propensity to A/T surgery of each Local Health Unit is similar in different age groups and for different surgical indications.</p

A European project on incidence, treatment, and outcome of sarcoma

Abstract BACKGROUND: Sarcomas are rare tumors (1-2% of all cancers) of mesenchymal origin that may develop in soft tissues and viscera. Since the International Classification of Disease (ICD) attributes visceral sarcomas (VS) to the organ of origin, the incidence of sarcoma is grossly underestimated. The rarity of the disease and the variety of histological types (more than 70) or locations account for the difficulty in acquiring sufficient personal experience. In view of the above the European Commission funded the project called Connective Tissues Cancers Network (CONTICANET), to improve the prognosis of sarcoma patients by increasing the level of standardization of diagnostic and therapeutic procedures through a multicentre collaboration. METHODS/DESIGN: Two protocols of epidemiological researches are here presented. The first investigation aims to build the population-based incidence of sarcoma in a two-year period, using the new 2002 WHO classification and the "second opinion" given by an expert regional pathologist on the initial diagnosis by a local pathologist. A three to five year survival rate will also be determined. Pathology reports and clinical records will be the sources of information.The second study aims to compare the effects on survival or relapse-free period - allowing for histological subtypes, clinical stage, primary site, age and gender - when the disease was treated or not according to the clinical practice guidelines (CPGs). DISCUSSION: Within CONTICANET, each group was asked to design a particular study on a specific objective, the partners of the network being free to accept or not the proposed protocol. The first protocol was accepted by the other researchers, therefore the incidence of sarcoma will be assessed in three European regions, Rhone-Alpes and Aquitaine (France) and Veneto (Italy), where the geographic distribution of sarcoma will be compared after taking into account age and gender. The conformity of the clinical practice with the recommended guidelines will be investigated in a French (Rhone Alps) and Italian (Veneto) region since the CPGs were similar in both areas