Display of small-area variation in health-related data: A methodology using resistant statistics

Health care planning requires characterization of the population to be served. Examination of available demographic and epidemiologic data is one early step in this process. However, aggregate data for the entire geographic area of concern often fail to reveal important differences among geographically defined sub-populations--differences that influence the form an effective delivery system should take. We present a methodology based on exploratory data analysis (EDA) techniques that we have found useful in examining health-related data for our ambulatory care catchment area. Our examples use three population characteristics that have major implications for health care planning for the elderly: 1970-1980 change in population aged 65 + ; the percent of the population aged 65 + below poverty level; and the percent of single-person households among households with one or more persons aged 65 +. With these data for the 25 municipalities of Middlesex County, New Jersey, we illustrate a two-step process: (1) the construction of stem-and-leaf displays that permit examination of a data distribution for asymmetry, concentrations around specific values, gaps in values, and outliers; and (2) the use of the median, the fourth-spread, and other information from the stem-and-leaf display in the systematic selection of data value classes to be given distinct shadings on a map of the selected geographic area. Discussion emphasizes the usefulness of graphic display of data in detecting similarities and unusual data values. Comparison of maps based on the EDA techniques and maps based on several traditional methods of value classing for the same data illustrates the influence of classing choices on the interpretation of cartographic displays of health-related data.health care planning human geography small-area variation resistant statistics cartography

Antecedents to effective treatment of hypertension in Hispanic populations.

Hypertension is a common medical disorder affecting \u3e50 million people. It is a primary modifiable risk factor to cardiovascular disease and a leading cause of death in black and Hispanic groups. This article focuses on patient-specific and physician-specific barriers that contribute to underdiagnosis, undertreatment, access issues, and poor adherence to therapy. Two cross-cultural interviewing frameworks, ETHNIC and ADHERE, are discussed as approaches that complement the traditional clinical assessment and treatment of hypertension in Hispanics

An insulin-like growth factor 2-derived self-antigen inducing a regulatory cytokine profile after presentation to peripheral blood mononuclear cells from DQ8(+) type 1 diabetic adolescents - Preliminary design of a thymus-based tolerogenic self-vaccination

This work aims to evaluate the potential use of insulin-like growth factor 2 (IGF-2) as the dominant thymic self-antigen precursor of the insulin family in designing a tolerogenic approach to type 1 diabetes (T1D) prevention. This evaluation was primarily based on cytokine profile driven by MHC presentation of insulin and IGF-2-derived antigens to PBMC cultures derived from 16 T1D DQ8(+) adolescents. Insulin B9-23, one dominant P-cell autoantigen, and the homologous sequence B11-25 of IGF-2 display the same affinity and fully compete for binding to DQ8, a MHC-II allele conferring major genetic susceptibility to type 1 diabetes (T1D). However, compared to insulin beta 9-23, presentation of IGF-2 B11-25 elicits a suppressive/regulatory cytokine profile with a higher number of IL-10-secreting cells (P < 0.05), a much higher ratio of IL-10/IFN-gamma (P < 0.01), as well as a lower number of IL-4-secreting cells (P < 0.05). Thus, with regard to T1D prevention, administration of IGF-2-derived self-antigen(s) seems to be an efficient approach that combines both antagonism for binding to a major susceptibility MHC-II allele, as well as downstream promotion of an antigen-driven tolerogenic response