FAT PARTITIONING AND SUBCLINICAL CARDIOVASCULAR DISEASE AMONG WOMEN IN MENOPAUSAL TRANSITION

Obesity is one of the major risk factors of atherosclerosis and arterial stiffness. Recent evidence suggests detrimental effect of fat mass rather than overall body mass. Abdominal fat has been indicated to have more negative impact than other fat depots. We evaluated the impact of regional fat distribution on atherosclerosis and compared the variances explained by 11-different adiposity measures on atherosclerosis and arterial stiffness among bi-racial women in menopausal transition. All analyses were cross-sectional.In the first analysis, adjusted for age, race, menopausal status, insulin, systolic blood pressure (SBP), triglycerides, height, high-density lipoprotein (HDL) and smoking; proportions of total (p= 0.03) and trunk fats (p= 0.03) were positively associated with common carotid adventitial diameter (AD). In contrast, proportion of leg fat was negatively associated with AD (p= 0.03). SBP attenuated the significant associations of total and regional fat distribution with carotid IMT.In the second analysis, adjusted for age, race, menopausal status, height, SBP, low-density lipoprotein (LDL), HDL and insulin; waist circumference (WC) explained 25.2% of variance in IMT and 27.0% of variance in AD, while proportion of trunk fat explained 22.7% of variance in IMT and 25.1% of variance in AD, and area of visceral adipose tissue (VAT) explained 22.7% of variance in IMT and 25.8% of variance in AD.When adjusted for age, race, menopausal status, height, SBP, insulin and C-reactive protein; WC, proportion of trunk fat and VAT explained comparable proportions of the variance in carotid-femoral pulse wave velocity (cfPWV) (WC, 9.0% of variance; proportion of trunk fat, 9.9%; and VAT, 10.3%). After adjusting for above mentioned variables, only proportion of total fat remained positively associated with cfPWV (p= 0.04).Overall, our findings provide evidence for differential role of regional fat distribution on atherosclerosis but not on arterial stiffness. Moreover, WC seems to be as good as computed tomography (CT) and dual-energy x-ray absorptiometry (DXA) measures of fat in explaining variability on atherosclerosis and arterial stiffness. Given the cost, difficulty in maintenance and exposure to radiation associated with CT and DXA, the use of WC in future research may have great public health significance

Time dependent ethnic convergence in colorectal cancer survival in hawaii

BACKGROUND: Although colorectal cancer death rates have been declining, this trend is not consistent across all ethnic groups. Biological, environmental, behavioral and socioeconomic explanations exist, but the reason for this discrepancy remains inconclusive. We examined the hypothesis that improved cancer screening across all ethnic groups will reduce ethnic differences in colorectal cancer survival. METHODS: Through the Hawaii Tumor Registry 16,424 patients diagnosed with colorectal cancer were identified during the years 1960–2000. Cox regression analyses were performed for each of three cohorts stratified by ethnicity (Caucasian, Japanese, Hawaiian, Filipino, and Chinese). The models included stage of diagnosis, year of diagnosis, age, and sex as predictors of survival. RESULTS: Mortality rates improved significantly for all ethnic groups. Moreover, with the exception of Hawaiians, rates for all ethnic groups converged over time. Persistently lower survival for Hawaiians appeared linked with more cancer treatment. CONCLUSION: Ethnic disparities in colorectal cancer mortality rates appear primarily the result of differential utilization of health care. If modern screening procedures can be provided equally to all ethnic groups, ethnic outcome differences can be virtually eliminated

Interactive disease maps for the snow agent system

The aim of this research was to develop an interactive disease map framework and integrate Silverlight map support for the research project developing the Snow Agent System. The interactive disease map can be used for visualizing information on the map during disease outbreak situations. An engineering approach was used for system design, development and testing. Three different inputs, Microsoft Virtual Earth, population data and epidemiological data formed the interactive map system. The interactive disease map framework extract data from database and was integrate with geo‐spatial information and presented as an interactive map system. The system integrates population data and epidemiological data with virtual earth and is present in a Silverlight presentation. The system user can interact with the system during run time and search zip code area of Norway, once the system match the zip code of Norway, the area is located on a map. The interactive maps integrate the population and epidemiological data with zip code and presents it as a Silverlight presentation. We have demonstrated the interactive disease map by integrating the population and epidemiological data with Microsoft Virtual earth and present it using a Silverlight presentation. The Microsoft .NET framework was used to implement a prototype. The interactive disease map framework may be used as a generic framework to create interactive maps in other areas with heterogeneous data sources

Medical Humanities in Nepal: Present scenerio

Medical Humanities is a relatively new concept even in developed countries, and is at the infancy stage in low income countries like Nepal. Medical humanities modules in Nepal are being conducted in a few medical schools. Humanities have an essential role in medical education, the gap between the humanities and medicine has to be bridged and there should be continuous and vigorous debate about the theory and practice of medical humanitie

Medical Humanities in Nepal: Present scenerio

Medical Humanities is a relatively new concept even in developed countries, and is at the infancy stage in low income countries like Nepal. Medical humanities modules in Nepal are being conducted in a few medical schools. Humanities have an essential role in medical education, the gap between the humanities and medicine has to be bridged and there should be continuous and vigorous debate about the theory and practice of medical humanitie

Perceptions of Medical Students About Bedside Teaching in a Medical School

Introduction: Bedside teaching is an important and established learning tool in medical education. However there is a decline in bedside teachings over the years throughout the world including Nepal, due to advancement in medical technology, clinical skills labs and simulation techniques. This study aimed to find out the perception of Nepalese medical students towards different domains of bedside teaching. Methods: This was a descriptive cross-sectional study. A questionnaire consisting of Likert scale, open ended and closed ended questions was developed on different aspect of bedside teaching and the filled questionnaires were included for analysis. Results: Three hundred and six questionnaires were included. Almost all of medical students responded that bedside teaching is a useful learning modality in clinical teaching 304 (99.3%) and provides active learning in real context 291 (95%). The majority of medical students 233 (76%) were satisfied with the steps of history taking, examination followed by management discussion employed at bedside teaching. The students 223 (73%) were satisfied, how to elicit signs following demonstration of clinical exam by teachers at bedside. However majority 196 (64%) felt lack of individual opportunity at bedside. According to students, focussing more on practically oriented clinical skills with proper supervision would improve learning while hindering factors were large number of students and patient’s uncooperativeness. Good communication was considered the best method of alleviating patient discomfort at bedside teaching in this study. Conclusions: The study concluded that medical students have positive response and learning attitudes towards different aspects of bedside teaching

The use of breast conserving surgery: linking insurance claims with tumor registry data

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to use insurance claims and tumor registry data to examine determinants of breast conserving surgery (BCS) in women with early stage breast cancer.</p> <p>Methods</p> <p>Breast cancer cases registered in the Hawaii Tumor Registry (HTR) from 1995 to 1998 were linked with insurance claims from a local health plan. We identified 722 breast cancer cases with stage I and II disease. Surgical treatment patterns and comorbidities were identified using diagnostic and procedural codes in the claims data. The HTR database provided information on demographics and disease characteristics. We used logistic regression to assess determinants of BCS <it>vs.</it> mastectomy.</p> <p>Results</p> <p>The linked data set represented 32.8% of all early stage breast cancer cases recorded in the HTR during the study period. Due to the nature of the health plan, 79% of the cases were younger than 65 years. Women with early stage breast cancer living on Oahu were 70% more likely to receive BCS than women living on the outer islands. In the univariate analysis, older age at diagnosis, lower tumor stage, smaller tumor size, and well-differentiated tumor grade were related to receiving BCS. Ethnicity, comorbidity count, menopausal and marital status were not associated with treatment type.</p> <p>Conclusions</p> <p>In addition to developing solutions that facilitate access to radiation facilities for breast cancer patients residing in remote locations, future qualitative research may help to elucidate how women and oncologists choose between BCS and mastectomy.</p

LOINC and SNOMED CT Code Use in Electronic Laboratory Reporting - US, 2011

Electronic Laboratory Reporting (ELR) has the potential to be more accurate, timely, and cost-effective. However, the continuing use of non-standard, local codes to represent laboratory test results complicates the use of ELR data in public health practice. Use of structured and standardized coding system(s) to support the concepts represented by local codes improves the computational characteristics of ELR data. We examined the use of LOINC and SNOMED CT codes for coding laboratory tests in hospital laboratory reports. We found that the hospitals more frequently used LOINC codes than SNOMED CT in reporting test results

Coding of Electronic Laboratory Reports for Biosurveillance, Selected United States Hospitals, 2011

ObjectiveElectronic laboratory reporting has been promoted as a public health priority. The Office of the U.S. National Coordinator for Health Information Technology has endorsed two coding systems: Logical Observation Identifiers Names and Codes (LOINC) for laboratory test orders and Systemized Nomenclature of Medicine-Clinical Terms (SNOMED CT) for test results.  Materials and MethodsWe examined LOINC and SNOMED CT code use in electronic laboratory data reported in 2011 by 63 non-federal hospitals to BioSense electronic syndromic surveillance system.  We analyzed the frequencies, characteristics, and code concepts of test orders and results.ResultsA total of 14,028,774 laboratory test orders or results were reported. No test orders used SNOMED CT codes. To describe test orders, 77% used a LOINC code, 17% had no value, and 6% had a non-informative value, “OTH”. Thirty-three percent (33%) of test results had missing or non-informative codes. For test results with at least one informative value, 91.8% had only LOINC codes, 0.7% had only SNOMED codes, and 7.4% had both. Of 108 SNOMED CT codes reported without LOINC codes, 45% could be matched to at least one LOINC code.ConclusionMissing or non-informative codes comprised almost a quarter of laboratory test orders and a third of test results reported to BioSense by non-federal hospitals. Use of LOINC codes for laboratory test results was more common than use of SNOMED CT. Complete and standardized coding could improve the usefulness of laboratory data for public health surveillance and response

Evaluation of Clinical and Administrative Data to Augment Public Health Surveillance

OBJECTIVE: To assess the utility of inpatient and ambulatory clinical data compiled by public and commercial sources to enhance the Centers for Disease Control and Prevention’s surveillance activities. INTRODUCTION: Medical claims and EHR data sources offer the potential to ascertain disease and health risk behavior prevalence and incidence, evaluate the use of clinical services, and monitor changes related to public health interventions. Passage of the HITECH Act of 2009 supports the availability of standardized EHR data for use by public health officials to obtain actionable information. While full adoption of EHRs is still years away, there are presently publicly- and commercially-available EHR and medical claims data sets that could enhance public health surveillance at a national, regional and state level. The purposes of this evaluation were to i.) demonstrate the feasibility of gaining access to such data, ii.) evaluate their ability to augment current surveillance activities by developing measures for twenty separate healthcare indicators (e.g., HIV screening), iii.) evaluate each data source across a set of criteria needed for an effective surveillance system, and iv.) assess the ability of the data sources to evaluate changes in healthcare utilization and preventive services that may be a result of the 2009 Health Reform legislation. METHODS: Ten separate data sources were selected for inclusion in the study based on a number of criteria, including availability, representativeness, population, data structure and content, cost, and longitudinality. In collaboration with staff from seven Divisions across the CDC, detailed specifications were developed for twenty separate indicators of healthcare utilization or preventive services using best practices in healthcare quality measurement. Specifications were developed separately for EHR and medical claims data due to their differing structure, content and use of medical code sets and terminologies. Specifications for EHR data sources relied on the National Quality Forum (NQF) Meaningful Use (MUse) clinical quality measure specifications. The use of NQF MUse specification guidelines allowed us to gauge the current ability of each data source to measure healthcare utilization and preventive services as recommended by NQF, the national leader in healthcare measurement. Each of the data sources was also evaluated across established public health surveillance criteria, including data quality, representativeness, and flexibility, among others. Data analysis was performed using SAS 9.3 (SAS Institute, Cary, NC). RESULTS: All twenty of the healthcare indicators were developed for at least one data source; however, many of the indicator specifications had to be modified due to the low frequency of certain code sets (e.g., CPT-4 II, LOINC). The observed strengths of medical claims data were the relatively low cost, ability to track patients longitudinally, and the standardized representation of procedures and diagnoses through use of medical codes, such as ICD-9-CM, CPT-4 and HCPCS. The observed strengths of EHR data sources were the availability of information related to health behavior (e.g., current smoker), health assessment (e.g., BMI), prognostic indicators (e.g., vital signs, laboratory result), diagnostic testing, and functional status. While EHR data also capture diagnoses using ICD-9-CM, procedures such as medical and laboratory procedures remain documented through use of free text or semi-structured text fields, making it difficult to process. CONCLUSIONS: Currently available healthcare data can improve the timeliness of health outcome monitoring and add complementary information on healthcare utilization to improve our interpretation of traditional public health surveillance data. Medical claims data support measurement of health outcomes and healthcare services provided to patient populations; however, without clinical encounter information, they cannot develop measures estimating the impact of services received on quality of care. EHR data have richer clinical information; however, the continued use of non-standards-based medical codes and free and semi-structured text fields make it difficult to analyze data at scale. Meaningful Use and other HITECH initiatives are changing this by incentivizing the standardization and aggregation of electronic healthcare data. In time, these data may yield timely, accurate and actionable information for public health surveillance