Validation and characterization of venous thromboembolism diagnoses in the Swedish National Patient Register among patients with rheumatoid arthritis.

OBJECTIVE: To assess the validity of venous thromboembolism (VTE) diagnoses registered in the Swedish National Patient Register (NPR) in patients with rheumatoid arthritis (RA). METHOD: We performed a validation study using manual chart reviews to validate ICD-10 codes for VTE from the NPR. We took a random sample of 269 VTE events registered at hospitals in Region Stockholm from 2009 to 2018 in patients with RA. RESULTS: Medical records for all 269 VTE events were available for review. Overall, the positive predictive value (PPV) for a VTE diagnosis was 95%. For incident VTE events, the PPV was 87% and ranged from 80% to 98% across six more or less restricted alternative definitions of incident VTE event. Out of 235 confirmed incident VTE events, the vast majority were diagnosed independently of the RA disease (three cases occurred as a result of clinical work-up for a presumed RA-related sign or symptom, and in 17 cases did the work-up involve a rheumatologist). CONCLUSIONS: This study demonstrates high validity for VTE diagnoses recorded in the NPR for patients with RA, thus confirming that the NPR may be used to identify prevalent VTE as well as incident VTE events in patients with RA. Our results further demonstrate that in patients with RA, diagnoses of VTE are only marginally influenced by work-up related to the rheumatic disease, suggesting a modest impact of surveillance or diagnostic bias.

Continued improvement in survival of acute myeloid leukemia patients: an application of the loss in expectation of life.

We evaluated temporal trends in survival of Swedish acute myeloid leukemia (AML) patients diagnosed between 1973 and 2011 using relative survival ratios (RSRs) and a measure called the loss in expectation of life (LEL). RSRs increased most for patients <60 years at diagnosis during the first calendar periods, but between 1997-2005 and 2006-2011 the most pronounced increase was for those aged 61-70 years at diagnosis; RSR changed from 0.16 (95% confidence interval (CI): 0.13-0.19) to 0.28 (95% CI: 0.23-0.33), respectively. The LEL for males aged 35 years at diagnosis was 41.0 (95% CI: 40.1-41.8) years in 1975 and 19.5 (95% CI: 16.4-22.5) years in 2011. For males aged 65 years, the corresponding figures were 13.8 (95% CI: 13.7-14.0) and 12.0 (95% CI: 11.3-12.8). Conditional LEL estimates suggested that patients who survive 5 years postdiagnosis have shorter remaining lifespan than the general population. The proportion of expected life lost (PELL) suggested that male 65-year-old patients lost 75% of their life expectancy in 2005 and 66% if they were diagnosed in 2011. Survival continued to increase to 2011, with larger improvements in those aged 61-70 years at diagnosis. The LEL and PELL are intuitive measures that may be useful in communicating survival statistics to patients, clinicians and health-care providers.

The gender identity disorder in the DSM-IV classification: a critical evaluation.

OBJECTIVE: The DSM-IV classification in its definition and description of the gender identity disorder omits a number of diagnostically significant features. This paper attempts to correct the deficiencies. METHOD: The text under the headings: 'Diagnostic features', 'Specifiers', 'Associated disorders', 'Laboratory findings', 'Prevalence', 'Course' and 'Differential diagnosis' is subjected to a detailed scrutiny, using the author's experience as consultant psychiatrist to the Monash University Gender Dysphoria Clinic over a period of 25 years as source and background. Results of two studies of male-to-female and female-to-male transsexuals are given in the Table. RESULTS: DSM-IV criteria are augmented and the symptomatology focused. The existing gaps in the delineation of specifiers and associated features are closed by providing additional clinical material. The description of the course and the differential diagnosis are enriched. CONCLUSIONS: Although the critical analysis of the DSM-IV classification of the gender identity disorder has shown the manual to be adequate, it nevertheless has shortcomings which may impede exact diagnosis.

Putting the capacity into capacity building in South Sudan.

PIP: This paper discusses the benefits of training local people to become community health workers in south Sudan. Joyce Kiden relates her experiences as a health worker and gives a detailed account on the benefits of the work as well as the fulfillment of helping others. Despite some challenges and difficulties, the training that was organized by WHO has made considerable impact on the improvement of primary health care services at the community level. Many agencies realize importance of community health workers training. These training enhances the basic skills of people and hopefully encourage international donors to support not just the international organizations that are vital, but also the local people who will make improving health a sustainable possibility.^ieng

Arming the population against polio in Somalia.

PIP: Negotiating protection against poliomyelitis has been a very difficult issue in Somalia, particularly in the conflict zone of Mogadishu where most of the remaining reservoirs of wild polio are found. This article focuses on the polio eradication campaign conducted by the WHO in the danger zones of Somalia. The importance of such a campaign is accounted for in the fact that, since January, there have been 14 confirmed cases of wild polio, with 32 more cases under investigation. Hence, the international staff aimed to surpass challenges, which include noncooperation of rival clans, in order to carry out the campaign. Their success is attributable to reports that the first round of the campaign in Mogadishu achieved average coverage rates of 95% on the north side of the Green Line and 130% on the south side. If these results will continue for the rest of the scheduled national immunizations, WHO estimates that Somalia could be free of polio within 24 months.^ieng

Learning to pull in one direction to improve Kosovo's health.

PIP: In response to the need of a health policy in Kosovo, the UN Mission in Kosovo produced their blueprint for a new health system--the Interim Health Policy Guidelines and Six-Month Action Plan. The document seeks not only to provide a framework for emergency work but also to bring about sustained reform in the current health care system. It also aimed to shift the focus of the whole health care system around giving primary care to Kosovars. Targeted areas are antenatal care and children's and mental health care which are currently falling well below European standards. Although a shift in the system will have huge effects on the health of Kosovars, a problem of changing the attitudes of doctors and of patients to accept general practice as real medicine is seen. However, without a policy framework, emergency activities can skew services dramatically. It can offer unsustainable levels of care and bring in uneven donations to different regions, which would encourage movement in the population.^ieng