Trends in young adult mortality in three European cities: Barcelona, Bologna and Munich, 1986-1995.

OBJECTIVE: In recent decades, in most European countries young adult mortality has risen, or at best has remained stable. The aim of this study was to describe trends in mortality attributable to the principal causes of death: AIDS, drug overdose, suicide and motor vehicle traffic accidents, among adults aged between 15 and 34 years in three European cities (Barcelona, Bologna and Munich), over the period 1986 to 1995. METHODS: The population studied consisted of all deaths that occurred between 1986 and 1995 among residents of Barcelona, Bologna and Munich aged from 15 to 34 years. Information about deaths was obtained from mortality registers. The study variables were sex, age, the underlying cause of death and year of death. Causes of death studied were: drug overdose, AIDS, suicide and motor vehicle traffic accidents. Age standardised mortality rates (direct adjustment) were obtained in all three cities for the age range 15-34. To investigate trends in mortality over the study period Poisson regression models were fitted, obtaining the average relative risk (RR) associated with a one year increment. RESULTS: Young adult mortality increased among men in Barcelona and Bologna (RR per year: 1.04, 95% confidence intervals (95%CI): 1.03, 1.06 in Barcelona and RR:1.03, 95%CI:1.01, 1.06 in Bologna) and among women in Barcelona (RR:1.02, 95%CI: 1.01, 1.04), with a change in the pattern of the main causes of death attributable to the increase in AIDS and drug overdose mortality. In Munich, the pattern did not change as much, suicides being the main cause of death during the 10 years studied, although they have been decreasing since 1988 (RR:0.92, 95%CI:0.88, 0.96 for men and 0.81, 95%CI: 0.75-0.87 for women). CONCLUSION: The increase in AIDS mortality observed in the three European cities in the mid-80s and mid-90s has yielded substantial changes in the pattern of the main causes of death at young ages in Barcelona and Bologna. Munich presented a more stable pattern, with suicide as the main cause of death.

The Telemedicine benchmark--a general tool to measure and compare the performance of video conferencing equipment in the telemedicine area.

In this paper, we describe the 'Telemedicine Benchmark' (TMB), which is a set of standard procedures, protocols and measurements to test reliability and levels of performance of data exchange in a telemedicine session. We have put special emphasis on medical imaging, i.e. digital image transfer, joint viewing and editing and 3D manipulation. With the TMB, we can compare the aptitude of different video conferencing software systems for telemedicine issues and the effect of different network technologies (ISDN, xDSL, ATM, Ethernet). The evaluation criteria used are length of delays and functionality. For the application of the TMB, a data set containing radiological images and medical reports was set up. Considering the Benchmark protocol, this data set has to be exchanged between the partners of the session. The Benchmark covers file transfer, whiteboard usage, application sharing and volume data analysis and compression. The TMB has proven to be a useful tool in several evaluation issues.

Technical validation of low-cost videoconferencing systems applied in orthopaedic teleconsulting services.

Investigation on the applicability of low-cost videoconferencing (VC) for health care services is becoming a real need. Reduced resources drive the administrators to evaluate inexpensive solutions for telemedicine. Considering this scenario, this work is a preliminary step to validate, from a technical point of view, if low-cost VC systems could be suitable for orthopaedic teleconsulting services. For this purpose, four different videoconferencing systems were tested. Each VC system was composed of a computer and a VC device installed in. VC devices were chosen among the most popular and distributed products (made by Intel, PictureTel and Aethra). The Telemedicine Benchmark, a specific tool defined by the authors, was applied to measure the overall systems performances in terms of time delays during basic rate ISDN connections (128 Kbit/s). Results showed that it is possible to apply low-cost videoconferencing systems for orthopaedic teleconsulting services. Most of the systems provided acceptable performance for medical image visualization and real time joint working. Further developments are recommendable to enhance the VC software tools capabilities and to improve software-user interface. reserved.

A study of the application sharing capabilities in telemedicine.

The main aim of this study was to find out if the image format (TIFF or JPEG) influenced the time delay for transferring radiological images by the application sharing tool of a desktop videoconferencing system. The second task of the study was to define a procedure that optimized the time delay to load and remotely visualize the images. The results were achieved by applying a test procedure called 'benchmark protocol'. The videoconferencing system used for the test was Intel ProShare 200 v2.0. The image transfer was performed by a BRI ISDN connection. We showed that the image format had no significant influence on the time delay. We presented an optimal procedure for image transfer. Furthermore, store and forward procedures with simple file transfer were shown to be inferior to the use of application sharing. For radiological image transfer we recommend to use lossless file formats and application sharing with the image already loaded in because this method achieves the lowest time delays.

Guidelines for multipoint videoconferencing using low-cost, PC-based equipment.

We have compiled a set of guidelines for effective multipoint videoconferencing carried out with low-cost, PC-based systems. The guidelines are based on experience gained during multipoint videoconferences in epidemiology and orthopaedics/radiology. Joint data inspection and manipulation were carried out by application sharing between the PCs. The guidelines are categorized by the time of their application and also by their content. For effective multipoint videoconferences, preparation of the agenda and of digital documents is mandatory. The prevention of echo effects and half-duplex audio connections are of special importance. A protocol to optimize the order of speakers increases the efficient use of conference time. The guidelines worked well when used in a multisite research project and addressed the most important weak points of multipoint videoconferences using low-cost equipment.

Low-cost ISDN videoconferencing equipment for orthopaedic second opinions.

We validated the application of low-cost ISDN videoconferencing equipment for telemedicine. A telemedicine benchmark was designed and four different office videoconferencing systems were evaluated, all using basic-rate ISDN connections (128 kbit/s). All the low-cost systems showed generally good or acceptable performance for clinical use. We also investigated the feasibility of videoconferencing for an orthopaedic second-opinion service. Eight point-to-point conferences were conducted to discuss real clinical cases by use of interactive sharing of medical images. The average duration of each session was 35 min. Encouraging results were obtained.

Practical evaluation of standard-based low-cost video conferencing in telemedicine and epidemiological applications.

The results of the evaluation of use of low-cost video conferencing systems (VCSs) in telemedicine is presented. Applications sharing, a new feature of these systems, recently has allowed high-quality computer-supported collaborative work (CSCW). The video conferencing (VCing) equipment used was Intel ProShare 200 v2.0a. It is representative of other low-cost VCSs. The areas of application are epidemiology and telemedicine (orthopaedics and radiology). Potential end users filled out 58 evaluation questionnaires concerning user profiles, contents and benefits of the sessions, organizational aspects, user friendliness, user acceptance, cost effectiveness, technical and multipoint related aspects. Although the end users had a lot of computer experience, their knowledge in VCSs was rather limited. The users assessed the system capable of being integrated into routine work, despite a high organizational impact. The VCS is user friendly, application sharing being used in almost every session. Audio quality was not always sufficient. The remote video was sufficient, as was the quality of medical images such as CT, MRI or X-ray. The user acceptance of the system was high. Multipoint sessions require a structured protocol to be effective. Some technical problems with MCUs (Multipoint Control Units) occurred. The use of low-cost standard VCSs in telemedicine is advisable and is a good substitute for real meetings.