Assessment of childhood diabetes-related quality-of-life in West Sweden.

AIM: To investigate health-related quality-of-life (HrQoL) in childhood diabetes and the level of agreement between West Sweden and European reference data for the new multi-cultural European questionnaire - DISABKIDS. METHOD: Twenty percent of the Swedish paediatric diabetes population was included in the survey. Child-parent pairs completed the DISABKIDS chronic generic (37 questions) and diabetes modules (10 questions) during their routine clinic visit. A one-page results summary, based on positive domains, was used to provide feedback to clinicians. RESULTS: Three hundred and sixty-one child-parent pairs were included in the analysis. In Sweden, diabetes was perceived by the children as having less impact than the European average. Swedish parents rated the HrQoL of their children lower than did the European parents. Swedish girls had a lower HrQoL than boys and greater difficulty accepting their diabetes; adolescents had greater difficulty accepting the diagnosis than younger children. Parents reported greater impact of diabetes on their children than the children themselves but reported no difference between boys and girls. Parents reported better acceptance of treatment in boys. The child's reported quality-of-life (QoL) is related to age and gender. CONCLUSION: Our results confirm the applicability of DISABKIDS to the Swedish paediatric diabetes population.

Adolescent enrollees in Medicaid managed care: the provision of well care and sexual health assessment.

PURPOSE: (1) To estimate the proportion of adolescents receiving outpatient care, well care, and sexual health assessment during 12 months of continuous enrollment in Medicaid managed care. (2) To investigate factors associated with provision of these categories of service. METHODS: Chart reviews were completed for a statewide random sample of adolescent Medicaid enrollees in Washington State. Multivariate logistic regression models included age, gender, race, language, residence, enrollment plan, and service level as independent variables. Dependent variables were receipt of outpatient care, well care, and sexual health assessment. RESULTS: Of 2000 enrollees' records, 78.3% provided evidence of outpatient service, 30.5% included well care, and 20.8% documented a sexual health assessment. Among adolescents who obtained service, younger enrollees and non-Whites were more likely to receive well care; females, older enrollees, and those with well care were more likely to have sexual health assessments. Use of standardized charting tools increased the likelihood that sexual health assessments would be documented. The variable most strongly associated with provision of outpatient service was plan of enrollment. Plan rankings on provision of outpatient care were not associated with organizational descriptions, such as for-profit status or plan structure. CONCLUSION: The low rates of well care and sexual health assessment documented for adolescents in Medicaid managed care suggest that interventions are needed.

Prospective peer review in surgical pathology.

Quality assurance (QA) in surgical pathology has focused primarily on retrospective audits of randomly selected cases. The authors describe an effective method of prospective audit for a selected class of surgical specimens--diagnostic biopsies--and document the benefits, additional staff time required and impact on turnaround time. Additionally, these results were compared with a retrospective review. During a 6-month period, all diagnostic surgical pathology biopsies (n = 2,694, 55% of all cases) were reviewed by a second pathologist before release of the final report. Errors detected were subdivided into four categories: (1) major: errors in diagnosis that could directly affect patient care; (2) diagnostic discrepancies: errors in diagnosis that should not affect patient care; (3) minor: correct diagnosis rendered, but report correction required to add supportive information; (4) clerical: typographical and grammatical errors. Thirty-two major errors were found, involving 1.2% of cases reviewed. This manner of review caused an increase in overall turnaround time from 1.62 days to 1.79 days, and an increase in turnaround time for diagnostic biopsies from 1.44 days to 1.50 days. Time spent in performing prospective peer review averaged 4 hours per day. For comparison, results were included from a retrospective review performed on 480 of the 5,556 cases accessioned in a 6-month period before the institution of prospective quality assurance. This retrospective review revealed eight major errors (1.7%). In conclusion, the prospective peer review of diagnostic biopsies yields sufficient benefits in increased accuracy of diagnostic reports to justify the slight increase in additional work by pathologists.

The effectiveness of vaccination against influenza in healthy, working adults.

BACKGROUND: Although influenza causes substantial morbidity and mortality in all age groups, current recommendations emphasize annual immunization for people at high risk for complications of influenza. We conducted a double-blind, placebo-controlled trial of vaccination against influenza in healthy, working adults. METHODS: In the fall of 1994, we recruited working adults from 18 to 64 years of age from in and around the Minneapolis-St. Paul area and randomly assigned them to receive either influenza vaccine or placebo injections. The primary study outcomes included upper respiratory illnesses, absenteeism from work because of upper respiratory illnesses, and visits to physicians' offices for upper respiratory illnesses. The economic benefits of vaccination were analyzed by estimating the direct and indirect costs associated with immunization and with upper respiratory illnesses. RESULTS: We enrolled a total of 849 subjects. Baseline characteristics were similar in the two groups. During the follow-up period, consisting of the 1994-1995 influenza season (December 1, 1994, through March 31, 1995), those who received the vaccine reported 25 percent fewer episodes of upper respiratory illness than those who received the placebo (105 vs. 140 episodes per 100 subjects, P < 0.001), 43 percent fewer days of sick leave from work due to upper respiratory illness (70 vs. 122 days per 100 subjects, P = 0.001), and 44 percent fewer visits to physicians' offices for upper respiratory illnesses (31 vs. 55 visits per 100 subjects, P = 0.004). The cost savings were estimated to be $46.85 per person vaccinated. CONCLUSIONS: Vaccination against influenza has substantial health-related and economic benefits for healthy, working adults.

A carrier method for the assessment of the effectiveness of disinfectants against Mycobacterium tuberculosis.

A method for testing the effect of disinfectants against Mycobacterium tuberculosis was developed using glass slide carriers contaminated with Myco. tuberculosis from spleens of guinea-pigs. The method was found to be useful although a greater number of colony forming units, permitting calculation of a reduction factor in the range of 10(5), is desirable. In tests with various disinfectants, alcohols were the most effective agents against Myco. tuberculosis.

The assessment of the static component in rhythmic exercise.

A new approach has been devised to assess the "static component" of dynamic exercise. This technique involves the measurement of the isometric endurance of muscles which have just taken part in rhythmic exercise and depends on the repeatability of trained subjects in isometric effort. The premise is that isometric endurance will be inversely related to the static component of the preceeding dynamic exercise. The subjects worked on a bicycle ergometer at known fractions of their maximal aerobic capacity (max Vo2). The rate of pedalling was varied from 30 to 90 rpm, so that for a given % max Vo2, the belt tension varied inversely with the speed of cycling. At any one speed of cycling, isometric endurance decreased as the belt tension increased. Following exercise at 30 rpm, the isometric endurance was 25 to 50% lower than that found at the most advantageous speed of cycling for our subuects; at these faster rates of cycling two subjects showed least static component following exercise at 90 rpm while the remaining subject performed best after cycling at 50 rpm.