Differences in prevalence of pre-existing morbidity between injured and non-injured populations
|
|
- Charles Sims
- 8 years ago
- Views:
Transcription
1 Differences in prevlence of pre-existing moridity etween injured nd non-injured popultions Cte M. Cmeron, 1, 2 Dvid M. Purdie, 3 Erich V. Kliewer, 4 & Roderick J. McClure 1 Ojectives To identify nd exmine differences in pre-existing moridity etween injured nd non-injured popultion-sed cohorts. Methods Administrtive helth dt from Mnito, Cnd, were used to select popultion-sed cohort of injured people nd smple of non-injured people mtched on ge, gender, originl sttus nd geogrphicl loction of residence t the dte of injury. All individuls ged yers who hd een hospitlized etween 1988 nd 1991 for injury (Interntionl Clssifiction of Diseses, Ninth Edition, Clinicl Modifiction (ICD-9-CM) code ) (n = ), were identified from the Mnito dischrge dtse. The mtched non-injured comprison group comprised individuls rndomly selected 1:1 from the Mnito popultion registry. Moridity dt for the 12 months prior to the dte of the injury were otined y linking the two cohorts with ll hospitl dischrge records nd physicin clims. Results Compred to the non-injured group, injured people hd higher Chrlson Comoridity Index scores, 1.9 times higher rtes of hospitl dmissions nd 1.7 times higher rtes of physicin clims in the yer prior to the injury. Injured people hd rte of dmissions to hospitl for mentl helth disorder 9.3 times higher, nd physicin clims for mentl helth disorder 3.5 times higher, thn tht of non-injured people. These differences were ll sttisticlly significnt (P < 0.001). Conclusion Injured people were shown to differ from the generl non-injured popultion in terms of pre-existing moridity. Existing popultion estimtes of the ttriutle urden of injury tht re otined y extrpolting from oserved outcomes in smples of injured cses my overestimte the mgnitude of the prolem. Keywords Wounds nd injuries/epidemiology/complictions; Comoridity; Cuslity; Helth services/utiliztion; Cost of illness; Retrospective studies; Cohort studies; Cnd (source: MeSH, NLM). Mots clés Plies et trumtismes/épidémiologie/compliction; Moridité ssociée; Cuslité; Services snté/utilistion; Coût mldie; Etude rétrospective; Etude cohorte; Cnd (source: MeSH, INSERM). Plrs clve Herids y lesiones/epidemiologí/complicciones; Comorilidd; Cuslidd; Servicios de slud/utilizción; Costo de l enfermedd; Estudios retrospectivos; Estudios de cohortes; Cndá (fuente: DeCS, BIREME). Bulletin of the World Helth Orgniztion 2005;83: Voir pge 351 le résumé en frnçis. En l págin 351 figur un resumen en espñol. Introduction WHO hs predicted tht injury will e the second leding cuse of the world disese urden y the yer 2020 (1, 2). A limittion in the current process of deriving popultion estimtes of the urden ttriutle to injury is the filure to tke into ccount pre-existing moridity. If injured people differ from the generl popultion in terms of pre-existing moridity, then oserved outcomes in injured smples tht re ttriuted to injury my in prt e due to pre-existing moridities rther thn to the injury in question. The Austrlin Burden of Disese study cknowledged the importnce of co-existing conditions in estimting the ttriutle urden of prticulr conditions (3). Mthers et l. (3) concluded tht severl methodologicl issues relting to comoridity remin to e ddressed if urden of disese models re to e dvnced. These issues include how comoridities ffect long-term disility; which comoridities re relevnt; nd how to del with the logistics of modelling lrge numers of comintions of comoridities (3). Although some ttempts hve een mde to look t differences in helth sttus in ptients pre- nd post-injury using self-reported retrospective recll (4), investigtors using this method cknowledge inevitle ises (5 9). Bis is etter mnged y scertining pre-injury moridity t point in time efore the injury ws sustined. Although rre in injury outcome studies (10, 11), the use of comoridity indices sed on dministrtive clims dt recorded prior to the index event is well estlished in other fields of reserch such s cncer, crdiovsculr disese nd dietes (12 14). 1 School of Popultion Helth, University of Queenslnd, Myne Medicl School, Herston Rod, Herston, Brisne, Queenslnd, Austrli Correspondence should e sent to Dr Cmeron t this ddress (emil: cmeronc@uq.edu.u). 2 Centre of Ntionl Reserch on Disility nd Rehilittion Medicine, University of Queenslnd, Queenslnd, Austrli. 3 Northern Cliforni Cncer Center, Cliforni, USA. 4 CncerCre Mnito, Mnito Helth, Winnipeg, Cnd. Ref. No (Sumitted: 6 Jnury 2004 Finl revised version received: 13 July 2004 Accepted: 10 Novemer 2004) Bulletin of the World Helth Orgniztion My 2005, 83 (5) 345
2 Reserch Glol urden of disese estimtes currently ssume tht the distriution of moridity in the community is independent of injury sttus. Outcome studies of clinicl cse series cnnot test this ssumption nd few popultion-sed studies tht compre injured nd non-injured people hve een reported in the literture (10). The present study used dministrtive helth dtses to compre the frequency nd distriution of moridity in people in the 12 months prior to their sustining n injury with the helth sttus of the generl non-injured popultion. Methods Study design The study descried in this pper is n exmintion of the prevlence of pre-existing disese in two smples drwn from dministrtive helth dt from Mnito, Cnd. The two smples were originlly identified on the sis of exposure to injury, for the purposes of conducting mtched, popultionsed retrospective cohort study, with follow-up period of 10 yers. The University of Mnito Reserch Ethics Bord nd the Helth Informtion Privcy Committee of Mnito Helth pproved this study. Dt extrctions were completed y Mnito Helth nd ll identifying vriles were removed from the dt efore the study investigtor ws grnted ccess to them. Dt sources The province of Mnito provides universl helth-cre coverge for popultion of 1.14 million residents (15). Mnito Helth mintins dtses of clims mde y helth providers for reimursement of services (hospitl, physicin nd extendedcre services), s well s popultion registry of those eligile for helth coverge (16). Virtully every resident of Mnito is covered y the provincil helth-cre pln (15). The dtses hve een used extensively in helth reserch nd re descried in detil elsewhere (17, 18). Setting nd prticipnts A cohort of injured people (n = ) ws identified s ll persons ged yers resident in the province of Mnito, who hd een hospitlized for tretment of n injury etween 1 Jnury 1988 nd 31 Decemer The cohort memers included ll individuls who hd n Interntionl Clssifiction of Diseses, Ninth edition, Clinicl Modifiction (ICD-9-CM) code (excluding lte effects from injury , nd llergies from within 995), in the first or second dignostic fields. For individuls who hd more thn one injury-relted hospitl dmission during the study period, the first dmission ws designted s the index cse record. For ech injured suject, non-injured person ws rndomly selected from the Mnito popultion registry nd mtched on ge, gender, originl sttus nd geogrphicl loction of residence t the dte of dmission of the index cse. Excluded from oth the injured nd non-injured cohorts were residents of nursing homes, ptients in extended hospitl cre nd people who hd not een resident in the province for 12 months prior to the dmission dte of the index record (for the purposes of extrcting seline dt). Helth service utiliztion nd mesurement of comoridity Informtion on helth service utiliztion ws extrcted from hospitl dischrge dt nd physicin services clims for oth Cte M. Cmeron et l. the injured nd non-injured cohorts. Dtes of dmissions, services, tretment, dignostic nd dischrge informtion were extrcted for the 12-month period prior to the dte of the index record for ll mtched pirs (19). Physicin clims were restricted to multory clims, including outptient, emergency deprtment (where ville) nd visits to medicl prctitioners in the community (20, 21). For individuls with multiple hospitl records ssocited with single episode (e.g. when interhospitl trnsfers or redmissions hd tken plce), they were integrted into one summry record. Frequency nd types of pre-existing comorid conditions for the two cohorts were determined from the extrcted hospitl nd physicin clims during the pre-injury period. For the purpose of identifying pre-existing comoridities, only the primry dignostic field ws used, nd conditions were ctegorized ccording to the 18 disese chpters of ICD-9-CM. The numer of comorid conditions ws counted y summing the numer of different disese ctegories present. Dt on comorid conditions from physicin clims were derived using the sme method. The Drtmouth-Mnito version of the Chrlson Comoridity Index (CCI) (22) ws lso used to quntify preexisting comoridity. The CCI ws computed for the injured cohort sed on 12 months of hospitl dt for the yer preceding the index injury record. For the non-injured cohort, the CCI ws clculted for the 12-month period prior to dte of injury of the mtched cse. If no comorid conditions were found, or where no hospitl records existed, the CCI score ws set to zero. Injury clssifiction The injured were nlysed s the totl cohort nd y the nture of injury codes (ICD-9-CM ). Seven sugroups (rin injury, spinl injury, urns, long-one frctures, poisonings, internl injuries nd other) were creted cross suchpter hedings to enle more comprehensive exmintion of those injury types commonly studied in injury outcomes reserch. ICDMAP-90 softwre from Johns Hopkins University ws used to generte n Injury Severity Score (ISS) for injured cses. These ISS scores were grouped into minor (ISS 1 8), moderte (ISS 9 15) nd severe (ISS 16) ctegories in ccordnce with the convention (23). ICDMAP-90 mps severity score for only proportion of the totl Injury nd Poisonings ICD-9-CM codes. Therefore not ll injured cses were scored. Anlysis Anlysis of dt involved univrite nd ivrite sttistics. The sttisticl significnce of differences etween groups nd sugroups ws ssessed y chi-squred sttistics for ctegoricl dt nd with the Mnn Whitney U test for continuous dt ecuse of non-norml distriutions. Rte rtio confidence intervls were djusted for mtching vriles using Poisson regression methods. All tests were two sided with 5% level of significnce. Rtes of helth service utiliztion were reported using person-yers (PYs) of exposure time. Anlysis ws conducted using SAS version 8.2 sttisticl softwre. Results Smple chrcteristics The chrcteristics of the injured cses re shown in Tle 1. The men ge t the strt of follow-up for oth injured nd non-injured cohorts ws 35.7 yers. Mles represented 346 Bulletin of the World Helth Orgniztion My 2005, 83 (5)
3 Cte M. Cmeron et l. lmost two-thirds of the cohort nd more injuries occurred in individuls in the younger ge ctegories (18 34 yers). Of the injury sugroups, frctures of long ones (12%), poisonings (10.3%) nd rin injury (6.1%) were the most common. An ISS ws generted for 62% of the totl injured (n = ). Over 85% of scored cses were of minor severity, 10% of moderte severity nd lmost 4% were clssified s mjor injuries. Pre-existing moridity for injured smple Memers of the injured cohort hd 1.9 times higher rte of hospitl dmissions in the 12 months efore the dte of the index record thn memers of the non-injured cohort (injured 276/1000 PYs nd non-injured 148/1000 PYs). The men numer of hospitl dmissions per person in the pre-injury yer ws 0.12 in the injured (rnge 0 19) nd 0.09 in the non-injured cohort (rnge 0 12). The men length of sty in hospitl differed significntly etween the two cohorts in the pre-injury yer (Tle 2). Injured people were less likely to e dmitted s dy ptients (28.6% versus 36.3%) nd more likely to hve totl length of sty greter thn 14 dys (13.3% versus 5.7%). The injured cohort hd 1.7 times higher rte of physicin clims in the pre-injury period (670/100 PYs, verge 3.9 clims per person) thn the non-injured cohort (387/100 PYs, verge 2.2 clims per person). A greter percentge of the injured cohort (65%) thn of the non-injured cohort (48%) hd three or more physicin clims in the 12-month pre-injury period (Tle 2). Significntly more people from the injured cohort (5.9%) thn from the non-injured cohort (1.2%) hd CCI scores of 1 or more (Tle 3). Overll, greter percentge of injured people hd comoridities, nd they hd more comoridities per person thn the memers of the non-injured cohort, sed on hospitliztions nd physicin clims. Injured people hd n verge of 2.2 different conditions (rnge 0 14) for which they hd consulted physicin in the pre-injury yer, wheres in the non-injured people this figure ws 1.5 (rnge 0 13). There were 1498 people in the injured group nd 423 in the non-injured cohort, who hd moderte or severe pre-existing mentl helth condition, s indicted y helth service use in the pre-injury period. The memers of the injured cohort hd higher rtes of hospitl dmissions nd physicin clims for ll cuses in the pre-injury period thn those in the non-injured cohort (Tle 4 nd Tle 5). The rte rtios were 1.5 or greter for 14 of the 18 chpters for hospitl dmissions nd for six chpters for physicin clims. When rnked y rte rtio, for oth hospitl dmissions nd physicin clims, the gretest differences were seen for mentl helth disorders nd previous injuries. Injured people hd 9.3 times higher rte of dmissions to hospitl for mentl helth disorder (injured 42/1000 PYs nd non-injured 4.5/1000 PYs) nd 3.5 times higher rte of mentl helth physicin clims (injured 98/100 PYs) thn the non-injured people (28/100 PYs). Mentl disorders were the most frequent cuse of ll hospitl dmissions for the totl injured cohort. Almost hlf of the mentl helth dmissions were for lcoholic psychoses, ffective psychoses nd schizophrenic disorders. Over 80% of ll mentl helth physicin clims for the injured cohort were for non-psychotic or personlity disorders, more specificlly for such conditions s pnic, nxiety or depression. During the pre-injury period, the injured cohort hd 3.7 times higher rte of dmissions to hospitl for previous injury (injured 9.9/1000 PYs nd non-injured 2.7/1000 PYs) Reserch Tle 1. Demogrphic chrcteristics for injured nd noninjured cohorts, injury sugroups nd injury severity scores t the time of the cse index injury dmission Injured Non-injured (n = ) (n = ) n % n % Gender Mle Femle Age in yers Plce of residence Urn Rurl Remote Injury sugroups Brin injury Spinl injury Burns Frctures of long ones Poisonings Internl injuries Other injuries Injury Severity Score (ISS) Minor (ISS 1 8) Moderte (ISS 9 15) Severe (ISS 16) Age-mtched on yer of irth nd plce of residence on prtil postcode, thus there re smll differences in ctul numers of injured nd non-injured. ISS not computed for 4030 cses. nd 2.7 times higher rte of physicin clims for injury-relted mtters (117/100 PYs) thn the non-injured group (43/100 PYs). Nineteen per cent of the previous injury-relted dmissions for the injured cohort (nd 10% for the non-injured) were for self-inflicted hrm or suicide ttempts y poisoning. Nineteen per cent of the previous physicin injury clims for the injured group (nd 28% for the non-injured) were for sprins nd strins. Pre-existing moridity y injury type Helth service use in the 12-month pre-injury period ws similr cross the injury types nlysed. However, memers of the injured cohort hospitlized for poisonings were notle in tht they only ccounted for 10% of the injured, ut ccounted for 24% of ll dmissions nd 20% of ll physicin clims in the pre-injury period. Furthermore, this group hd 59 times higher rte of hospitl dmissions (95% confidence intervl (CI), ) nd n 11 times higher rte of physicin clims (95% CI, ) for mentl helth disorders thn their mtched counterprts in the uninjured group. Over 50% of the hospitl dmissions for mentl helth prolems nd 78% of physicin clims for the poisonings group in the pre-injury Bulletin of the World Helth Orgniztion My 2005, 83 (5) 347
4 Reserch Cte M. Cmeron et l. Tle 2. Hospitl dmissions, length of sty nd physicin clims in the 12-month period prior to the index dmission for injured nd non-injured cohorts Helth service use for the 12 months prior to injury Injured (21 032) Non-injured (21 032) Significnce n % n % Totl hospitl dmissions Admissions per person No dmissions dmission P < dmissions dmissions or more dmissions Men numer of dmissions (rnge) c 0.12 (0 19) 0.09 (0 12) P < Totl length of sty in hospitl (dys) Dy ptient P < dys or more Men length of sty in dys (rnge) c 0.36 (0 248) 0.18 (0 258) P < Totl physicin clims Clims per person No clims clims clims P < clims clims clims or more clims Men numer of clims (rnge) c 3.9 (0 295) 2.2 (0 127) P < Determined y χ 2 sttistics. Determined y Mnn Whitney U test. c Geometric men clculted due to non-norml distriutions. yer were for non-psychotic, neurotic or personlity disorders often for specific nxiety or depressive disorders. The poisonings group hd significntly more hospitl dmissions in the pre-injury yer for previous injuries nd poisonings (rte rtio (RR) = 11.5; 95% CI, ), circultory diseses (RR = 6.2; 95% CI, ) nd ill-defined conditions (RR = 4.7; 95% CI, ) thn the mtched sugroup. This injury group lso hd higher rtes of physicin clims for ill-defined conditions (RR = 3.4; 95% CI, ), neoplsms (RR = 2.9; 95% CI, ), digestive diseses (RR = 2.7; 95% CI, ), thn the mtched sugroup. Excluding poisonings from the nlysis hd little effect on the sttisticl significnce of differences etween helth service utiliztion y the memers of the injured nd non-injured cohorts during the pre-injury period. Discussion To the est of our knowledge, this is the first study to quntify difference in pre-existing moridity etween injured nd non-injured popultions. Compred to non-injured people, injured people were lmost five times s likely to hve CCI score of one or more, were dmitted to hospitl t lmost twice s often, nd hd 1.7 times the rte of physicin clims. The injured cohort hd fewer memers with no comorid conditions nd significntly more memers with greter numers of different conditions present thn did the mtched smple from the generl popultion. The results of this study support the concern tht current urden of injury estimtes my e inccurte if the influence of pre-existing ill-helth is not tken into ccount. Although few studies reported in the literture hve een similr in scope nd methods to the current study (3), one key popultion-sed study of elderly people with nd without hip frctures, did find similr results (10). This study found tht, prior to their injury, the study sujects hd significntly higher comoridities using the CCI, higher disility mesures nd were more likely to e residents of nursing homes thn controls (10). Severl studies of clinicl injury outcome hve mesured comoridities using numer of different methods, mostly relying on the dignostic fields of the index dmission record (7, 8, 24). These studies hve found consistent ssocition etween the presence of comorid conditions nd incresed risk of mortlity following injury. Smller nd less consistent ssocitions were found in the few studies tht hve considered comoridity nd non-ftl outcomes (25 27). 348 Bulletin of the World Helth Orgniztion My 2005, 83 (5)
5 Cte M. Cmeron et l. Reserch Tle 3. Comorid conditions in the 12-month period prior to the index dmission for injured nd non-injured cohorts Comorid conditions for the 12 months prior to injury Injured (21 032) Non-injured (21 032) Significnce n % n % Chrlson Comoridity Index No comoridity P < or more comoridity Comorid conditions per person (sed on hospitl dmissions) No comoridities comoridity P < comoridities or more comoridities Men numer of conditions (rnge) c 0.15 (0 6) 0.09 (0 6) P < Comorid conditions per person (sed on physicin clims) No comoridities comoridity comoridities P < comoridities comoridities or more comoridities Men numer of conditions (rnge) c 2.2 (0 14) 1.5 (0 13) P < Determined y χ 2 sttistics. Determined y Mnn-Whitney U test. c Geometric men clculted due to non-norml distriutions. Tle 4. Hospitl dmissions per 1000 person-yers for ll ICD-9-CM disese chpters during the 12-month period prior to the injury, for the injured nd mtched non-injured cohort, rnked y rte rtios Rte of hospitl dmissions per 1000 PYs ICD-9-CM chpters Injured Non-injured Adjusted rte rtio 95% confidence n = n = intervls Mentl helth disorders Injury nd poisonings Blood diseses Endocrine nd metolic Musculoskeletl diseses Nervous system diseses Ill-defined conditions Respirtory diseses Circultory diseses Supplementry clssifiction Congenitl nomlies Skin diseses Digestive diseses Infectious diseses Genitourinry diseses Complictions of pregnncy c Neoplsms Conditions of perintl period NA NA PYs = person yers. Adjusted for ge, gender nd plce of residence. c Undjusted confidence intervl. Bulletin of the World Helth Orgniztion My 2005, 83 (5) 349
6 Reserch Cte M. Cmeron et l. Tle 5. Physicin clims per 100 person-yers for ll ICD-9-CM disese chpters during the 12-month period prior to the injury, for the injured nd mtched non-injured cohort, rnked y rte rtios Rte of physicin clims per 100 PYs ICD-9-CM chpters Injured Non-injured Adjusted rte rtio 95% confidence n = n = intervls Mentl helth disorders Injury nd poisonings Ill-defined conditions Musculoskeletl diseses Digestive diseses Blood diseses Nervous system diseses Congenitl nomlies Respirtory diseses Endocrine nd metolic Genitourinry diseses Skin diseses Infectious diseses Neoplsms Circultory diseses Supplementry clssifiction Complictions of pregnncy c Conditions of perintl period PYs = person-yers. Adjusted for ge, gender nd plce of residence. c Undjusted confidence intervl. This study identified two res of importnce for estimting the ttriutle urden of injury. The first is tht injured people hve significntly more hospitl dmissions nd physicin clims prior to their injury, cross lmost every disese clssifiction, thn do the generl popultion. The differentil ws most pronounced for hospitliztions for which 14 of the 18 chpters hd rte rtios of 1.5 or greter, wheres six of the 18 chpters for physicin clims hd rte rtios of 1.5 or greter. When rnked y the rte rtios, two disese chpters, mentl helth disorders nd previous injuries, consistently hd the highest rtes of hospitl dmission nd physicin clims. The finding regrding mentl helth is consistent with previous study of trum ptients, which found tht more thn 30% of trum ptients were ffected y psychitric moridity efore the trum event, nd tht psychitric conditions represented 18% of the totl moridity (9). Outcome studies of the mentl helth consequences of injury should consider controlling for pre-existing conditions efore scriing mentl helth disorders s consequence of the injury. Second, there ws no single injury sugroup tht ccounted for the overll differences in the prevlence of preexisting disese. However, the poisonings sugroup hd greter solute nd reltive moridity in lmost ll ICD-9-CM disese chpters nd hd the highest rte rtio for mentl helth dmissions when compred with the findings in non-injured counterprts. The poisonings sugroup tended to e younger, femle nd hd mde greter use of helth services for tretment of non-psychotic, neurotic or personlity disorders. Nevertheless, excluding this group from the nlysis hd little effect on the overll findings. Helth service use following n dmission for poisoning, if considered solely s consequence of tht injury dmission does not tke ccount of the high seline service use tht would most likely hve continued irrespective of the poisoning event. Aspects of the methodology need to e considered s possile study limittions. First, helth service use ws used s proxy for helth sttus. Although previous studies conducted in this study popultion hve supported the vlidity of this prctice (21, 28), it does entil severl ssumptions out the equity of ccess to helth services, ptterns of referrl, nd service delivery eing dependent on helth sttus nd consistent cross ll susections of the community. Second, the generlizility of the findings my e compromised y injured cses eing defined s those hospitlized during the study period. This excludes injuries tht did not led to hospitliztion nd pre-hospitl ftlities, nd my e ised y issues of service ccess nd referrl pthwys (29). Third, is the question of whether incident cses could e ccurtely identified from the dministrtive dtses used to select the injured cohort. Of the people in the injured smple only 60 hd een dmitted in the previous 12 months for n injury with the sme ICD-9 injury group code. Of these, 24 were cses of poisoning with repet dmissions mostly occurring fter numer of months, nd re likely to hve een new episodes rther thn repet dmissions for the originl injury, leving only 36 cses (i.e. 0.17%) which could potentilly hve een misclssified s incident cses. Finlly, exmintion of the six ctegories of injury type, while justified on the sis tht they re the groups most relevnt to injury outcomes reserch, ccounts for only 35% of ll the cses. Further rekdown of the other ctegory for the purposes of nlysis creted numer of smll ctegories nd did not contriute informtion relevnt to the ims of the study. 350 Bulletin of the World Helth Orgniztion My 2005, 83 (5)
7 Cte M. Cmeron et l. There re mny strengths which set this study prt from previous studies tht hve included considertion of comoridity in their exmintion of injury outcomes. The injured group in this study is popultion-sed incidence smple nd s such, voids the ises inherent in most clinicl study smples. This is one of the few studies to hve included popultion-sed non-injured comprison group. The smple size of the injured group ws sufficiently lrge to enle considerle degree of nlysis of injury sugroups, which will provide rich context for future work in the field. Of principl vlue hs een the ility to mesure helth sttus prior to injury in the injured smple, nd previous helth sttus in the noninjured group. Through the use of dministrtive dt, nlysis of the 12-month pre-injury period circumvents the recll is noted previously, which hs hmpered ttempts to identify pre-injury Reserch helth sttus. This study hs shown tht clrifying the contriution of pre-existing moridity, to enle the refined clcultion of popultion ttriutle-urden estimtes, is vitlly importnt in urden-of-disese pproches to pulic helth policy. O Acknowledgements We grtefully cknowledge the provision of the dt used in this study y Mnito Helth, Winnipeg, Cnd. We lso wish to thnk Mr André Wjd for his invlule ssistnce with dt extrction nd project consulttion. This reserch ws funded y the Centre of Ntionl Reserch on Disility nd Rehilittion Medicine, University of Queenslnd, Austrli. Competing interests: none declred. Résumé Comprison de l moridité pré-existnte entre des popultions de personnes ynt été victimes d un trumtisme et ne l ynt ps été Ojectif Identifier et étudier les différences de moridité préexistnte entre des cohortes en popultion de personnes ynt Résultts Pr rpport u groupe de personnes n ynt ps sui de remoursement de soins médicux. été victimes d un trumtisme et ne l ynt ps été. trumtisme, les individus victimes d un trumtisme présentient Méthodes Les uteurs ont utilisé les données snitires dministrtives des vleurs plus fortes de l indice de comoridité de Chrlson, du Mnito, Cnd, pour sélectionner une cohorte en popultion de des tux d hospitlistion 1,9 fois plus élevés et des tux de personnes ynt sui un trumtisme et un échntillon de personnes remoursement de soins médicux 1,7 fois plus élevés dns l nnée n en ynt ps sui, ppriées selon l âge, le sexe, l origine utochtone précédnt le trumtisme. Les personnes ynt sui un trumtisme ou non et le lieu de résidence à l dte du trumtisme. Ils ont présentient un tux d hospitlistion pour troules mentux 9,3 fois identifié, à prtir de l se de données de déchrge hospitlière du plus élevé et des tux de demnde de remoursement concernnt Mnito, tous les individus âgés de 18 à 64 ns ynt fit l ojet d une des troules mentux 3,5 fois plus élevés que les personnes n ynt hospitlistion pour trumtisme entre 1988 et 1991 [Clssifiction ps été victimes d un trumtisme. Ces différences étient toutes interntionle des mldies, neuvième édition, Modifiction clinique sttistiquement significtives (p < 0,001). (ICD-9-CM) codes 800 à 995] (n = ). Les uteurs vient Conclusion Les uteurs ont montré que les personnes victimes de constitué le groupe de comprison, composé de personnes n ynt trumtisme différient de l popultion générle n ynt ps sui ps sui de trumtisme ppriées, en choisissnt u hsrd, dns un de trumtisme pr l moridité pré-existnte. Les estimtions en rpport 1/1, des individus dns le registre de popultion du Mnito. popultion disponiles de l chrge de trumtisme ttriule à Ils ont otenu les données de moridité pour les 12 mois précédnt l moridité pré-existnte, otenues pr extrpoltion des résultts l dte du trumtisme en mettnt en reltion les deux cohortes vec oservés sur des échntillons de cs de trumtismes, peuvent l ensemle des registres de déchrge hospitlière et des demndes de surestimer l mpleur du prolème. Resumen Diferencis en l prevlenci de morilidd previ entre polciones de trumtizdos y no trumtizdos Ojetivo Identificr y nlizr ls diferencis en l morilidd con todos los registros de lts hospitlris y ls fcturs de preexistente entre cohortes polcionles de persons trumtizds los médicos. y no trumtizds. Resultdos En comprción con el grupo de no trumtizdos, Métodos Se usron los dtos dministrtivos snitrios de pr ls persons trumtizds se hllron puntuciones Mnito (Cndá) pr seleccionr un cohorte polcionl myores del Índice de Comorilidd de Chrlson, tss de ingreso de persons trumtizds y un muestr de persons no hospitlrio 1,9 veces myores, y tss de fcturción de médicos trumtizds preds por edd, sexo, originlidd y 1,7 veces superiores durnte el ño previo l trumtismo. Ls lugr geográfico de residenci en l fech del trumtismo. Se persons trumtizds presentn tss de ingreso hospitlrio identificó en l se de dtos de lts de Mnito todos por trstornos de slud mentl 9,3 veces superiores, y en su cso los individuos de ños que hín sido hospitlizdos ls fcturs médics por tles trstornos ern 3,5 veces myores entre 1988 y 1991 cus de trumtismos (Clsificción que ls de los no trumtizdos. Tods ess diferencis ern Interncionl de Enfermeddes, 9ª revisión, Modificción estdísticmente significtivs (P < 0,001). Clínic (CIE-9-MC) códigos ) (n = ). El grupo de Conclusión Ls persons trumtizds diferín de l polción comprción de no trumtizdos predos est integrdo no trumtizd en cunto l morilidd preexistente. Ls por individuos selecciondos l zr, en proporción 1:1, prtir ctules estimciones polcionles de l crg triuile de del registro de polción de Mnito. Se otuvieron los dtos trumtismos, otenids extrpolndo prtir de los resultdos de morilidd correspondientes los 12 meses previos l fech oservdos en muestrs de persons trumtizds, podrín estr del trumtismo, pr lo cul se relcionron ls dos cohortes sorestimndo l mgnitud del prolem. Bulletin of the World Helth Orgniztion My 2005, 83 (5) 351
8 Reserch Cte M. Cmeron et l. References 1. Murry CJ, Lopez AD. The glol urden of disese: comprehensive ssessment of mortlity nd moridity from diseses, injuries nd risk fctors in 1990 nd projected to Cmridge (MA): Hrvrd School of Pulic Helth; Stone DH, Jrvis S, Pless B. The continuing glol chllenge of injury. BMJ 2001;322: Mthers CD, Vos ET, Stevenson CE, Begg SJ. The urden of disese nd injury in Austrli. Bulletin of the World Helth Orgniztion 2001;79: Amertung SN, Norton RN, Whitlock G, Mcmhon S, Coggn, C, Jckson RT, et l. The New Zelnd Blood Donors Helth Study: seline findings of lrge prospective cohort study of injury. Injury Prevention 2002;8: Whitlock JA, Hmilton BB. Functionl outcome fter rehilittion for severe trumtic rin injury. Archives of Physicl Medicine nd Rehilittion 1995; 76: Morris JA Jr, McKenzie EJ, Edelstein SL. The effect of preexisting conditions on mortlity in trum ptients. JAMA 1990; 263: Scco WJ, Copes WS, Bin LW Jr, McKenzie EJ, Frey CF, Hoyt DB, et l. Effect of preinjury illness on trum ptient survivl outcome. Journl of Trum 1993; 35:538-42; discussion Milzmn DP, Boulnger BR, Rodriguez A, Soderstrom CA, Mitchell KA, Mgnnt CM. Pre-existing disese in trum ptients: predictor of fte independent of ge nd injury severity score. Journl of Trum 1992;32:236-43; discussion Wrdle TD. Co-morid fctors in trum ptients. British Medicl Bulletin 1999;55: Leison CL, Tosteson AN, Griel SE, Rnsom JE, Melton LJ. Mortlity, disility, nd nursing home use for persons with nd without hip frcture: popultion-sed study. Journl of the Americn Geritrics Society 2002;50: Rozentl TD, Brns CC, Bozentk DJ, Beredjiklin PK. Survivl mong elderly ptients fter frctures of the distl rdius. Journl of Hnd Surgery 2002;27: Klunde CN, Wrren JL, Legler JM. Assessing comoridity using clims dt: n overview. Medicl Cre 2002;40 Suppl:IV Reid BC, Alerg AJ, Klssen AC, Rozier RG, Grci I, Winn DM, et l. A comprison of three comoridity indexes in hed nd neck cncer popultion. Orl Oncology 2002;38: Schneeweiss S, Mclure M. Use of comoridity scores for control of confounding in studies using dministrtive dtses. Interntionl Journl of Epidemiology 2000;29: Bernstein CN, Blnchrd JF, Leslie W, Wjd A, Yu BN. The incidence of frcture mong ptients with inflmmtory owel disese. A popultionsed cohort study. Annls of Internl Medicine 2000;133: Young TK, Kliewer E, Blnchrd J, Myer T. Monitoring disese urden nd preventive ehvior with dt linkge: cervicl cncer mong Aoriginl people in Mnito, Cnd. Americn Journl of Pulic Helth 2000;90: Roos LL, Nicol JP. A reserch registry: uses, development, nd ccurcy. Journl of Clinicl Epidemiology 1999;52: Burchill C, Roos LL, Fergusson P, Jemni L, Turner K, Dueck S. Orgnizing the present, looking to the future: n online knowledge repository to fcilitte collortion. Journl of Medicl Internet Reserch 2000;2:E Finn J, Holmn D, Jcos I. The use of linked mulnce dt to estimte the effect of comoridity on determinnts nd outcomes of out-of-hospitl crdic rrest in Perth, Western Austrli. Symposium on Helth Dt Linkge: Its vlue for Austrlin helth policy development nd policy relevnt reserch, Sydney, Austrli, Mrch, Adelide, South Austrli: Adelide University; p Aville from: Ttryn DJ, Roos NP, Blck CD. Utiliztion of physicin resources for multory cre. Medicl Cre 1995;33 Suppl:DS Cohen MM, McWillim L. Mesuring the helth of the popultion. Medicl Cre 1995;33 Suppl:DS Roos LL, Strnc L, Jmes RC, Li J. Complictions, comoridities, nd mortlity: improving clssifiction nd prediction. Helth Services Reserch 1997;32:229-38; discussion Stevenson M, Segui-Gomez M, Lescohier I, Di Scl C, McDonld-Smith G. An overview of the Injury Severity Score nd the New Injury Severity Score. Injury Prevention 2001;7: Morris JA Jr, McKenzie EJ, Dmino AM, Bss SM. Mortlity in trum ptients: the interction etween host fctors nd severity. Journl of Trum 1990;30: Rochon PA, Ktz JN, Morrow LA, McGlinchey-Berroth R, Ahlquist MM, Srkrti M, et l. Comorid illness is ssocited with survivl nd length of hospitl sty in ptients with chronic disility. A prospective comprison of three comoridity indices. Medicl Cre 1996;34: Richmond TS. An explntory model of vriles influencing postinjury disility. Nursing Reserch 1997;46: Nordin M, Hieert R, Pietrek M, Alexnder M, Crne M, Lewis S. Assocition of comoridity nd outcome in episodes of nonspecific low ck pin in occuptionl popultions. Journl of Occuptionl nd Environmentl Medicine 2002;44: Roos NP, Blck CD, Frohlich N, Decoster C, Cohen MM, Ttryn DJ, et l. A popultion-sed helth informtion system. Medicl Cre 1995;33 Suppl:DS Lngley J, Stephenson S, Cryer C, Bormn B. Trps for the unwry in estimting person sed injury incidence using hospitl dischrge dt. Injury Prevention 2002;8: Bulletin of the World Helth Orgniztion My 2005, 83 (5)
Small Businesses Decisions to Offer Health Insurance to Employees
Smll Businesses Decisions to Offer Helth Insurnce to Employees Ctherine McLughlin nd Adm Swinurn, June 2014 Employer-sponsored helth insurnce (ESI) is the dominnt source of coverge for nonelderly dults
More informationUtilization of Smoking Cessation Benefits in Medicaid Managed Care, 2009-2013
Utiliztion of Smoking Cesstion Benefits in Medicid Mnged Cre, 2009-2013 Office of Qulity nd Ptient Sfety New York Stte Deprtment of Helth Jnury 2015 Introduction According to the New York Stte Tocco Control
More informationDlNBVRGH + Sickness Absence Monitoring Report. Executive of the Council. Purpose of report
DlNBVRGH + + THE CITY OF EDINBURGH COUNCIL Sickness Absence Monitoring Report Executive of the Council 8fh My 4 I.I...3 Purpose of report This report quntifies the mount of working time lost s result of
More informationARTICLE IN PRESS. i n t e r n a t i o n a l j o u r n a l o f m e d i c a l i n f o r m a t i c s x x x ( 2 0 1 2 ) xxx xxx
IJB-2938; No. of Pges 12 i n t e r n t i o n l j o u r n l o f m e d i c l i n f o r m t i c s x x x ( 2 0 1 2 ) xxx xxx j ourn l homepge: www.ijmijournl.com Description nd comprison of qulity of electronic
More informationThe Determinants of Private Medical Insurance Prevalence in England
The Determinnts of Privte Medicl Insurnce Prevlence in Englnd Derek R. King, Elis Mossilos LSE Helth nd Socil Cre, London School of Economics nd Politicl Science LSE Helth nd Socil Cre Discussion Pper
More informationActive & Retiree Plan: Trustees of the Milwaukee Roofers Health Fund Coverage Period: 06/01/2015-05/31/2016 Summary of Benefits and Coverage:
Summry of Benefits nd Coverge: Wht this Pln Covers & Wht it Costs Coverge for: Single & Fmily Pln Type: NPOS This is only summry. If you wnt more detil bout your coverge nd costs, you cn get the complete
More informationJuly 2005, NCJ 209588 Substance Dependence, Abuse, and Treatment of Jail Inmates, 2002. Highlights. No dependence or abuse 53 47 32.
U.S. Deprtment of Justice Office of Justice Progrms Bureu of Justice Sttistics Specil Report By Jennifer C. Krerg nd Doris J. Jmes BJS Sttisticins In 2002 more thn two-thirds of jil inmtes were found to
More informationUnit 29: Inference for Two-Way Tables
Unit 29: Inference for Two-Wy Tbles Prerequisites Unit 13, Two-Wy Tbles is prerequisite for this unit. In ddition, students need some bckground in significnce tests, which ws introduced in Unit 25. Additionl
More informationAdditional Protocol to the Convention on Human Rights and Biomedicine concerning Genetic Testing for Health Purposes
Council of Europe Trety Series - No. 203 Additionl Protocol to the Convention on Humn Rights nd Biomedicine concerning Genetic Testing for Helth Purposes Strsourg, 27.XI.2008 2 CETS 203 Humn Rights nd
More informationSubjective health complaints and psychosocial work environment among university personnel
Occuptionl Medicine Advnce Access published November 8, 2012 Occuptionl Medicine doi:10.1093/occmed/kqs188 Subjective helth complints nd psychosocil work environment mong university personnel Bente E.
More informationTreatment Spring Late Summer Fall 0.10 5.56 3.85 0.61 6.97 3.01 1.91 3.01 2.13 2.99 5.33 2.50 1.06 3.53 6.10 Mean = 1.33 Mean = 4.88 Mean = 3.
The nlysis of vrince (ANOVA) Although the t-test is one of the most commonly used sttisticl hypothesis tests, it hs limittions. The mjor limittion is tht the t-test cn be used to compre the mens of only
More informationHealth insurance exchanges What to expect in 2014
Helth insurnce exchnges Wht to expect in 2014 33096CAEENABC 02/13 The bsics of exchnges As prt of the Affordble Cre Act (ACA or helth cre reform lw), strting in 2014 ALL Americns must hve minimum mount
More informationAnthem Blue Cross Life and Health Insurance Company University of Southern California Custom Premier PPO 800/20%/20%
Anthem Blue Cross Life nd Helth Insurnce Compny University of Southern Cliforni Custom Premier 800/20%/20% Summry of Benefits nd Coverge: Wht this Pln Covers & Wht it Costs Coverge Period: 01/01/2015-12/31/2015
More informationClearPeaks Customer Care Guide. Business as Usual (BaU) Services Peace of mind for your BI Investment
ClerPeks Customer Cre Guide Business s Usul (BU) Services Pece of mind for your BI Investment ClerPeks Customer Cre Business s Usul Services Tble of Contents 1. Overview...3 Benefits of Choosing ClerPeks
More informationHealth Information Systems: evaluation and performance of a Help Desk
536 Digitl Helthcre Empowering Europens R. Cornet et l. (Eds.) 2015 Europen Federtion for Medicl Informtics (EFMI). This rticle is published online with Open Access by IOS Press nd distributed under the
More informationReasoning to Solve Equations and Inequalities
Lesson4 Resoning to Solve Equtions nd Inequlities In erlier work in this unit, you modeled situtions with severl vriles nd equtions. For exmple, suppose you were given usiness plns for concert showing
More informationHealth insurance marketplace What to expect in 2014
Helth insurnce mrketplce Wht to expect in 2014 33096VAEENBVA 06/13 The bsics of the mrketplce As prt of the Affordble Cre Act (ACA or helth cre reform lw), strting in 2014 ALL Americns must hve minimum
More informationPatient Perceptions of Reimbursement for Arthroscopic Meniscectomy and Anterior Cruciate Ligament Reconstruction
Ptient Perceptions of Reimursement for Arthroscopic nd Anterior Crucite Ligment Reconstruction Kelechi R. Okoroh, MD; Roert A. Keller, MD; Nthn E. Mrshll, MD; Jonthn R. Lynch, MD; John-Michel Guest, BS;
More informationNational Diabetes Audit. Report 1: Care Processes and Treatment Targets
Ntionl Dietes Audit 2012 2013 Report 1: Cre Processes nd Tretment Trgets The Ntionl Dietes Audit is commissioned y The Helthcre Qulity Improvement Prtnership (HQIP) The Ntionl Dietes Audit is commissioned
More informationHematopoietic stem cell transplantation
Online Clinicl Investigtions Improved outcomes for stem cell trnsplnt recipients requiring peditric intensive cre Rnjit S. Chim, MD; Rodney C. Dniels, MD; Mi-Ok Kim, PhD; Dndn Li, MS; Derek S. Wheeler,
More informationNavy Asbestos Medical Surveillance Program 1990 1999: Demographic Features and Trends in Abnormal Radiographic Findings
MILITARY MEDICINE, 171, 8:717, 2006 Nvy Asbestos Medicl Surveillnce Progrm 1990 1999: Demogrphic Fetures nd Trends in Abnorml Rdiogrphic Findings Gurntor: Dnielle M. Dell, MPH Contributors: Dnielle M.
More informationHelicopter Theme and Variations
Helicopter Theme nd Vritions Or, Some Experimentl Designs Employing Pper Helicopters Some possible explntory vribles re: Who drops the helicopter The length of the rotor bldes The height from which the
More informationAnnual Statistical Report on the Social Security Disability Insurance Program, 2001
Annul Sttisticl Report on the Socil Security Disility Insurnce Progrm, 2001 Socil Security Administrtion Office of Policy Office of Reserch, Evlution, nd Sttistics Highlights 2001 Size nd Scope of the
More informationWhy is the NSW prison population falling?
NSW Bureu of Crime Sttistics nd Reserch Bureu Brief Issue pper no. 80 September 2012 Why is the NSW prison popultion flling? Jcqueline Fitzgerld & Simon Corben 1 Aim: After stedily incresing for more thn
More informationArthritis in the Canadian Aboriginal population: north-south differences in prevalence and correlates*
Arthritis in the Cndin Aoriginl popultion: north-south differences in prevlence nd correltes* C. Ng, MSc (1); S. Chtwood, MSc (2,3); T. K. Young, MD, PhD (3) * This rticle is prt of joint puliction inititive
More information2015 EDITION. AVMA Report on Veterinary Compensation
2015 EDITION AVMA Report on Veterinry Compenstion AVMA Report on Veterinry Compenstion 2015 EDITION Copyright 2015 by the All rights reserved. ISBN-13: 978-1-882691-31-9 AVMA Report on Veterinry Compenstion
More informationMAX. As an increasingly larger share of Medicaid enrollees MEDICAID POLICY BRIEF
MAX CENTERS FOR MEDICARE & MEDICAID SERVICES MEDICAID POLICY BRIEF Brief 14 December 2012 The Avilbility nd Usbility of Behviorl Helth Orgniztion Encounter Dt in MAX 2009 Jessic Nysenbum, Ellen Bouchery,
More informationRapid critical appraisal. using GATE. GATE: Graphic Appraisal Tool for Epidemiology. One picture: the GATE frame. 1 picture, 2 formulas & 3 acronyms 2
Rpid criticl pprisl GA: Grphic Apprisl ool for pidemiology using GA Rod Jckson University of Aucklnd, NZ Ferury 2011 1 1 picture, 2 formuls & 3 cronyms 2 ne picture: the GA frme British doctors smoking
More informationAssessing the Burden of Disease and Injury in Los Angeles County Using Disability-Adjusted Life Years
Reserch Articles Assessing the Burden of Disese nd Injury in Los Angeles County Using Disbility-Adjusted Life Yers Gerld F. Kominski, PhD,b Pul A. Simon, MD, MPH c,d Alex Ho, MD, MPH c Jeffrey Luck, PhD,
More informationExcess Costs and Utilization Associated with Methicillin Resistance for Patients with Staphylococcus aureus Infection
infection control nd hospitl epidemiology pril 2010, vol. 31, no. 4 originl rticle Excess Costs nd Utiliztion Associted with Methicillin Resistnce for Ptients with Stphylococcus ureus Infection Gregory
More informationNote: Principal version Modification Amendment Equivalence list Consolidated version from October 1 2014
Note: The following curriculum is consolidted version. It is leglly non-inding nd for informtionl purposes only. The leglly inding versions re found in the University of Innsruck Bulletins (in Germn).
More informationSchedule of benefits Benefits Preferred Advantage Basic Enhanced C
Schedule of enefits Benefits Preferred Advntge Bsic Enhnced C Wrd entitlement Stndrd room in privte hospitl or privte medicl institution Restructured hospitl for wrd clss A nd elow Restructured hospitl
More informationRecent health policy efforts have targeted healthcare
Medicre Clim Processors Reimursement nd G-CSF Choice Among Non-Hodgkin Lymphom Ptients At Glnce Prcticl Implictions p 148 Author Informtion p 153 Full text nd PDF www.jplive.com Originl Reserch Xioyun
More informationLump-Sum Distributions at Job Change, p. 2
Jnury 2009 Vol. 30, No. 1 Lump-Sum Distributions t Job Chnge, p. 2 E X E C U T I V E S U M M A R Y Lump-Sum Distributions t Job Chnge GROWING NUMBER OF WORKERS FACED WITH ASSET DECISIONS AT JOB CHANGE:
More informationCOVER CROP VARIETY AND SEEDING RATE EFFECTS ON WINTER WEED SEED PRODUCTION
COVER CROP VARIETY AND SEEDING RATE EFFECTS ON WINTER WEED SEED PRODUCTION Nthn S. Boyd nd Eric B. Brennn, USDA-ARS, Orgnic Reserch Progrm, 1636 E. Alisl Street, Slins, CA 93905 Astrct Weed mngement is
More informationCombined Liability Insurance. Information and Communication Technology Proposal form
Comined Liility Insurnce Informtion nd Communiction Technology Proposl form Comined Liility Insurnce Informtion nd Communiction Technology - Proposl form This proposl form must e completed nd signed y
More informationLobe of Origin and Histologic Type of Lung Cancer Associated With Asbestos Exposure in the Carotene and Retinol Efficacy Trial (CARET)
AMERICAN JOURNAL OF INDUSTRIAL MEDICINE 32:582 591 (1997) Loe of Origin nd Histologic Type of Lung Cncer Associted With Asestos Exposure in the Crotene nd Retinol Efficcy Tril (CARET) C. Andrew Brodkin,
More informationHealth insurance exchanges What to expect in 2014
Helth insurnce exchnges Wht to expect in 2014 33096CAEENABC 11/12 The bsics of exchnges As prt of the Affordble Cre Act (ACA or helth cre reform lw), strting in 2014 ALL Americns must hve minimum mount
More informationProfile of Jail Inmates, 2002
U.S. Deprtment of Justice Office of Justice Progrms Revised, 10/12/04 th Bureu of Justice Sttistics Specil Report July 2004, NCJ 201932 Profile of Jil Inmtes, 2002 By Doris J. Jmes BJS Sttisticin At midyer
More informationYour duty, however, does not require disclosure of matter:
Your Duty of Disclosure Before you enter into contrct of generl insurnce with n insurer, you hve duty, under the Insurnce Contrcts Act 1984 (Cth), to disclose to the insurer every mtter tht you know, or
More informationPsychological health and safety in the workplace Prevention, CAN/CSA-Z1003-13/BNQ 9700-803/2013
Psychologicl helth nd sfety in the workplce Prevention, CAN/CSA-Z1003-13/BNQ 9700-803/2013 promotion, nd guidnce to stged implementtion This smple udit tool is n nnex of the Ntionl Stndrd of Cnd on Psychologicl
More informationAs posted for public comment 2/25/2015 to 8 a.m. March 30, 2015. HERC Coverage Guidance
HEALTH EVIDENCE REVIEW COMMISSION (HERC) COVERAGE GUIDANCE: PROTON BEAM THERAPY HERC Coverge Guidnce Proton em therpy (PBT) is ed for coverge for mlignnt oculr tumors (strong tion). Proton em therpy is
More informationMental Health Issue MEDICAL SURVEILLANCE MONTHLY REPORT JULY 2013. Editorial: the mental health of our deploying generation
JULY 2013 Volume 20 Number 7 msmr MEDICAL SURVEILLANCE MONTHLY REPORT Mentl Helth Issue PAGE 2 Editoril: the mentl helth of our deploying genertion Richrd F. Stoltz, PhD PAGE 4 Summry of mentl disorder
More informationHow To Write A Jcc Letter
JOINT CONCILIATION COMMITTEE OF THE HEATING, VENTILATING AND DOMESTIC ENGINEERING INDUSTRY COMPRISING: 107 Building & Engineering Services Assocition (B&ES) (formerly Heting nd Ventilting Contrctors' Assocition
More informationHumana Critical Illness/Cancer
Humn Criticl Illness/Cncer Criticl illness/cncer voluntry coverges py benefits however you wnt With our criticl illness nd cncer plns, you'll receive benefit fter serious illness or condition such s hert
More informationQuality and Cost Evaluation of a Medical Financial Assistance Program
Qulity nd Cost Evlution of Medicl Finncil Assistnce Progrm Dougls A Conner, PhD; Arne Beck, PhD; Christin Clrke; Leslie Wright, MA; Koml Nrwney, MD, PhD; Neys W Berminghm Perm J 2013 Winter;17(1):31-37
More informationAn Undergraduate Curriculum Evaluation with the Analytic Hierarchy Process
An Undergrdute Curriculum Evlution with the Anlytic Hierrchy Process Les Frir Jessic O. Mtson Jck E. Mtson Deprtment of Industril Engineering P.O. Box 870288 University of Albm Tuscloos, AL. 35487 Abstrct
More informationRevisions published in the University of Innsbruck Bulletin of 18 June 2014, Issue 31, No. 509
Plese note: The following curriculum is for informtion purposes only nd not leglly inding. The leglly inding version is pulished in the pertinent University of Innsruck Bulletins. Originl version pulished
More informationEuropean Convention on Certain International Aspects of Bankruptcy
Europen Trety Series - No. 136 Europen Convention on Certin Interntionl Aspects of Bnkruptcy Istnul, 5.VI.1990 Premle The memer Sttes of the Council of Europe, signtories hereto, Considering tht the im
More informationNational Diabetes Audit. Report 1: Care Processes and Treatment Targets
Ntionl Dibetes Audit 2011 2012 Report 1: Cre Processes nd Tretment Trgets The Ntionl Dibetes Audit is commissioned by The Helthcre Qulity Improvement Prtnership (HQIP) promotes qulity in helthcre. HQIP
More informationOr more simply put, when adding or subtracting quantities, their uncertainties add.
Propgtion of Uncertint through Mthemticl Opertions Since the untit of interest in n eperiment is rrel otined mesuring tht untit directl, we must understnd how error propgtes when mthemticl opertions re
More informationSTATISTICAL BRIEF #188
HEALTHCARE COST AND UTILIZATION PROJECT STATISTICAL BRIEF #188 Agency for Helthcre Reserch nd Qulity Februry 2015 Surgeries in Hospitl-Owned Outptient Fcilities, 2012 Luren M. Wier, M.P.H., Cludi A. Steiner,
More information13 June 2013 www.wao.gov.uk. Implementation of the National Framework for Continuing NHS Healthcare
13 June 2013 www.wo.gov.uk Implementtion of the Ntionl Frmework for Continuing NHS Helthcre Implementtion of the Ntionl Frmework for Continuing NHS Helthcre I hve prepred this report for presenttion to
More informationBayesian Updating with Continuous Priors Class 13, 18.05, Spring 2014 Jeremy Orloff and Jonathan Bloom
Byesin Updting with Continuous Priors Clss 3, 8.05, Spring 04 Jeremy Orloff nd Jonthn Bloom Lerning Gols. Understnd prmeterized fmily of distriutions s representing continuous rnge of hypotheses for the
More informationSubscriber churn in the Australian ISP market
MPRA Munich Personl RePEc Archive Suscrier churn in the Austrlin ISP mrket Gry G Mdden nd Scott J Svge nd Grnt Cole-Nel Curtin University of Technology, School of Economics nd Finnce, Perth WA 6845, Austrli,
More informationAntiSpyware Enterprise Module 8.5
AntiSpywre Enterprise Module 8.5 Product Guide Aout the AntiSpywre Enterprise Module The McAfee AntiSpywre Enterprise Module 8.5 is n dd-on to the VirusScn Enterprise 8.5i product tht extends its ility
More informationTort Trials and Verdicts in Large Counties, 2001
U.S. Deprtment of Justice Office of Justice Progrms Bureu of Justice Sttistics Bulletin Civil Justice Survey of Stte Courts, 2001 Novemer 200, NCJ 20620 Tort Trils nd Verdicts in Lrge Counties, 2001 By
More informationINITIATION OF THERAPY Patient-specific considerations for initiation of apixaban therapy include the following:
UNC HEALTH CARE GUIDELINE Mngement of Apixn in Adults Apixn (Eliquis ) is n orl nticogulnt tht cts s fctor X inhiitor. It is pproved y the FDA for the prevention of stroke nd systemic emolism in ptients
More informationSTATUS OF LAND-BASED WIND ENERGY DEVELOPMENT IN GERMANY
Yer STATUS OF LAND-BASED WIND ENERGY Deutsche WindGurd GmbH - Oldenburger Strße 65-26316 Vrel - Germny +49 (4451)/9515 - info@windgurd.de - www.windgurd.com Annul Added Cpcity [MW] Cumultive Cpcity [MW]
More informationFDIC Study of Bank Overdraft Programs
FDIC Study of Bnk Overdrft Progrms Federl Deposit Insurnce Corportion November 2008 Executive Summry In 2006, the Federl Deposit Insurnce Corportion (FDIC) initited two-prt study to gther empiricl dt on
More informationJuly 22, 2009. The Honorable Henry A. Waxman Chairman Committee on Energy and Commerce House of Representatives
United Sttes Government Accountbility Office Wshington, DC 20548 July 22, 2009 The Honorble Henry A. Wxmn Chirmn Committee on Energy nd Commerce House of Representtives The Honorble John D. Dingell Chirmn
More informationA COMPARISON OF ALCOHOL SCREENING INSTRUMENTS AMONG UNDER-AGED DRINKERS TREATED IN EMERGENCY DEPARTMENTS
Alcohol & Alcoholism Vol. 37, No. 5, pp. 444 450, 2002 A COMPARISON OF ALCOHOL SCREENING INSTRUMENTS AMONG UNDER-AGED DRINKERS TREATED IN EMERGENCY DEPARTMENTS THOMAS M. KELLY 1 *, JOHN E. DONOVAN 1, JANET
More informationCHARACTERIZATION OF HASS AVOCADO PROLEPTIC AND SYLLEPTIC SHOOT PROPORTION IN VALPARAISO REGION, CHILE
Proceedings VI World Avocdo Congress (Acts VI Congreso Mundil del Agucte) 2007. Viñ Del Mr, Chile. 12 16 Nov. 2007. ISBN No 978-956-17-0413-8. CHARACTERIZATION OF HASS AVOCADO PROLEPTIC AND SYLLEPTIC SHOOT
More informationFactors Related to Radiation Safety Practices in California
... PEER REVIEW Fctors Relted to Rdition Sfety Prctices in Cliforni JANET THOMPSON REAGAN, PhD ANITA MARIE SLECHTA, MS, R.T.(R)(M), FASRT Bckground A ntionl study of rdiologic technologists rdition sfety
More informationEQUATIONS OF LINES AND PLANES
EQUATIONS OF LINES AND PLANES MATH 195, SECTION 59 (VIPUL NAIK) Corresponding mteril in the ook: Section 12.5. Wht students should definitely get: Prmetric eqution of line given in point-direction nd twopoint
More informationSection 5-4 Trigonometric Functions
5- Trigonometric Functions Section 5- Trigonometric Functions Definition of the Trigonometric Functions Clcultor Evlution of Trigonometric Functions Definition of the Trigonometric Functions Alternte Form
More informationMEDICAL SURVEILLANCE MONTHLY REPORT
AUGUST 2015 Volume 22 Number 8 msmr MEDICAL SURVEILLANCE MONTHLY REPORT PAGE 2 PAGE 9 Updte: Routine screening for ntibodies to humn immunodeficiency virus, civilin pplicnts for U.S. militry service nd
More informationPrevalence Estimates for Risk Factors and Health Indicators. State of Michigan. Selected Tables. Michigan Behavioral Risk Factor Survey
Prevlence Estimtes for Risk Fctors nd Helth Indictors Stte of Michign Selected Tles Michign Behviorl Risk Fctor Survey 2014 Chronic Disese Epidemiology Section Lifecourse Epidemiology nd Genomics Division
More informationRecognition Scheme Forensic Science Content Within Educational Programmes
Recognition Scheme Forensic Science Content Within Eductionl Progrmmes one Introduction The Chrtered Society of Forensic Sciences (CSoFS) hs been ccrediting the forensic content of full degree courses
More informationMorgan Stanley Ad Hoc Reporting Guide
spphire user guide Ferury 2015 Morgn Stnley Ad Hoc Reporting Guide An Overview For Spphire Users 1 Introduction The Ad Hoc Reporting tool is ville for your reporting needs outside of the Spphire stndrd
More informationTogether for Health. Stroke Delivery Plan, Annual Report 2014
Together for Helth Stroke Delivery Pln, Annul Report 2014 Contents 1. Introduction 2 2. How well re we doing on stroke services in Wles? 4 2.1 Overview 4 2.2 Stroke incidence rtes 4 2.3 Stroke mortlity
More informationpersons withdrawing from addiction is given by summarizing over individuals with different ages and numbers of years of addiction remaining:
COST- BENEFIT ANALYSIS OF NARCOTIC ADDICTION TREATMENT PROGRAMS with Specil Reference to Age Irving Leveson,l New York City Plnning Commission Introduction Efforts to del with consequences of poverty,
More informationTHE EFFECTS OF INCREASED PROTEIN INTAKE ON KIDNEY SIZE AND FUNCTION
The Journl of Experimentl iology 21, 281 29 (1998) Printed in Gret ritin The Compny of iologists Limited 1998 JE1492 281 THE EFFECTS OF INCRESED PROTEIN INTKE ON KIDNEY SIZE ND FUNCTION KIMERLY. HMMOND
More informationUNITED STATES DEPARTMENT OF AGRICULTURE Washington, D.C. 20250. ACTION BY: All Divisions and Offices. FGIS Directive 2510.
UNITED STATES DEPARTMENT OF AGRICULTURE Wshington, D.C. 20250 ACTION BY: All Divisions nd Offices FGIS Directive 2510.1 12-11-73 FEDERAL TORT CLAIMS I PURPOSE This Instruction: A Sets forth the bsic provisions
More informationReversing Medications That Cause Bleeding
Reversing Medictions Tht Cuse Bleeding Dine M. Birnbumer, M.D., FACEP Professor of Medicine University of Cliforni, Los Angeles Senior Fculty Deprtment of Emergency Medicine Hrbor-UCLA Medicl Center The
More informationEconomics Letters 65 (1999) 9 15. macroeconomists. a b, Ruth A. Judson, Ann L. Owen. Received 11 December 1998; accepted 12 May 1999
Economics Letters 65 (1999) 9 15 Estimting dynmic pnel dt models: guide for q mcroeconomists b, * Ruth A. Judson, Ann L. Owen Federl Reserve Bord of Governors, 0th & C Sts., N.W. Wshington, D.C. 0551,
More informationThe Effect of Internet Experience on Consumer Expectations of Responsiveness and Control in Offline Services Marketing Interactions
The Effect of Internet Experience on Consumer Expecttions of Responsiveness nd Control in Offline Services Mrketing Interctions Lind F. Alwitt DePul University llwitt@wppost.depul.edu Lwrence O. Hmer DePul
More information** Dpt. Chemical Engineering, Kasetsart University, Bangkok 10900, Thailand
Modelling nd Simultion of hemicl Processes in Multi Pulse TP Experiment P. Phnwdee* S.O. Shekhtmn +. Jrungmnorom** J.T. Gleves ++ * Dpt. hemicl Engineering, Ksetsrt University, Bngkok 10900, Thilnd + Dpt.hemicl
More informationc. Values in statements are broken down by fiscal years; many projects are
Lecture 18: Finncil Mngement (Continued)/Csh Flow CEE 498 Construction Project Mngement L Schedules A. Schedule.of Contrcts Completed See Attchment # 1 ll. 1. Revenues Erned 2. Cost of Revenues 3. Gross
More informationPrevalence of Skin Disease among Nursing Home Staff in Southern Taiwan
Industril Helth 2002, 40, 54 58 Short Communiction Prevlence of Skin Disese mong Nursing Home Stff in Southern Tiwn Derek Richrd SMITH 1, 2, Yue-Ling Leon GUO 2, 3, Yung-Ling LEE 2, 3, Fu-Sen HSIEH 4,
More informationAsbestosis is a fibrosing lung disease caused by exposure
Asestos Fier Content of Lungs With Diffuse Interstitil Firosis An Anlyticl Scnning Electron Microscopic Anlysis of 249 Cses Frnk Schneider, MD; Thoms A. Sporn, MD; Victor L. Roggli, MD Context. Asestosis
More informationOscar Brook *, Hein van Hout, Hugo Nieuwenhuyse, Eibert Heerdink
Europen Neuropsychophrmcology 13 (003) 1 9 www.elsevier.com/ locte/ euroneuro Impct of coching y community phrmcists on drug ttitude of depressive primry cre ptients nd cceptility to ptients; rndomized
More informationOutsourcing versus in-house maintenance of medical devices: a longitudinal, empirical study
Investigción originl / Originl reserch Outsourcing versus in-house mintennce of medicl devices: longitudinl, empiricl study Antonio Miguel-Cruz, 1 Adrin Rios-Rincón, 1 nd Gregory L. Hugn 1 Suggested cittion
More informationTreating Prostate Cancer
CHAPTER 4 Treting Prostte Cncer here is controversy bout the optiml tretment for cliniclly loclized prostte cncer (i.e., cncer tht ppers not to hve spred beyond the prostte bsed on informtion vilble without
More informationGAO IRS AUDIT RATES. Rate for Individual Taxpayers Has Declined But Effect on Compliance Is Unknown
GAO United Sttes Generl Accounting Office Report to the Chirmn, Subcommittee on Oversight, Committee on Wys nd Mens, House of Representtives April 2001 IRS AUDIT RATES Rte for Individul Txpyers Hs Declined
More informationInjuries From Combat Explosions in Iraq: Injury Type, Location, and Severity
Injuries From Combt Explosions in Irq: Injury Type, Loction, nd Severity Susn L. Eskridge Croline A. Mcer Michel R. Glrneu Troy L. Holbrook Susn I. Woodruff Andrew J. McGregor Deborh J. Morton Richrd A.
More informationRoudmup for Los Angeles Pierce College ADIV Program ancl csu Dominguez Hilk Rlt-B^sr/ progrum
Roudmup for Los Angeles Pierce College ADIV Progrm ncl csu Dominguez Hilk Rlt-B^sr/ progrum Admission Requirements for Los Angeles pierce (LApC) LAPC hs four-semester Associte Degree in Nursing (ADN) Progrm.
More informationDistributions. (corresponding to the cumulative distribution function for the discrete case).
Distributions Recll tht n integrble function f : R [,] such tht R f()d = is clled probbility density function (pdf). The distribution function for the pdf is given by F() = (corresponding to the cumultive
More informationFeatures. This document is part of the Terms and Conditions for Personal Bank Accounts. 16-20 Barolin St, PO Box 1063 Bundaberg Queensland 4670
S This document is prt of the Terms nd Conditions for Personl Bnk Accounts Issued y Auswide Bnk Ltd ABN 40 087 652 060/Austrlin Finncil Services & Austrlin Credit Licence 239686 Effective from Jnury 18
More informationSerial Testing Using QuantiFERON TB Gold In tube
Seril Testing Using QuntiFERON TB Gold In tue Assy in High Risk Popultion Richrd S. Grfein, PhD, MPH Professor Division of Glol Pulic Helth, School of Medicine University of Cliforni Sn Diego rgrfein@ucsd.edu
More informationHow To Get Low Wage Workers Covered By Insurance Through Their Employer
Stephen H. Long M. Susn Mrquis Low-Wge Workers nd Helth Insurnce Coverge: Cn Policymkers Trget Them through Their Employers? Mny policy inititives to increse helth insurnce coverge would subsidize employers
More informationNOTES. Cohasset Associates, Inc. 2015 Managing Electronic Records Conference 8.1
Cohsset Assocites, Inc. Expnding Your Skill Set: How to Apply the Right Serch Methods to Your Big Dt Problems Juli L. Brickell H5 Generl Counsel MER Conference My 18, 2015 H5 POWERING YOUR DISCOVERY GLOBALLY
More informationAppendix D: Completing the Square and the Quadratic Formula. In Appendix A, two special cases of expanding brackets were considered:
Appendi D: Completing the Squre nd the Qudrtic Formul Fctoring qudrtic epressions such s: + 6 + 8 ws one of the topics introduced in Appendi C. Fctoring qudrtic epressions is useful skill tht cn help you
More informationPrevalence of Cerebral Palsy in Quebec: Alternative Approaches
Originl Pper Received: My 25, 2012 Accepted: September 20, 2012 Published online: Jnury 24, 2013 Prevlence of Cerebrl Plsy in Quebec: Alterntive Approches M. Oskoui L. Joseph b L. Dgenis c M. Shevell Deprtment
More informationTHE PARAMETERS OF TRAPS IN K-FELDSPARS AND THE TL BLEACHING EFFICIENCY
GEOCHRONOMETRIA Vol. 2, pp 15-2, 21 Journl on Methods nd Applictions of Asolute Chronology THE PARAMETERS OF TRAPS IN K-FELDSPARS AND THE TL BLEACHING EFFICIENCY ALICJA CHRUŒCIÑSKA 1, HUBERT L. OCZKOWSKI
More informationEnterprise Risk Management Software Buyer s Guide
Enterprise Risk Mngement Softwre Buyer s Guide 1. Wht is Enterprise Risk Mngement? 2. Gols of n ERM Progrm 3. Why Implement ERM 4. Steps to Implementing Successful ERM Progrm 5. Key Performnce Indictors
More informationSurvival of Non-small Cell Lung Cancer Patients with Postoperative Recurrence at Distant Organs
Survivl of Non-smll Cell Cncer Ptients with Postopertive Recurrence t Distnt Orgns Ichiro Yoshino, MD, 1,2 Tomofumi Yohen, MD, 1 Mschik Kitjim, MD, 1 Chie Ushijim, MD, 1 Kenichi Nishiok, MD, 1 Yukito Ichinose,
More informationContinuing NHS Healthcare Follow-up Report
29 Jnury 2015 Archwilydd Cyffredinol Cymru Auditor Generl for Wles Continuing NHS Helthcre Follow-up Report I hve prepred nd pulished this report in ccordnce with the Government of Wles Acts 1998 nd 2006.
More informationSimulation of operation modes of isochronous cyclotron by a new interative method
NUKLEONIKA 27;52(1):29 34 ORIGINAL PAPER Simultion of opertion modes of isochronous cyclotron y new intertive method Ryszrd Trszkiewicz, Mrek Tlch, Jcek Sulikowski, Henryk Doruch, Tdeusz Norys, Artur Srok,
More information