bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic polyarthritis as the first manifestation of childhood systemic polyarteritis nodosa
Authors: Novak Glaucia Vanessa , Hayashi Koken , Sampa Kohei , Okumura Yosuke , Ferreira Gabriela Ribeiro Viola , Silva Clovis Artur
Published: April 2017

ABSTRACT Arthritis has been reported as an acute pattern, generally evanescent with oligoarthritis, mostly affecting knees and ankles in childhood systemic polyarteritis nodosa. However, chronic polyarthritis with morning stiffness mimicking juvenile idiopathic arthritis has not been reported. We describe the case of a 4-year old girl who had additive and chronic polyarthritis with edema, tenderness, pain on motion and morning stiffness for 2 months. After 45 days, she also presented painful subcutaneous nodules and erythematous-violaceous lesions in the extensor region of upper and lower limbs. She was admitted to university hospital due to high fever, malaise, myalgia, anorexia, loss of weight (1kg), painful skin lesions and severe functional disability. She was bedridden by chronic polyarthritis with limitation on motion. Systolic and diastolic blood pressures were greater than 95th percentile for height. Urine protein/creatinine ratio was 0.39g/day, and immunological tests were negative. Anti-streptolysin O was 1,687UI/mL. Skin biopsy revealed necrotizing vasculitis in medium- and small-sized vessels compatible with polyarteritis nodosa. Therefore, we had the diagnosis of systemic polyarteritis nodosa. Prednisone 2mg/kg/day was administered with complete resolution of skin lesions and arthritis, and improvement of proteinuria (0.26g/day) after 15 days. The diagnosis of childhood systemic polyarteritis nodosa should be considered for patients with chronic polyarthritis associated to cutaneous vasculitis triggered by streptococcal infection.
Experimental analysis of the concrete contribution to shear strength beams without shear reinforcement
Authors: Samora M. S. , Santos A. C. DOS , Trautwein L. M. , Marques M. G.
Published: April 2017

Abstract There are many theories and empirical formulas for estimating the shear strength of reinforced concrete structures without transverse reinforcement. The security factor of any reinforced concrete structure, against a possible collapse, is that it does not depend on the tensile strength of the concrete and the formation of any collapse is ductile, thus giving advance warning. The cracking from tensile stress can cause breakage of the concrete and should be avoided at all cost, with the intent that any such breakage does not incur any type of failure within the structure. In the present research study, experiments were performed in order to analyze the complementary mechanisms of the shear strength of lattice beams of reinforced concrete frames without transverse reinforcement. The experimental program entails the testing of eight frames that were subjected to a simple bending process. Two concrete resistance classes for analyzing compressive strength were considered on the construction of frames, 20 MPa and 40 MPa. To resist the bending stresses, the beams of the frames are designed in domain 3 of the ultimate limit states. Different rates and diameters of longitudinal reinforcement were used, 1.32% and 1.55% with 12.5 mm diameter and 16.0 mm in longitudinal tensile reinforcement. From the obtained results, an analysis was made of the criteria already proposed for defining the norms pertinent to the portion of relevant contribution for the shear resistance mechanisms of concrete without the use of transverse reinforcement and the influence of the concrete resistance and longitudinal reinforcement rates established in the experimental numerical results.
Thrombin-Induced Podocyte Injury Is Protease-Activated Receptor Dependent
Authors: Sharma Ruchika , Waller Amanda P. , Agrawal Shipra , Wolfgang Katelyn J. , Luu Hiep , Shahzad Khurrum , Isermann Berend , Smoyer William E. , Nieman Marvin T. , Kerlin Bryce A.
Published: April 2017

Nephrotic syndrome is characterized by massive proteinuria and injury of specialized glomerular epithelial cells called podocytes. Studies have shown that, whereas low-concentration thrombin may be cytoprotective, higher thrombin concentrations may contribute to podocyte injury. We and others have demonstrated that ex vivo plasma thrombin generation is enhanced during nephrosis, suggesting that thrombin may contribute to nephrotic progression. Moreover, nonspecific thrombin inhibition has been shown to decrease proteinuria in nephrotic animal models. We thus hypothesized that thrombin contributes to podocyte injury in a protease-activated receptor-specific manner during nephrosis. Here, we show that specific inhibition of thrombin with hirudin reduced proteinuria in two rat nephrosis models, and thrombin colocalized with a podocyte-specific marker in rat glomeruli. Furthermore, flow cytometry immunophenotyping revealed that rat podocytes express the protease-activated receptor family of coagulation receptors in vivo. High-concentration thrombin directly injured conditionally immortalized human and rat podocytes. Using receptor-blocking antibodies and activation peptides, we determined that thrombin-mediated injury depended upon interactions between protease-activated receptor 3 and protease-activated receptor 4 in human podocytes, and between protease-activated receptor 1 and protease-activated receptor 4 in rat podocytes. Proximity ligation and coimmunoprecipitation assays confirmed thrombin-dependent interactions between human protease-activated receptor 3 and protease-activated receptor 4, and between rat protease-activated receptor 1 and protease-activated receptor 4 in cultured podocytes. Collectively, these data implicate thrombinuria as a contributor to podocyte injury during nephrosis, and suggest that thrombin and/or podocyte-expressed thrombin receptors may be novel therapeutic targets for nephrotic syndrome.
Current issues of diagnosis and treatment of osteoporosis in men in general practice
Authors: Lesnyak Olga M
Published: April 2017

The author revises the latest evidence in the literature regarding managing of osteoporosis in men. Osteoporosis is an important under-recognized problem threatening men. Among people over 50 years of age, a fifth of men will suffer a fragility fracture during their remaining lifetime. The leading risk factors of male osteoporosis are genetic predisposition, low sex hormones and secondary osteoporosis. The latter comprises up to 40% of all male osteoporosis cases. The most common causes of secondary osteoporosis in men are alcohol abuse, endogenic and exogenic hypercortisolism and hypogonadism. Treatment of the underlying disease may result in BMD increase and probably fracture risk improvement. Bisphosphonates (alendronate, risedronate and zoledronic acid), denosumab and teriparatide are approved for treatment of male osteoporosis. Non-pharmacological treatment including avoiding smoking and excessive drinking, health lifestyle and a diet rich in bone-healthy nutrients should also be considered.
Acute coronary syndrome
Authors: Dubikaitis Tatiana A
Published: April 2017

Current approaches for outpatient diagnosis of acute coronary syndrome are presented in the article with detailed consideration for atypical presentation of special groups of patients. The first steps management of acute coronary syndrome in outpatient settings is described.
تطبيق إدارة الجودة الشاملة في التعليم الجامعي: دراسة حالة في كلية الدراسات الإسلامية جامعة المحمدية مالانج
Authors: Shuhub Lubna Ahmad
Published: April 2017

The success of an institution or university depends on how the leader educates and implements the strategy. Therefore, an education strategy must be developed by university in every nation worldwide. This research aims to know the implementation of TQM on the Faculty of Islamic Study in Muhammadiyah University, Malang, Indonesia, which are Quality standard, TQM implementation strategy, TQM evaluation, the obstacles of TQM implementation in the Faculty of Islamic Study in Muhammadiyah University, Malang. This research employs descriptive analysis. The instrument of data collection is by interviewing, documenting and observing. The most important findings from this research is the quality standard in Muhammadiyah University Malang follows the regulation of National Higher Education and formulated based on KKNI. The strategy of TQM implementation was conducted from the central of quality management, while the process of quality evaluation was conducted directly from the teaching and learning activities. The obstacles faced by the TQM implementation is the lack of professionals and the lack of awareness to implement the new quality standard, and the development of TQM is done by implementing the education policy firmly and it must be controlled continuously.
What Do You Do With A Problem? by K. Yamada
Authors: Murugan Sherry
Published: April 2017

Yamada, Kobi. What Do You Do With A Problem?, illustrated by Mae Besom. Compendium, 2016.This second collaboration of Kobi Yamada and Mae Besom offers children and adults alike some advice on how to deal with the universal task of dealing with a problem. The story follows the struggle of a child who encounters a problem that just won’t go away. It is through the child’s narrative that we, immerse ourselves. We can feel this struggle, the immense pains and terrifying feelings because all humans big and small have all dealt with the same question “What do you do with a Problem?” Fortunately, Yamada offers readers a solution. Like with many things in life, we must face it. Once the child finds the courage to tackle the problem, it becomes something other than what the child first imagined it to be.The illustrations by Mae Besom beautifully capture the feelings and emotions that are present when someone finds themselves in the throes of a problem. The illustrator’s combination of pencil and water colours create strong images of the struggles and emotions that are displayed in the book. Her use of line and her specific use of colour in contrast with white space alerts the reader to the change in the problem solving stages, one of frustration and struggle to resolution.While this picture book has an intended audience of children ages 5 to 12, the story itself and the lesson learned will resonate with all children and the young at heart.What Do You Do with a Problem? would be an excellent addition to libraries and home collections.Highly recommended: 4 stars out of 4Reviewer: Sherry MuruganSherry is a Graduate student in the department of Elementary Education.  She is a mother of two and an elementary school teacher who loves to share stories with her children and students.
Effect of Legislation on Indoor Tanning Prevalence in Alabama
Authors: Blashill Aaron J. , Pagoto Sherry
Published: April 2017

Objectives. To examine changes in indoor tanning prevalence among Alabama high school students the year before and after its 2014 legal restrictions compared with Florida, which had more lenient legislation.

Methods. We analyzed the Alabama and Florida 2015 Youth Risk Behavior Survey (n = 14 389; population = 1 864 241) by gender, age, year (2013, 2015), state (Alabama, Florida), and year-by-state interactions.

Results. Prevalence of indoor tanning was higher among Alabama youths, but the difference did not significantly change after the law was passed in Alabama (between-state change differences ranged from a 3.3% increase among 14-year-old Alabama girls to a 9.7% decrease among 14-year-old Alabama boys).

Conclusions. We found no significant changes in indoor tanning among adolescents since the enactment of Alabama’s tanning restrictions in 2014. More oversight and monitoring are needed to ensure that indoor tanning facilities are compliant with emerging laws.
Framing Mechanisms Linking HIV-Related Stigma, Adherence to Treatment, and Health Outcomes
Authors: Turan Bulent , Hatcher Abigail M. , Weiser Sheri D. , Johnson Mallory O. , Rice Whitney S. , Turan Janet M.
Published: April 2017

We present a conceptual framework that highlights how unique dimensions of individual-level HIV-related stigma (perceived community stigma, experienced stigma, internalized stigma, and anticipated stigma) might differently affect the health of those living with HIV.

HIV-related stigma is recognized as a barrier to both HIV prevention and engagement in HIV care, but little is known about the mechanisms through which stigma leads to worse health behaviors or outcomes. Our conceptual framework posits that, in the context of intersectional and structural stigmas, individual-level dimensions of HIV-related stigma operate through interpersonal factors, mental health, psychological resources, and biological stress pathways.

A conceptual framework that encompasses recent advances in stigma science can inform future research and interventions aiming to address stigma as a driver of HIV-related health.
The Pivotal Role of a Lawyer in Combating Official Corruption in Nigeria
Authors: Ebuara Ushie James
Published: April 2017

Nigeria is ranked internationally as one of the most corrupt nations in the world. As embarrassing as this status is, it is indeed the reality of our situation. The general public and now even the executive arm of the Federal government have continued to question how members of the legal profession discharge their role in applying the law because they have absolute belief in the law as their protection against the tendencies that are depriving them of their well being, dehumanizing them and even threatening the existence of their country, they waited for the law to respond to these tendencies by putting them in check, stop them completely or control them, they have watched helplessly the inability of law to effectively respond to these tendencies and have watched the tendencies continue unabated and escalated into the conditions we found ourselves today The purpose of this paper is to examine the role of lawyers as Judges, as Prosecutors and defence Attorneys in promoting and encouraging corruption in our body politics. It further examines in contrast the role lawyers should play in the renewed fight against corruption. Lawyers as  agents of social change should be in the vanguard for the reorientation of the mind set of Nigerian in the renewed fight against corruption and social rebirth generally. To effectively play this role members of the legal profession must purge themselves of corrupt tendencies and must be seen to be above board.
Anthracnose Severity and Annual Bluegrass Quality as Influenced by Nitrogen Source
Authors: Schmid Charles J. , Clarke Bruce B. , Murphy James A.
Published: April 2017

Anthracnose (caused by Colletotrichum cereale Manns sensu lato Crouch, Clarke & Hillman) of annual bluegrass [ABG, Poa annua L. f. reptans (Hausskn.) T. Koyama] turf is a destructive fungal disease that has been shown to be more severe under nitrogen (N) deficiencies. Little is known about the effect of soluble N source on this disease. A 3‐yr field study was initiated in 2010 to evaluate the effect of soluble N source on anthracnose severity and to determine if N source alters the effect of N frequency on this disease during midseason on an ABG turf maintained at 3.2 mm. Nitrogen treatments were applied at 4.9 kg N ha−1 every 7 or 14 d (frequency factor) as solutions of ammonium sulfate, ammonium nitrate, urea, calcium nitrate, or potassium nitrate. Both N frequency and N source affected disease severity throughout 2010, 2011, and 2012. In general, soluble N applied at 4.9 kg N ha−1 every 7 d reduced disease compared with N applied at the same rate every 14 d. Of the N sources, potassium nitrate provided the greatest reduction in disease severity over the 3‐yr study, whereas ammonium sulfate treatments resulted in the greatest disease severity. Soil pH was also influenced by N source, with ammonium sulfate treatments resulting in the lowest soil pH (most acidic), and potassium nitrate consistently producing the highest soil pH (most basic) throughout the study. Potassium nitrate also greatly increased soil K. This study has shown that anthracnose severity on ABG putting green turf is influenced by N source, and that low‐rate applications of potassium nitrate every 7 d were most effective at reducing disease severity under moderately acidic soil conditions and moderate to low soil K levels.
End‐Use Quality of CIMMYT‐Derived Soft‐Kernel Durum Wheat Germplasm: II. Dough Strength and Pan Bread Quality
Authors: Boehm Jeffrey D. , Ibba M. Itria , Kiszonas Alecia M. , Morris Craig F.
Published: April 2017

Durum wheat (Triticum turgidum ssp. durum) is considered unsuitable for the majority of commercial bread production because of its weaker gluten strength, combined with a larger flour particle size and higher level of starch damage after milling. Recently, a new durum cultivar with soft kernel texture, Soft Svevo, was developed by the Ph1b‐mediated homoeologous transfer of the Puroindoline genes at the Hardness (Ha) locus from the D genome of T. aestivum L. The objective of this research was to evaluate the dough strength and pan bread‐making potential of soft‐kernel durum germplasm developed from crossing Soft Svevo to selected entries of the International Maize and Wheat Improvement Center (CIMMYT) 44th International Durum Yield Nursery. Forty‐six F2:5 soft durum full and half‐sib lines were grown in replicated plots in two locations. Grain samples were evaluated for flour protein quality, dough mixing, and strength characteristics and bread baking. Significant differences (p < 0.05) were detected among lines for flour sodium dodecylsulfate (SDS) sedimentation volume (3.2–12.6 mL g−1), solvent retention capacity lactic acid (63.2–112.6 g 100 g−1), Mixograph water absorption (59.8–64.5 g 100 g−1), peak height (37.1–52.8), and peak width (55.4–125.2), and loaf volume (629–864 cm3).These results indicate that the bread‐making potential of soft durum can be improved if hard durum cultivars with favorable alleles for protein quality, dough strength, and bread making are chosen as crossing parents with Soft Svevo and, by extension, other soft‐kernel durum wheat germplasm.
MODEL PEMBELAJARAN BERBASIS PONDOK PESANTREN DALAM MEMBENTUK KARAKTER SISWA DI PONDOK PESANTREN RAOUDHOTUT THOLIBIN REMBANG JAWA TENGAH
Authors: Hasan Nur
Published: April 2017

Abstrack

Tujuan yang hendak dicapai dalam penelitian ini adalah untuk mengetahui dan menemukan tentang penerapan model pembelajaran karakter di pondok pesantren Roudhotut Tholibin Kabupaten Rembang.
Metode yang di gunakan dalam penelitian ini adalah penelitian kualitatif yakni lebih melihat seperti apa penerapan media belajar dan pembelajaran berbasis pondok pesantren di Pondok Pesantren. Sedangkan metode pengumpulan data yang digunakan metode observasi, wawancara dan dokumentasi. Analisis data dalam penelitian kualitatif dilakukan sejak sebelum memasuki lapangan, selama di lapangan dan setelah selasai di lapangan.
Model pembelajaran pendidikan berbasis karakter di Pondok Pesantren Roudhotut Tholibin terdapat beberapa upaya dan rencana pembentukan karakter pada siswa atau santrinya. Hal ini ditunjukkan tata tertib santri pada buku peraturan disiplin santri, tentang tata tertib disiplin santri seperti menyiapkan petugas piket, etika izin dan berbagai jenis pelanggaran dengan konsekuensi hukuman. Proses pendidikan di Pondok pesantern melalui tahapaan-tahapan pembelajaran dalam hal penguasaan baca tulis dan hafalan al-Qur’an.

Keywords: model pembelajaran, karakter siswa dan pondok pesantren.
The Impact of Combined Oral Sildenafil and Inhaled Nitric Oxide for Treating Persistent Pulmonary Hypertension of the Newborn: A Single Center Experience
Authors: Kanmaz Hayriye Gozde , Büyüktiryaki Mehmet , Oğuz Şerife Suna , Dizdar Alyamac Evrim , Sarı Fatma Nur , Canpolat Fuat Emre , Uras Nurdan
Published: April 2017

Objective: We aimed to compare the effect of the combined therapy, sildenafil and inhaled nitric oxide with inhaled nitric oxide monotherapy for the treatment of Pulmonary Hypertension of the Newborn.Study Design: Newborn infants (gestational age greater than 34 weeks) who were diagnosed with pulmonary hypertension between December 2008 and 2010 were retrospectively evaluated. Group I (n=14) received monotherapy with inhaled nitric oxide and Group II (n=9) received combined therapy with inhaled nitric oxide and oral sildenafil. Primary outcome was to compare the duration of inhaled nitric oxide therapy between groups.Results: Demographic characteristics were similar between the groups. Combination therapy was associated with early weaning of inhaled nitric oxide (4.8±1.5 vs. 13.5±7.6 hours). The duration of inhaled nitric oxide therapy was slightly shorter in combined therapy group (75[24-125] vs. 109[24-210] hours), however, the difference was insignificant (p=0.2). The incidence of mortality and neonatal outcomes were similar between the groups (p>0.05).Conclusion: Combined therapy did not result in shorter duration of inhaled nitric oxide therapy. Further well designed and larger studies that will elucidate the benefits of combination therapies and optimal therapy whereinhaled nitric oxide is not available are warranted.
Por uma terceira idade saudável: programa melhor idade
Authors: PFULLER Ernane Ervino
Published: April 2017

Nos últimos anos, diversos estudos têm colocado em discussão o conceito de saúde, distanciando-se do entendimento como ausência de doenças ou enfermidades e passando-se a incorporar um significado mais abrangente que incluiu os múltiplos aspectos que a envolve. Ao mesmo tempo, os cuidados com a promoção de saúde passaram a se intensificar nas sociedades modernas, que tem envidado esforços para mudanças de comportamento que atenuem processos degenerativos, garantam uma maior expectativa de vida, maior produtividade no trabalho e menores custos com tratamentos. Estas mudanças perpassam ações preventivas com adoção de uma alimentação mais saudável, maior educação e informação e demais atitudes que melhorem o equilíbrio físico, mental, espiritual e social, permitindo ao ser humano estar bem consigo mesmo.
Creative practices and public engagement
Authors: Daša Spasojevic  , Ana Souto Galvan
Published: April 2017

This exposition explores the role of creative practices in creating methods for public engagement and the promotion and recognition of tangible and intangible heritage at a local community level. It argues that principles of participatory design and co-creation have the power to contribute to community social cohesion and development. A literature review covering the main concepts and methods is introduced to provide an appropriate context for the main case study: Mapping Nottingham’s Identity. This research project includes the methodological and conceptual framework that were piloted and tested in collaboration with three localities within Nottingham (Sneinton, Carrington, and West Bridgford), including different stakeholders (community organisations, higher education, primary schools, local authorities, and the general public), producing a variety of outputs (a participatory methods’ toolkit, performative maps, community furniture, exhibition, websites) and reflecting on their role in creating meaningful interactions and place-making.
Formation of ArF laser-induced self-assembled macrostructures on poly methyl methacrylate and CR-39 polymers
Authors: Refahizadeh M. , Parvin P. , Silakhori K. , Mortazavi S. Z. , Reyhani A. , Abolhosseini Sh. , Hojati Rad H. , Majdabadi A.
Published: April 2017

ArF excimer laser at λ = 193 nm induces the regular macrostructures on poly methyl methacrylate (PMMA) and CR-39 with the periodicity Λ under the proper UV doses. The periodic self-organizing pattern lucidly appears on the polymeric surface, creating the grooves parallel along with the direction of the focal line of the cylindrical lens. The spatial period Λ is enlarged in terms of the focal length f varying tens of microns, much larger than the laser wavelength (22–145 μm, Λ ≫ λ). The interspacing also alters in terms of the incident angle θ by the expression 1/ cos θ, however it remains nearly invariant against the laser fluence F ranging several hundreds of mJ/cm2. Finally, the crisscross macroripples are created by situating a couple of cylindrical lenses in the orthogonal configuration. The formation of the gridiron patterns on PMMA and CR-39 attests that the linear superposition holds accordingly.
Outcomes in Paediatric Intensive Care Units for Children with Life-Limiting Conditions: A national data linkage study
Authors: Fraser Lorna , Fleming Sarah , Parslow Roger
Published: April 2017

ABSTRACT

ObjectiveTo identify children with a Life-Limiting Condition (LLC) who have had an admission to a Paediatric Intensive Care Unit (PICU) in England and their outcomes.

ApproachData for all children who had had a PICU admission in the UK between 1st Jan 2004 and 31st March 2015 were identified from the PICANet dataset.

Linkage to inpatient Hospital Episode Statistics (HES) data was undertaken by the NHS Health and Social Care Information Centre for all children who had been resident in England. Their standard algorithm using NHS number, date of birth, sex and postcode was used. All inpatient HES episodes from the financial years 1997/98-2014/15 were received.

Although the data quality is high in the PICANet dataset, comorbidities are variably coded therefore identifying whether a child has a LLC or not is not possible. A previously developed ICD10 coding framework was used to identify individuals with one or more of these LLC codes in the inpatient HES dataset.

ResultsA total of 199,548 PICU admissions in the UK for 135,759 individuals occurred during the time period of the study. Data for 43,565 admissions (32,025 individuals) were excluded due to not having been resident in England or poor quality demographic data.

Data on 103,734 individuals (155,983 admissions) were sent for linkage. Successful linkage occurred in 102,722 individuals (99.4%). Individuals who could not be linked were excluded from the analysis.51.0% of these children had a LLC and these children accounted for 62.7% of the PICU admissions.

The crude PICU death rate in the children with a LLC was 5.0% (n=4826) compared to 3.1% (n=1786) in those without a LLC. The OR of death in a model adjusted for diagnostic group, sex, age, and expected risk of mortality for children with a LLC was 2.11 (95%CI 1.97-2.27).

ConclusionsChildren with a LLC account for a large proportion of all PICU admissions in England. Although only one in twenty of these children die in PICU, as death may be expected in this population of children more integration of specialist palliative care with PICU services may allow more choice for children and families.
The Housing Regeneration and Health Study
Authors: Rodgers Sarah , Johnson Rhodri , Bailey Rowena , Dunstan Frank , Poortinga Wouter , Berridge Damon , Smith Robert , Lyons Ronan
Published: April 2017

ABSTRACT

ObjectivesA social housing regeneration programme, delivered by one Welsh local authority, has invested £204M (US$308M) to upgrade its housing stock in order to meet a national housing quality standard; the Welsh Housing Quality Standard (WHQS). Homes may receive new bathrooms, kitchens, heating, windows and doors, and insulation. Our objective is to evaluate the effect of implementing the concentrated WHQS investment policy on the physical and mental health of the residents compared to the standard ‘business as usual’ policy of housing stock maintenance.

ApproachUsing housing and regeneration data from the Local Authority and an anonymised databank (Secure Anonymised Information Linkage, SAIL) we have established a residence-based cohort. The primary outcome is a relative change in emergency hospital admissions (injuries, cardiovascular and respiratory conditions) following housing improvements; secondary outcomes include health care utilisation costs, primary care mental health conditions and deaths. Different comparator groups will be used to adjust for trends over time.

ResultsWe have linked housing data to individuals and their health data using a novel data linkage system. There are about 32 000 residents in the intervention group, 49 000 in a social housing comparator group; and 231 000 in a large general comparator group. Residents who migrate within the social housing cohort are retained using data linkage methods. Records relating to respiratory and cardiovascular conditions as well as falls and burns were obtained retrospectively for each individual, from 2005 to 2015, with measurements captured in 123 monthly time intervals. We are using a three-level negative binomial model, in which time is nested within individuals within properties, to examine the effects of the housing improvements on the mean number of emergency hospital admissions, whilst adjusting for individual-level explanatory variables such as gender, age and comorbidities.

Conclusion We discuss the challenges and benefits of linking routine housing and health data to evaluate a natural experiment. We have identified differences between residents in the study area and the comparator groups to evaluate the health benefits of a targeted housing improvement program to implement the WHQS.

The evaluation was funded by the National Institute for Health Research, Public Health Research Programme, United Kingdom. (http://www.nets.nihr.ac.uk/projects/phr/09300602).
The comparative analysis of the welfare attitude in accordance with the dual status of taxpayer and welfare recipient by using data linkage
Authors: Oh Miae , Choi Hyunsoo
Published: April 2017

ABSTRACT

BackgroundData linkage is a method to form a complete data that can provide more abundant information by combining a plurality of different data files. In this study, we construct the matched data combined with Korea Welfare Panel Survey and National Survey of Tax and Benefit by using statistical matching methodology. We aim to provide the empirical and advisable evidence for tax and welfare policy by analyzing about the welfare attitude in accordance with the welfare status of taxpayer or welfare recipient using matched data. 

ResultsAccording to the analysis results, people with dual status of taxpayer above the tax break-even point and welfare recipient due to recent enlargement of welfare programs are relatively more positive about the expansion of the universal welfare than taxpayers who never receive welfare benefit. Also, in the group with dual status, the recognition that the current tax burden of middle class is low is relatively higher and the negative thinking about the need to increase tax burden for the enlargement of the universal welfare programs is relatively lower than the group who pay tax but never receive welfare benefit.
Mothers of children with autism have different rates of cancer according to the presence of intellectual disability in their child
Authors: Fairthorne Jenny , Leonard Helen , De Klerk Nick , Whitehouse Andrew
Published: April 2017

ABSTRACTBackground Autism Spectrum Disorder (ASD) and Intellectual Disability (ID) are neurodevelopmental disorders with a strong genetic component. Increasing research attention has focused on whether the genetic factors that convey susceptibility for these conditions, also influence the risk for other health conditions, such as cancer. AimsWe compared hospital admissions and treatment/services for cancer in mothers of ASD probands to other mothers.

MethodsUsing West Australian databases, we calculated the hazard ratios (HRs) of hospitalisations for cancer in case and comparator mothers.Results In the multivariate model and compared to mothers of children with no ASD or ID, mothers of children with ASD without ID were more likely to have had an admission associated with a cancer diagnosis [HR=1.33(95% CI: 1.1, 1.7)] or a treatment or service associated with cancer [HR=1.54(95% CI: 1.1, 2.2)]. Furthermore, these HRs were significantly greater (p-values < 0.00005) than the corresponding HRs for mothers of children with ASD with ID [HR=1.05(95% CI: 0.8, 1.3) and HR= 0.97(95% CI: 0.7, 1.4)].

Conclusions We suggest that genes increasing the risk of autism without ID and cancer have common pathways and that the genetic basis of ASD with ID differs from ASD without ID.
The paradox of invasive therapy following non-ST-acute coronary syndrome in older higher risk patients: A population level study in South Wales 2000-2014
Authors: Protty Majd , Lacey Arron , Smith Dave , Freeman Phillip
Published: April 2017

ABSTRACT

ObjectivesFollowing non-ST-elevation acute coronary syndrome (NSTEACS), patients are treated with medication and considered for invasive therapy and revascularization. Mortality for this whole population is high in the first year with multiple studies suggesting anything from 4% to 10%. However, the risk of death after the first year has a wide distribution amongst the whole population with a much higher risk in older patients. We will highlight that decisions to revascularise are predominantly focused on a younger lower risk population with smaller improvements in outcome. Older, higher risk patients frequently do not receive invasive therapy despite the potential to benefit the most. However, the evidence base for using invasive therapy in this group is poor overall. With the use of data linkage from a novel national NSTEACS registry dataset we aim to clarify the influence of invasive therapy on this group in terms of adjusted mortality, reinfarction, re-admission with ischaemia, stroke and major bleeding.

ApproachAll patients over a 14-year period in south Wales with a first diagnosis of NSTEACS and treated either medically or invasively. Cohorts identified by a combination of ICD-10 codes, operation codes, and linkage to coronary angiography data. Extraction of cohorts validated externally using novel national NSTEACS registry data. Multivariate analysis of baseline-characteristics for understanding how these factors influence treatment decisions. Propensity matching between medical cohorts and invasive cohorts to show the corrected effect of invasive vs. medical therapy.

ResultsTotal population 83,712 from 2000 until 2015. With 23,670 patients invasive therapy, 57,042 medical therapy. Invasive therapy was common in the 65-69 age groups and below but the proportion was never more than 50%. Above 65-69 exponential decline in invasive therapy, 75-79 (24.4%) 80-84 (14.7%) and 85-89 (6.5%). Unadjusted mortality revealed highly significant improvements in survival for the invasively treated patients in all age groups but with large increases as age increased. Adjusted and matched results to follow.

ConclusionInitial results suggest increasing age and cardiovascular risk is associated with much higher mortality at one year and beyond. Older higher risk patients have very low rates of invasive revascularization but appear to have more to gain from this approach (than younger, lower risk patients), in terms of mortality and morbidity. In the older higher risk population these results suggest that increased frequency of invasive therapy will lead to reduced short and long term mortality, reduced hospital readmission with less frequent development of heart failure and reinfarction.
Linking Federal Administrative Records to Respondents and Nonrespondents in Household Surveys: A Case Study
Authors: Sakshaug Joseph , Antoni Manfred , Sauckel Reinhard
Published: April 2017

ABSTRACT

BackgroundIn response to increasing nonresponse rates in household surveys, auxiliary information is being sought to augment survey samples and adjust for possible nonresponse bias in key survey estimates. Auxiliary data options are typically limited in most general population surveys and there are questions concerning their utility for nonresponse adjustment. Federal administrative databases provide a potentially rich source of auxiliary information for nonresponse adjustment, but linking them to general population samples is usually restricted to surveys which draw their samples from population registers containing unique personal identity numbers which can be directly linked to federal databases.

MethodIn this article, we examine the feasibility of linking a federal administrative database to a general population survey sample without a unique identifier. We employ a series of indirect linkage procedures that rely instead on non-unique and error-prone identifiers collected from the sampling frame to link a federal employment database to a general population survey in Germany. The quality and selectivity of the established links are evaluated using household- and person-level interview data in accordance with German data protection laws.

ResultsWe report a linkage rate of 60 percent for the entire sample under a strict linkage criterion, and 80 percent under a more relaxed criterion. Linkage rates varied across some household- and person-level characteristics that are likely specific to the particular administrative database used in this case study.

ConclusionWe conclude with a general discussion of the practical implications of this work for survey organizations considering performing similar linkages and highlight some opportunities for future linkage research.
Refining an antidepressant-based indicator to improve the ascertainment of depression from Australian administrative data
Authors: Havard Alys , Lujic Sanja , Tran Duong , Jorm Louisa
Published: April 2017

ABSTRACTObjectivesIn the absence of whole-of-population data regarding depression in Australia, antidepressant supply identified through pharmaceutical data has been used by some as an indicator of depression. This approach has been criticised on the basis that up to 30% of antidepressants are prescribed for indications other than depression, including anxiety disorders, insomnia and pain. This study examines whether the identification of patients treated for depression can be improved by refining this antidepressant-based indicator via a series of pre-determined algorithms.ApproachPharmaceutical Benefits Scheme (PBS) and Medicare Benefits Scheme (MBS) records were linked to follow-up questionnaires completed between September 2012 and December 2014 by participants of the 45 and Up Study - a cohort study of residents of New South Wales, Australia, aged 45 years and older. After exclusions, 58,425 participants were included in the analyses. According to the basic antidepressant-based indicator, the supply of any antidepressant (Anatomical Therapeutic Chemical classification (ATC) code beginning with N06A) in the 30 days prior to the survey completion date was considered indicative of depression treatment in the last month. This algorithm was refined to: i) exclude tricyclic antidepressants (ATC code N06AA), which are commonly prescribed for insomnia and pain; and ii) re-categorise as ‘not treated for depression’ those antidepressant recipients who were also supplied an anxiolytic or sedative (ATC codes beginning with N05B and N05C) in the 12 months prior to the survey. Self-reported receipt of treatment for depression in the last month, from the questionnaire data, was used as a gold standard.ResultsThe basic antidepressant-based indicator returned a sensitivity (Sn) of 59.9%, a positive predictive value (PPV) of 43.4% and a specificity (Sp) of 94.7%. When refined algorithm i) was applied, the PPV and Sp increased to 51.8% and 96.5% respectively, while Sn decreased to 54.6%. Refined algorithms ii) yielded similar PPVs and Sps to algorithm i) while Sns were lower. Further refinements to the indicator will be explored using primary care (MBS) data. Although MBS data do not contain diagnoses, they do contain indicators of when certain mental health services were provided, allowing for algorithms in which the prescription of antidepressants for mental health reasons is distinguished from their prescription for physical health problems.ConclusionThe algorithms developed in this study can be applied to identify depression in future research based on Australian administrative health data.

We acknowledge the Commonwealth Department of Human Services for supplying PBS and MBS data.
Conducting Population Health Intervention Research using Linked Databases: An Evaluation of Home Visiting Programs for At-Risk Families
Authors: Chartier Mariette , Brownell Marni , Isaac Mike , Chateau Dan , Nickel Nathan , Sarkar Joykrishna , Burland Elaine , Katz Alan
Published: April 2017

ABSTRACTObjectiveThe objective of this population health intervention research was to determine the effectiveness in improving children’s outcomes of a provincial home visiting program for at-risk families in Manitoba, Canada. Home visiting programs have been evaluated in highly structured and supervised conditions which may provide different results than those evaluated in real-world delivery systems.

ApproachIn this retrospective cohort study, data for 4,562 children from home visiting program families and 5,184 comparison children were linked to de-identified administrative health, social services, and education data held securely at the Manitoba Centre for Health Policy. Inverse probability of treatment weights were used to address the selection bias inherent in delivering a voluntary program. We used generalized linear modelling to calculate program effects among those exposed to the program, those unexposed and the average effect. Child outcomes examined included being taken into care of child welfare, hospitalizations for maltreatment-related injuries, and child development scores at school entry.

ResultsThe home visiting program was associated with lower rates of children being taken into care and lower rates of hospitalization for maltreatment-related injuries. For being taken into care by child’s first birthday, the adjusted Risk Ratio (aRR) was 0.75 (95% Confidence Interval [CI]: 0.66, 0.86); for being taken into care by second birthday, aRR=0.79, (95% CI: 0.70, 0.88); and for hospitalizations for maltreatment-related injuries by third birthday, aRR=0.59 (95% CI: 0.35, 0.99). Similar program effects would be expected among comparison children if they had received the program (i.e., average treatment effect for the untreated). No differences between groups were found across five domains of child development at school entry.

ConclusionHome visiting programs can be an effective strategy for decreasing child maltreatment at a population level. Home visiting program enhancements are necessary to improve child development scores when children enter school. Use of population-based linkable data systems provides an opportunity to evaluate interventions using large, real-world samples, adjusting for a wide range of risk factors, and examining a variety of outcomes.
Influence of early life exposure to social disadvantages on deliberate self-harm (DSH) among children of parents with mental health disorders
Authors: Hu Nan , Taylor Catherine , Glauert Rebecca , Li Jianghong , Wong Janice
Published: April 2017

ABSTRACTIntroductionIt is well established that parental mental health disorders increase children’s risk of deliberate self-harm (DSH). However, little is known about how early life exposure to social disadvantage influences DSH among children whose parents have a mental health disorder.

AimsTo examine how early life exposure to high neighbourhood socioeconomic disadvantage and having a teen mother influence the DSH risk among children whose parents have a mental health disorder.

MethodsThis study was based on the linkage of population-level records routinely collected by government agencies in Western Australia. A birth cohort including 474,860 non-Aboriginal individuals born between 1981 and 2001 was followed up until 2011. A nested case-control sample was compiled from the birth cohort for data analysis. A total of 7,151 people with DSH-related contacts (cases) and 143,020 matched controls were analysed. Conditional logistic regression models were utilised in this study.

ResultsExposure to high neighbourhood socioeconomic disadvantage was associated with additionally increased odds of DSH among children exposed to maternal mental health disorders during early childhood (1-4 years) (OR=1.75, 95%CI:1.30-2.36, p<0.001). However, this was not observed for children exposed to maternal mental health disorders during late childhood (5-9 years) or adolescence (10-19 years). Comparatively, exposure to high socioeconomic disadvantage was related to additionally increased odds of DSH among children exposed to paternal mental health disorders during adolescence (10-19 years) (OR=2.25, 95%CI:1.60-3.16, p<0.001), but not childhood. Having a teen mother was significantly associated with additionally increased odds of DSH, regardless of when the parental mental health disorders occurred. Children with a teen mother and early life exposure to socioeconomic disadvantage were at additionally increased odds of DSH, compared to children with only one form of disadvantage (OR=1.51,95%CI:1.07-2.12%,p=0.018) among children exposed to parental mental health disorders during childhood, but not during adolescence.

Conclusion Among children of parents with mental health disorders, early life exposure to social disadvantage is not uncommon, and confers additionally increased risk of DSH. Therefore, preventive strategies need to be based on joint actions involving both social and health services, and need to incorporate child mental health interventions into adult mental health services. The cross-cutting efforts would provide a greater positive impact in effectively addressing the multifaceted nature of reducing DSH among children of parents with mental health disorders.
Understanding the coverage of Statistics New Zealand's Integrated Data Infrastructure
Authors: Minshall Gareth , Gomez Antony , Christine Bycroft
Published: April 2017

ABSTRACTObjectivesStatistics New Zealand’s Integrated Data Infrastructure (IDI) combines information from a range of government agencies (such as tax, health and education data) in order to provide the insights government needs to improve social and economic outcomes for New Zealanders. New Zealand has no national population register or unique identifier used in common across these multiple data sources, and probabilistic linkages are a feature of the IDI. A challenge for researchers is to understand the impact of linkage errors and coverage issues present in the linked data, and to develop the rules necessary to define their target population. We outline the statistical infrastructure Statistics New Zealand is developing to help researchers navigate these issues.

ApproachA method has been developed to identify NZ residents at a given time from the much larger number of individuals present in the IDI. Census data linked to the IDI offers insight into the coverage of key population groups and the quality of the attribute information held in the IDI (e.g. location and ethnicity). We are assessing ways that Statistics New Zealand could use these findings to assist researchers in forming their population of interest and assess the potential for bias.

ResultsThe derived administrative resident population is compared with the official population figures and patterns of under- and over-coverage are identified at an aggregate, and individual level. Some coverage discrepancies may be improved through reducing linkage errors. Comparison with census data reveals some significant quality issues with location and ethnicity variables in administrative collections. Work is underway to improve methods for combining information from multiple sources of varying quality.

ConclusionIdentifying NZ residents at a given time, and quantifying errors in administrative data sources will assist researchers ability to recognise and adjust for these errors in their analysis. Simply quantifying (often for the first time) the limitations of administrative sources also provides impetus to improving the collection of these variables at source.