Recognition of Dementia in General Practice: Comparison of General Practitioners' Opinions with Assessments Using the Mini-Mental State Examination and the Blessed Dementia Rating Scale

Mant A, Eyland E A, Pond D C, Saunders N A and Chancellor AH B. Recognition of dementia in general practice: comparisonof general practitioners' opinions with assessments using themini-mental state examination and the Blessed dementia ratingscale. Family Practice 1988; 5: 184–188. In a study of 226 elderly residents in a retirement villagein Sydney, Australia, general practitioners' opinions aboutdementia status had high positive and negative predictive valuesand high specificity, but low sensitivity when evaluated againstthe mini-mental state examination and the Blessed dementia ratingscale. General practitioners were found to disagree with thesetwo measures more often when patients were in advanced old age,and when they considered the patients to be depressed. We concludethat the general practitioner can increase his or her sensitivityto dementia in the elderly by use of either measure.     

Identifying Opportunities to Strengthen the Public Health Informatics Infrastructure: Exploring Hospitals’ Challenges with Data Exchange

Policy Points

• Even though most hospitals have the technological ability to exchange data with public health agencies, the majority continue to experience challenges.
• Most challenges are attributable to the general resources of public health agencies, although workforce limitations, technology issues such as a lack of data standards, and policy uncertainty around reporting requirements also remain prominent issues.
• Ongoing funding to support the adoption of technology and strengthen the development of the health informatics workforce, combined with revising the promotion of the interoperability scoring approach, will likely help improve the exchange of electronic data between hospitals and public health agencies.

ContextThe novel coronavirus 2019 (COVID‐19) pandemic has highlighted significant barriers in the exchange of essential information between hospitals and local public health agencies. Thus it remains important to clarify the specific issues that hospitals may face in reporting to public health agencies to inform focused approaches to improve the information exchange for the current pandemic as well as ongoing public health activities and population health management.MethodsThis study uses cross‐sectional data of acute‐care, nonfederal hospitals from the 2017 American Hospital Association Annual Survey and Information Technology supplement. Guided by the technology‐organization‐environment framework, we coded the responses to a question regarding the challenges that hospitals face in submitting data to public health agencies by using content analysis according to the type of challenge (i.e., technology, organization, or environment), responsible entity (i.e., hospital, public health agency, vendor, multiple), and the specific issue described. We used multivariable logistic and multinomial regression to identify characteristics of hospitals associated with experiencing the types of challenges.FindingsOur findings show that of the 2,794 hospitals in our analysis, 1,696 (61%) reported experiencing at least one challenge in reporting health data to a public health agency. Organizational issues were the most frequently reported type of challenge, noted by 1,455 hospitals. The most common specific issue, reported by 1,117 hospitals, was the general resources of public health agencies. An advanced EHR system and participation in a health information exchange both decreased the likelihood of not reporting experiencing a challenge and increased the likelihood of reporting an organizational challenge.ConclusionsOur findings inform policy recommendations such as improving data standards, increasing funding for public health agencies to improve their technological capabilities, offering workforce training programs, and increasing clarity of policy specifications and reporting. These approaches can improve the exchange of information between hospitals and public health agencies.     

Anthropometric Characteristics of Mohawk Children Aged 6 to 11 Years: A Population Perspective

OBJECTIVE: Recent studies have concluded that Native North American children have higher proportions of overweight and obesity than children from the general North American population. This study presents anthropometric data on a representative sample of children from the Mohawk Nation that can be used for comparison with other Native American populations. DESIGN: This is a cross-sectional study comparing distributions of anthropometric characteristics of Mohawk children to the corresponding age and gender data from the Second National Health and Nutrition Examination Survey (NHANES II). Weight, height, triceps and subscapular skinfold thickness, and waist and hip circumferences were measured in 527 children. SUBJECTS/SETTING: All children in grades 1 to 6 (aged 6 to 11 years) in the 3 elementary schools of 2 Mohawk communities in Canada, for whom parental consent was obtained, were enrolled in the present study. There were no exclusion criteria. With a participation rate of 83%, the 527 children enrolled in this study represent an unbiased sample of the population from 2 Mohawk territories. RESULTS: Compared with children studied in NHANES II, Mohawk children were similar in height and triceps skinfolds but were generally heavier, had thicker subscapular skinfolds, and had greater waist and hip circumferences. These differences were greater in older children. Mohawk children who had extreme-high weight values compared with their population means were heavier than their NHANES II counterparts. APPLICATIONS/CONCLUSIONS: Results indicated that, on average, Mohawk children seem to be slightly heavier than children in NHANES II. Except for those with extreme overweight values, Mohawk children show less variation of weight and body mass index than children in NHANES II. Finally, overweight Mohawk children seem to be more likely to carry their excess body fat truncally, compared with overweight children from NHANES II. Health practitioners working with Native American populations should be careful when assessing childhood obesity. Simple comparisons of weight or body mass index with NHANES standards may lead to inappropriate risk assessments.     

Energy Intake and Glycemia in Lactating Women with Type 1 Diabetes

Objective To describe glycemia and insulin administration in lactating women with type 1 diabetes and compare their energy intake, lactation onset, and postpartum weight to lactating women without diabetes.Design A prospective observational study conducted at 2, 3, 6, 14, 42, and 84 days postpartum. Insulin dosage and glucose levels after fasting and at 80 and 110 minutes after eating (by measuring capillary blood glucose concentrations and glycated hemoglobin [HbA_1c] values) are described for women with type 1 diabetes. Dietary intake, weight, and lactation onset for women with type 1 diabetes are compared with those without the disease.Subjects/setting Fourteen lactating women with type 1 diabetes and 25 women without diabetes (control subjects) were recruited from private obstetrician offices and high-risk prenatal clinics at 3 major medical centers.Statistical analyses A repeated-measures 2-factor analysis of variance was used to determine group, time, and interaction effects between women with type 1 diabetes and the control group at 2, 3, 7, 14, 42, and 84 days postpartum.Results Seven women with type 1 diabetes breast-fed through 84 days postpartum, although they perceived later onset of milk and had fasting and postprandial hyperglycemia. Their HbA_1c levels increased by 20%, confirming relative hyperglycemia. After adjustment for prepregnancy weight, women with type 1 diabetes consumed 7 kcal fewer per kilogram per day than control subjects. Average insulin dose was returned to prepregnancy levels of 45.3±3.6 U/d (least square means±standard error of the mean) by 1 week.Application Achieving desired metabolic control during the establishment of lactation is difficult. A better understanding of energy and insulin needs and their relationship to lactation in women with type 1 diabetes is needed. J Am Diet Assoc. 1998; 98: 642–648.     

Dipeptidyl peptidase IV expression in cancer and stromal cells of human esophageal squamous cell carcinomas,adenocarcinomas and squamous cell carcinoma cell lines

Dipeptidyl peptidase IV (DPPIV) is a transmembrane serine protease which is involved in the process of tumor invasion and development of metastases in human cancers. The aim of this study was to investigate the expression of DPPIV in cancer and stromal cells of both esophageal adenocarcinoma and squamous cell carcinoma (SCC). Tissue material from 159 patients was analyzed using immunohistochemistry. Western blotting was performed on cell lines and fresh frozen tissue sections. Results were compared with clinicopathological features. Evaluation of the immunohistochemical findings revealed significant differences between DPPIV expression in carcinoma cells and stromal cells, depending on the histological tumor type. A significantly higher level of DPPIV was found in adenocarcinomas compared to SCCs while no DPPIV was detected in normal esophageal epithelium. Overexpression of DPPIV in patients with adenocarcinoma was additionally associated with distant metastases. Thus, differences of DPPIV level in esophageal carcinomas compared with normal epithelium showed that esophageal malignancies were associated with an increased amount of cell surface‐bound DPPIV. Radiotherapy in patients had no impact on DPPIV expression in analyzed tissue samples. There was no correlation between DPPIV expression in cancer or stromal cells and survival of the patients.