Health and poverty among elderly persons: a community-oriented primary care survey

Providing health care for independent-living elderly persons is important, yet family physicians often lack accurate information about needs and access to care. The Community-Oriented Primary Care (COPC) approach and health status models from health services research provide a framework for assessing need and access to care. Personal interviews were conducted with 990 noninstitutionalized elderly persons in Youngstown, Ohio. Results showed that poverty, gender, and race were not strongly related to health status as measured by numbers of symptoms, functional status, or subjective health status. In addition, elderly persons had fewer health care needs and greater access to care than expected. Simple models of health status, need, and access do not seem to apply. The study shows the usefulness of COPC in planning health services; however, more effort is needed to refine measures of health status, need, and access.     

“Sometimes it’s a bit too much Disney”: exploring Norwegian parents and their ambiguous domestication of Disney

Parents are often ambivalent about their children’s engagement with popular culture, where popular culture is seen as trivial and potentially harmful. In this article, I explore how Norwegian parents of girls experienced the Disney tween shows, and tied in merchandise of Hannah Montana and High School Musical. As the parents interviewed reported feeling ambivalent and conflicted about the Disney shows, the article makes use of Bakhtin’s dialogism and domestication theory to explore this ambivalence. Employing the concept of voice from Bakhtin, the interview data suggest five voices the parents drew on – the educational voice, the voice of children’s autonomy, Disney as innocent and safe, the voice of caring consumption and the culture critical voice. The analysis focuses on how these voices operated, how they were expressed in the interviews, and what these different voices produced in terms of how Disney was included in the everyday home life.     

Nordic OCD & Related Disorders Consortium: Rationale,design, and methods

Obsessive‐compulsive disorder (OCD) is a debilitating psychiatric disorder, yet its etiology is unknown and treatment outcomes could be improved if biological targets could be identified. Unfortunately, genetic findings for OCD are lagging behind other psychiatric disorders. Thus, there is a pressing need to understand the causal mechanisms implicated in OCD in order to improve clinical outcomes and to reduce morbidity and societal costs. Specifically, there is a need for a large‐scale, etiologically informative genetic study integrating genetic and environmental factors that presumably interact to cause the condition. The Nordic countries provide fertile ground for such a study, given their detailed population registers, national healthcare systems and active specialist clinics for OCD. We thus formed the Nordic OCD and Related Disorders Consortium (NORDiC, www.crowleylab.org/nordic ), and with the support of NIMH and the Swedish Research Council, have begun to collect a large, richly phenotyped and genotyped sample of OCD cases. Our specific aims are geared toward answering a number of key questions regarding the biology, etiology, and treatment of OCD. This article describes and discusses the rationale, design, and methodology of NORDiC, including details on clinical measures and planned genomic analyses.     

Estimating genotype error rates from high-coverage next-generation sequence data

Exome and whole-genome sequencing studies are becoming increasingly common, but little is known about the accuracy of the genotype calls made by the commonly used platforms. Here we use replicate high-coverage sequencing of blood and saliva DNA samples from four European-American individuals to estimate lower bounds on the error rates of Complete Genomics and Illumina HiSeq whole-genome and whole-exome sequencing. Error rates for nonreference genotype calls range from 0.1% to 0.6%, depending on the platform and the depth of coverage. Additionally, we found (1) no difference in the error profiles or rates between blood and saliva samples; (2) Complete Genomics sequences had substantially higher error rates than Illumina sequences had; (3) error rates were higher (up to 6%) for rare or unique variants; (4) error rates generally declined with genotype quality (GQ) score, but in a nonlinear fashion for the Illumina data, likely due to loss of specificity of GQ scores greater than 60; and (5) error rates increased with increasing depth of coverage for the Illumina data. These findings, especially (3)–(5), suggest that caution should be taken in interpreting the results of next-generation sequencing-based association studies, and even more so in clinical application of this technology in the absence of validation by other more robust sequencing or genotyping methods.With the recent development of next-generation sequencing technologies, there has been an explosion in the number of whole-exome (Choi et al. 2009; Ng et al. 2009, 2010) and whole-genome (Lupski et al. 2010; Rios et al. 2010; Roach et al. 2010) biomedical sequencing studies, which have grown to include up to thousands of samples (The 1000 Genomes Project Consortium 2012; Tennessen et al. 2012; Fu et al. 2013). While several different sequencing platforms are available, the vast majority of studies utilize either Illumina (IL) (Bentley et al. 2008) or Complete Genomics (CG) (Drmanac et al. 2010) sequencing technologies. In the only published comparison between the two platforms (Lam et al. 2012), the investigators estimated that 12% of the called genotypes were discordant between IL and CG whole-genome sequences obtained from the same sample. This estimated error rate is several orders of magnitude higher than the published error rates of the two technologies (Bentley et al. 2008; Drmanac et al. 2010), and much larger than the error rates estimated using various genotype-calling algorithms. If correct, a 12% error rate would have serious implications for the interpretation and power of sequence-based genetic studies that are attempting to find rare variants affecting complex disease susceptibility, and even more critically in the clinical translation of this technology.In this study, we conduct a detailed, quantitative comparison of single-nucleotide variant (SNVs, i.e., genotypes different from the reference sequence) calling with IL and CG platforms, using both whole-genome (WGS) and whole-exome sequence (WES) data generated from blood and saliva samples from four different individuals. SNVs were called separately for each sample. Agilent and Nimblegen in-solution capture methods were used to generate the exome data from both DNA sources and all four individuals. The individuals are members of the Kaiser Permanente Medical Care Plan Northern California Region (KPNC) and participated in the Research Program on Genes, Environment, and Health (RPGEH). We focus on estimating genotype discordance rates as a function of the genotype quality (GQ) score, a phred-like measure that base-calling algorithms use to estimate the accuracy of a genotype call. The GQ score is logarithmic and defined by GQ = −10log₁₀(Error Rate) (so that GQ = 10 corresponds to an estimated error rate of 10%, GQ = 20 reflecting an estimated error rate of 1%, and so on). We also estimate genotype discordance rates as a function of the minor allele frequency (MAF) of the putative variant, since sequence-based genetic and clinical studies are generally searching for rare causal variants. Finally, we perform subsampling experiments to determine what effect depth of coverage has on the number and accuracy of SNV genotype calls for the Illumina sequencing. While some comparisons of the effect of depth of coverage on SNV calls have been performed before (Clark et al. 2011; Meynert et al. 2013), none have estimated error rates as a function of sequencing depth.     

Guidelines for the practice of anesthesia in Norway

Since the first version saw the light of day in 1991 the Guidelines have occupied a central position in the Norwegian practice of anesthesia. This document comprises part of the quality management documents held in the departments of anesthesia in Norwegian hospitals. If departments of anesthesia are unable to adhere to certain specific points in the Guidelines, it is recommended that this should be documented in writing. It has been stated by central governmental bodies and patients' insurance organizations that the Guidelines will be an important factor in medico legal cases, although it is not an obligatory legal document for hospital owners. It is our objective that the document will form the foundation for quality assurance work in the departments of anesthesia in Norway. The purpose of this document is to ensure a satisfactory standard for the practice of anesthesia in Norway. 'The Guidelines for the Practice of Anesthesia in Norway' (the Guidelines) is a series of recommended guidelines. The practice of anesthesia in this context includes general anesthesia, regional anesthesia, controlled sedation, postoperative monitoring, and other observations where anesthesia personnel are required. The Guidelines apply to all doctors, nurses, and other personnel undertaking the delegated practice of anesthesia. Deviations from the Guidelines should be explained and documented in every case. The Guidelines should be adhered to in medical emergencies as far as possible. The Guidelines must not be allowed to prevent the execution of immediate and lifesaving measures. The Guidelines should be revised at regular intervals so that it is up-to-date with current legislation and medical and technological developments and practice.     

Effect of recall on estimation of non-fatal injury rates: a community based study in Tanzania

STUDY OBJECTIVE: To investigate the effect of recall on estimation of non-fatal injury rates in Tanzania. DESIGN: Retrospective population based survey. SETTING: Eight branches in an urban area and six villages in a relatively prosperous rural area in Tanzania. SUBJECTS: Individuals of all ages living in households selected by cluster sampling. MAIN OUTCOME MEASURES: Estimated non-fatal injury rates calculated at each of the 12 recall periods (one to 12 months before the interview). RESULTS: Out of a population of 15 223 persons, 509 individuals reported 516 injuries during the preceding year. Of these 313 (61.5%) were males and 196 (38.5%) females. The data showed notable declining incidence rates from 72 per 1000 person-years when based on a one month recall period to 32.7 per 1000 person-years for a 12 month recall period (55% decline). The decline was found for injuries resulting in fewer than 30 days of disability whereas rates for severe injuries (disability of 30 days or more) did not show a consistent variation with recall period. Decline in injury rates by recall period was higher in rural than in urban areas. Age, sex, and education did not notably affect recall. CONCLUSIONS: Longer recall periods underestimate injury rates compared with shorter recall periods. For severe injuries, a recall period of up to 12 months does not affect the rate estimates. It is essential that a recall period of less than three months be used to calculate injury rates for less severe injuries.     

Multiple sclerosis and mortality statistics

ABSTRACT – We have previously found a 3-fold increase in prevalence and a corresponding increase in incidence of multiple sclerosis (MS) from 1963 to 1983 in the county of Hordaland, Norway. When studying the official mortality statistics and the deceased patients in our clinical MS-material, no increase in death rate could be observed in the same period.
We also found that official mortality statistics include both over- and underestimates of MS-patients. Of definite MS-patients in the clinical material, 91.7% were registered with MS on the death certificates, either as underlying or contributory cause of death. When studying only underlying cause of death, we found that 59.5% of deceased definite MS patients were registered as MS on the death certificates.
This study shows that official mortality statistics reflect a change in incidence of MS both incompletely and with a delay of several decades.