In the current context of health care in South Africa, STIs and HIV/AIDS, as well as maternal mortality, partnered deliveries, and involving men in reproductive health, including PMTCT are important issues and priorities. Very little can be achieved for either mothers or infants unless reproductive health providers realize the need and take active steps toward involving men in reproductive health services. The Reproductive Health Research Unit (RHRU) University of the Witwatersrand, in partnership with the FRONTIERS Program of the Population Council, and the KwaZulu Natal Department of Health conducted a three-year operations research study titled "Men in Maternity" (MIM) in the Ethekwini district. The study was completed in July 2003. A randomized cluster matched paired design was used with six clinics implementing the intervention and another six control clinics continuing to provide services following the current practices and guidelines of the Department of Health. Both rural and urban clinics were included.
The Medicare claims-based algorithm showed good discrimination of phenotypic frailty and high predictive ability with adverse health outcomes. This algorithm can be used in future Medicare claims analyses to reduce confounding by frailty and improve study validity.
Although many countries allow over-the-counter distribution of oral contraceptives, doubt remains about whether such provision is safe for the user. The greatest concern is whether women with contraindications for use are given access to the pill. Clearly, women without such contraindications should be given access to it and be offered adequate information about its correct use. In 15 pharmacies in Jamaica, mystery clients approached pharmacists to determine their willingness to sell oral contraceptives and to solicit information from them about correct use of the method. In addition to data from mystery-client observations, interviews were conducted with 78 pharmacists and with 524 pharmacy customers who bought oral contraceptives, providing complementary information about knowledge of, attitudes toward, and experiences with the method. Analysis of the combined findings suggests that over-the-counter provision of oral contraceptives is a safe, practical, and effective method of distribution in Jamaica.
Purpose
To quantify the influence of the length of the look-back period on misclassification of heart failure (HF) incidence in Medicare claims available for participants of a population-based cohort.
Methods
Atherosclerosis Risk in Communities (ARIC) participants with ≥3 years of continuous fee-for-service Medicare enrollment from 2000–2012 was assigned an index date 36 months after enrollment separating the time-in-observation into the look-back and the incidence periods. Incident HF events were identified using ICD-9-CM code algorithms as the first observed hospitalization claim or the second of two HF outpatient claims occurring within 12 months. Using 36 months as a referent, the look-back period was reduced by 6-months increments. For each look-back period, we calculated the incidence rate, percent of prevalent HF events misclassified as incident, and loss in sample size.
Results
We identified 9,568 ARIC participants at risk for HF. For hospitalized and outpatient HF, the number of events misclassified as incident increased and the total number of incident events decreased with increased length of the look-back period. The incident rate (per 1,000 person years) decreased with increased length of the look-back period from 6 to 36 months and had a greater impact on outpatient HF; for example, from 11.2 to 10.6 for ICD-9-CM 428.xx hospitalization in the primary position and 10.5 to 7.9 for outpatient HF.
Conclusion
Our estimates can be used to optimize trade-offs between the degree of misclassification and number of events in the estimation of incident HF from administrative claims data, as pertinent to different study questions.
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