RESUMEN
Billing data from the Health Care Financing Administration (HCFA) indicated that the influenza immunization rates for dialysis patients in the United States do not meet the goal of 60% set by Healthy People 2000, and fall significantly short of the goal of 90% of all Medicare beneficiaries as outlined in Healthy People 2010. Influenza and pneumonia together are the sixth leading cause of death in the United States. Despite the known benefits of influenza vaccination in reducing morbidity and mortality, only 40% to 50% of high-risk patients are immunized. Although HCFA/Medicare billing data may not provide the best measurement of actual practice, it is currently the only measure available from any national source. The data suggest that there is a need for improvement. Because the HCFA/Medicare rates were based only on those immunizations for which Medicare was billed, End-Stage Renal Disease Network 15 embarked on a project to determine a more accurate rate of immunization within the Network based on information provided by the dialysis facilities. Influenza vaccination rates for the winter 1998 flu season ranged from 51.5% to 84.9% for the states in the Network; the rate for the whole Network was 74.6%. The HCFA/Medicare billed influenza immunization rates were 26.5 to 45.6 percentage points lower.
Asunto(s)
Vacunas contra la Influenza/administración & dosificación , Gripe Humana/prevención & control , Arizona , Centers for Medicare and Medicaid Services, U.S. , Colorado , Humanos , Inmunización/estadística & datos numéricos , Fallo Renal Crónico/terapia , Nevada , New Mexico , Gestión de la Calidad Total , Estados Unidos , Utah , WyomingRESUMEN
The rates of end-stage renal disease are much increased in American Indians, but no longitudinal study of its rates and causes has been undertaken in any tribe. This 15-year study of rates and causes of treated end-stage renal disease in the Navajo, the largest Indian tribe, supplies an important model on which to base projections and plan interventions. Treated end-stage renal disease in Navajos has increased to an age-adjusted incidence 4 times that in whites in the United States. Diabetic nephropathy accounted for 50% of all new cases in 1985, with an incidence 9.6 times that in US whites, and was due entirely to type II disease. Glomerulonephritis caused end-stage renal disease in Navajos at a rate at least 1.8 times that in US whites and afflicted a much younger population. The predominant form was mesangial proliferative glomerulonephritis associated with an immune complex deposition. Renal disease of unknown etiology, which probably includes much silent glomerulonephritis, accounted for 20% of all new cases. The aggregate Navajo population with end-stage renal disease was 9 years younger than its US counterpart. These observations reflect the genesis of the epidemic of diabetic nephropathy afflicting many tribes. Urgent measures are needed to contain this. In addition, the etiology and control of mesangiopathic, immune-complex glomerulonephritis of unusual severity, a previously unrecognized problem, need to be addressed.
Asunto(s)
Indígenas Norteamericanos , Fallo Renal Crónico/etnología , Adolescente , Adulto , Anciano , Humanos , Fallo Renal Crónico/epidemiología , Fallo Renal Crónico/etiología , Persona de Mediana Edad , New Mexico , Población BlancaRESUMEN
Tunable bandwidth-limited light pulses exhibiting ~3-psec FWHM duration and 2-7 microJ/pulse have been obtained at repetition rates up to ~5 Hz with good mode-locking quality in a transverse-flow flashlamp-pumped rhodamine 590 laser mode-locked with 3,3'-diethyl-oxadicarbocyanine iodide (DODCI). The present picosecond laser design can be extended to higher repetition rates, pulse energies, and average powers.