Diabetes duration and health-related quality of life in individuals with onset of diabetes in the age group 15-34 years - a Swedish population-based study using EQ-5D.

BACKGROUND: Diabetes with onset in younger ages affects both length of life and health status due to debilitating and life-threatening long-term complications. In addition, episodes and fear of hypoglycaemia and of long-term consequences may have a substantial impact on health status. This study aims to describe and analyse health-related quality of life (HRQoL) in individuals with onset of diabetes at the age of 15-34 years and with a disease duration of 1, 8, 15 and 24 years compared with control individuals matched for age, sex and county of residence. METHODS: Cross-sectional study of 839 individuals with diabetes and 1564 control individuals. Data on socioeconomic status and HRQoL using EQ-5D were collected by a postal questionnaire. Insulin treatment was self-reported by 94% of the patients, the majority most likely being type 1. RESULTS: Individuals with diabetes reported lower HRQoL, with a significantly lower mean EQ VAS score in all cohorts of disease duration compared with control individuals for both men and women, and with a significantly lower EQ-5Dindex for women, but not for men, 15 years (0.76, p = 0.022) and 24 years (0.77, p = 0.016) after diagnosis compared with corresponding control individuals. Newly diagnosed individuals with diabetes reported significantly more problems compared with the control individuals in the dimension usual activities (women: 13.2% vs. 4.0%, p = 0.048; men: 11.4% vs. 4.1%, p = 0.033). In the other dimensions, differences between individuals with diabetes and control individuals were found 15 and 24 years after diagnosis: for women in the dimensions mobility, self-care, usual activities and pain/discomfort and for men in the dimension mobility. Multivariable regression analysis showed that diabetes duration, being a woman, having a lower education and not being married or cohabiting had a negative impact on HRQoL. CONCLUSIONS: Our study confirms the negative impact of diabetes on HRQoL and that the difference to control individuals increased by disease duration for women with diabetes. The small difference one year after diagnosis could imply a good management of diabetes care and a relatively quick adaptation. Our results also indicate that gender differences still exist in Sweden, despite modern diabetes treatment and management in Sweden.

Diffusion of interferon beta in Iran and its utilization in Tehran.

PURPOSE: There are few studies on the diffusion of expensive new therapies in low- or middle-income countries. The objectives of this study were to describe the diffusion of interferon beta for the treatment of patients with multiple sclerosis (MS) in Iran and to analyze its use in a cohort of 890 patients in Tehran registered in the Iranian MS Society (IMSS) registry. METHODS: Data on the diffusion of interferon beta drugs from 2000 to 2004 in Iran were obtained from the Ministry of Health (MOH). Data on the utilization of interferon beta in selected patient groups were collected from routine clinical data of the IMSS in a sample of population in Tehran province from 2003 to 2005. RESULTS: Interferon beta had a rapid diffusion in Iran during the study period, and it was used in all 28 provinces in 2004, however, much less in the poor provinces. Interestingly, interferon beta was prescribed to 68% of the patients in Tehran registered in the IMSS registry during 2003-2005. The usage of interferon beta as registered in the IMSS was higher (p < 0.0001) among insured than uninsured patients. CONCLUSION: The use of interferon beta treatment has grown considerably in Iran. In Tehran, interferon beta seems to be mainly used by young ambulatory patients with relapsing-remitting MS, indicating a rational drug use.

Patient claims and complaints data for improving patient safety.

PURPOSE: The purpose of this paper is to describe patient complaints and claims data from Swedish databases and assess their value for scientific research and practical health care improvement. DESIGN/METHODOLOGY/APPROACH: The article first describes previous research into patient claims and similar schemes. It then presents three types of data on patient claims and complaints in Sweden: data generated by the Patient Insurance Fund, the Medical Responsibility Board and the Patients' Advisory Committees and considers methodological issues in using the data. FINDINGS: The databases' value is problems related to spontaneous reporting, which makes it difficult to know how much the data correspond to general injury rates and health care patterns. Another issue is the balance between the size of study materials and the timeliness, e.g. when diagnosis-specific analysis requires data pooling over several years in order to reach adequate case numbers. Adjustment for confounders not present in the databases, e.g. data on hospital case-mix, may add to difficulties using the data in comparative analyses of safety performance. RESEARCH LIMITATIONS/IMPLICATIONS: The databases' safety analysis and quality improvement value depends on understanding their function, data collection method and their limitations as a source of data about the true incidence and prevalence of injuries and safety problems. ORIGINALITY/VALUE: This is the first thorough review of the possibilities and limitations associated with the use of claims and complaints data in health care research and improvement.

Diffusion of magnetic resonance imaging in Iran.

OBJECTIVES: The aim of this article is to describe the diffusion of magnetic resonance imaging (MRI) in Iran, including regional variations during the period of 1990 to 2005 and international comparisons. METHODS: Data on the diffusion of MRI were obtained from the Medical Equipment Office of the Ministry of Health (MOH) and, using self-administered questionnaires, from forty-one universities specializing in medical sciences. Data were gathered from the year of first purchase up to mid-2005. Information for international comparisons was obtained from the Organization for Economic Cooperation and Development health data of 2006. RESULTS: Iran purchased its first MRI unit in 1990. Since then, the number of MRI units has increased remarkably. The diffusion curve of MRI in Iran follows an S-shaped curve with a very slow speed in the period of 1991-95. Accelerated adoption occurred later coinciding with a significant influence from the private sector, especially from 1999. Iran had ninety-three MRI units in 2005, and the number of MRI units per million in the population was 1.36. CONCLUSIONS: The number of MRI units in provinces is not in direct proportion to the number of their inhabitants. Rational adoption and equitable diffusion of MRI may require the MOH and regulatory bodies to improve their ability in health technology assessment and integrate it into the policy making regarding adoption, diffusion, and utilization of health technologies.

Selecting indicators for patient safety at the health system level in OECD countries.

BACKGROUND: Concerns about patient safety have arisen with growing documentation of the extent and nature of harm. Yet there are no robust and meaningful data that can be used internationally to assess the extent of the problem and considerable methodological difficulties. PURPOSE: This article describes a project undertaken as part of the Organization for Economic Cooperation and Development (OECD) Quality Indicator Project, which aimed at developing an initial set of patient safety indicators. METHODS: Patient safety indicators from OECD countries were identified and then rated against three principal criteria: importance to patient safety, scientific soundness, and potential feasibility. Although some countries are developing multi-source monitoring systems, these are not yet mature enough for international exchange. This project reviewed routine data collections as a starting point. RESULTS: Of an initial set of 59 candidate indicators identified, 21 were selected which cover known areas of harm to patients. CONCLUSIONS: This project is an important initial step towards defining a usable set of patient safety indicators that will allow comparisons to be made internationally and will support mutual learning and quality improvement in health care. Measures of harm should be complemented over time with measures of effective improvement factors.

Gender equity in health care in Sweden--minor improvements since the 1990s.

A report by the Swedish National Committee on Gender Disparities in Patient Care (1996) identified many shortcomings in the ability of the health sector to gear patient management and treatment to the specific needs of men and women. To promote gender equity in health care, the Committee presented several proposals relating to research, education, monitoring, and evaluation of health services and the responsibilities of health authorities. In 2002, the Swedish Government authorised the National Board of Health and Welfare to review and analyse gender equity trends in health care. Data from, e.g. the national quality registers, epidemiological health data registers, population surveys, and Patient Trust Boards were compiled to identify gender disparities in the quality and accessibility of health services. The curricula of medical universities and the policies of major research funds were reviewed, as were developments in major fields of health research. The National Board found that many of the gender disparities identified in the 1990s still exist, e.g. access to advanced evidence-based technologies such as coronary interventions. As previously, women account for around 60%, and men for 40%, of complaints, e.g. to the Patients' Advisory Committees. Many of the proposals of the National Committee have not been fully implemented by the national authorities or the county councils. We conclude that promoting gender equity in health care is an important but difficult task for health authorities. To make health services more gender sensitive a combination of strategies, including enforcement by guidelines and regulations, may be needed.