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Deals with a study which examined the use of screening and preventive services among adults with mobility problems of physical impairments. Methodology; Results; Discussion. [ABSTRACT FROM AUTHOR]

Objectives. This research examined whether judgments about a hospital's risk-adjusted mortality performance are affected by the severity-adjustment method. Methods. Data came from 100 acute care hospitals nationwide and 11 880 adults admitted in 1991 for acute myocardial infarction. Ten severity measures were used in separate multivariable logistic models predicting in-hospital death. Observed-to-expected death rates and z scores were calculated with each severity measure for each hospital. Results. Unadjusted mortality rates for the 100 hospitals ranged from 4.8% to 26.4%. For 32 hospitals, observed mortality rates differed significantly from expected rates for 1 or more, but not for all 10, severity measures. Agreement between pairs of severity measures on whether hospitals were flagged as statistical mortality outliers ranged from fair to good. Severity measures based on medical records frequently disagreed with measures based on discharge abstracts. Conclusions. Although the 10 severity measures agreed about relative hospital performance more often than would be expected by chance, assessments of individual hospital mortality rates varied by different severity-adjustment methods. [ABSTRACT FROM AUTHOR]

We examined the ability of MedisGroups, a severity measure based on clinical data abstracted from the medical record, to predict mortality 30 days following admission. MedisGroups measures severity both on admission and approximately one week into the hospital stay. The data base was a random sample of 20,985 admissions of Medicare beneficiaries with one of six conditions from 833 hospitals in seven states between January 1985 and May 1986. In all six conditions, higher admission and mid-stay severity scores were generally associated with higher risk of death. Across the six conditions, the R-squared values for predicting death using admission scores ranged from 0.01 to 0.16; R-squared values using mid-stay scores ranged from 0.03 to 0.34; and R-squared values from combining admission and mid-stay scores ranged from 0.05 to 0.41. Admission MedisGroups score was thus only modestly predictive of 30-day mortality. While the mid-stay score was more powerful, it may not be an appropriate severity adjuster to screen for quality using hospital mortality rates because it could be influenced by substandard care. [ABSTRACT FROM AUTHOR]

Objectives. We examined trends in obesity and arthritis prevalence among the "baby boom" (born 1946-1965) and "silent" (born 1926-1945) generations. Methods. We conducted birth cohort analyses using successive waves of the National Health and Nutrition Examination Survey (1971-2002). Results. Obesity rates increased markedly, beginning earlier in life with each successive birth cohort. When the members of the silent generation were aged 35-44 years, 14%-18% were obese. At comparable ages, 28%-32% of the youngest baby boomers were obese. Differences in arthritis prevalence were not evident across birth cohorts. However, the relative risk of arthritis because of obesity increased over time; consequently, the percentage of arthritis cases attributable to obesity increased from 3% to 18% between 1971 and 2002. Conclusions. Our results showed that members of the baby boom generation were more obese, and became so at younger ages than their predecessors. Although differences in arthritis prevalence are not yet evident, findings suggest that obesity has contributed to more cases of arthritis in recent years than in previous decades. [ABSTRACT FROM AUTHOR]

A response by S. G. Leveille, C. C . Wee and L. I. Iezzoni to a letter to the editor about their article Trends in Obesity and Arthritis Among Boomers and Their Predecessors in a 2005 issue of the American Journal of Public Health is presented.