National Identification Number Research Articles

Mortality in adult patients with culture-positive and culture-negative meningitis in the Botswana national meningitis survey: a prevalent cohort study

SummaryBackgroundCNS infections are a leading cause of HIV-related deaths in sub-Saharan Africa, but causes and outcomes are poorly defined. We aimed to determine mortality and predictors of mortality in adults evaluated for meningitis in Botswana, which has an estimated 23% HIV prevalence among adults.MethodsIn this prevalent cohort study, patient records from 2004–15 were sampled from the Botswana national meningitis survey, a nationwide audit of all cerebrospinal fluid (CSF) laboratory records from patients receiving a lumbar puncture for evaluation of meningitis. Data from all patients with culture-confirmed pneumococcal and tuberculous meningitis, and all patients with culture-negative meningitis with CSF white cell count (WCC) above 20 cells per μL were included in our analyses, in addition to a random selection of patients with culture-negative CSF and CSF WCC of up to 20 cells per μL. We used patient national identification numbers to link CSF laboratory records from the national meningitis survey to patient vital registry and HIV databases. Univariable and multivariable Cox proportional hazards models were used to evaluate clinical and laboratory predictors of mortality.FindingsWe included data from 238 patients with culture-confirmed pneumococcal meningitis, 48 with culture-confirmed tuberculous meningitis, and 2900 with culture-negative CSF (including 1691 with CSF WCC of up to 20 cells per μL and 1209 with CSF WCC above 20 cells per μL). Median age was 37 years (IQR 31–46), 1605 (50%) of 3184 patients were male, 2188 (72%) of 3023 patients with registry linkage had documentation of HIV infection, and median CD4 count was 139 cells per μL (IQR 63–271). 10-week and 1-year mortality was 47% (112 of 238) and 49% (117 of 238) for pneumococcal meningitis, 46% (22 of 48) and 56% (27 of 48) for tuberculous meningitis, and 41% (1181 of 2900) and 49% (1408 of 2900) for culture-negative patients. When the analysis of patients with culture-negative CSF was restricted to those with known HIV infection, WCC (0–20 cells per μL vs >20 cells per μL) was not predictive of mortality (average hazard ratio 0·93, 95% CI 0·80–1·09).InterpretationMortality from pneumococcal, tuberculous, and culture-negative meningitis was high in this setting of high HIV prevalence. There is an urgent need for improved access to diagnostics, to better define aetiologies and develop novel diagnostic tools and treatment algorithms.FundingNational Institutes of Health, President's Emergency Plan for AIDS Relief, National Institute for Health Research.

Increase in tympanostomy tube placements despite pneumococcal vaccination, a population-based study.

AimThe aim was to estimate the impact of the 10‐valent pneumococcal vaccine (PHiD‐CV) on tympanostomy tube placements (TTP) in children under five years of age in Iceland.MethodsThis population‐based observational cohort study followed 11 consecutive birth‐cohorts 2005–2015 from birth until their fifth birthday. Population registries were merged using national identification numbers. The risk of TTP was compared between birth‐cohorts adjusted for the number of previous otitis media diagnoses and antimicrobial prescriptions. A Cox regression model was applied and the hazard ratio (HR) of TTP was estimated between each birth‐cohort and the last vaccine non‐eligible birth‐cohort. The vaccine impact of PHiD‐CV10 on TTP was estimated as 1‐HR ×100%.ResultsIn total, 51 247 children were followed for 210 724 person‐years, of which 14 351 underwent 20 373 procedures. The estimated vaccine impact on TTP was −6% (95% CI −16% to 2.7%). Children in the vaccine‐eligible cohorts had fewer previous otitis media diagnoses and had been prescribed fewer antimicrobials prior to the procedure than children in the vaccine non‐eligible cohorts.ConclusionDespite high uptake of PHiD‐CV10, tympanostomy procedures increased in Iceland during the study period. Vaccine‐eligible children had milder disease prior to the procedure. The reason underlying these findings are speculative.

Burden of hypertension and associated risks for cardiovascular mortality in Cuba: a prospective cohort study

SummaryBackgroundIn Cuba, hypertension control in primary care has been prioritised as a cost-effective means of addressing premature death from cardiovascular disease. However, there is little evidence from large-scale studies on the prevalence and management of hypertension in Cuba, and no direct evidence of the expected benefit of such efforts on cardiovascular mortality.MethodsIn a prospective cohort study, adults in the general population identified via local family medical practices were interviewed between Jan 1, 1996, and Nov 24, 2002, in five areas of Cuba, and a subset of participants were resurveyed between July 14, 2006, and Oct 19, 2008, in one area. During household visits, blood pressure was measured and information obtained on diagnosis and treatment of hypertension. We calculated the prevalence of hypertension (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg, or receiving treatment for hypertension) and the proportion of people with hypertension in whom it was diagnosed, treated, and controlled (systolic blood pressure <140 mm Hg, diastolic blood pressure <90 mm Hg). Deaths were identified through linkage by national identification numbers to the Cuban Public Health Ministry records, to Dec 31, 2016. We used Cox regression analysis to compare cardiovascular mortality between participants with versus without uncontrolled hypertension. Rate ratios (RRs) were used to estimate the fraction of cardiovascular deaths attributable to hypertension.Findings146 556 participants were interviewed in the baseline survey in 1996–2002 and 24 345 were interviewed in the resurvey in 2006–08. After exclusion for incomplete data and age outside the range of interest, 136 111 respondents aged 35–79 years (mean age 54 [SD 12] years; 75 947 [56%] women, 60 164 [44%] men) were eligible for inclusion in the analyses. 34% of participants had hypertension. Among these, 67% had a diagnosis of hypertension. 76% of participants with diagnosed hypertension were receiving treatment and blood pressure was controlled in 36% of those people. During 1·7 million person-years of follow-up there were 5707 cardiovascular deaths. In the age groups 35–59, 60–69, and 70–79 years, uncontrolled hypertension at baseline was associated with RRs of 2·15 (95% CI 1·88–2·46), 1·86 (1·69–2·05), and 1·41 (1·32–1·52), respectively, and accounted for around 20% of premature cardiovascular deaths.InterpretationIn this Cuban population, a third of people had hypertension. Although levels of hypertension diagnosis and treatment were commensurate with those in some high-income countries, the proportion of participants whose blood pressure was controlled was low. As well as reducing hypertension prevalence, improvement in blood pressure control among people with diagnosed hypertension is required to prevent premature cardiovascular deaths in Cuba.FundingMedical Research Council, British Heart Foundation, Cancer Research UK.

Examining Turkish law on data protection

One of the biggest government data breaches in history took place in 2016 when the personal data of 50 million Turkish citizens was posted online in a single file. This politically motivated hack exposed two-thirds of the Turkish population to the risk of identity fraud, by publishing their names, addresses, dates of birth and national identity numbers. Turkey keeps much of its legal system in line with the EU and recently passed a law similar to the General Data Protection Regulation (GDPR). Turkey's data protection laws allow for administrative fines of up to 3% of a company's net annual sales to be levied if personal data is stolen, or disclosed without consent. In our increasingly online world, even companies without any physical presence in Turkey may be subject to Turkish data protection law and may have to register there if their activities have an effect in Turkey. Eren Can Ersoy of Kılınç Law &amp; Consulting takes us through the regulations and how to ensure compliance.

Momentousness of denture labeling using Aadhaar number in Indian population.

Personal identification is of prime importance for forensic and medicolegal purposes especially in case of natural calamities, accidents, state of unconsciousness, or loss of memory. The denture labeling is an important method which has been acknowledged by the field of dentistry. Various denture labeling techniques have been advocated but none of them is universal. Aadhaar is the instantly verifiable national identification number assigned to residents of India, which is currently being used vastly by the Government of India. The article describes a simple, economical, and permanent method for inclusion of Unique Identification Number and bar code in dentures.

A peerless method for identification of removable prosthesis

IntroductionForensic Odontology is the branch of dentistry, that plays a very important role in identification of individuals involved in accident, natural and mass disaster, civil unrest and also in genocide crimes. When natural teeth are not present, marking or labeling of removable partial denture plays an important role in the personal identification. The aim of this study was to obtain a denture identification technique that should be easy, less expensive, long lasting, and standardized. Methods & materialsThis poster illustrates an inclusion of the casted individual national identification number that is printed in the patient’s residence or national identity card issued by the ministry of interior of country in the lingual surface of mandibular removable partial denture. ResultThe label used in this method is durable and can withstand high temperature, it has less chances of deterioration, and is visible radio graphically. It provides all important information about an individual that is standardized, reliable, and is also easily accessible from any remote location. ConclusionThis technique is easy, less expensive, long lasting, visible radio graphically, and a standardized method of identification.

Impact of the 10-valent pneumococcal conjugate vaccine on antimicrobial prescriptions in young children: a whole population study

BackgroundAntimicrobial resistance is a public-health threat and antimicrobial consumption is the main contributor. The ten-valent pneumococcal conjugate vaccine (PHiD-CV10) was introduced into the Icelandic vaccination program in 2011.The aim was to estimate the vaccine impact of PHiD-CV10 on outpatient antimicrobial prescriptions in children.MethodsEleven Icelandic birth-cohorts (2005–2015) were followed from birth until three years of age or to the end of the study period (December 31, 2016). Birth-cohorts were grouped as vaccine non-eligible (VNEC, 2005–2010) or vaccine eligible (VEC, 2011–2015). Data on primary care visits for respiratory infections and antimicrobial prescriptions were extracted from two national registers. Using national identification numbers, prescriptions were linked to physician visits if filled within three days of the visit. Incidence rates and incidence rate ratios between VNEC and VEC were calculated. An Andersen-Gill model was used to model the individual level data, accounting for repeated events and censoring. Vaccine impact was calculated as (1 – Hazard Ratio) × 100%.ResultsIncluded were 53,510 children who contributed 151,992 person-years of follow-up and filled 231,660 antimicrobial prescriptions. The incidence rate was significantly lower in the VEC compared to the VNEC, 144.5 and 157.2 prescriptions per 100 person-years respectively (IRR 0.92, 95%CI 0.91–0.93). Children in VEC were more likely to have filled zero (IRR 1.16 (95%CI 1.10–1.23) and 1–4 (IRR 1.08 95%CI 1.06–1.11) prescriptions compared to children in VNEC. The vaccine impact of PHiD-CV10 against all-cause antimicrobial prescriptions was 5.8% (95%CI 1.6–9.8%).When only considering acute otitis media-associated prescriptions, the vaccine impact was 21.8% (95%CI 11.5–30.9%).ConclusionThe introduction of PHiD-CV10 lead to reduced antimicrobial use in children, mainly by reducing acute otitis media episodes. This intervention therefore reduces both disease burden and could slow the spread of antimicrobial resistance.

Cancer trends and disparities in India: data needs for providing equitable cancer care.

Cancer trends and disparities in India: data needs for providing equitable cancer care.

Mortality and causes of death among people who inject amphetamine: A long-term follow-up cohort study from a needle exchange program in Sweden

BackgroundAbuse of amphetamines is a worldwide problem with around 34 million users, and amphetamine is commonly used by people who inject drugs (PWID). Despite this, there is relatively little research on mortality and cause of death among people who use amphetamines primarily. The present study aimed to examine mortality and causes of death among people who inject amphetamine, and compare these results to the general population. MethodsThis retrospective cohort study was based on data from The Malmö Needle Exchange Program in Sweden (MNEP) and on data from The Swedish National Cause of Death Register. Participants in the MNEP, between 1987 and 2011, with registered national identity number and amphetamine as their primary drug of injection use, were included in the study. Standardized mortality ratios (SMR) was calculated for overall mortality and categories of causes of death. Results2019 individuals were included (mean follow-up-time 13.7 years [range 0.02–24.2 years], a total of 27,698 person-years). Of the 448 deceased, 428 had a registered cause of death. The most common causes of death were external causes (n = 162, 38%), followed by diseases of the circulatory system (n = 67, 16%). SMR were significantly elevated (8.3, 95% CI [7.5-9.1]) for the entire study population, and for every category of causes of death respectively. ConclusionsPeople injecting amphetamine as a primary drug were found to have significantly elevated mortality compared with the general population, with high rates of both external and somatic causes of death.

Characteristics of fatal road crashes involving unlicensed drivers or riders: Implications for countermeasures

Drivers or riders without a valid license are involved in 10% of fatal road crashes in Norway. This was shown by an analysis of data from all fatal crashes in the period 2005–2014. A literature review shows that unlicensed drivers have a considerably increased crash risk. Such crashes could be prevented by electronic driver authentication, i.e., a technical system for checking that a driver or rider has legal access to a vehicle before driving is permitted. This can be done by requiring the driver/rider to identify themselves with a national identity number and a unique code or biometric information before driving may commence. The vehicle thereafter verifies license availability and vehicle access by communication with a central register. In more than 80% of fatal crashes with unlicensed drivers/riders, speeding and/or drug influence contributed to the crash. This means that a majority of crashes with unlicensed drivers alternatively could be prevented by already available systems, such as alcolock and speed limit dependent speed adapters. These systems will have a wider influence, by preventing crashes also among licensed drivers. Mandatory implementation of alcolock, speed limiter, and electronic driver authentication in all motorized vehicles is estimated to prevent up to 28% of fatal road crashes, depending on effectiveness of the systems.

Longitudinal pharmacoepidemiological and health services research for substance users in treatment: protocol of the Belgian TDI-IMA linkage

BackgroundNot much is known about the health seeking behavior of people with substance use disorders before they enter specialized treatment and afterwards. This paper explains in detail the protocol that has been followed to establish the Belgian TDI-IMA-database, which is linking two separate databases: the Treatment Demand Indicator (TDI) and the database of the Intermutualistic Agency (IMA). The Treatment Demand Indicator is measuring incidence of people with substance use disorders entering drug treatment. The IMA-database covers data, collected in the framework of the compulsory Belgian health care and benefits insurance program, on reimbursed medication and the use of reimbursed health services. The linkage results in pharmacoepidemiological and health service data for people who were in treatment for substance use disorders and for a group of comparators.MethodsThe TDI-database was linked to the IMA-database for the period between 01/01/2008 and 31/12/2017, based on the national identification number of patients who have been in alcohol or drug treatment between 01/01/2011 and 31/12/2014. Through this linkage, pharmacoepidemiological and health service data became available for at least 3 years before the first registered episode in the TDI-database till at least 3 years after the first episode. For each person in TDI four comparators, who were not in specialized treatment, were matched on age, sex and place of residence.DiscussionThe TDI-IMA-database allows for an analysis of health seeking behavior and health care pathways of people before and after they entered specialized alcohol and drug treatment. The presented protocol could be used in other European countries to establish a linkage between existing health databases. This will allow for a better understanding of the health care needs of patients with substance use disorders.

Factors associated with non-response at health-related quality of life follow-up in a septic shock trial.

Follow-up of intensive care unit (ICU) patients often includes health-related quality of life (HRQoL) surveying, but non-responders hamper the interpretation. Our aim was to assess factors for non-response to HRQoL survey in ICU patients with septic shock at follow-up in a clinical trial. In a post hoc follow-up registry study, we assessed all the Danish survivors in the Transfusion-Requirements in Septic Shock trial patients, who were mailed the Short Form 36-item Survey (SF-36) 1-year after randomization. We used covariates from the trial database merged with covariates from nation-wide registries using the unique national identification number to explore possible factors for not responding. Five covariates were pre-specified to be included in the primary multivariate analysis: age, number of days in hospital from randomization to follow-up, level of education, cohabitation and employment status at follow-up. We compared the mortality from 1-year survival (2012-2014) till end of final follow-up (January 2016) between non-responders and responders. We assessed 308 survivors of whom 108 (35%) were non-responders. In the primary analysis lower age (odds ratio 1.03, 95% CI [1.01-1.05]), more admission days in hospital (1.006 [1.001-1.011]) and living alone (4.33 [2.46-7.63]) were associated with non-responding, whereas the level of education and employment status were not. Non-responders had a hazard ratio of 1.63 [0.97-2.72] for mortality from 1-year follow-up to final follow-up as compared to the responders. Being younger, spending more days in hospital and living alone were all associated with non-response at 1-year HRQoL follow-up among ICU patients with septic shock.

Familial Mediterranean Fever and Incidence of Cancer: An Analysis of 8,534 Israeli Patients With 258,803 Person-Years.

Familial Mediterranean fever (FMF) is an autoinflammatory disease manifested as recurrent serosal inflammation. An association between FMF and malignancy has not been evaluated. The aim of this study was to estimate cancer risk in a large cohort of FMF patients from a single institution. The study cohort consisted of 8,534 FMF patients registered at the National FMF Center in Tel Hashomer, Israel. We linked the study cohort to the database of the Israel National Cancer Registry using the national identity number. Cancer incidence in FMF patients was determined and then stratified by age and sex. Standardized incidence ratios (SIRs) for cancers were calculated. Among 8,534 FMF patients (4,400 men, 4,134 women), 350 developed cancer during the years 1970-2011. The overall cancer risk among patients with FMF was significantly lower than was expected in specific sex and ethnic groups of the Israeli population: for males of Jewish ethnicity, SIR 0.66 (95% confidence interval [95% CI] 0.55-0.77), P < 0.001; for females of Jewish ethnicity, SIR 0.75 (95% CI 0.64-0.86), P < 0.001; and for males of Arab ethnicity, SIR 0.34 (95% CI 0.07-0.99), P = 0.024. FMF patients have a significantly lower incidence of cancer than the general population of Israel. This pattern was demonstrated in 2 ethnic populations: Jewish and Arab. We speculate that the lower cancer incidence could be attributed to a direct physiologic effect of FMF or to its treatment.

All-Cause Mortality Following an Acute Coronary Syndrome: 12-Year Follow-Up of the Comprehensive 2002 New Zealand Acute Coronary Syndrome Audit

To describe the long-term mortality of a complete national cohort of acute coronary syndrome (ACS) patients enrolled in 2002, to compare this with a national age, sex and Māori ethnicity matched population, and to assess the influence of baseline factors on the 12-year mortality. We reviewed 721 patients with a discharge diagnosis of an ACS who were enrolled in the first New Zealand ACS audit group cohort over 14days in May 2002. We matched the cohort to the national mortality database using each patient's unique national identity number. Over a median follow-up of 12.7 years of 721 patients discharged with an ACS, overall mortality was 52%: ST-elevation myocardial infarction (STEMI) (58%), non-ST-elevation myocardial infarction (NSTEMI) (61%) and unstable angina pectoris (UAP) (42%) patients, p<0.0001. In an age-adjusted survival model, males had a 29% increased mortality rate compared to females with a hazard ratio of 1.29 (95% CI 1.04, 1.61, p=0.019). Over 12 years there were 339 (47%) deaths, compared to 284 (39%) deaths observed in the matched population. The standardised mortality ratio for patients admitted with an ACS in New Zealand is 1.3 (95% CI 1.2, 1.5) with eight patients per 100 not surviving to 12 years compared to this matched population. The high mortality rate in this ACS cohort is a stark reminder of the prognostic implications of a presentation with an ACS. It emphasises the on-going need for optimal management of these patients throughout every stage of their initial treatment and subsequent on-going care.

High agreement between the new Mongolian electronic immunization register and written immunization records: a health centre based audit.

IntroductionMonitoring of vaccination coverage is vital for the prevention and control of vaccine-preventable diseases. Electronic immunization registers have been increasingly adopted to assist with the monitoring of vaccine coverage; however, there is limited literature about the use of electronic registers in low- and middle-income countries such as Mongolia. We aimed to determine the accuracy and completeness of the newly introduced electronic immunization register for calculating vaccination coverage and determining vaccine effectiveness within two districts in Mongolia in comparison to written health provider records.MethodsWe conducted a cross-sectional record review among children 2–23 months of age vaccinated at immunization clinics within the two districts. We linked data from written records with the electronic immunization register using the national identification number to determine the completeness and accuracy of the electronic register.ResultsBoth completeness (90.9%; 95% CI: 88.4–93.4) and accuracy (93.3%; 95% CI: 84.1–97.4) of the electronic immunization register were high when compared to written records. The increase in completeness over time indicated a delay in data entry.ConclusionThrough this audit, we have demonstrated concordance between a newly introduced electronic register and health provider records in a middle-income country setting. Based on this experience, we recommend that electronic registers be accompanied by routine quality assurance procedures for the monitoring of vaccination programmes in such settings.

172 Trends in Site of Care for Low-Acuity Conditions Among Those With Commercial Insurance, 2008-2015

Over the last two decades, new acute health care venues in the United States have emerged and grown. Urgent care centers, retail clinics and telemedicine have expanded as alternative convenient care options. Despite the rapid growth of these alternatives, the relative use of these venues and their impact on the volume of emergency department (ED) use is not well described. We aimed to describe trends in utilization of EDs, urgent care centers, retail clinics and telemedicine, with a focus on low-acuity conditions. Using claims data from a large national commercial health insurer from 2008-2015, we tracked utilization of different care venues. ED visits were identified by an ED-specific place of service code. Other care sites were identified using a combination of place of service codes, national provider identifiers and tax identification numbers. Our focus was on visits for a set of low-acuity conditions such as bronchitis, urinary tract infections, and rashes that are managed at all of these settings. These previously derived conditions each comprise 2% or more of all visits to retail clinics and urgent care centers, and excluded diagnostic codes that would require treatment in an ED. Patient burden of illness was captured using the diagnostic-cost-group (DxCG) risk score. From 2008 to 2015, an average of 21 million insured members per study year made 52 million visits to acute care venues, with 23 million visits for low-acuity conditions. The number of visits for low-acuity conditions increased from 127 to 154 visits/1,000 members. There were substantial increases in the utilization of urgent care (93% increase, 41 to 79 visits/1,000), retail clinics (183% increase, 6 to 17 visits/1,000) and telemedicine (0 to 4 visits/1,000) (Figure 1). In contrast, there was a 31% decrease in visits to EDs for these conditions (80 to 55 visits/1,000). From 2008 to 2015 the fraction of low-acuity visits that occurred in the ED decreased from 63% to 35%. The pediatric population accounted for most of the decline in low-acuity ED visits (0-17 years: 44 to 22 visits/1,000 vs. 18-64 years: 29 to 27 visits/1,000). In contrast, the growth in urgent care utilization was more evenly distributed (0-17 years: 13 to 22 visits/1,000, 18-44 years: 18 to 35 visits/1,000, 45-64 years: 8 to 18 visits/1,000). Patients visiting non-ED settings for low-acuity conditions were healthier (mean risk score: ED 3.31, urgent care 1.25, retail clinic 0.94, telemedicine 0.94), and a greater proportion were female (ED 54%, urgent care 58%, retail clinic 64%, telemedicine 68%). Over the eight-year period from 2008-2015, there were dramatic shifts in where patients in a national commercial insurance plan received care for low-acuity conditions. While use of retail clinics and telemedicine is rising, these settings represent a low proportion of visits. There has been an almost doubling of urgent care use with a corresponding drop in ED utilization. EDs now provide a minority of on-demand care visits for low-acuity conditions.

Anti-cancer effect among patients with familial Mediterranean fever: Outcome of 258,803 person-years analysis.

1566 Background: Familial Mediterranean fever (FMF) is an autoinflammatory disease that causes recurrent serosal inflammation. The association between FMF and malignancy has not been previously described. We estimated cancer risk in a large single-institution cohort of FMF patients. Methods: The study cohort consisted of 8,534 FMF patients registered in the Israel National FMF Center at Tel Hashomer, Israel. We linked the study cohort to the database of the Israel National Cancer Registry using the national identity number. Cancer incidence in FMF patients was determined and stratified by age and gender. Standardized incidence ratios (SIR) for cancers were calculated. Results: Among 8,534 FMF patients (4,400 men, 4,134 women), 350 developed cancer during the years 1970-2011. Overall cancer risk among patients with FMF was significantly lower than that expected in the following gender and population groups, based on cancer incidence rates in those groups in the Israeli population: males of Jewish ethnicity SIR 0.66, CI 95% [0.55-0.77], p&lt; 0.001; females of Jewish ethnicity SIR 0.75 CI 95% [0.64-0.86], p&lt; 0.001; males of Arabic ethnicity SIR 0.34, CI 95% [0.07-0.99], p= 0.024. Conclusions: FMF patients have a significantly lower incidence of cancer than the general population. This pattern was demonstrated in two different ethnic populations, Jewish and Arabic. We speculate that the lower cancer incidence could be attributed to the direct physiological effect of FMF or to the anti-FMF treatment.

Coronary heart disease incidence and mortality, and all-cause mortality among diabetic and non-diabetic people according to their smoking behavior in Finland

BackgroundAs type 2 diabetes (T2D) patients have a high risk for coronary heart disease (CHD) and all-cause mortality and smoking is a major single risk factor for total and CHD mortality, it is important to understand the impact of smoking to the outcome events in comparison to people without T2D. Studies of excess risk of CHD incidence and mortality, and all-cause mortality in T2D patients related to smoking are controversial. We aimed to assess the risk of CHD incidence and mortality, and all-cause mortality in a large Finnish population cohort consisting of people with and without T2Daccording to smoking status.MethodsProspective follow-up of 28 712 men and 30 700 women aged 25–64 years living in eastern and south-western Finland. The data on mortality were obtained from the nationwide death register using the unique national personal identification number. Follow-up information regarding CHD was based on the Finnish Hospital Discharge Register for non-fatal outcomes. The Cox proportional hazards models were used to estimate the association between diabetes and smoking subgroups and the risk for total and CHD mortality.ResultsT2D patients who were smoking had higher all-cause mortality in both men (HR 3.76; 95% CI 2.95-4.78) and women (HR 4.51; 95% CI 2.91-7.00) than non-smoking diabetic men (HR 2.03; 95% CI 1.51-2.74) and women (HR 2.11; 95% CI 1.71-2.59). The CHD mortality risk for smoking men with T2D was higher (HR 6.15; 95% CI 4.22-8.96) than in non-smoking diabetic men (HR 2.62; 95% CI 1.60-4.29). Similar results were found in women revealing corresponding HR for CHD mortality of 6.92 (95% CI 2.79-17.19) for smoking, T2D women and 4.06 (95% CI 2.83-5.82) for non-smoking T2D women, respectively. Even though the risk of CHD incidence in T2D patients who had stopped smoking was statistically significantly higher than in their non-smoking non-diabetic counterparts, their CHD incidence was lower than in smoking T2D patients (HR in men 3.00; HR in women 2.80).ConclusionIt is important to address tobacco consumption in T2D patients, especially during primary health care contacts in order to reduce their high risk of CHD and all-cause mortality.

Schematic Structure of National Data Harmonization System for Identity Management

Imagine a web-application in which a user can query varieties of information about an individual (like name, age, state of origin, driver’s license number, national identification number, etc.). This information would be stored on different databases, each having its own schema. Often times, these resources are replicated in different locations and on different platforms. Hence, the need for data harmonization or integration. Data harmonization addresses this issue by considering these external resources as materialized views over a virtual mediated schema resulting in “virtual data integration”. When mediated schema is queried, the solution transforms the result into appropriate queries over the various and existing data sources. This paper focuses on data harmonization that cuts across different governmental database and incorporating them all into a centralized view and this is possible as a result of development and implementation of a webbased databank application.

Denture identification using individual national identification number of Saudi Arabia: An innovative inclusion method of casted metal.

Context:Forensic odontology is one of the branches of dentistry, which played a very important role in identification of individuals in accident, natural and mass disaster, and civil unrest and in genocide crimes. In the absence of natural teeth, marking or labeling of denture plays a vital role in the personal identification.Background:Various types of marking or labeling methods are reported. However, many are not according to the criteria put forth by American Dental Association or other professional association. Majority of these techniques may be time consuming and expansive, may not be standardized, long lasting and do not permit the incorporation of a large amount of information.Aim:The aim of this study is to find out a denture identification technique that should be easy, less expensive, long lasting, and standardized.Materials and Methods:This article illustrates an inclusion denture casted metal technique of the individual national identification number printed in the patient's residence number or iquama or national identity card issued by the ministry of interior, Kingdom of Saudi Arabia is used as a denture marker in the lingual surface of mandibular denture.Results:The label in this method is durable and can withstand high temperature, less chances of deterioration, visible radiographically, and provide all important information about individual that is standardized, reliable, and also accessible from any remote location.Conclusion:Hence, the proposed technique is an easy, less expensive, long lasting, radiographically visible, and standardized method of identification.