Disease identification based on ambulatory drugs dispensation and in-hospital ICD-10 diagnoses: a comparison.

BACKGROUND: Pharmacy-based case mix measures are an alternative source of information to the relatively scarce outpatient diagnoses data. But most published tools use national drug nomenclatures and offer no head-to-head comparisons between drugs-related and diagnoses-based categories. The objective of the study was to test the accuracy of drugs-based morbidity groups derived from the World Health Organization Anatomical Therapeutic Chemical Classification of drugs by checking them against diagnoses-based groups. METHODS: We compared drugs-based categories with their diagnoses-based analogues using anonymous data on 108,915 individuals insured with one of four companies. They were followed throughout 2005 and 2006 and hospitalized at least once during this period. The agreement between the two approaches was measured by weighted kappa coefficients. The reproducibility of the drugs-based morbidity measure over the 2 years was assessed for all enrollees. RESULTS: Eighty percent used a drug associated with at least one of the 60 morbidity categories derived from drugs dispensation. After accounting for inpatient under-coding, fifteen conditions agreed sufficiently with their diagnoses-based counterparts to be considered alternative strategies to diagnoses. In addition, they exhibited good reproducibility and allowed prevalence estimates in accordance with national estimates. For 22 conditions, drugs-based information identified accurately a subset of the population defined by diagnoses. CONCLUSIONS: Most categories provide insurers with health status information that could be exploited for healthcare expenditure prediction or ambulatory cost control, especially when ambulatory diagnoses are not available. However, due to insufficient concordance with their diagnoses-based analogues, their use for morbidity indicators is limited.

Gondwana-derived microcontinents - The constituents of the Variscan and Alpine collisional orogens

The European Variscan and Alpine mountain chains are collisional orogens, and are built up of pre-Variscan ``building blocks'' which, in most. cases, originated at the Gondwana margin. Such pre-Variscan elements were part of a pre-Ordovician archipelago-like continental ribbon in the former eastern prolongation of Avalonia, and their present-day distribution resulted from juxtaposition through Variscan and/or Alpine tectonic evolution. The well-known nomenclatures applied to these mountain chains are the mirror of Variscan resp. Alpine organization. It is the aim of this paper to present a terminology taking into account their pre-Variscan evolution at the Gondwana margin. They may contain relics of volcanic islands with pieces of Cadomian crust, relics of volcanic arc settings, and accretionary wedges, which were separated from Gondwana by initial stages of Rheic ocean. opening. After a short-lived Ordovician orogenic event and amalgamation of these elements at the Gondwanan margin, the still continuing Gondwana-directed subduction triggered the formation of Ordovician Al-rich granitoids and; the latest Ordovician opening of Palaeo-Tethys. An example from the Alps (External Massifs) illustrates the gradual reworking of Gondwana-derived, pre-Variscan. elements during the Variscan and Alpine/ Tertiary orogenic cycles. (C) 2003 Elsevier Science B.V. All rights reserved.

Organization of pre-Variscan basement areas at the north-Gondwanan margin

Pre-Variscan basement elements of Central Europe appear in polymetamorphic domains juxtaposed through Variscan and/or Alpine tectonic events. Consequently, nomenclatures and zonations applied to Variscan and Alpine structures, respectively, cannot be valid for pre-Variscan structures. Comparing pre-Variscan relics hidden in the Variscan basement areas of Central Europe, the Alps included, large parallels between the evolution of basement areas of future Avalonia and its former peri-Gondwanan eastern prolongations (e.g. Cadomia, Intra-Alpine Terrane) become evident. Their plate-tectonic evolution from the Late Proterozoic to the Late Ordovician is interpreted as a continuous Gondwana-directed evolution. Cadomian basement, late Cadomian granitoids, late Proterozoic detrital sediments and active margin settings characterize the pre-Cambrian evolution of most of the Gondwana-derived microcontinental pieces. Also the Rheic ocean, separating Avalonia from Gondwana, should have had, at its early stages, a lateral continuation in the former eastern prolongation of peri-Gondwanan microcontinents (e.g. Cadomia, Intra-Alpine Terrane). Subduction of oceanic ridge (Proto-Tethys) triggered the break-off of Avalonia, whereas in the eastern prolongation, the presence of the ridge may have triggered the amalgamation of volcanic arcs and continental ribbons with Gondwana (Ordovician orogenic event). Renewed Gondwana-directed subduction led to the opening of Palaeo-Tethys.