Cervical dystonia (CD) incidence and diagnostic delay in a multiethnic health maintenance organization. (S36.004)
Bibliographic record
Abstract
OBJECTIVE: To determine incidence and characterize diagnostic delay of cervical dystonia (CD) within a large, multiethnic integrated health maintenance organization. BACKGROUND: There are few CD incidence studies. Diagnostic delay has not been studied systematically. DESIGN/METHODS: CD cases were identified using electronic medical record review in > 3 million members of Kaiser Permanente Northern California (KPNC) during 2003-2007. Final diagnosis was determined by consensus of two movement disorders specialists. Incidence rates were standardized using the 2000 U.S. Census population. Diagnostic delay was assessed by comparing physician visits before CD diagnosis or an equivalent time in controls (index date). Controls were matched for age, sex and membership duration (1case:10controls). Odds ratios were determined using logistic regression adjusted for age, gender and membership duration. The frequency and impact of diagnostic delay were assessed by structured interviews in a subgroup. RESULTS: CD incidence standardized to the US 2000 Census population was 1.18/100,000 person-years (p-y), (95[percnt] C.I.: 0.35, 2.0; women: 0.93, men: 0.25) based on 200 cases over 15.4 million p-y. Incidence increased with age through the 7th decade. CD diagnosis was delayed a median of 730 days. Diagnoses more common in CD vs. controls before index date included essential tremor (OR 68.1, 95[percnt] C.I. 28.2, 164.5), cervical disk disease (OR 3.83, 95[percnt] C.I. 2.83,5.17), neck sprain/strain (OR 2.68, 95[percnt] C.I. 1.99, 3.62), anxiety (OR 2.24, 95[percnt] C.I. 1.63,3.11) and depression (OR 1.94, 95[percnt] C.I. 1.4, 2.68 ). 50[percnt] of CD patients interviewed reported diagnostic delay; of these, 75[percnt] had difficulties at work and 48[percnt] difficulties with family relationships due to the delay. CONCLUSIONS: CD incidence is higher in women. Diagnostic delay is common, with adverse impacts. Diagnoses preceding CD may reflect comorbid conditions, diagnostic errors or etiologic factors. Support: NIH-1RO1-NS046340, AHRQ-RO1-HS018413, Dystonia Medical Research Foundation, KPNC, James & Sharron Clark
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".