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Epidemiologic Study (epidemiologic + study)
Selected AbstractsAn Epidemiologic Study of Closed Emergency Department Malpractice Claims in a National Database of Physician Malpractice InsurersACADEMIC EMERGENCY MEDICINE, Issue 5 2010Terrence W. Brown MD Abstract Objectives:, The objective was to perform an epidemiologic study of emergency department (ED) medical malpractice claims using data maintained by the Physician Insurers Association of America (PIAA), a trade association whose participating malpractice insurance carriers collectively insure over 60% of practicing physicians in the United States. Methods:, All closed malpractice claims in the PIAA database between 1985 and 2007, where an event in an ED was alleged to have caused injury to a patient 18 years of age or older, were retrospectively reviewed. Study outcomes were the frequency of claims and average indemnity payments associated with specific errors identified by the malpractice insurer, as well as associated health conditions, primary specialty groups, and injury severity. Indemnity payments include money paid to claimants as a result of settlement or court adjudication, and this financial obligation to compensate a claimant constitutes the insured's financial liability. These payments do not include the expenses associated with resolving a claim, such as attorneys' fees. The study examined claims by adjudicatory outcome, associated financial liability, and expenses of litigation. Adjudicatory outcome refers to the legal disposition of a claim as it makes its way into and through the court system and includes resolution of claims by formal verdict as well as by settlement. The study also investigated how the number of claims, average indemnity payments, paid-to-close ratios (the percentage of closed claims that resolved with a payment to the plaintiff), and litigation expenses have trended over the 23-year study period. Results:, The authors identified 11,529 claims arising from an event originating in an ED, representing over $664 million in total liability over the 23-year study period. Emergency physicians (EPs) were the primary defendants in 19% of ED claims. The largest sources of error, as identified by the individual malpractice insurer, included errors in diagnosis (37%), followed by improper performance of a procedure (17%). In 18% of claims, no error could be identified by the insurer. Acute myocardial infarction (AMI; 5%), fractures (6%), and appendicitis (2%) were the health conditions associated with the highest number of claims. Over two-thirds of claims (70%) closed without payment to the claimant. Most claims that paid out did so through settlement (29%). Only 7% of claims were resolved by verdict, and 85% of those were in favor of the clinician. Over time, the average indemnity payments and expenses of litigation, adjusted for inflation, more than doubled, while both the total number of claims and number of paid claims decreased. Conclusions:, Emergency physicians were the primary defendants in a relatively small proportion of ED claims. The disease processes associated with the highest numbers of claims included AMI, appendicitis, and fractures. The largest share of overall indemnity was attributed to errors in the diagnostic process. The financial liability of medical malpractice in the ED is substantial, yet the vast majority of claims resolve in favor of the clinician. Efforts to mitigate risk in the ED should include the diverse clinical specialties who work in this complex environment, with attention to those health conditions and potential errors with the highest risk. ACADEMIC EMERGENCY MEDICINE 2010; 17:553,560 © 2010 by the Society for Academic Emergency Medicine [source] The impact of diabetes on employment: genetic IVs in a bivariate probitHEALTH ECONOMICS, Issue 5 2005H. Shelton Brown III Abstract Diabetes has been shown to have a detrimental impact on employment and labor market productivity, which results in lost work days and higher mortality/disability. This study utilizes data from the Border Epidemiologic Study on Aging to analyze the endogeneity of diabetes in an employment model. We use family history of diabetes as genetic instrumental variables. We show that assuming that diabetes is an exogenous variable results in an overestimate (underestimate) of the negative impact of diabetes on female (male) employment. Our results are particularly relevant in the case of populations where genetic predisposition has an important role in the etiology of diabetes. Copyright © 2004 John Wiley & Sons, Ltd. [source] Frailty in Older Mexican AmericansJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2005Kenneth J. Ottenbacher PhD Objectives: To identify sociodemographic characteristics and health performance variables associated with frailty in older Mexican Americans. Design: A prospective population-based survey. Setting: Homes of older adults living in the southwest. Participants: Six hundred twenty-one noninstitutionalized Mexican-American men and women aged 70 and older included in the Hispanic Established Populations for Epidemiologic Study of the Elderly participated in a home-based interview. Measurements: Interviews included information on sociodemographics, self-reports of medical conditions (arthritis, diabetes mellitus, heart attack, hip fracture, cancer, and stroke) and functional status. Weight and measures of lower and upper extremity muscle strength were obtained along with information on activities of daily living and instrumental activities of daily living. A summary measure of frailty was created based on weight loss, exhaustion, grip strength, and walking speed. Multivariable linear regression identified variables associated with frailty at baseline. Logistic regression examined variables predicting frailty at 1-year follow-up. Results: Sex was associated with frailty at baseline (F=4.28, P=.03). Predictors of frailty in men included upper extremity strength, disability (activities of daily living), comorbidities, and mental status scores (Nagelkerke coefficient of determination (R2)=0.37). Predictors for women included lower extremity strength, disability (activities of daily living), and body mass index (Nagelkerke R2=0.29). At 1-year follow-up, 83% of men and 79% of women were correctly classified as frail. Conclusion: Different variables were identified as statistically significant predictors of frailty in Mexican-American men and women aged 70 and older. The prevention, development, and treatment of frailty in older Mexican Americans may require consideration of the unique characteristics of this population. [source] An Epidemiologic Study of Aboriginal Adolescent Risk in Canada: The Meaning of SuicideJOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 1 2008Melanie S. MacNeil RN BACKGROUND:,Current rates of Aboriginal youth suicide suggest that an epidemiologic review is needed to understand the impact of culture, community, and environment specific to suicide within this population. PURPOSE:,This paper aims to (a) examine the literature on the incidence of suicide with special attention to that of adolescents in Aboriginal communities in Canada, (b) review factors hypothesized to place Aboriginals at risk, and (c) explore research directions that would contribute to our understanding of an Aboriginal perspective of suicide. CONCLUSION:,A clear description of the meaning of adolescent Aboriginal suicide and an understanding of the factors that create risk is needed. [source] Sociodemographic Predictors of Pattern and Volume of Alcohol Consumption Across Hispanics, Blacks, and Whites: 10-Year Trend (1992,2002)ALCOHOLISM, Issue 10 2010Raul Caetano Background:, There have been limited trend studies examining variations on the patterns of alcohol consumption among Whites, Blacks, and Hispanics in the United States. The current paper reports national trends in drinking patterns, volume of drinking (number of drinks per month), binge drinking, and drinking to intoxication among Blacks, Whites, and Hispanics over a period of 10 years and identifies sociodemographic predictors of these behaviors across the 3 ethnic groups. Methods:, Data are from the 1991 to 1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES; n = 42,862) and the 2001 to 2002 National Epidemiologic Study on Alcohol and Related Conditions (NESARC; n = 43,093). Both surveys used multistage cluster sample procedures to select respondents 18 years of age and older from the U.S. household population. Results:, Trends varied across different dimensions of drinking and ethnic groups. There were no statistically significant differences in the mean number of drinks consumed per month among men and women in any of the 3 ethnic groups between 1992 and 2002, but there was a significant rise in the proportion of current drinkers in both genders and in all 3 ethnic groups. Multivariate analysis indicated that, compared to Whites in 1992, Blacks and Hispanics did not increase their volume of drinking, but Whites did. Drinking 5 or more drinks in day at all did not increase between 1992 and 2002, but drinking 5 or more drinks at least once a month was more likely for all groups in 2002 compared to Whites in 1992. Drinking to intoxication at all was more likely among Whites in 2002 than 1992, but drinking to intoxication at least once a month was more likely among Whites and Blacks in 2002 than 1992. Conclusion:, The only common trend between 1992 and 2002 across both genders and 3 ethnic groups was a rise in the proportion of drinkers. There was also a rise in drinking 5 or more drinks in a day (Whites, Blacks, and Hispanics) and drinking to intoxication (Whites and Blacks), but this was limited to those reporting such drinking at least once a month. The reasons for these changes are many and may involve complex sociodemographic changes in the population. It is important for the field to closely monitor these cross-ethnic trends in alcohol consumption. [source] Trends in the clinical characteristics of the U.S. cystic fibrosis patient population from 1995 to 2005PEDIATRIC PULMONOLOGY, Issue 8 2008Donald R. VanDevanter Abstract Rationale Respiratory signs and symptoms (cough, sputum production, or crackles) are considered bellwethers of underlying cystic fibrosis (CF) lung disease. If respiratory signs and symptoms predict future lung function loss, then improvements in population lung function over the past decade should have been paralleled by a decrease in the prevalence of these variables in the same population. Additionally, changes in these variables over the past decade may provide insight into the improving health of the CF population. Methods Cross-sectional data from the Epidemiologic Study of Cystic Fibrosis for each year between 1995 and 2005 were analyzed to characterize changes in pulmonary function and respiratory signs and symptoms over time. Patients were separated into five age groups: <6, 6,12, 13,17, 18,24, and ,25 years. Results Serial cross-sectional analyses of an average of 13,381 patients per year indicated that mean pulmonary function for the CF population improved and the percent of patients reporting cough or sputum production or having crackles or wheeze at their clinic visit decreased over the study period. Observed changes in pulmonary function were not consistently mirrored by changes in symptoms, which differed as a function of the variable studied and the age group. Conclusions Reductions in respiratory signs and symptoms have paralleled improvements in pulmonary function. Both the absolute and relative magnitude of changes in prevalence for cough, sputum production, crackles, and wheeze differed among age groups and among variables. These results suggest the possibility that differences in respiratory signs and symptoms may arise from different underlying pathologies and may be influenced differently by therapeutic interventions. Pediatr Pulmonol. 2008; 43:739,744. © 2008 Wiley-Liss, Inc. [source] Pulmonary exacerbations in cystic fibrosis,PEDIATRIC PULMONOLOGY, Issue 5 2004Harvey R. Rabin MD Abstract The clinical characteristics most relevant to the decision to treat for a pulmonary exacerbation with antibiotics in cystic fibrosis patients were determined. Variables including age, increased cough frequency and sputum production, new crackles and wheezing, asthma, symptomatic sinusitis, hemoptysis, decreased lung function, weight loss, and new acquisition of Pseudomonas aeruginosa were collected in a large prospective multicenter database (Epidemiologic Study of Cystic Fibrosis). During a 12-month baseline period, data from 11,692 patients were compared with data collected during the subsequent 6-month study period. Because pulmonary function assessments were unavailable for patients <6 years of age, separate analyses were done for those <6 and ,6 years of age. The outcome of interest was any antibiotic treatment in the 6-month study period reported as indicated for an exacerbation. Characteristics with the most discriminatory power were determined using stepwise multiple logistic regression. For patients <6 years of age, the strongest independent associations with treatment for a pulmonary exacerbation were new crackles, increased cough frequency, decline in weight, and increased sputum production. For those patients ,6 years of age, the strongest independent associations were a relative decrease in percent predicted forced expired volume in 1 sec, increased cough frequency, new crackles, and hemoptysis. The presence of three or more of these key characteristics was strongly associated with the occurrence of a treated exacerbation. The reproducibility of the model over time was confirmed by application to a subsequent set of data. This model has potential for use as an outcome measure in clinical trials, and to assist in treatment decisions for individual patients. Pediatr Pulmonol. 2004; 37:400,406. © 2004 Wiely-Liss, Inc. [source] Effect of housing factors and surficial uranium on the spatial prediction of residential radon in IowaENVIRONMETRICS, Issue 5 2007Brian J. Smith Abstract Growing epidemiologic evidence suggests that residential radon is an important risk factor for lung cancer. Consequently, public health professionals have expressed interest in characterizing the spatial distribution of radon concentrations in order to identify geographic regions of high exposure. Ambient radon concentrations are a function of geologic features including soil radium content. Indoor radon concentrations can vary based on building characteristics that affect the entry of radon into the building and movement between rooms therein. We present a geostatistical hierarchical Bayesian model for radon that allows for spatial prediction based on geologic data and housing characteristics. Our model is applied to radon data from an epidemiologic study in Iowa that consist of 136 outdoor measurements and 2590 indoor measurements from 614 residential homes. Housing characteristics collected in the Iowa Study are included as predictors in the model. Geologic data in the form of county-average surficial uranium concentrations from the USGS National Uranium Resource Evaluation project are also considered. A ,change of support' approach is implemented to combine the radon measurements, collected at points in space, and the uranium concentrations, averaged over counties, so that point-source concentrations for the latter are available for the analysis. Estimates of the effect of select housing factors on radon are provided along with spatial maps of predicted radon concentrations in Iowa. Copyright © 2006 John Wiley & Sons, Ltd. [source] An Epidemiologic Study of Closed Emergency Department Malpractice Claims in a National Database of Physician Malpractice InsurersACADEMIC EMERGENCY MEDICINE, Issue 5 2010Terrence W. Brown MD Abstract Objectives:, The objective was to perform an epidemiologic study of emergency department (ED) medical malpractice claims using data maintained by the Physician Insurers Association of America (PIAA), a trade association whose participating malpractice insurance carriers collectively insure over 60% of practicing physicians in the United States. Methods:, All closed malpractice claims in the PIAA database between 1985 and 2007, where an event in an ED was alleged to have caused injury to a patient 18 years of age or older, were retrospectively reviewed. Study outcomes were the frequency of claims and average indemnity payments associated with specific errors identified by the malpractice insurer, as well as associated health conditions, primary specialty groups, and injury severity. Indemnity payments include money paid to claimants as a result of settlement or court adjudication, and this financial obligation to compensate a claimant constitutes the insured's financial liability. These payments do not include the expenses associated with resolving a claim, such as attorneys' fees. The study examined claims by adjudicatory outcome, associated financial liability, and expenses of litigation. Adjudicatory outcome refers to the legal disposition of a claim as it makes its way into and through the court system and includes resolution of claims by formal verdict as well as by settlement. The study also investigated how the number of claims, average indemnity payments, paid-to-close ratios (the percentage of closed claims that resolved with a payment to the plaintiff), and litigation expenses have trended over the 23-year study period. Results:, The authors identified 11,529 claims arising from an event originating in an ED, representing over $664 million in total liability over the 23-year study period. Emergency physicians (EPs) were the primary defendants in 19% of ED claims. The largest sources of error, as identified by the individual malpractice insurer, included errors in diagnosis (37%), followed by improper performance of a procedure (17%). In 18% of claims, no error could be identified by the insurer. Acute myocardial infarction (AMI; 5%), fractures (6%), and appendicitis (2%) were the health conditions associated with the highest number of claims. Over two-thirds of claims (70%) closed without payment to the claimant. Most claims that paid out did so through settlement (29%). Only 7% of claims were resolved by verdict, and 85% of those were in favor of the clinician. Over time, the average indemnity payments and expenses of litigation, adjusted for inflation, more than doubled, while both the total number of claims and number of paid claims decreased. Conclusions:, Emergency physicians were the primary defendants in a relatively small proportion of ED claims. The disease processes associated with the highest numbers of claims included AMI, appendicitis, and fractures. The largest share of overall indemnity was attributed to errors in the diagnostic process. The financial liability of medical malpractice in the ED is substantial, yet the vast majority of claims resolve in favor of the clinician. Efforts to mitigate risk in the ED should include the diverse clinical specialties who work in this complex environment, with attention to those health conditions and potential errors with the highest risk. ACADEMIC EMERGENCY MEDICINE 2010; 17:553,560 © 2010 by the Society for Academic Emergency Medicine [source] Squamous cell carcinoma of the head and neck in never smoker,never drinkers: A descriptive epidemiologic studyHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 1 2008Kristina R. Dahlstrom BS Abstract Background. While the attributed risk factors for the vast majority of patients with squamous cell carcinoma of the head and neck (SCCHN) are smoking and alcohol abuse, there appears to be a rising proportion of SCCHN patients who report no significant smoking or drinking history. This study reports the demographic and potential risk factors of a large series of never smoker,never drinker (NSND) patients. Methods. All subjects were participants in a prospective epidemiologic study of incident SCCHN. We obtained demographic data, clinical characteristics, and potential etiologic factors for 172 NSND patients and 1131 ever smoker,ever drinker (ESED) patients. Results. NSND patients were more likely to be female and to present at extremes of age, but overall were significantly younger than ESED patients. NSND patients had a higher proportion of oral cavity and oropharyngeal cancers than ESED patients had. Eleven percent of NSND patients (17% of NSND men) reported regular use of noncigarette tobacco products or marijuana, 41% (45% of NSND women) reported regular environmental exposure to tobacco smoke, 24% (36% of NSND men) reported regular occupational exposures to carcinogens/toxins, and 30% had a history of gastroesophageal reflux disease. More than half the NSND patients with an oropharyngeal primary were serologically positive for human papillomavirus type 16. Conclusion. NSND patients with SCCHN are commonly young women with oral tongue cancer, elderly women with gingival/buccal cancer, or young to middle-aged men with oropharyngeal cancer. While several exposures studied may be important to the etiology of a subset of these cancers in NSND patients, it is likely that no single known factor is responsible for a majority of SCCHN in NSNDs. © 2007 Wiley Periodicals, Inc. Head Neck, 2008 [source] Intrafamilial Transmission of Helicobacter pylori among the Population of Endemic Areas in JapanHELICOBACTER, Issue 2 2007Yayoi Fujimoto Abstract Background:,Helicobacter pylori (H. pylori) infection is a worldwide phenomenon related to several gastrointestinal diseases. However, because many aspects concerning the route of transmission remain unclear, we performed this epidemiologic study to clarify the route of intrafamilial transmission of H. pylori. Materials and Methods:, A retrospective study was performed in three widely separate areas in Japan to investigate the prevalence of H. pylori infection. In 1993, 613 residents were tested as were 4136 in 2002, including 1447 family members of 625 families. Antibody to H. pylori (anti- H. pylori) was determined by enzyme-linked immunosorbent assay. Results:, In 2002, the age-adjusted anti- H. pylori prevalence in Hoshino Village (67.5%) was significantly higher than in Kasuya Town (55.0%) and in Ishigaki City (54.7%) (p < .0001, p = .0039, respectively). The age-adjusted anti- H. pylori prevalence of Ishigaki City significantly decreased from 1993 (68.4%) to 2002 (52.5%), showing an age cohort effect. However, the prevalence did not significantly differ in children aged 0,6 years of Ishigaki City between 1993 (9.6%) and 2002 (10.3%). A familial analysis in 2002 demonstrated that the prevalence of anti- H. pylori was significantly higher in children with anti- H. pylori -positive (21.6%, 22 of 102) than with -negative mothers (3.2%, 3 of 95) (p < .0001, by Mantel,Haenszel test), whereas there was no significant difference between children with anti- H. pylori -positive and -negative fathers. Moreover, the prevalence was significantly higher in wives with anti- H. pylori -positive (64.0%, 208 of 325) than with -negative husbands (46.5%, 80 of 172) (p = .0071, by Mantel,Haenszel test) and in husbands with anti- H. pylori -positive (72.2%, 208 of 288) than with -negative wives (56.0%, 117 of 209) (p = .0106, by Mantel,Haenszel test). Conclusions:, In the last decade, H. pylori infection decreased in the general population of Japan by improvement of general hygiene conditions, but did not differ in young children, most likely because of mother-to-child transmission. [source] The performance of the Japanese version of the K6 and K10 in the World Mental Health Survey JapanINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 3 2008Toshi A. Furukawa Abstract Two new screening scales for psychological distress, the K6 and K10, have been developed using the item response theory and shown to outperform existing screeners in English. We developed their Japanese versions using the standard backtranslaton method and included them in the World Mental Health Survey Japan (WMH-J), which is a psychiatric epidemiologic study conducted in seven communities across Japan with 2436 participants. The WMH-J used the WMH Survey Initiative version of the Composite International Diagnostic Interview (CIDI) to assess the 30-day Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition (DSM-IV). Performance of the two screening scales in detecting DSM-IV mood and anxiety disorders, as assessed by the areas under receiver operating characteristic curves (AUCs), was excellent, with values as high as 0.94 (95% confidence interval = 0.88 to 0.99) for K6 and 0.94 (0.88 to 0.995) for K10. Stratum-specific likelihood ratios (SSLRs), which express screening test characteristics and can be used to produce individual-level predicted probabilities of being a case from screening scale scores and pretest probabilities in other samples, were strikingly similar between the Japanese and the original versions. The Japanese versions of the K6 and K10 thus demonstrated screening performances essentially equivalent to those of the original English versions. Copyright © 2008 John Wiley & Sons, Ltd. [source] Interstitial cystitis, gynecologic pelvic pain, prostatitis, and their epidemiologyINTERNATIONAL JOURNAL OF UROLOGY, Issue 2003ANANIAS C. DIOKNO Abstract Aim: To determine a uniform definition of interstitial cystitis (IC) and to develop a strategy on how to study its epidemiology. Methods: Initially, the committee reviewed the literature regarding the definition of IC currently being used and information regarding its epidemiology. The committee held three 1-hour hearings and discussions on the opinions of invited IC specialists. The issues were presented and discussed. Consensus was sought when possible. The committee members met and summarized the gist of the three sessions. Results: A consensus emerged as to what constitutes IC. Interstitial cystitis must have the elements of chronic pelvic pain and urinary frequency and/or urgency. It was also the recommendation that the term IC be retained followed by chronic pelvic pain syndrome represented by the acronym IC/CPPS. A strategy on the epidemiologic study of IC/CPPS was also recommended. Conclusions: A consensus from this workshop has emerged in terms of defining the component of IC, the preferred terminology, and the strategy to study its epidemiology. [source] Failure time regression with continuous covariates measured with errorJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES B (STATISTICAL METHODOLOGY), Issue 4 2000Halbo Zhou We consider failure time regression analysis with an auxiliary variable in the presence of a validation sample. We extend the nonparametric inference procedure of Zhou and Pepe to handle a continuous auxiliary or proxy covariate. We estimate the induced relative risk function with a kernel smoother and allow the selection probability of the validation set to depend on the observed covariates. We present some asymptotic properties for the kernel estimator and provide some simulation results. The method proposed is illustrated with a data set from an on-going epidemiologic study. [source] A population-based epidemiologic study of irritable bowel syndrome in South China: stratified randomized study by cluster samplingALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 11 2004L. S. Xiong Summary Background :,The detailed population-based data on irritable bowel syndrome in South China are lacking. Aims :,To assess the prevalence of irritable bowel syndrome in South China and its impact on health-related quality of life. Subjects and methods :,A face-to-face interview was carried out in South China to assess the prevalence of irritable bowel syndrome. Random clustered sampling of permanent inhabitants aged 18,80 years was carried out under stratification of urban and suburban areas. The impact of irritable bowel syndrome on health-related quality of life was evaluated using the Chinese version of SF-36. Results :,A total of 4178 subjects (1907 male and 2271 female) were interviewed. The adjusted prevalence of irritable bowel syndrome in South China is 11.50% according to the Manning criteria and 5.67% according to the Rome II criteria. Factors including history of analgesic use such as non-steroidal anti-inflammatory drug (odds ratio 3.83), history of food allergies (odds ratio 2.68), psychological distress (odds ratio 2.18), life events (odds ratio 1.89), history of dysentery (odds ratio 1.63) and negative coping style (odds ratio 1.28) were significantly associated with the presence of irritable bowel syndrome (P < 0.05). Irritable bowel syndrome was significantly associated with a decrement in health-related quality of life score. Conclusion :,Irritable bowel syndrome is a common disorder in South China and has a negative impact on health-related quality of life. [source] Identification of spore allergens from the indoor mould Aspergillus versicolorALLERGY, Issue 4 2008D. Benndorf Background:, Indoor mould growth and dampness are associated with respiratory health effects and allergies and several studies demonstrated that mainly Aspergillus versicolor and Penicillium expansum are responsible for indoor mould exposure. In contrast, commercialized test systems to diagnose allergic reactions to this mould species are not available. In this study, allergenic proteins from spores of the indoor relevant species A. versicolor and P. expansum should get detected and identified. Methods:, We used two-dimensional (2D)-gel electrophoresis of spore proteins and immunoblotting with sera from patients participating in an epidemiologic study about indoor exposure of moulds and their influence on the development of allergies (ESTERSPEGA). Sera were screened for IgE antibodies specific for proteins from A. versicolor, A. fumigatus and P. expansum in one-dimensional blots and in 2D immunoblots. From the 2D gels, the corresponding spots were picked and identified by mass spectrometry. Results:, More than 20 allergens from A. versicolor were identified; in particular, seven major allergens were selected, which were detected by more than 90% of the positive sera. The most abundant allergen was glyceraldehyde-3-phosphate dehydrogenase, followed by an unnamed protein, which displays a high homology to sobitol/xylose reductase. The other allergens were identified as catalase A, hypothetical protein AN6918.2, enolase, hypothetical protein AN0297.2 and a protein with homology to a fungal malate dehydrogenase. Conclusions:, The results indicate an important role of spore proteins from A. versicolor for sensitization against indoor moulds and identification of the major allergens might enable species-specific diagnosis of allergic reactions. [source] Incidence of giardiasis among siblings in TurkeyPEDIATRICS INTERNATIONAL, Issue 3 2003I. Cüneyt Balcioglu AbstractBackground:,Giardiasis, a common infection among children, is caused by a flagellated protozoan called Giardia lamblia. It is well known to be contagious in common living places. This is an epidemiologic study investigating the incidence of giardiasis among the siblings of patients with giardiasis living in the same household. Methods:,Stool samples of 50 patients with a G. lamblia positive sibling in the same household, and 50 patients with a G. lamblia negative sibling in the same household, were examined for giardiasis by saline-Lugol, formalin-ethyl acetate concentration and trichrome staining methods. Other causes of diarrhea were excluded by microbiologic laboratory tests. Results:,Thirty-eight per cent of siblings of G. lamblia positive patients and 8% of siblings of G. lamblia negative children were found to be positive for G. lamblia cysts and/or trophozoites. The differences between the groups were statistically significant (P < 0.001). Conclusion:,The results suggested that the examination of G. lamblia among the siblings of patients with giardiasis both in the same age group and living in the same household should be considered. [source] Identification of patients with Churg,Strauss syndrome (CSS) using automated dataPHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 10 2004Leslie R. Harrold MD Abstract Purpose Our aim was to identify individuals with Churg,Strauss syndrome (CSS) among asthma drug users, based on patterns of diagnostic and procedural codes (termed ,algorithms') contained in automated claims data. Methods A retrospective study was conducted among patients who had been dispensed asthma drugs at three HMOs. Individuals who received ,3 dispensings of an asthma drug during any consecutive 12-month period beginning 1 January 1994 through 20 June 2000 were identified. Information on patient age, gender, enrollment status, asthma drugs dispensed, inpatient and outpatient diagnoses and procedures were obtained from the HMO automated databases. Twelve combinations of diagnostic and billing codes (,algorithms') were developed using the claims data to identify potential cases of CSS. Chart reviews blinded to drug exposure were performed using a standardized abstraction form. A rheumatologist reviewed abstracted information on all subjects, and those who met two or more American College of Rheumatology (ACR) criteria for CSS were further reviewed by two clinical experts. Cases were classified as unlikely, possible, or probable/definite CSS. Each clinical expert independently rated the cases; disagreements were resolved by consensus. Results A total of 185,604 patients who had been dispensed asthma drugs were identified. Three hundred fifty subjects were selected for chart review, and 15 were classified as having ,probable/definite' CSS. The algorithms that were most successful in identifying patients with CSS were as follows: (1) two or more codes for vasculitis (13 confirmed cases from 129 reviewed; positive predictive value 10%); (2) codes for both vasculitis and neurologic symptoms (6 confirmed cases from 15 reviewed; positive predictive value 40%) and (3) codes for both eosinophilia and vasculitis (4 confirmed cases from 5 reviewed; positive predictive value 80%). Conclusion Automated claims data can be used to identify patients with CSS. This approach can facilitate better epidemiologic study of the risk factors for the condition. Copyright © 2003 John Wiley & Sons, Ltd. [source] Cluster of presumed organic dust toxic syndrome cases among urban landscape workers,Colorado, 2007,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 7 2009Tegan K. Boehmer PhD Abstract Background Organic dust toxic syndrome (ODTS) is an influenza-like illness typically affecting agricultural workers exposed to organic dusts. In July 2007, Tri-County Health Department investigated a cluster of acute respiratory illnesses among urban landscape workers with known mulch exposure. Methods An epidemiologic study of landscape workers was conducted. Employees were interviewed regarding illness and occupational exposures. Medical records were reviewed. Mulch samples were tested for fungi and endotoxins. Results Five (12%) of 43 employees experienced respiratory illness compatible with ODTS. Illness was associated with prolonged mulch exposure (,6 vs. <6 hr/day; relative risk,=,24.7; 95% confidence interval,=,3.3,184.9). Mulch samples contained high levels of Aspergillus spores and endotoxin. Conclusions Contaminated mulch was implicated as the source of presumed ODTS among landscape workers, highlighting that ODTS is not limited to rural agricultural settings. Education of employers, safety officers, and clinicians is necessary to improve recognition and prevention of ODTS within urban occupational groups. Am. J. Ind. Med. 52:534,538, 2009. © 2009 Wiley-Liss, Inc. [source] Modeling and analysis of disease and risk factors through learning Bayesian networks from observational dataQUALITY AND RELIABILITY ENGINEERING INTERNATIONAL, Issue 3 2008Jing Li Abstract This paper focuses on identification of the relationships between a disease and its potential risk factors using Bayesian networks in an epidemiologic study, with the emphasis on integrating medical domain knowledge and statistical data analysis. An integrated approach is developed to identify the risk factors associated with patients' occupational histories and is demonstrated using real-world data. This approach includes several steps. First, raw data are preprocessed into a format that is acceptable to the learning algorithms of Bayesian networks. Some important considerations are discussed to address the uniqueness of the data and the challenges of the learning. Second, a Bayesian network is learned from the preprocessed data set by integrating medical domain knowledge and generic learning algorithms. Third, the relationships revealed by the Bayesian network are used for risk factor analysis, including identification of a group of people who share certain common characteristics and have a relatively high probability of developing the disease, and prediction of a person's risk of developing the disease given information on his/her occupational history. Copyright © 2007 John Wiley & Sons, Ltd. [source] Epidemiology of Voice Disorders in the Elderly: Preliminary FindingsTHE LARYNGOSCOPE, Issue 4 2007Nelson Roy PhD Abstract Objectives: Epidemiologic studies of the prevalence and risk factors of voice disorders in the elderly, nontreatment seeking population are nonexistent. The purpose of this preliminary investigation was to 1) estimate the prevalence of voice disorders, 2) identify variables associated with increased risk of voice disorders, and 3) measure the socioemotional impact of voice disorders on the elderly who live independently. Study Design: Prospective, cross-sectional survey. Methods: One hundred seventeen seniors (39 males and 78 females; mean age, 76.1 yr; SD, 8.5 yr; range, 65,94 yr), residing in Utah and Kentucky, were interviewed using a questionnaire that addressed three areas related to voice disorders: prevalence, potential risk factors, and socioemotional consequences/effects. Results: The lifetime prevalence of a voice disorder was 47%, with 29.1% of participants reporting a current voice disorder. The majority of respondents (60%) reported chronic voice problems persisting for at least 4 weeks. Seniors who had experienced esophageal reflux, severe neck/back injury, and chronic pain were at increased risk. Voice-related effort and discomfort, combined with increased anxiety and frustration and the need to repeat oneself, were specific areas that adversely affected quality of life. Conclusions: This preliminary epidemiologic study confirmed that voice disorders are common among the elderly, and further research is needed to identify additional risk factors contributing to voice disorder vulnerability. [source] Occupational magnetic field exposures of garment workers: Results of personal and survey measurementsBIOELECTROMAGNETICS, Issue 5 2003Michael A. Kelsh Abstract To explore the feasibility of performing an epidemiologic study of female breast cancer and magnetic field (MF) exposures, we chose to study garment workers, who reportedly have some of the highest MF exposures. We collected personal exposure (PE, n,=,48) and survey measurements (n,=,77) near commercial sewing machines at three garment facilities and conducted a pilot interview among 25 garment workers asking about exposure duration, activities, and machine characteristics. MF levels were higher for older machines with alternating current (AC) than newer machines with direct current (DC) motors. MF levels were comparable for both idling and sewing activities. Most interviewed workers could describe duration of exposure and machine type (automatic/manual), but not other machine characteristics. Measurements were lower than previously reported for garment workers but were higher than exposures to most women. A historical exposure assessment can be conducted by linking duration of exposure with reconstructed exposure measurements but may be limited by the accuracy of work history data. Bioelectromagnetics 24:316-326, 2003. © 2003 Wiley-Liss, Inc. [source] Static magnetic field measurements in residences in relation to resonance hypotheses of interactions between power-frequency magnetic fields and humansBIOELECTROMAGNETICS, Issue 5 2001W. T. Kaune Abstract Bowman et al. used epidemiologic data to test a model in which subjects were classified as being "in-resonance" or "not-in-resonance" for 60-Hz magnetic-field exposures depending on single static magnetic-field measurements at the centers of their bedrooms. A second paper by Swanson concluded that a single static magnetic-field measurement is insufficient to meaningfully characterize a residential environment. The main objective of this study was to investigate exposure-related questions raised by these two papers in two U.S. data sets, one containing single spot measurements of static magnetic fields at two locations in homes located in eight states, and the other repeated spot measurements (seven times during the course of one year) of the static magnetic fields at the centers of bedrooms and family rooms and on the surfaces of beds in 51 single-family homes in two metropolitan areas. Using Bowman's criterion, bedrooms were first classified as being in-resonance or not-in-resonance based on the average of repeated measurements of the static magnetic field measured on the bed where the presumed important exposure actually occurred. Bedrooms were then classified a second time using single spot measurements taken at the centers of bedrooms, centers of family rooms, or on the surfaces of beds, as would be done in the typical epidemiologic study. The kappa statistics characterizing the degree of concordance between the first (on-bed averages) and second (spot measurements) methods of assessing resonance status were 0.44, 0.33, and 0.67, respectively. This level of misclassification could significantly affect the results of studies involving the determination of resonance status. Bioelectromagnetics 22:294,305, 2001. © 2001 Wiley-Liss, Inc. [source] 3223: Dry eye syndrome and omega-3 fatty acidsACTA OPHTHALMOLOGICA, Issue 2010T KAERCHER Purpose Dry eye disease is characterized by an inflammatory component of the ocular surface. Pathways to modulate inflammation include corticoids and cyclosporine. Omega-3 fatty acids like eicosapentaenoic acid and docosahexaenoic acid represent an alternate pharmacologic way to influence the inflammatory cascade. Methods Clinical studies. Results An epidemiologic study in 32.470 healthy women showed that those with a higher intake of omega-3 fatty acids had a 68% decreased prevalence of dry eye syndrome. Hyposecretory dry eye was tested after intake of omega-3 fatty acids for 45 days. Symptoms, signs and inflammatory markers like HLA-DR improved. Hyperevaporative dry eye improved after a long-term supplementation with omega-3 fatty acids with respect to symptoms, break-up time and meibom score. Patients with refractive surgery (PRK) improved after omega-3 fatty acids intake; this was derived from the OSDI-score, Schirmer I test and tear clearance. In 102 contact-lens wearers the symptoms and signs of dry eye improved after 12 weeks therapy with omega-3 fatty acids. Conclusion Nutricionals with omega-3 fatty acids show evidence-based effects on the inflammatory component of ocular surface disease and tear film disorder. Their beneficial effect was tested for hypovolemic and hyperevaporative dry eye. Patients after refractive surgery and contact lens wearers improved after supplementation, too. In contrast to the available anti-inflammatory therapy the supplementation is apt for a long-term application. [source] | |||||||||||||