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Prospective Surveillance (prospective + surveillance)
Selected AbstractsProspective Surveillance of Hypertension in FirefightersJOURNAL OF CLINICAL HYPERTENSION, Issue 5 2003Elpidoforos S. Soteriades MD The authors evaluated blood pressure and antihypertensive medication use in 334 firefighters in an occupational medical surveillance program. Firefighters received written summaries of their examination results, including blood pressures, and were encouraged to see their personal physicians for any abnormal results. The mean age of the participants was 39 years, and the vast majority were men (n=330). The prevalence of hypertension was 20% at baseline (1996), 23% in 1998, and 23% in 2000. Among firefighters with high blood pressure readings, only 17%, 25%, and 22% were taking antihypertensive medications at the baseline, 1998, and 2000 examinations, respectively. Medical surveillance was effective in detecting hypertension in firefighters; however, after 4 years of follow-up, only 42% of hypertensives were receiving treatment with medications, including only 22% of firefighters with hypertensive readings. Overall, 74% of hypertensives were not adequately controlled. Possible reasons for low treatment rates may be the inadequate recognition among primary care physicians that mild hypertension is a significant risk factor for cardiovascular disease. [source] Residual Urine as a Risk Factor for Lower Urinary Tract Infection: A 1-Year Follow-Up Study in Nursing HomesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2008Ragnhild Omli RN OBJECTIVES: To determine whether postvoid urine is a risk factor for the development of lower urinary tract infections (UTIs) in nursing home residents. DESIGN: Prospective surveillance with a follow-up period of 1 year. SETTING: Six Norwegian nursing homes. PARTICIPANTS: One hundred fifty nursing home residents. METHODS: Postvoid residual (PVR) urine volumes were measured using a portable ultrasound. UTIs were registered prospectively for 1 year. RESULTS: Ninety-eight residents (65.3%) had a PVR less than 100 mL, and 52 (34.7%) had a PVR of 100 mL or greater. During the follow-up period, 51 residents (34.0%) developed one or more UTIs. The prevalence of UTI in women was higher than in men (40.4% vs 19.6%; P=.02). There was no significant difference in mean PVR between residents who did and did not develop a UTI (79 vs 97 mL, P=.26). PVR of 100 mL or greater was not associated with greater risk of developing a UTI (P=.59). CONCLUSION: High PVR is common in nursing home residents. No association between PVR and UTI was found. [source] Recognising and responding to outbreaks of hepatitis A associated with child day-care centresAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 6 2001Jeffrey N. Hanna Objectives: To assess the appropriateness of a protocol for recognising and responding to outbreaks of hepatitis A in child day-care centres and to determine if measles-mumps-rubella (MMR) vaccine was given too soon following the administration of normal human immunoglobulin (NIGH) to young children to control the outbreaks. Design: Prospective surveillance to recognise cases of hepatitis A associated with, and outbreaks of hepatitis A in, day-care centres. Main outcome measures: The percentage of initial (,sentinel') cases of hepatitis A associated with day-care centres that were subsequently recognised as also being 'index' cases of outbreaks of hepatitis A in the centres, and the number of children 9,13 months of age when given NIGH who were subsequently given MMR less than three months later. Results: Only 18 (16%) of the 114 sentinel day-care associated cases of hepatitis A were also index cases of outbreaks of hepatitis A in their respective centres. A total of 105 cases of hepatitis A were associated with the 18 outbreak centres; NIGH was administered to 928 (78%) of the attendee children, and to 105 (82%) of the susceptible staff, at the 18 centres. Three of the five children 9,13 months of age when given NIGH were given MMR less that three months later. Conclusions: Although outbreaks of hepatitis A were common events in day-care centres in north Queensland during the two-year study period, a single case of hepatitis A associated with a centre was a poor predictor of an outbreak within that centre. Precautions must be taken to ensure that live vaccines are not administered to young children too soon after NIGH. [source] Entities and frequency of neonatal diabetes: data from the diabetes documentation and quality management system (DPV)DIABETIC MEDICINE, Issue 6 2010J. Grulich-Henn Diabet. Med. 27, 709,712 (2010) Abstract Aims, The aim of this study was to elucidate the entities and the frequency of neonatal diabetes mellitus (NDM) in a large representative database for paediatric diabetes patients in Germany and Austria. Methods, Based on the continuous diabetes data acquisition system for prospective surveillance (DPV), which includes 51 587 patients with onset of diabetes before the age of 18 years from 299 centres in Germany and Austria, we searched for patients with onset of diabetes mellitus in the first 6 months of life. Results, Ninety patients were identified, comprising 0.17% of all paediatric cases in the DPV registry. This represented an incidence of approximately one case in 89 000 live births in Germany. A monogenic basis for NDM was established in 30 subjects (seven UPD6, 10 KCNJ11, seven ABCC8, two FOXP3, two PDX1, one INS, one EIF2AK3). Pancreatic hypoplasia or agenesis was reported in 10 patients and seven subjects were classified as having Type 1 diabetes by their centres. Transient neonatal diabetes (TNDM) accounted for approximately 10% of all cases with NDM. No aetiology was defined in 41 subjects, which may reflect incomplete genetic testing or novel genetic aetiologies. Conclusion, Based on a large database, we identified a higher rate of NDM in Germany than has been reported previously. Full molecular genetic testing should be performed in all patients diagnosed before 6 months of age. [source] Sequential case series analysis for pharmacovigilanceJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES A (STATISTICS IN SOCIETY), Issue 1 2009Mounia N. Hocine Summary., The self-controlled case series method is used to evaluate drug safety, particularly the safety of paediatric vaccines with respect to rare adverse reactions. We propose a group sequential version of the method for prospective surveillance of drug safety. We focus on the surveillance of new vaccines. We develop methods that are based on the sequential probability ratio test applied at predetermined surveillance intervals, using both simple and composite alternative hypotheses. We investigate the properties of the methods analytically in a simple setting and by simulations in more realistic scenarios. The methods are applied to data on influenza vaccine and Bell's palsy, and to data on measles, mumps and rubella vaccine and bleeding disorders. [source] A review and discussion of prospective statistical surveillance in public healthJOURNAL OF THE ROYAL STATISTICAL SOCIETY: SERIES A (STATISTICS IN SOCIETY), Issue 1 2003Christian Sonesson Summary. A review of methods suggested in the literature for sequential detection of changes in public health surveillance data is presented. Many researchers have noted the need for prospective methods. In recent years there has been an increased interest in both the statistical and the epidemiological literature concerning this type of problem. However, most of the vast literature in public health monitoring deals with retrospective methods, especially spatial methods. Evaluations with respect to the statistical properties of interest for prospective surveillance are rare. The special aspects of prospective statistical surveillance and different ways of evaluating such methods are described. Attention is given to methods that include only the time domain as well as methods for detection where observations have a spatial structure. In the case of surveillance of a change in a Poisson process the likelihood ratio method and the Shiryaev,Roberts method are derived. [source] Interaction between smoking and the stromelysin-1 (MMP3) gene 5A/6A promoter polymorphism and risk of coronary heart disease in healthy menANNALS OF HUMAN GENETICS, Issue 5-6 2002S. E. HUMPHRIES Smoking is a major risk factor for coronary heart disease (CHD), but this risk may be modified by an individual's genotype. A common functional 5A/6A polymorphism in the promoter of the stromelysin-1 (matrix metalloproteinase 3, MMP3) gene has been identified. The 6A allele has been consistently associated with faster progression of angiographically determined CHD, while the 5A allele has recently been associated with risk of acute myocardial infarction (MI) in patients with unstable angina. To date there has been no prospective study of the relationship of this genotype to CHD risk in smokers and non-smokers. DNA was available from 2743 middle-aged men, free of CHD at baseline, recruited through nine general practices in the UK for prospective surveillance. To date there have been almost 24000 person-years of follow-up with 125 CHD events (fatal and non-fatal MI, sudden coronary death, need for coronary artery surgery or new major ECG Q-wave abnormality). Men with events were each matched for age, practice and cholesterol level with three healthy men. Smoking habit was determined by questionnaire. 5A/6A genotype was determined using a heteroduplex generator method. Associations between genotype and disease outcome, according to smoking status, were assessed using conditional logistic regression. Overall, current smoking was associated with a relative risk (RR) of 1.99 (95% CI 1.30,3.06) as compared with never-smokers and ex-smokers combined (p<0.002). In non-smoking men, and after adjustment for conventional risk factors, compared with the 5A5A group, the RR was 1.37 (0.64,2.94) in those with the genotype 5A6A and 3.02 (1.38,6.61) in those with the genotype 6A6A. Smoking increased risk 1.4 fold in the 5A6A group to 1.91 (1.84,4.36), by 1.3 fold in the 6A6A group to 4.01 (1.57,10.24), but by 3.81 fold (1.54,9.40) in the 5A5A group (smoking,genotype interaction p = 0.01). The data indicate a key role for stromelysin in the atherosclerotic process. Men with the stromelysin genotype 5A5A represent 29% of the general population, and their high risk, if smokers, provides a further strong argument for smoking avoidance. [source] Interdisciplinary surveillance of intraventricular haemorrhage associated conditions in infants <1000 gACTA PAEDIATRICA, Issue 6 2008Michael Obladen Abstract Aim: Intraventricular haemorrhage (IVH) causes some of the most adverse outcomes in infants with birthweight <1000 g. Incomplete antenatal steroids, acidosis, inflammation, postnatal transfer, delayed surfactant administration, hypothermia, hypotension, hypocapnia, persistent ductus arteriosus and pneumothorax are all associated with IVH. We hypothesized that prospective surveillance of these IVH-associated conditions decreases their frequency and thus the frequency of IVH. Methods: Cranial ultrasound was performed on days 1, 3, 7, 30 after birth and at discharge, and was assessed according to Papile. The incidence of IVH and IVH-associated conditions was monitored prospectively in all infants <1000 g born in our perinatal centre in 2005/2006, and obstetricians and neonatologists held monthly interdisciplinary review conferences to discuss the preventability of IVH-associated conditions (IVH surveillance). These data were compared to existing prospective data gathered during routine monitoring in 2004. Results: IVH (all grades) occurred in 29/86 extremely low birthweight (ELBW) infants during routine monitoring and in 12/89 ELBW infants during IVH surveillance (p = 0.007). IVH grades 3,4 dropped from 20% to 3.4% (p = 0.0006). There were significant differences in completeness of antenatal steroids (54% vs. 67%, p = 0.04) and timeliness in initial surfactant substitution (45% vs. 71%, p = 0.01). Most other IVH-associated conditions were reduced during IVH surveillance without reaching significance. Conclusions: IVH is not always an inevitable disaster. Obstetricians and neonatologists can reduce its incidence by joint prospective surveillance of IVH-associated conditions. [source] | ||||||||||