Biomedical subjects
A Staines
Publications and source records attributed to A Staines.
Oral fluid collection by post for viral antibody testing.
BACKGROUND: The objective of this study was to estimate the prevalence of hepatitis B virus exposure (HBV) in the population of the Republic of Ireland, by using oral fluid (saliva) collection by post for hepatitis B anti-core antibody (anti-HBc). This paper discusses the methodological approach used and the strategies that were adopted to improve response rates. METHODS: The sampling frame used was the Register of Electors for Irish parliamentary elections. A multistage stratified cluster sample was taken, and a total of 962 households were selected nationally. A four-letter approach was employed for sample collection. Households received an initial letter outlining the purpose of the study. This was followed by a letter containing six swabs for oral fluid collection, along with easy-to-follow instructions. Non-respondents received two reminder letters, and were also telephoned where possible. A telephone helpline was provided. All testing was anonymous and unlinked. RESULTS: The study achieved a good household response rate (60.4%), and more than 98% of the 1738 specimens received were suitable for testing. The prevalence of anti-HBc in the Irish population was estimated to be 0.51%. The observed design effect was 1.29. DISCUSSION: From a review of the literature, this is the first study where a representative sample of a national population was asked to self-collect oral fluid samples and return these by post for serological testing. The technique may have many future applications in epidemiological research.
The North Dublin Diabetes Shared Care (DiSC) Project: a profile of current diabetes care in Ireland.
The DiSC Project aims to assess the feasibility, effectiveness and costs of diabetes shared care in Ireland. Baseline results provide a profile of diabetes care in Ireland. Thirty general practices are participating in this randomised controlled trial. Outcomes include biophysical and psychosocial measures. The majority of patients agreed to participate in diabetes shared care. Data was collected from 183 patients with type 2 diabetes. The mean age of the patients is 65 years, 56% are male and 63% are GMS eligible. The mean HBA1c was 6.8% though 21% of patients had a HBA1c>8%. The majority of patients had a blood pressure, total cholesterol and body mass index above recommended guidelines. Only half the patients are attending a dietician or a chiropodist. The majority of patients have good glycaemic control but poor blood pressure and cholesterol control. The full trial results will determine if a shared care approach can improve clinical and psychosocial outcomes for patients.
Prevalence of hepatitis B anti-core antibody in the Republic of Ireland.
The aim of this study was to estimate the prevalence of hepatitis B exposure in the population of the Republic of Ireland, by measuring the prevalence of hepatitis B anti-core antibody in oral fluid collected by postal survey. A random multi-stage stratified sample of Irish households was obtained, using the Irish electoral register as the sampling frame. A total of 962 households were selected, and a household response rate of 60.4% was achieved. Oral fluid specimens totalling 1714 were tested for antibody to hepatitis B core antigen (anti-HBc), using an Immune Capture Enzyme Immuno-Assay. Five specimens (0.29%) were found to contain anti-HBc. Adjusting for study design, the estimated anti-HBc prevalence in the Republic of Ireland is 0.51%. This study demonstrates that self-collection of oral fluid samples is acceptable to the public, and based upon the data generated, that the Republic of Ireland has a low prevalence of hepatitis B infection.
Benefits of an ISO 9001 certification--the case of a Swiss regional hospital.
This paper reports the experience of a quality management project leading to an ISO 9001 certification in a Swiss regional hospital. It describes the motivations for the project, the process that was followed and the benefits of the approach. It also shows its limitations, problems encountered as well as costs and resources involved. The emphasis is on practical issues. Choices that were made are discussed and lessons are drawn.
Incidence of childhood diabetes mellitus in Yorkshire, northern England, is associated with nitrate in drinking water: an ecological analysis.
The relationship between the incidence of childhood-onset insulin-dependent diabetes mellitus and levels of nitrate in drinking water in the former Yorkshire Regional Health Authority was investigated by means of an ecological analysis. A population-based register contributed 1797 0-16-year-olds diagnosed with diabetes between 1978 and 1994. Nitrate data were based on 9330 samples of drinking water tested between 1990 and 1995 in 148 water supply zones, for which 1991 census small area statistics were taken on population density, ethnicity and socio-economic status. Diabetes incidence was positively associated with raised mean nitrate levels with a standardised incidence ratio of 115 in zones with greater than 14.85 mg.1-1 (chi2 = 26.81, 1 df, p < 0.001). Significant negative trends were found between standardised incidence ratios and proportion of non-whites in the population (chi2 = 33.57, 1 df, p < 0.001), childhood population density (chi2 = 30.81, 1 df, p < 0.001) and the Townsend deprivation score (chi2 = 33.89, 1 df, p < 0.001). Poisson regression modelling, adjusting for the other factors, showed a significant increase in relative incidence rate ratio from a baseline of 1 at nitrate levels below 3.22 mg.1-1 to 1.27 (95% confidence interval 1.09, 1.48) for mean nitrate levels above 14.85 mg.1-1. An association between higher nitrate levels in domestic drinking water and incidence of childhood diabetes has been demonstrated. This was not explained by the ethnic composition of the population, population density or socioeconomic status. Nitrate in drinking water may be a precursor of chemicals which are toxic to the pancreas.
A comparison of three methods of analysis for age-period-cohort models with application to incidence data on non-Hodgkin's lymphoma.
BACKGROUND: Various methods of analysis have been used to study age-period-cohort models. The main aim of this paper is to illustrate and compare three such methods. Those of Clayton and Schifflers, Robertson and Boyle, and De Carli and La Vecchia. The main differences between these methods lie in their approach to distinguish between linear-period and linear-cohort effects. Clayton and Schifflers do not attempt to solve this identification problem, whereas Robertson and Boyle, and De Carli and La Vecchia attempt to tackle this question. METHODS: In order to study the assumptions and problems of these methods, we analysed data from 2678 subjects aged 30-84 in Yorkshire, UK, who were diagnosed with non-Hodgkin's lymphoma (NHL) during the period 1978-1991. Loglinear Poisson models were used to examine the effects of age, period and cohort. RESULTS: All three methods of analysis agree that, after stratification for sex and county, the age-standardized rate has been increasing at about 5% per year. The Robertson-Boyle method differed from the Clayton-Schifflers method in showing a significant non-linear cohort effect, and a significant county-cohort interaction. The method of De Carli-La Vecchia agreed more closely with Clayton-Schifflers than with Robertson-Boyle. CONCLUSIONS: The linear increase in incidence would lead to a doubling of the number of cases within 15 years. There is controversy over whether the identification problem can be solved and should be solved. Many authors would not rely on the results of the methods of Robertson and Boyle, or De Carli and La Vacchia.
Small area variation in the incidence of childhood insulin-dependent diabetes mellitus in Yorkshire, UK: links with overcrowding and population density.
BACKGROUND: The incidence of insulin-dependent diabetes mellitus (IDDM) incidence varies between and within countries. The origins of this variation are disputed, but they involve both genetic and non-genetic influences. To explore the role of environmental factors in the aetiology of IDDM we have examined the incidence in small geographical areas and related it to variables derived from national censuses. METHODS: This is an ecological analysis of incidence data from a register of children with IDDM covering the counties of West Yorkshire, North Yorkshire and Humberside in the north of England. All children aged < or = 16, diagnosed with IDDM between 1978 and 1990 were eligible for inclusion. Spatial variation in incidence between electoral wards was investigated using Poisson regression, in relation to socioeconomic status, population density, urban-rural status and measures of geographical isolation. Ward child populations varied in size from 84 to 7197 (mean = 1545). RESULTS: Rates were significantly lower in wards of high population density and with many overcrowded houses. The rate ratio for areas in the upper half of the childhood density distribution was 0.88 (95% confidence interval (CI): 0.78-0.99) and for the two upper tertiles of household overcrowding the rate ratios were 0.84 (95% CI: 0.74-0.95) and 0.68 (95% CI: 0.58-0.79) respectively. CONCLUSIONS: The incidence of childhood IDDM was associated with environmental factors including population density and overcrowded homes. A possible inference from these data is that patterns of infection are involved in the occurrence of IDDM. Analytical epidemiological studies will be needed to investigate these ideas further.
Incidence of insulin dependent diabetes mellitus in Karachi, Pakistan.
OBJECTIVES: To determine the incidence of insulin dependent diabetes mellitus (IDDM) among children aged up to 16 years residing in the city of Karachi, Pakistan, during the five years from 1989 to 1993. DESIGN: Retrospective study of incidence using hospital and clinic records. SETTING: The city of Karachi, Pakistan. SUBJECTS: Children satisfying standard criteria for the diagnosis of IDDM, attending treatment facilities for the first time during the study period. MAIN OUTCOME MEASURES: The incidence of IDDM in this population and its variation by age and sex. RESULTS: The incidence of IDDM in this population is 1.02/100000 per year, which is one of the lowest incidence rates yet reported. CONCLUSIONS: The very low incidence of IDDM, contrasted with the substantially higher incidence among migrants, supports the view that environmental factors are the major determinants of variations in the incidence of this condition between populations.
Clustering of childhood IDDM. Links with age and place of residence.
OBJECTIVE: To improve understanding of the etiology of IDDM by analyzing spatial and space-time distribution of the incidence in children. RESEARCH DESIGN AND METHODS: Statistical tests to detect clustering were applied to a population-based register of 1,490 children (aged 0-16 years) with IDDM in Yorkshire, northern England. The Knox test analyzed clustering in space and time, and the Potthoff-Whittinghill test quantified spatial differences in incidence between small-area census units (electoral wards). The Potthoff-Whittinghill test was conditioned for childhood population density and deprivation (Townsend index). RESULTS: Both tests demonstrated clustering of IDDM in Yorkshire children. Space-time and spatial clustering is strongest in the younger children (0-4 and 5-9 years of age), even after conditioning for known associations. Clustering was more common in the county of Humberside during the years 1982-1985 and in wards of low population density (< 0.26 0- to 16 year-old subjects per hectare). CONCLUSIONS: The study revealed a nonrandom space-time distribution of IDDM in children not accounted for by known covarying demographic factors. The Potthoff-Whittinghill test has not previously been applied to childhood IDDM. The new finding of strong clustering in young children is consistent with early exposure, possibly in utero, to infectious agents or localized environmental sources.
Seasonality of birth of patients with childhood diabetes in Britain.
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Geographical mapping of childhood diabetes in the northern English county of Yorkshire.
This study aimed to highlight geographical differences in childhood Type 1 (insulin dependent) diabetes mellitus (IDDM) by mapping incidence at 3 different geographical scales, within the northern English county of Yorkshire. Mapping techniques are applied to incident cases from a population-based regional register of childhood IDDM. The Yorkshire Children's Diabetes Register (YCDR) comprises 1310 children (0-14 years) diagnosed with IDDM from 1978-1990. Age standardized incidence rates (cases/100000/year) are given for administrative county, standardized incidence ratios (SIRs) are mapped by local government district and electoral ward. Heterogeneity between areas was assessed by a chi 2 test. At county level, incidence is 25% higher in Humberside (16.82 per 100000 per year) compared to West Yorkshire (12.21 per 100000 per year) (p < 0.001). SIRs for the 22 districts display significant heterogeneity (p < 0.001) with deficits in the urban areas of Kirklees (70 95% CI 57-85) and Bradford (81 95% CI 68-95) and significant excesses in the rural districts of Ryedale (147 95% CI 106-198), Beverley (149 95% CI 113-193), Holderness (166 95% CI 112-237) and Boothferry (186 95% CI 134-250). At the smallest scale, variation between wards is significant (p < 0.001) and low incidence in urban areas is notable. Geographical variation in the incidence of childhood IDDM may provide strong clues to its aetiology. Within Yorkshire, geographical distribution shows significant heterogeneity at three different scales. The magnitude of the variation is not explained by ethnic or genetic differences in the population and underlines the important influence of environmental factors in disease aetiology.
The hazards of epidemiology, continued.
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The incidence and distribution of leukaemia and lymphoma within Northern Ireland in the period 1989-1993.
This is the first attempt to systematically record haematological malignancies in Northern Ireland. The methods are identical to a similar effort in other parts of the UK, except that an independent cross check with a cancer registry source was not possible. In addition problems with the census may create differences. Generally, the rates for the leukaemias are slightly lower than in England and Wales, except for acute lymphoblastic leukaemia whilst non-Hodgkin's lymphoma rates are higher. It remains to be seen how stable this situation is as further data are accumulated.
A randomised double blind placebo controlled trial of fish oil in high risk pregnancy.
OBJECTIVE: To determine whether n-3 fatty acid (EPA/DCHA) prophylaxis is beneficial in high risk pregnancies. DESIGN: A randomised, double blind, placebo controlled trial. SETTING: Antenatal clinic of St James's University Hospital, Leeds. SUBJECTS: Two hundred and thirty-three pregnant women at high risk of developing proteinuric or nonproteinuric pregnancy induced hypertension or asymmetrical intrauterine growth retardation. INTERVENTION: Active treatment was 2.7 g of MaxEpa daily (1.62 g of eicosapentaenoic acid and 1.08 g of docosahexaenoic acid). Placebo were matching air-filled capsules. MAIN OUTCOME MEASURES: Occurrence of proteinuric, nonproteinuric pregnancy induced hypertension or birthweight < 3rd centile. RESULTS: There was no difference in an intention to treat analysis between the placebo and active treatment groups for occurrence of proteinuric pregnancy induced hypertension (relative risk (RR) = 0.88; 95% CI 0.47-1.66), nonproteinuric pregnancy induced hypertension (RR = 0.89; 95% CI 0.48-1.64), birthweight < 3rd centile (RR = 0.89; 95% CI 0.48-1.64), or the duration of pregnancy (difference of mean durations = 0.1 days; 95% CI -4.8 to 4.9 days). Analyses stratified by use of tobacco, and analyses excluding known major protocol violators gave essentially identical results. CONCLUSION: There is no evidence from this study for any useful effect of fish oil supplementation for women at high risk of adverse outcomes from a pregnancy, but a small protective effect remains a possibility.
Selection of control subjects for case/control analysis of susceptibility to type 1 (insulin-dependent) diabetes mellitus.
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The increasing incidence of non-Hodgkin's lymphoma (NHL): the possible role of sunlight.
This review critically examines the rise in incidence in non-Hodgkin's Lymphoma (NHL) in selected parts of the world and concludes that much of the increase is likely to be due to unknown biological factors. It postulates that one reasonable explanation for the rise in incidence of NHL is the ever increasing exposure of populations, particularly in the Northern Hemisphere, to sunlight. Support for the hypothesis is supplied from both epidemiological evidence and studies of the responses of lymphocytes to ultra-violet light in both in vitro and in vivo experimental work.
Multiple author trend worst in medicine.
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