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Biomedical subjects

E S Smith

Publications and source records attributed to E S Smith.

At least 37 records · Page 2Linked to original sources
PubMed1987

A prospective study of the epidemiology and ecology of Lassa fever.

In studies of Lassa fever in Sierra Leone, the prevalence of human antibody to Lassa virus ranged from 8% to 52%. Mastomys natalensis, the reservoir of Lassa virus, constituted 50%-60% of the rodents captured in houses but only 10%-20% of those captured in surrounding agriculture and bush areas (chi 2 = 90.2, P less than 10(-6), df = 1), a finding suggesting that houses are the most-important location for transmission of Lassa virus. Viral infection of Mastomys from houses ranged from 0% to 80%. The incidence of seroconversions in susceptible persons ranged from 5% to 22% per year; the ratio of illness to infection ranged from 9% to 26%, and the proportion of febrile illness associated with seroconversion was 5%-14%. Eightfold rises in titer of antibody occurred in 1%-18% of the antibody-positive population, a result suggesting reinfection. We estimate the ratio of fatalities to infection to be 1%-2%, a rate lower than estimates based on hospitalized cases. The high incidence of Lassa fever makes it a major problem in West Africa.

Adolescent↗
PubMed1987

A case-control study of the clinical diagnosis and course of Lassa fever.

A prospective case-control study of Lassa fever was established in Sierra Leone to measure the frequency and case-fatality ratio of Lassa fever among febrile hospital admissions and to better delineate the clinical diagnosis and course of this disease. Lassa fever was responsible for 10%-16% of all adult medical admissions and for approximately 30% of adult deaths in the two hospitals studied. The case-fatality ratio for 441 hospitalized patients was 16.5%. We found the best predictor of Lassa fever to be the combination of fever, pharyngitis, retrosternal pain, and proteinuria (predictive value together, .81); of outcome, the best predictor was the combination of fever, sore throat, and vomiting (relative risk of death, 5.5). Complications included mucosal bleeding (17%), bilateral or unilateral eighth-nerve deafness (4%), and pleural (3%) or pericardial (2%) effusion. Lassa fever is endemic in this area and is a more-common cause of hospital admission and death than has previously been described; this disease must be considered when diagnosing febrile illness in West Africa.

Adolescent↗
PubMed1987

Clinical virology of Lassa fever in hospitalized patients.

We measured levels of virus in sequential specimens from 137 patients with Lassa fever. The probability of fatal disease increased significantly with the level of viremia measured either on admission or during the course of illness. The odds ratio of death in patients with viremia greater than 10 TCID50/ml was 3.7 (90% confidence interval, 1.9-7.2). The same ratio in patients with viremia greater than 10 TCID50/ml and with levels of aspartate aminotransferase greater than or equal to 150 IU/liter was 21.5 (95% confidence interval, 5.2-99.0). Virus was found in throat cultures from 39% of viremic patients, compared with 14% of nonviremic patients (P less than .002); however, the level of virus was usually less than or equal to TCID50/ml. Fewer than 3% of patients were viruric during acute illness, and virus was isolated from three of three samples of cerebrospinal fluid. On admission, 53% of patients had IgG antibodies, and 67% had IgM antibodies. Recovery was not associated with the presence of either IgG or IgM. Virus was isolated from greater than 100 serum specimens that also contained high titers of IgG. Clinical Lassa fever was shown to be a disseminated systemic, primary viral infection, with an outcome highly associated with viremia but not with development of antibody.

Adult↗
PubMed1987

An analysis of methods to reform Medicare payment for physician services.

Congress and the administration are changing Medicare's method of paying for physician services, with the intention of reducing the growth in or absolute level of Medicare payment rates. We analyzed the implications of four possible strategies for payment reform: modifications to the present system of paying by customary, prevailing, and reasonable (CPR) charges; payment based on fee schedules; payment for packages of related services; and capitation payment. In some cases, improved quality or access may result. The inherent danger is that constraining program expenditures may impair access to and quality of care to beneficiaries, especially for poor or infirm people, who are more vulnerable. Thus, any payment reform will require careful monitoring to safeguard beneficiaries' quality of care.

Capitation Fee↗
PubMed1983

Parents' weekend.

Explore the source record for details and available documents.

District of Columbia↗
PubMed1982

Developing a forensic dental code and programme.

An attempt was made to develop a computer-assisted programme to aid in the positive identification of human remains. The first and second generations of a computer code and programme for entering ante-mortem and post-mortem records into a computer data bank are discussed. The initial code is presented along with the results following the computer evaluation of 50 record pairs. The self-evaluating aspects of the programme are discussed and the proposed second generation code is presented. The programme exhibits some promising characteristics but further refinement based on increased data banks is needed.

Computers↗
PubMed1982

Adolescent pregnancy: a twenty year review.

In 20 years, from 1957 through 1977, there were 2,280 cases of adolescent pregnancy. The number one problem was low birth weight which occurred in 17 percent of all patients. The second significant obstetrical risk was toxemia of pregnancy, occurring in 15 percent of the cases. The cesarean section rate was 6.7 percent. There were 1.8 percent stillbirths and one maternal death.

Adolescent↗
PubMed1980

Matrix organization of a residency program in an academic medical center.

Matrix organization has recently been employed in health care administration to integrate individuals from different disciplines in complex projects and tasks. As residency training in primary care develops and its leaders recognize the need for multidisciplinary inputs to medical education, similar integrative methods of organization will become necessary. Matrix organization offers a structure which can facilitate coordination, communication, and cooperation in health care educational administration as well as in service administration.

Academic Medical Centers↗
PubMed1977

Case-control study of recidivist drivers involved in fatal highway accidents in Alberta in 1970-72.

A 3-year enpidemiologic study of fatal motor vehicle accidents was carried out by the Alberta Task Force on Highway Accidents. It was found that 11.1% of culpable drivers had been driving while impaired by alcohol on at least one occasion prior to the fatal accident, while only 3.3% of exonerated drivers had previous records. This significant difference led to a case-control study that demonstrated that the recidivist drivers (case group) differed significantly in a number of aspects from the innocent drivers (control group)--notably, age distribution, sex, whether drinking before the accident, blood alcohol concentration, ethnic distribution, class of accident and type of collision. Thus the recidivist driver is a greater threat to highway safety than the innocent driver and needs special attention by legislators and law enforcement agencies.

Accidents, Traffic↗
PubMed1977

An epidemiological study of congenital reduction deformities of the limbs.

A retrospective study that was undertaken to determine why more infants had been born with congenital reduction deformities of the limbs is reported. The increase was detected by the Congenital Anomaly Surveillance System in 1969. Ninety-three infants born in Alberta and British Columbia in 1969-71 with congenital reduction deformities were matched with 93 normal infants and 93 infants with congenital malformations of a different type. The mothers of all infants were interviewed to obtain information on factors thought relevant to the establishment of a causal relationship. Although there were some significant differences between cases and normaland/or abnormal controls, this number of differences might have been expected by chance. No single causal relationship was established.

Alberta↗
PubMed1976

Survey of impaired drivers, fatally injured or surviving, who caused fatal highway accidents in Alberta in 1970-72.

In 1970-72, 456 (53.4%) of 854 drivers responsible for a motor vehicle accident in which either they or other persons were killed had been drinking beforehand. Of surviving culpable drivers tested for blood alcohol concentration 81.7% were found to be legally impaired; however, only 24.8% of these drivers were tested. Because surviving culpable drivers pose a possible future hazard to highway safety it is important that data on this group be collected and analysed.

Accidents, Traffic↗