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E Susser

Publications and source records attributed to E Susser.

At least 73 records · Page 4Linked to original sources
PubMed1996

Choosing a future for epidemiology: I. Eras and paradigms.

To inform choices about the future of epidemiology, the present condition of epidemiology is examined, in terms of its evolution through three eras, each demarcated by its own paradigm: (1) the era of sanitary statistics with its paradigm, miasma; (2) the era of infectious disease epidemiology with its paradigm, the germ theory; and (3) the era of chronic disease epidemiology with its paradigm, the black box. The historical context in which these eras arose is briefly described. In each era, the public health was at the center of the concerns of the founders and early protagonists of the prevailing paradigm. Around this intellectual development we weave a further theme. We argue that in the present era, the public health has become less central a concern. At the same time, in epidemiology today the dominant black box paradigm is of declining utility and is likely soon to be superseded.

Communicable Diseases↗
PubMed1996

Choosing a future for epidemiology: II. From black box to Chinese boxes and eco-epidemiology.

Part I of this paper traced the evolution of modern epidemiology in terms of three eras, each with its dominant paradigm, culminating in the present era of chronic disease epidemiology with its paradigm, the black box. This paper sees the close of the present era and foresees a new era of eco-epidemiology in which the deployment of a different paradigm will be crucial. Here a paradigm is advocated for the emergent era. Encompassing many levels of organization--molecular and societal as well as individual--this paradigm, termed Chinese boxes, aims to integrate more than a single level in design, analysis, and interpretation. Such a paradigm could sustain and refine a public health-oriented epidemiology. But preventing a decline of creative epidemiology in this new era will require more than a cogent scientific paradigm. Attention will have to be paid to the social processes that foster a cohesive and humane discipline.

Epidemiologic Methods↗
PubMed1995

Reliability of post-mortem chart diagnoses of schizophrenia and dementia.

The reliability of psychiatric diagnosis has a direct effect on the validity of post-mortem analyses of neuropathological data, yet little is known about the reliability of retrospective diagnostic procedures which rely on review of medical records. In this paper, we report on the reliability of DSM-III-R psychiatric diagnoses assigned by a pool of 8 raters to a set of 106 state hospital charts of elderly, chronic patients who had died while institutionalized and were autopsied. Diagnoses were grouped by general diagnostic class, and Kappa coefficients computed for agreement among raters, as well as for agreement between ultimate consensus diagnoses and those made while subjects were living. Interrater agreement for those diagnoses that occurred most frequently in this sample (e.g. Schizophrenia and Dementia) was excellent, and comparable to the the agreement observed for ratings of live patients. Interrater agreement for less frequently occurring diagnoses (e.g. Mental Retardation, Mood Disorders, other non-Schizophrenic Psychoses) ranged from excellent to poor. We found high agreement between our rates diagnoses and those assigned by state hospital personnel while patients were living, although post-mortem review produced lower rates of diagnosis of both schizophrenia and Alzheimer-type dementias. Overall, results suggest that the reliability of chart review diagnosis is comparable to that obtained from interviews of live patients when experienced raters are used and diagnostic base rates are high enough to produce stable estimates of reliability.

Aged↗
PubMed1995

Lifetime and five-year prevalence of homelessness in the United States: new evidence on an old debate.

A 1990 household-based telephone survey of 1,507 people was followed up by surveying a subsample of those interviewed for the initial report. Results showed very high prevalence figures for homelessness, quite close to those found in the earlier survey. Moreover, using explicit and stringent definitions of literal homelessness and doubling up, most periods of homelessness were found to last for more than one month and, particularly with regard to literal homelessness, to involve serious deprivations and violent victimization.

Adult↗
PubMed1995

Epidemiology, diagnosis, and course of brief psychoses.

OBJECTIVE: This study investigated acute and nonacute brief psychoses. On the basis of previous work, the authors proposed that 1) acute brief psychoses occur predominantly in females, 2) they often do not conform to the diagnoses of DSM-III-R, 3) they are temporally stable, and 4) nonacute brief psychoses do not share these distinctive features. METHOD: The data are from a follow-up study of 221 first-admission patients with affective and nonaffective psychoses. Patients were given extensive assessments at initial evaluation, 6-month follow-up, and 24-month follow-up. The research team made consensus ratings of the presence of psychosis, DSM-III-R diagnosis, mode of onset of disorder, and course of disorder. Brief psychoses were defined by a diagnosis of nonaffective psychosis at the initial evaluation and a rating of full remission at 6-month follow-up; acute brief psychoses met the additional criterion of acute onset as defined by ICD-10. RESULTS: Twenty (9%) of the 221 psychoses were brief psychoses. Only seven (3%) were acute brief psychoses, but among these, six occurred in women, five were undiagnosable, and none had evolved into an affective disorder or a chronic disorder by the time of the 24-month follow-up. The 13 nonacute brief psychoses did not exhibit distinctive features, and five of them later evolved into chronic disorders. CONCLUSIONS: Acute brief psychoses emerged as a highly distinctive and temporally stable form of psychosis that may merit a separate diagnostic classification. The more numerous nonacute brief psychoses may represent mild forms of nonaffective psychoses such as schizophrenia.

Acute Disease↗
PubMed1995

Sexual behavior of homeless mentally ill men at risk for HIV.

OBJECTIVE: The authors investigated sexual behaviors related to HIV transmission among homeless mentally ill men in a New York City shelter. A previous study of a similar population found HIV prevalence to be 19%. METHODS: In standardized interviews with 122 men, data on sexual behaviors for the previous 6 months were collected. The frequency and nature of sexual episodes that may facilitate HIV transmission were examined. In addition, sexual risk behaviors among broadly defined diagnostic groups were compared. RESULTS: Of the 122 men, 65 (53%) had sex, 56 with women and 20 with men (11 who had sex with both women and men are counted in each group). The sexually active men, in most cases, had only occasional sex (once per month or less). The majority of sexually active men--29 (52%) of those who had sex with women and 12 (60%) of those who had sex with men--had sex without a condom and with nonmonogamous partners. Comorbid cocaine abuse or dependence was significantly associated with high-risk sexual behaviors. CONCLUSIONS: The majority of these men had sex occasionally or not at all. Nonetheless, because many of them had unprotected sex with nonmonogamous partners, the few sexual episodes may have carried an appreciable risk of HIV transmission. Moreover, men with a comorbid cocaine dependence may represent a group with an especially high risk for sexual HIV transmission. The authors propose that in this population, preventive interventions could modify the nature, if not the frequency, of sexual episodes.

Adult↗
PubMed1995

Delineation of acute and transient psychotic disorders in a developing country setting.

BACKGROUND: We examined whether acute transient psychoses can be distinguished from schizophrenia and the affective disorders. METHOD: We studied 46 cases of nonaffective acute psychosis in the Chandigarh Acute Psychosis Study. With respect to separation from schizophrenia, we examined the distribution of duration of the episode. With respect to separation from affective disorders, we assessed the frequency of affective symptoms. RESULTS: Duration was bimodal, suggesting the presence of two distinct conditions of short and long duration. Affective symptoms were minimal, suggesting that these were not atypical affective syndromes. CONCLUSIONS: Acute transient psychoses conform neither with schizophrenia of brief duration nor with atypical affective psychosis, and thus require separate classification as proposed in the ICD-10.

Acute Disease↗
PubMed1994

Epidemiology of nonaffective acute remitting psychosis vs schizophrenia. Sex and sociocultural setting.

BACKGROUND: This article first examines the epidemiology of nonaffective acute remitting psychosis with respect to variation in incidence by sex and sociocultural setting. Second, it examines whether nonaffective acute remitting psychosis can be epidemiologically differentiated from schizophrenia. METHODS: The data were drawn from the World Health Organization Determinants of Outcome Study. Sex-specific incidence rates were obtained for two sites in the developing-country setting and for six sites in the industrialized-country setting. RESULTS: For nonaffective acute remitting psychosis, the incidence in men was about one-half the incidence in women, and the incidence in the developing-country setting was about 10-fold the incidence in the industrialized-country setting. These associations with sex and with setting were sharply distinct from those of schizophrenia. CONCLUSION: The epidemiologic patterns of this form of psychosis may be distinct from those of schizophrenia and could yield clues to its causes.

Acute Disease↗
PubMed1994

A preliminary cost effectiveness analysis of an intervention to reduce homelessness among the mentally ill.

The Critical Time Intervention Project is a three-year clinical trial which tests a time-limited, supportive intervention to reduce recurrent homelessness among mentally ill men moving from a shelter to the community. Along with a comparison of nights spent homeless and other outcomes, the evaluation of the Critical Time Intervention includes a comparison of the relative costs of the intervention, compared to usual treatment. Such cost effectiveness analyses are difficult to perform and are rarely applied to mental health treatments. This paper presents the general scheme of this analysis and discusses critical issues in the construction and measurement of cost variables. Preliminary results which have implications for the cost analysis are presented.

Activities of Daily Living↗
PubMed1994

No relation between risk of schizophrenia and prenatal exposure to influenza in Holland.

The authors compared the risk of schizophrenia in Dutch birth cohorts that were or were not exposed during the second trimester of gestation to the 1957 A2 influenza epidemic. Exposed birth cohorts did not have a higher risk of schizophrenia. These findings suggest that, in some populations, there is no relation between prenatal exposure to influenza and risk of schizophrenia.

Adult↗
PubMed1994

Lifetime and five-year prevalence of homelessness in the United States.

OBJECTIVE: Intense debate exists concerning the number of homeless people in the United States. Previous studies, counting currently homeless people, have provided point-prevalence estimates of homelessness but have been criticized on methodological grounds. This study reports lifetime and 5-year prevalence estimates of homelessness using a different methodological approach. METHODS: Random-digit dialing was used to interview 1507 adults living in households with telephones in the 48 contiguous states in the fall of 1990. Respondents were asked whether they had ever been homeless and if so, where they had slept while homeless. RESULTS: Lifetime and 5-year prevalence of all types of homelessness combined were 14.0% (26 million people) and 4.6% (8.5 million people), respectively. Lifetime "literal homelessness" (sleeping in shelters, abandoned buildings, bus and train stations, etc.) was 7.4% (13.5 million people). Five-year (1985 through 1990) prevalence of self-reported homelessness among those who had ever been literally homeless was 3.1% (5.7 million people). CONCLUSIONS: The magnitude of the problem of homelessness is much greater than most previous attempts to enumerate homeless people have led us to believe. This finding requires reconsideration of inferences about the causes of homelessness that were derived from point-prevalence studies of currently homeless people.

Adolescent↗
PubMed1993

Prevalence of HIV infection among psychiatric patients in a New York City men's shelter.

We report on the prevalence of human immunodeficiency virus (HIV) infection among psychiatric patients in a New York City shelter for homeless men. We reviewed the records of all 90 men discharged from the shelter psychiatry program to community housing over a 2-year period. HIV serostatus was recorded for 62 of the 90 men. Of these 62, 12 (19.4%) were positive. There were 28 men whose serostatus was not recorded. Data on the HIV risk behaviors of these 28 men suggested that seroprevalence could have been similarly high among them. The results indicate an urgent need to develop and apply preventive interventions for HIV in this population.

Adolescent↗
PubMed1991

Control for environmental risk factors in assessing genetic effects on disease familial aggregation.

A probabilistic model was developed to assess the impact of two independent dichotomous familial risk factors on familial aggregation of a disorder in pairs of relatives where one member was ascertained as a proband or index subject (i.e., a case or control). Under this model, one risk factor is of primary interest (i.e., a susceptibility gene), while the effect of the other is to be controlled (i.e., an environmental risk factor). Familial aggregation was examined within strata defined by the status of proband and relative with respect to the environmental factor. The findings suggest that for proband-relative pairs, under both the additive and multiplicative models, an environmental factor can be controlled in the analysis based solely on the status of the proband. If the relation between the genetic and environmental factors is neither additive nor multiplicative, however, the analysis must take account of environmental risk factors in both proband and relative.

Bias↗