Communicating information for action.
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Humans↗
Biomedical subjects
R A Goodman
Publications and source records attributed to R A Goodman.
Transmission of infectious diseases in outpatient health care settings.
Increased provision of health care in outpatient settings and concerns about occupational transmission of infections have focused attention on the risk of transmission of infectious diseases in ambulatory health care settings. In contrast to inpatient nosocomial infections, infections transmitted in outpatient settings are neither systematically monitored nor likely to be detected by routine qi surveillance. To better define the spectrum of such events, we reviewed the literature to identify cases and clusters of infections associated with outpatient health care. In this review, we identified and epidemiologically characterized 53 such reports that occurred from 1961 through 1990. Transmission occurred in general medical offices, clinics, and emergency departments (23); ophthalmologists' offices and clinics (11); dental offices (13); and alternative-care settings (six). Our findings suggest that inpatient infection-control practices should be extended to outpatient health care settings by assigning specific responsibility for infection control and by adapting surveillance methods and prevention measures.
Ambulatory Care Facilities↗
Alcohol and fatal injuries in Oklahoma.
To assess the usefulness of medical examiner data in describing the relationship between alcohol use and fatal injuries, 1978-84 data from the Office of the Chief Medical Examiner (ME), State of Oklahoma, was examined. In each year in the study period, approximately 1,500 deaths resulted from unintentional injuries (UI) and 800 deaths resulted from intentional injuries (i.e., suicides and homicides). For persons who died on the same day they were injured, testing for blood alcohol ranged from 90% of homicide victims, to 73% of suicide victims and to 66% of UI victims. Alcohol was associated with 52% of homicides, 49% of UI and 40% of suicides. Alcohol was detected most often in samples from Hispanic men and from Native Americans of both sexes. This study suggests that state public health agencies and researchers should consider the use of ME data for epidemiologic information on the relationship between alcohol and injury-related mortality and for surveillance of these problems.
Adolescent↗
The epidemiologic field investigation: science and judgment in public health practice.
Epidemiologic field investigations are often done in response to acute public health problems. When outbreaks of disease occur, there usually is an urgent need to identify the source and/or cause of the problem as a basis for control. Alternatively, the identification of environmental or occupational hazards frequently demands evaluation of exposed persons and assessment of the risks of disease. In this commentary, the authors present a perspective on the public-sector practice of epidemiology by considering the factors that influence epidemiologic prospectively planned studies; and examining the complexities of the relations between epidemiology and public health practice.
Causality↗
Fatal injuries in Oklahoma: descriptive epidemiology using Medical Examiner data.
To characterize mortality associated with injuries and other health problems in Oklahoma, we examined data from the Office of the Chief Medical Examiner of the State of Oklahoma for the years 1978 through 1984. Each year, approximately 1,500 and 800 deaths resulted from unintentional injury (UI) and intentional injury (ie, suicide and homicide), respectively. The medical examiner (ME) data differed substantially from the state's vital statistics (VS); over the seven years, the ME records showed 2,021 (16%) fewer UI deaths than did the VS, as well as 24 (1%) more cases of suicide and 499 (23%) more cases of homicide. Rates for UI and suicide were highest for young adults and for the elderly; in contrast, rates for homicide were highest for young adults, and then decreased with age. For each of the three categories of injury-related deaths, rates for male subjects were approximately three times those for female subjects; rates also varied by race-ethnic group. Deaths due to UI and homicide occurred more often in the summer and on weekends, though suicides did not vary by month and were slightly more common on weekdays. This study indicates that ME data represent an important source of epidemiologic information for the surveillance and study of injury-related mortality.
Adolescent↗
Estimating the prevalence of leisure-time physical activity.
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Adolescent↗
Physicians, vital statistics, and disease reporting.
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Death Certificates↗
An evaluation of the use of medical examiner data for epidemiologic surveillance.
To assess the value of medical examiner (ME) data bases for use in epidemiologic surveillance, we compared data from non-injury deaths that became ME cases to all non-injury deaths occurring in 1984 among Fulton County, Georgia residents. The decedents in the ME series were younger and included a large proportion of Black males. Although not representative of all deaths in a community, ME data bases include demographic and medical information that is often difficult to collect in community studies and in other surveillance systems.
Adolescent↗
Prevention and control of type A influenza infections in nursing homes. Benefits and costs of four approaches using vaccination and amantadine.
We developed a model to project morbidity, mortality, and costs attributable to type A influenza virus infections in nursing homes and to evaluate the relative benefits and costs of programs for prevention and control. Influenza vaccination was the most cost-effective intervention under various simulations in the model but usually allowed for higher rates of morbidity and mortality compared with other alternatives. The combined use of previous vaccination and chemoprophylaxis during outbreaks in the nursing home was associated with significantly fewer cases than use of vaccination alone, with only modest increases in net program costs. The use of chemoprophylaxis throughout the influenza season (without vaccination) resulted in the fewest number of illnesses, hospitalizations, and deaths but would cost at least 650% more than alternatives involving vaccination. Regardless of which strategy is chosen, our model suggests that influenza control programs in nursing homes are both beneficial and cost-effective and should be considered a part of standard care.
Amantadine↗
Cognitive processes in verbal-number production: inferences from the performance of brain-damaged subjects.
This article presents a model of the cognitive processes involved in the spoken production of verbal numbers (e.g., thirteen thousand four hundred two). On the basis of single-case studies of two brain-damaged subjects with number production deficits, we argue that verbal-number production involves the generation of a syntactic frame that constitutes a plan for the production of the appropriate sequence of words. The syntactic frame specifies each to-be-retrieved word in terms of a number-lexical class (i.e., ones, teens, or tens) and a position within that class. These class/position-within-class specifications guide the retrieval of lexical representations from a production lexicon that is partitioned into functionally distinct ones, teens, and tens classes. We conclude with a brief discussion of the rationale for, and advantages of, using patterns of impaired performance as a basis for drawing inferences about normal cognition.
Adult↗
Drug use and interpersonal violence. Barbiturates detected in homicide victims.
To characterize patterns of barbiturate use in homicide victims, we used data from the Los Angeles City Police Department and the Medical Examiner-Coroner's Office to study 4,950 victims of criminal homicide committed in that city in 1970-1979. Barbiturates were detected in 323 (7.9 per cent) of the 4,063 victims who were tested. Detectable levels were present most often in black victims (10.4 per cent), in equal proportions of Anglos and Hispanics (6 per cent), and least often among victims in other race-ethnic groups (4.1 per cent). Among specific subgroups, barbiturate use was greatest in black female victims (15.1 per cent). The detection of barbiturates more commonly among certain subgroups and in specific types of homicidal encounters suggests that barbiturate use may be linked to specific behaviors that precede homicide.
Barbiturates↗
Motorcycle-associated fatalities in Georgia, 1980-1981.
In 1980-1981, 158 motorcycle-associated fatalities occurred in Georgia, accounting for an estimated 6,113 lost years of productive life. Death ratios were highest for men 20 to 29 years of age, and motorcycle-associated fatalities occurred most frequently during summer months, on weekends, and during afternoon and evening hours. Forty-six percent of motorcycle-associated fatalities did not involve another vehicle, and head injuries alone or in combination with other injuries were responsible for death in approximately half. Helmet use, an effective measure for preventing motorcycle-associated fatalities, is required in Georgia; additional injury prevention strategies are discussed.
Accidents, Traffic↗
Alcohol use and interpersonal violence: alcohol detected in homicide victims.
To characterize the relationship between alcohol use and homicide victimization, we used data from the Los Angeles City Police Department and the Los Angeles Medical Examiner's Office to study 4,950 victims of criminal homicides in Los Angeles in the period 1970-79. Alcohol was detected in the blood of 1,883 (46 per cent) of the 4,092 victims who were tested. In 30 per cent of those tested, the blood alcohol level was greater than or equal to 100 mg/100 ml, the level of legal intoxication in most states. Blood alcohol was present most commonly in victims who were male, young, and Latino, categories where rates have been increasing at an alarming pace. Alcohol was also detected most commonly in victims killed during weekends, when homicides occurred in bars or restaurants, when homicides resulted from physical fights or verbal arguments, when victims were friends or acquaintances of offenders, and when homicides resulted from stabbings. The evidence for alcohol use by homicide victims focuses attention on the need for controlled epidemiologic studies of the role played by alcohol as a risk factor in homicide and on the importance of considering situational variables in developing approaches to homicide prevention.
Adolescent↗
Patterns of homicide victimization in the city of Los Angeles, 1970-79.
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Adolescent↗
Hepatitis B markers in Southeast Asian refugees.
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Adolescent↗
A cluster of cases of Mycobacterium chelonei keratitis associated with outpatient office procedures.
We studied three cases of keratitis caused by Mycobacterium chelonei, a nontuberculous mycobacterial species. The cases occurred in two women, 76 and 80 years old, and one man, 67 years old, treated as outpatients in the same office. One case followed suture removal and the other two occurred after posterior capsulotomy. Corneal lesions appeared within two to three weeks of trauma and were white, round infiltrates with indistinct margins and radiating projections. The lesions were found at all levels of the stroma and were associated with an epithelial defect. Anterior chamber reaction varied from a minimal response to a hypopyon. One patient responded to topical therapy with amikacin and erythromycin, but the other two patients required penetrating keratoplasties because of deep abscesses, which progressed toward the sclera despite therapy. These cases emphasized the possibility of rapidly growing nontuberculous mycobacteria producing serious ocular infections.
Aged↗
Nosocomial mycobacterial pseudoinfection in a Georgia hospital.
Nosocomial pseudoepidemics may be detected when clustering of pseudoinfections occur or when artificial clusters of real infection are observed. Nontuberculous mycobacteria were reportedly isolated from specimens obtained from seven patients at one hospital from October 1980 to January 1981. Because the patients' clinical illnesses were not uniformly consistent with mycobacterial disease, we hypothesized that pseudoinfections had occurred and searched for a common source of contamination. The investigation suggested that specimen contamination was associated with one microbiology laboratory technician: 6 of 22 (27%) specimens processed by that person were positive compared with 1 of 103 (1%) specimens processed by the other five technicians. However, a specific mechanism of contamination was not identified. Nosocomial pseudoepidemics associated with false infections should be suspected and investigated when clinical features and laboratory findings do not agree.
Adult↗