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Biomedical subjects

R Upshur

Publications and source records attributed to R Upshur.

8 recordsLinked to original sources
PubMed2007

Duration and distance of exposure are important predictors of transmission among community contacts of Ontario SARS cases.

We report attack rates and contact-related predictors among community contacts of severe acute respiratory syndrome (SARS) cases from the 2003 Toronto-area outbreak. Community contact data was extracted from public health records for single, well-defined exposures to a SARS case. In total, 8662 community-acquired exposures resulted in 61 probable cases; a crude attack rate of 0.70% [95% confidence interval (CI) 0.54-0.90]. Persons aged 55-69 years were at higher risk of acquiring SARS (1.14%) than those either younger (0.60%) or older (0.70%). In multivariable analysis exposures for at least 30 min at a distance of <or=1 m increased the likelihood of becoming a SARS case 20.4-fold (95% CI 11.8-35.1). Risk related to duration of illness in the source case at time of exposure was greatest for illness duration of 7-10 days (rate ratio 3.4, 95% CI 1.9-6.1). Longer and closer proximity exposures incurred the highest rate of disease. Separate measures of time and distance from source cases should be added to minimum datasets for the assessment of interventions for SARS and other emerging diseases.

Adolescent↗
PubMed2001

Applying Aristotle's doctrine of causation to Aboriginal and biomedical understanding of diabetes.

Aristotle's doctrine on causation identifies four distinct types of cause: formal, efficient, material, and final. Science is said to have differentiated itself from philosophy by concentrating solely on efficient causes. Nonetheless, when applied to narratives of causation, Aristotle's doctrine provides a useful heuristic to explore the issues such as Aboriginal and biomedical perceptions of causal factors for non-insulin dependent diabetes mellitus (NIDDM) on Manitoulin Island, Ontario. This paper also outlines two divergent causal stories for NIDDM and the associated moral positions regarding the 'righteous' pursuit of health. Biomedical narratives emphasize the role of lifestyle factors, particularly the impact of obesity, in causation. In the case of diabetes, the moral course of action is pursued through lifestyle choices. In contrast, Aboriginal narratives emphasize the role of genetics in causation. These narratives describe diabetes as collectively affecting Aboriginal people - thus identifying Aboriginal people as different. Aboriginal frameworks for health venture beyond the 'efficient' cause of biomedicine and thus the moral pursuit of health within this framework involves returning to an initial state of health and purity through traditional knowledge.

Anecdotes as Topic↗
PubMed1997

Certainty, probability and abduction: why we should look to C.S. Peirce rather than Gödel for a theory of clinical reasoning.

This paper argues that Gödel's proof does not provide the appropriate conceptual basis on which to counter the claims of evidence-based medicine. The nature of, and differences between, deductive, inductive and abductive inference are briefly surveyed. The work of the American logician C.S. Peirce is introduced as a possible framework for a theory of clinical reasoning which can ground the claims of both evidence-based medicine and its critics.

Evidence-Based Medicine↗
PubMedDate not supplied

Short-term adverse health effects in a community exposed to a large polyvinylchloride plastics fire.

The purpose of this study was the documentation of the short-term morbidity and mortality experiences of an urban community exposed to the airborne byproducts of a large polyvinylchloride plastics fire. The authors administered a survey to representatives of each household who had lived in an area evacuated during the fire. A time-series analysis was performed on emergency room visits and admissions for all hospitals in the city. Chloracne surveillance was instituted. Sixty-two percent of the individuals surveyed from the evacuation area reported no health concerns or symptoms related to the fire. Thirty-eight percent of the residents reported symptoms, and less than 2% of those surveyed reported that they sought medical attention for their health concerns. There was no evidence of increased hospital admissions or emergency room use during and immediately following the fire. No cases of chloracne were reported, and no deaths or serious injuries occurred during the fire. Polyvinylchloride plastics recycling plants pose potential health hazards to civilian populations. Public health authorities should be prepared to assess population health status rapidly and to disseminate relevant health information in a timely way during a crisis.

Adult↗