Biomedical subjects
S B Cohen
Publications and source records attributed to S B Cohen.
A modified approach to small area estimation.
The ever-growing need for good estimates of the health, social, political, and economic parameters of local areas has served as the motivating force for new developments in methodology. Due to the constraints of sample size, design, and cost, accessible data from large areas for criterion variables of interest is often used jointly with local data on symptomatic variables. Furthermore, several procedures have derived local area estimators by combining symptomatic information and sample data into a multiple regression format. In those situations where assumptions are too strict or unrealistic, as when a nonlinear model is more appropriate, the merits of a more flexible approach are obvious. Our research focuses upon a further investigation of an alternative strategy for which the most limiting assumption is the availability of good symptomatic information. A more formal representation of the model is developed within the framework of a poststratification scheme. The methodology involves ratio estimation of the respective stratum means via indicator variables which serve the purpose of classification. To determine the accuracy of the proposed small area estimator and allow for comparisons of precision with respect to other strategies, we express the relationship between criterion and symptomatic variables by relevant continuous multivariate distributions. Specifically, comparisons are made with the results obtained using a regression estimator which is applicable to the same general setting. The theoretical framework considers multivariate stratification, where boundary determination is achieved by application of practical methods which use minimum variance stratification as a criterion.
Physician opnions on the use of antibiotics in respiratory infections.
To investigate the feasibility of establishing standards of care based on a broad consensus, a questionnaire concerning the management of signs and symptoms of common respiratory infections in infants was given to a national sample of pediatric infectious disease specialists, general pediatricians, and family physicians. There was significant disagreement (p less than .01) among the three groups of physicians in 15 of the 18 clinical situations concerning the appropriateness of prescribing antibiotics. Whenever there was disagreement, the family physician group was most inclined and the infectious disease group least inclined to favor antibiotics therapy. More than 75% of each group favored antibiotics in the same situation in only three instances. These results suggest that it may be difficult to set widely accepted standards for the evaluation of medical care where there are such differences of opinion.
Should medical associations discourage smoking?
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Acetaminophen overdoses at a county hospital: a year's experience.
During a recent one-year period nine cases of hepatotoxicity caused by overdoses of acetaminophen were recognized at Parkland Memorial Hospital. This contrasted with the previous year in which no cases were seen. These cases and an additional case seen after the one-year period are presented and discussed. Hepatic injury ranged from mild, with only SGOT elevations in several patients, to severe, with marked prolongation of prothrombin times in four and stage IV hepatic encephalopathy in two. One patient died of fulminant hepatic failure. Other manifestations of acetaminophen overdoses included renal dysfunction in three patients, lactic acidosis in three, shock in two, and hyperamylasemia in two. These findings indicate that extrahepatic complications of acetaminophen overdose may be more common than indicated in previous reports. Because of the delayed nature of the clinical manifestations of acetaminophen overdose, as clearly demonstrated in these patients, decisions on hopsitalization and treatment must be made early based on the history and on acetaminophen levels.
Selective attention and locus of control in learning disabled and normal children.
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Hereditary polyposis coli I: the diagnostic value of colonoscopy, barium enema, and fecal occult blood.
In families with one of the Mendelian hereditary polyposes, one can predict the proportion of patients at risk and thus obtain a denominator against which colonoscopy, barium enema, and fecal occult blood can be validated. Colonoscopy is more sensitive than barium enema. There were 42 positive colonoscopies, 12 positive barium enemas, both being positive in 10 of these. There were 141 negative enemas, 133 negative colonscopies, and 118 negative for both. Occult blood was positive in 30% of patients with polyposis, five to seven times more frequently than in those without evident polyposis. Colonoscopy detected polyposis in 30% of the progeny of affected people. The shortfall, compared with the 50% expected under the Mendelian hypothesis, is readily explained by removal of affected cases from the study by surgery or death from cancer.
Hypnosis for sexual problems.
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