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Biomedical subjects

S B Thacker

Publications and source records attributed to S B Thacker.

At least 55 records · Page 3Linked to original sources
PubMed1992

Infectious diseases and injuries in child day care. Opportunities for healthier children.

OBJECTIVE: To provide pertinent background information on infectious diseases and injury in child day care and outline measures to address these health care needs. DESIGN: We reviewed published English-language literature identified through a MEDLINE bibliographic search, major literature summaries, and bibliographies from identified articles. SETTING: Child day-care settings reviewed included family child care homes, centers, special facilities for ill children, and facilities for children with special needs. PATIENTS OR OTHER PARTICIPANTS: Primarily children in a variety of day-care settings, often compared with children cared for at home. MAIN OUTCOMES: The occurrence of outbreaks and illness related to infectious disease and injury. RESULTS: Compared with preschool-aged children reared at home, among children in day care the risk of some infectious diseases was two to four times greater. Rates of both intentional and unintentional injuries in day-care settings were somewhat lower than those for children cared for at home. CONCLUSIONS: Because preschool-aged children spend increasing time in structured day-care settings, the risk for some infectious diseases has increased. At the same time, child day-care settings present opportunities for ensuring healthier children through enhanced development, safer environments, better nutrition, increased vaccination coverage, and health promotion.

Child Abuse↗
PubMed1992

The role of public health surveillance: information for effective action in public health.

Public health surveillance can provide the quantitative information needed for setting priorities and establishing rational health policy. Although there are many examples of the effective use of such information, the full potential for surveillance has not yet been realized. To a large degree, failure to achieve this potential has resulted from limited perspectives regarding the role and conduct of surveillance. Both practitioners (those who conduct surveillance) and users (those who apply surveillance data in a real-world setting) have fallen victim to such myopia. Public health surveillance must be advocated as an essential part of the global health agenda if we are to achieve international goals for improving health status. As we improve our appreciation of the variety of uses for public health surveillance data, we need to understand more fully the determinants of the decision-making process. Effective dissemination of information and effective communication are as important as data collection and analysis. No longer do we have--or should we have--the luxury of collecting information for its own sake. The information collected must have a demonstrated utility. Developing and training personnel to have expertise in public health surveillance will necessarily incur opportunity costs. Bridging gaps in data methodology and coverage will force us to weigh alternatives and to compromise. We hope that the International Symposium on Public Health Surveillance will accomplish several goals. First, we wish to foster international understanding of the definition, role, and importance of surveillance in reducing morbidity and mortality, in improving quality of life, and in setting effective health priorities. Second, we hope that this symposium will serve as a springboard for identifying issues and topics that can be addressed in greater depth at future international meetings. Finally, we see the symposium as an essential step in developing a firm commitment on the part of countries, donor agencies, and multilateral organizations to develop the essential capacity for public health surveillance throughout the world. Each country should have the capacity to measure and monitor changes in health status, risk factors, and health-service access and utilization among its people. All countries should have the means to detect emerging health problems and implement measures for their control, to evaluate the impact of health policies and programs, and to communicate health information in a meaningful fashion to policymakers and the public. If we are successful in these endeavors, the long-term effects on the public's health will be well worth the struggle required to achieve them.(ABSTRACT TRUNCATED AT 400 WORDS)

Global Health↗
PubMed1991

The role of home environment in infant diarrhea in rural Egypt.

In 1982 and 1983, a descriptive environmental survey was conducted in 317 households with newborn infants in rural Bilbeis, Egypt. The incidence of infant diarrhea in these households was ascertained by twice-weekly home visits for a 1-year period (1981-1982). Using univariate and multivariate analyses, the authors identified household factors that were statistically associated with infant diarrhea incidence, including number of children in the house under 4 years of age; number of persons per household; incidence of diarrhea in other family members; having a dirt (vs. concrete) dining room floor; having multiple living areas in the house; having a house or roof in need of repair; using well water rather than tap water for cooking or bathin; the absence of a sewer for waste bathwater; food being left out at room temperature between meals; and having many rodents in the house. Two practices involving interaction with the environment appeared to be protective: butchering of cattle by the family for home consumption, and protection of the infant from flies by a veil during napping. The combined household variables explained 25% of the variance in the total incidence of diarrhea. Categories of variables that accounted for most of the total variance explained by environmental factors are, in decreasing order: house structure (28%); water usage (24%); toilet and bathing area (12%); animal management (11%); food preparation area (10%); hygiene (8%); and wastewater management (6%). This approach may be useful in identifying environmental characteristics whose change would reduce diarrheal illness among infants.

Abattoirs↗
PubMed1991

A meta-analysis of the effect of estrogen replacement therapy on the risk of breast cancer.

To quantify the effect of estrogen replacement therapy on breast cancer risk, we combined dose-response slopes of the relative risk of breast cancer against the duration of estrogen use across 16 studies. Using this summary dose-response slope, we calculated the proportional increase in risk of breast cancer for each year of estrogen use. For women who experienced any type of menopause, risk did not appear to increase until after at least 5 years of estrogen use. After 15 years of estrogen use, we found a 30% increase in the risk of breast cancer (relative risk, 1.3; 95% confidence interval [CI], 1.2 to 1.6). The increase in risk was largely due to results of studies that included premenopausal women or women using estradiol (with or without progestin), studies for which the estimated relative risk was 2.2 (CI, 1.4 to 3.4) after 15 years. Among women with a family history of breast cancer, those who had ever used estrogen replacement had a significantly higher risk (3.4; CI, 2.0 to 6.0) than those who had not (1.5; CI, 1.2 to 1.7).

Adult↗
PubMed1991

Mathematical modeling and attempts to eliminate measles: a tribute to the late Professor George Macdonald.

In 1983, 5 years after the inception of an aggressive national measles elimination strategy, the United States experienced its lowest level of reported numbers of cases of measles. This accomplishment was the result of an effective vaccination strategy coupled with surveillance and control efforts by local, state, and national public health agencies. After 1983, however, the reported number of measles cases slowly increased until 1989, when the number exceeded that of 1979, the first full year of the National Measles Elimination Program. In 1990, we are experiencing epidemics throughout the United States and expect the reported number of cases of measles to exceed that of 1989. In this context, we felt it was timely to reflect on this experience in light of previous measles control efforts. In particular, we looked back to the contributions of Professor George Macdonald, which were critical to the successful elimination of measles from The Gambia in 1969. As we enter the last decade of this century, the sensible merging of mathematics and epidemiology in useful models, and the appropriate use of such models for planning, offers the best hope for achieving the elimination of measles either in this or the next century.

Child↗
PubMed1990

The case for reassessment of health care technology. Once is not enough.

Assessment of health care technologies should be an iterative process, not a single event. In the United States there are an increasing number of organized attempts at reassessment of technologies by the health industry, professional societies, and national government agencies, such as the Medical Necessity Project of Blue Cross/Blue Shield, the Clinical Efficacy Assessment Project of the American College of Physicians, and the work of the US Preventive Services Task Force. We examine four clinical practices--electronic fetal monitoring, episiotomy, electroencephalography, and hysterectomy--to illustrate the need to continuously reassess existing technologies and to challenge our current inertia in this critical arena of health practice.

Advisory Committees↗
PubMed1990

Persistence of influenza A by continuous close-contact transmission: the effect of non-random mixing.

The interaction of two populations has variable effects on the nature and duration of epidemic activity, depending on the transmissibility of the virus, the susceptibility of the population, migration, birth and death rates, and the initial number of cases. Under circumstances where transmission stops in a single population (the infectious contact number is less than or equal to one), transmission may continue indefinitely when two populations interact under many different parameter combinations. A mass-action model was constructed using difference equations for two populations that included parameters for migration between populations and variable transmissibility between and within these populations. The limitations of extrapolating the model to actual conditions in human populations result from assumptions inherent in these models, such as fractional infection of individuals.

Disease Outbreaks↗
PubMed1989

The science of public health surveillance.

Improved public health surveillance can lead to earlier implementation of prevention and control measures. Better surveillance data lead to a more rational establishment of priorities. More timely and accurate data facilitate earlier epidemic detection and control. With better surveillance data, the impact of intervention activities and other public health programs can be evaluated more accurately. In this paper we describe how to improve the science of surveillance in terms of data collection, analysis, and dissemination and its application to public health practice. We then discuss the potential benefits and costs of such efforts and suggest methods for evaluating alternative approaches. The argument for science in surveillance, on the other hand, may be subject to excess. Surveillance is not an end unto itself, but rather a tool. This tool should be refined and modified to adapt to the goals of a particular public health program. It is the development of methods to apply creative ideas to surveillance, and the rigorous assessment of the process, that will benefit from the application of scientific principles.

Data Interpretation, Statistical↗
PubMed1988

Meta-analysis. A quantitative approach to research integration.

Meta-analysis is being used with increasing frequency in clinical medicine as an attempt to improve on traditional methods of narrative review by systematically aggregating information and quantifying its impact. Combining data from several studies using meta-analysis can increase statistical power, provide insight into the nature of relationships among variables, and increase generalizability of results more rigorously than less quantitative review methods. Like all review methods, meta-analysis can be limited by sampling bias, inadequate data, and biased outcome interpretation. Still, the advantages noted above make meta-analysis a methodology that warrants testing and empirical evaluation.

Data Collection↗
PubMed1988

Application of multiple time series analysis to the estimation of pneumonia and influenza mortality by age 1962-1983.

We employed multiple time series analysis to estimate the impact of influenza on mortality in different age groups, using a procedure for updating estimates as current data become available from national mortality data collected from 1962 to 1983. We compared mortality estimates that resulted from a multivariate model for epidemic forecasting with those obtained from univariate models. We found more accurate prediction of deaths from all age groups using the multivarate model. While the univariate models show an adequate fit to the data, the multivariate model often enables earlier detection of epidemics. Additionally, the multivariate approach provides insight into relationships among different age groups at different points in time. For both models, the largest excess mortality due to pneumonia and influenza during influenza epidemics occurred among those 65 years of age and older. Although multiple time series models appear useful in epidemiologic analysis, the complexity of the modelling process may limit routine application.

Adolescent↗
PubMed1988

An assessment of the use of Bayes' Theorem for forecasting in public health: the case of epidemic meningitis in China.

A mathematical model based upon Bayes' Theorem (BT) was used to forecast the occurrence of epidemic cerebrospinal meningitis (ECM) in ten communities in North China. Reports of ECM from each ten-day period during the meningitis season and records of special population movement during 1960-82 were analysed to establish forecast models. Calibration, split-sample, random-sample selection, as well as actual forecast tests, were used to check the efficiency of the models. For all the tests, the theoretical occurrence of ECM forecast by the BT method was compared with the observational data. Since the BT method offers efficiency and convenience, it is recommended for use in planning for the prevention and control of ECM in China.

Bayes Theorem↗
PubMed1988

A proposal for more informative abstracts of review articles.

This proposal presents guidelines for preparing informative abstracts of review articles. Six guidelines are proposed: 1. The abstract should begin with a precise statement of the primary objective of the review. 2. The data sources for the review should be succinctly summarized. 3. The criteria used to select studies from the data sources and the method by which these criteria were applied should be specified. 4. The guidelines used for abstracting data and assessing data quality should be described. 5. The main results of the review and the methods used to obtain these results should be stated. 6. Conclusions and potential applications of the review's results should be clearly and succinctly stated. Application of these guidelines can lead to efficient identification of relevant, scientifically sound review articles, a greater awareness of the vital elements of a good review article, more precise computerized literature searches, and improved peer-review processes.

Abstracting and Indexing↗
PubMed1988

A method for evaluating systems of epidemiological surveillance.

Epidemiological surveillance is the systematic collection, analysis and dissemination of health data for the planning, implementation and evaluation of public health programmes. Established surveillance systems should be regularly reviewed on the basis of explicit criteria of usefulness, cost and quality; systems should be modified as a result of such review. Attributes of quality include: (i) sensitivity, (ii) specificity, (iii) representativeness, (iv) timeliness, (v) simplicity, (vi) flexibility and (vii) acceptability. To date, evaluation of surveillance systems has been limited in scope and content. The evaluation method proposed in this article offers an organized approach to the evaluation of epidemiological surveillance systems. The usefulness of a surveillance system is measured by whether it leads to prevention or control or a better understanding of adverse health events. The measure can be qualitative, in terms of the subjective views of those using the system, or quantitative in terms of the impact of surveillance data on policies, interventions or the occurrence of a health event. The cost of a system includes indirect as well as direct costs, and should be measured in relation to the benefits obtained, such as reduction of medical-care expenses and of time lost from work. All elements of the system should be included in the cost: data collection, analysis and dissemination. The sensitivity of a surveillance system is its ability to detect health events (completeness of reporting). Its specificity is inversely proportional to the number of false positives it reports. Reports of a disease that do not meet the case definition are false positives, and may result in resources being wasted in investigating them.(ABSTRACT TRUNCATED AT 250 WORDS)

Costs and Cost Analysis↗
PubMed1987

The efficacy of intrapartum electronic fetal monitoring.

With basic methodologic criteria as a framework, this report assesses the quality of the seven randomized controlled clinical trials conducted in five countries to compare a policy of routine electronic fetal monitoring with a policy of fetal heart rate monitoring by auscultation. One trial found a statistically significant decrease in the occurrence of neonatal seizures in the electronic fetal monitoring group. The trials demonstrated no other statistically significant benefit associated with the use of electronic fetal monitoring, but most reported significant increases in the rates of abdominal and vaginal operative deliveries associated with electronic fetal monitoring. Taken together, the seven trials provide valuable information about the routine use of intrapartum electronic fetal monitoring; they do not demonstrate that it is a useful screening procedure for all women in labor.

Australia↗
PubMed1987

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↗