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Biomedical subjects

W O Spitzer

Publications and source records attributed to W O Spitzer.

At least 91 records · Page 5Linked to original sources
PubMed1987

Subjective fears and objective data: an epidemiologic study of environmental health concerns.

A political emergency arose in 1985 for the province of Alberta, Canada, because allegations of increased health risk had frightened rural Alberta residents exposed for 28 years to the airborne effluent of sour gas processing plants. In an epidemiologic study that took 3 months in the field, cross-sectional and cohort comparisons were conducted for these residents and for two carefully selected control groups. Clinical examinations were conducted with objective methods and criteria. No excess rates were found in the exposed group for any life-threatening or seriously disabling conditions. For the exposed group in the index area the reported cardinal symptoms were slightly higher than in the main unexposed reference group, but the observed cardinal signs were slightly lower. This project shows that scientifically sound strategies can be used to investigate major health controversies. Rigorous clinical methods of measurement, incorporated into a classical epidemiologic study, can inspire confidence in the studied population and can make the results acceptable to clinicians and policy makers. The studies can be done rapidly in response to urgent or crisis situations without compromising methodologic rigor or the quality of the analyses.

Air Pollution↗
PubMed1986

Importance of valid measurements of benefit and risk.

Without good measurement of both the risks and benefits of drugs, perceptions are bound to be distorted. Similarly, interpretations of findings are likely to be inappropriate, thus leading to decisions by regulatory bodies that are less than optimal. When measuring health phenomena in populations, both numerators and denominators must be determined to permit calculation of prevalence (frequency at a given time), incidence (frequency of new events over a specified period of time), mortality and case-fatality rates. Attribution of an adverse drug reaction to a particular drug can be the most demanding challenge for the clinician, the scientific investigator and the regulator. Criteria that must be met to establish a link between an apparent adverse drug reaction and an incriminated product include, biological plausibility, chronological and timing relationships, specificity, and response to dechallenge and to rechallenge. Acceptable chronology requires that a drug be shown to be taken before the onset of the adverse effect, not after symptoms have appeared. The unmet challenge of measuring benefit is more difficult than the measurement of harm. The need for valid measurements of risk and benefit remains compelling and urgent.

Drug-Related Side Effects and Adverse Reactions↗
PubMed1985

Immunologic findings in healthy Haitians in Montreal.

To investigate the occurrence of acquired immune deficiency syndrome in Haitians, a health status questionnaire was administered and selected studies of immune status done in a randomly chosen sample of 189 healthy adult Haitians living in Montreal. The study group was comparable to a large sample of Haitians in Montreal interviewed in the 1981 census with respect to age, sex, number of persons per household and year of immigration, but the proportion of currently married people in the study was larger (60.8% v. 42.6%). The results in the study group were compared with those in a sample of 189 non-Haitians matched for age, sex and neighbourhood of residence. Persons with known causes of impaired immune function were excluded. The participation rate was 87.5%. The study and control groups both reported few symptoms and chronic health problems and had comparable demographic data, including rate of employment and income. The mean total numbers of lymphocytes, OKT3 and OKT4 (helper) and OKT8 (suppressor) cells were significantly higher in the Haitians than in the controls, though still within normal limits. There was a borderline elevation of the lymphocyte response to phytohemagglutinin in the Haitians. The ratios of helper to suppressor T cells in the two groups were, however, not significantly different. The Haitians, in comparison with non-Haitians living in the same community, had no demonstrable abnormalities of cellular immune function.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Patterns of preventive practice in New Brunswick.

A survey of active general practitioners was conducted in New Brunswick to ascertain their patterns of preventive practice with respect to cancer of four anatomic sites: the breast, the cervix, the colon and rectum, and the lung. Ninety-two percent of the physicians reported that they taught breast self-examination to their female patients, 98% that they performed breast examinations, 98% that they did Papanicolaou smears routinely, and 97% that they provided counselling against smoking. Few of the physicians reported that they submitted women aged 50 to 59 years to annual mammography (3%) or examined stool samples from asymptomatic patients over 44 years of age for occult blood (20%). Many (77%) said they still routinely performed chest roentgenography for early detection of lung cancer; an estimated 49% of the physicians said they performed cytologic screening of sputum samples for the same purpose. Preventive practices, when used, were usually carried out during major encounters with patients, such as general check-ups. The potential for prevention through this clinically based approach is still largely unrealized.

Breast Neoplasms↗
PubMed1983

Adult cancer prevention in primary care: contrasts among primary care practice settings in Québec.

Four strata of Québec primary care (general practitioner) physicians were delineated: fee-for-service physicians in urban and in rural settings, salaried physicians in Community Health Centers (CLSCs) and physicians reimbursed per session in Family Medicine Teaching Centers (FMCs). Physicians in CLSCs and FMCs did more mammographies in women aged 50 to 59, more testing for occult blood in stools of patients aged 45 and over, more Papanicolaou tests, and pursued preventive activities in a broader range of medical encounters than fee-for-service physicians.

Community Health Centers↗
PubMed1982

Cancer in a Montreal suburb: the investigation of a nonepidemic.

In response to an alarming newspaper report of 34 cases of cancer in Chomedey, a suburb of Montreal, an epidemiologic survey was undertaken to determine the incidence of cancer in selected Montreal census tracts during the period 1975-79. Cases of cancer, were ascertained from the Quebec Tumour Registry, then age-standardized incidence ratios (SIRs) were calculated, the expected incidence being based on provincial age-specific rates and 1976 populations. The SIRs were significantly lower for males living in the implicated area (P less than 0.01) and were within expected limits for female residents. Further analysis revealed neither an elevated frequency of any particular tumour type nor a clustering of cases in this area. Following additional ascertainment of cases through the examination of hospital records, the SIRs were recalculated. No significant differences were found between those of the implicated area and those of the most demographically comparable census tract. Finally, an independent inquiry failed to uncover any actual or potential sources of environmental carcinogens.

Disease Outbreaks↗
PubMed1982

Physician Sensitivity to the price of diagnostic tests: A U.S.-Canadian analysis.

A questionnaire containing 11 patient management problems was completed by 495 physicians and medical students at an American and a Canadian medical school. Respondents indicated whether they would order a particular diagnostic test in each case, given five different prices for the test. Approximately 25 per cent of attending staff and a higher proportion of residents, interns and clerks responded that they would order the test depending on its price. Approximately 50 per cent of attending staff and smaller proportions of residents, interns and clerks indicated that they would not order the test even if there were no price. Respondents in Montreal were more likely than those in Philadelphia to select a price-sensitive response, the reverse of the expected tendency. Since some tests may be ordered on the basis of price, education of physicians regarding the price of diagnostic test may alter their use of these services, but a large proportion of tests are ordered because of clinically absolute reasons, which may be insensitive to price.

Costs and Cost Analysis↗