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PubMed2005

Epidemiologic measures and policy formulation: lessons from potential outcomes.

This paper provides a critique of the common practice in the health-policy literature of focusing on hypothetical outcome removal at the expense of intervention analysis. The paper begins with an introduction to measures of causal effects within the potential-outcomes framework, focusing on underlying conceptual models, definitions and drawbacks of special relevance to policy formulation based on epidemiologic data. It is argued that, for policy purposes, one should analyze intervention effects within a multivariate-outcome framework to capture the impact of major sources of morbidity and mortality. This framework can clarify what is captured and missed by summary measures of population health, and shows that the concept of summary measure can and should be extended to multidimensional indices.

Journal Article↗
PubMed1998

The association between epidemiological measures of the occurrence of asthma.

SETTING: The prevalence of asthma is useful for studying the causes of asthma. OBJECTIVE: To ascertain whether there is a relationship between the prevalence and incidence of asthma. DESIGN: The association between age and the occurrence of asthma was analysed in an epidemiological study of 15,813 persons. RESULTS: Different conclusions were reached depending on whether the point prevalence, cumulative prevalence or the incidence rates were studied. The relation between the incidence and prevalence of asthma is described in two epidemiological models, and none of the models seem to fit empirical data. Furthermore, it is shown that estimating incidence rates by prospectively measuring the point prevalences may introduce a considerable bias if the reliability of the diagnosis of asthma is around or below an agreement of 99%, which is probably usually the case. Including asthmatic symptoms during the last year in the definition of point prevalence means that there is no simple relation between incidence rates and point prevalences. CONCLUSION: The point prevalence may be a biased measure in the study of the etiology of asthma, as there is no simple relationship between the incidence and prevalence of asthma.

Adult↗
PubMed1983

[Priorities among antitubercular measures: epidemiologic arguments].

A patient with positive smear tuberculosis infects approximately 50% of his domestic contacts; post-primary morbidity may reach 10% of the cases infected under the age of 24 years. Infection rate among professional and social contacts is low and the morbidity much lower. Smear-positive tuberculous patients develop the disease in a few months, therefore indiscriminate case finding is not effective in disclosing patients before they are infectious. Smear-negative, culture-positive patients do not play a role as far as epidemiology is concerned. Prognostic significance of tuberculin conversion depends upon the duration and closeness of the contact with the infectious patient, and chemoprophylaxis of infected contacts reduces post-primary morbidity. Chemotherapy of smear-positive patients suppresses infectiousness in a few weeks, where it lasted for several months previously. Therefore hospitalization of treated patients does not afford additional protection to contacts, and disinfection is superfluous. In a country where tuberculosis prevalence is low, the influence of BCG vaccination in decreasing morbidity can hardly be demonstrated. The three main antituberculous measures remain case-finding of smear-positive patients, identification of infected domestic contacts, and their treatment.

Antitubercular Agents↗
PubMed1990

Impairment in the epidemiological measurement of childhood psychopathology in the community.

The desirability of incorporating a measure of impairment to the categorization of childhood psychopathology in the community is examined. The use of the Children's Global Assessment Scale (CGAS) for this purpose is recommended. The choice of 61 (definite case) and 71 (probable case) as cutpoints on the Children's Global Assessment Scale is supported empirically by the data on service utilization, parental perceived need, and behavior problem scores obtained in the Puerto Rico Child Psychiatry Epidemiological Study.

Adolescent↗
PubMed1985

A comparison of direct adjustment and regression adjustment of epidemiologic measures.

Although regression adjustment can provide a useful alternative to direct adjustment, especially when data are sparse, many researchers are unaware that adjusted summary measures can be easily derived from regression coefficients. In a non-technical discussion with examples, the direct adjustment procedure is compared with three methods of regression adjustment based on analysis of covariance models: the conditional prediction method, the stratified prediction method, and the marginal prediction method. Both the stratified prediction and direct adjustment methods yield summary measures that are weighted averages of stratum-specific measures, while adjusted measures from the conditional prediction method are similar to stratum-specific estimates. In contrast to the other adjustment procedures, which can use internal or external weights, the marginal prediction method always gives an internally adjusted measure. Under certain conditions, the three regression adjustment procedures produce identical results. Major advantages of direct adjustment include computational simplicity and relatively few statistical assumptions. Regression adjustment, however, is more convenient for statistical tests for interactions and group differences, and often precludes the need to categorize continuous variables, so that problems with empty strata are avoided.

Age Factors↗
PubMed2004

Perspectives on cancer therapy-induced mucosal injury: pathogenesis, measurement, epidemiology, and consequences for patients.

BACKGROUND: A frequent complication of anticancer treatment, oral and gastrointestinal (GI) mucositis, threatens the effectiveness of therapy because it leads to dose reductions, increases healthcare costs, and impairs patients' quality of life. The Multinational Association of Supportive Care in Cancer and the International Society for Oral Oncology assembled an international multidisciplinary panel of experts to create clinical practice guidelines for the prevention, evaluation, and treatment of mucositis. METHODS: The panelists examined medical literature published from January 1966 through May 2002, presented their findings at two separate conferences, and then created a writing committee that produced two articles: the current study and another that codifies the clinical implications of the panel's findings in practice guidelines. RESULTS: New evidence supports the view that oral mucositis is a complex process involving all the tissues and cellular elements of the mucosa. Other findings suggest that some aspects of mucositis risk may be determined genetically. GI proapoptotic and antiapoptotic gene levels change along the GI tract, perhaps explaining differences in the frequency with which mucositis occurs at different sites. Studies of mucositis incidence in clinical trials by quality and using meta-analysis techniques produced estimates of incidence that are presented herein for what to our knowledge may be a broader range of cancers than ever presented before. CONCLUSIONS: Understanding the pathobiology of mucositis, its incidence, and scoring are essential for progress in research and care directed at this common side-effect of anticancer therapies.

Antineoplastic Agents↗
PubMed1993

Dentin as a possible bio-epidemiological measure of exposure to mercury.

The subtle human health effects from prolonged exposure to small amounts of mercury vapor are unknown. It has been difficult to study possible effects of low-dose exposure for lack of a good measure of long-term exposure. Current methods which use blood, urine, hair, and nails reliably measure only recent exposures. Long-term exposure to lead has been measured using levels found in human dentin. The purpose of this study was to determine whether mercury also accumulates in dentin. In this study, dentin from 16 human teeth, all without dental amalgam restorations, was analyzed by thermal neutron activation analysis. The teeth were selected from people with and without dental mercury amalgam restorations elsewhere in their dentitions. Mercury was found in amounts up to 5.9 ppm. While the highest mercury level was from a sample from someone who had dental amalgam restorations elsewhere in their dentition, the second highest was from someone who had no amalgam restorations. Also, a sample which was not used for any statistical comparisons but which was analyzed because the tooth contained an amalgam restoration had one of the lowest levels of mercury. These results, while inconclusive due to a small sample size, suggest that inorganic mercury vapor is a relatively small contributor to the overall body burden of mercury.

Adolescent↗
PubMed1997

The waiting time distribution as a graphical approach to epidemiologic measures of drug utilization.

The emergence of large, computerized pharmacoepidemiologic databases has enabled us to study drug utilization with the individual user as the statistical unit. A recurrent problem in such analyses, however, is the overwhelming volume and complexity of data. We here describe a graphical approach that effectively conveys some essential utilization parameters for a drug. The waiting time distribution for a group of drug users is a charting of their first prescription presentations within a specified time window. For a drug used for chronic treatment, most current users will be captured at the beginning of the window. After a few months, the graph will be dominated by new, incident users. As examples, we present waiting time distributions for insulin, ulcer drugs, systemic corticosteroids, antidepressants, and disulfiram. Appropriately analyzed and interpreted, the waiting time distributions can provide information about the period prevalence, point prevalence, incidence, duration of use, seasonality, and rate of prescription renewal or relapse for specific drugs. Each of these parameters has a visual correlate. The waiting time distributions may be an informative supplement to conventional drug utilization statistics, and possibly also a useful screening tool for unusual prescribing patterns.

Adrenal Cortex Hormones↗
PubMed2003

[Cut-off values for the diagnosis of obesity and hypertension based on epidemiologic measurements in Hungarian youth].

INTRODUCTION: A representative nutritional hygienic survey was performed in a population of secondary school students (ageing from 15 to 18 years) between the years of 1997 and 2000. Herewith, the authors give an account on the anthropometric and blood pressure studies. METHODS SAMPLING: the representative sampling sites were selected randomly. In the capital three-stage, in the counties four-stage stratified groups were assigned for the studies. The data for 3071 girls and 3274 boys were evaluated. Anthropometric parameters determined were as follows, body mass, body height, waist and hip circumference. The body mass index (BMI) and the waist/hip ratio was calculated. Blood pressure values were recorded using OMRON M4 automatic device. Repeated blood pressure measurements were performed twice at least > or = two weeks apart if the systolic blood pressure was 135 and/or the diastolic pressure was > or = 85 mmHg. Statistical analysis was performed using SPSS for Windows 9.0. RESULTS: Out of the anthropometric parameters the gender and age-specific percentile distribution is given in regard to body mass, body height, body mass index (BMI), waist circumference, and waist/hip ratio. There was a strong relationship between the waist circumference and BMI. Elevated blood pressure values were found at the first recording in 14.1% of boys and in 2.5% of girls. In students who presented three times, the incidence of high blood pressure was 7.5% in boys and 1.1% in girls. Only 1% of students was aware of his or her hypertension. CONCLUSIONS: The representative survey provides reference values concerning body mass, body height, BMI, waist circumference, waist/hip ratio and blood pressure values in the age group of 15 to 18 years. It also provides data for the prevalence of hypertension and gives cut off values for the diagnosis of leanness, overweight and obesity.

Adolescent↗