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PubMed1999

Relation of probability of causation to relative risk and doubling dose: a methodologic error that has become a social problem.

Epidemiologists, biostatisticians, and health physicists frequently serve as expert consultants to lawyers, courts, and administrators. One of the most common errors committed by experts is to equate, without qualification, the attributable fraction estimated from epidemiologic data to the probability of causation requested by courts and administrators. This error has become so pervasive that it has been incorporated into judicial precedents and legislation. This commentary provides a brief overview of the error and the context in which it arises.

Causality↗
PubMed1997

Comparison of alcohol consumption patterns and social problems between women and men drink-drivers.

OBJECTIVE: To compare the sociodemographic characteristics, patterns of alcohol consumption and driving histories of women and men drink-drivers. DESIGN: Cross-sectional descriptive study. SETTING AND SUBJECTS: All 156 women who attended the Drink-Drive Program at St Vincent's Hospital, Melbourne, between January 1990 and December 1993, and an age-matched sample of 298 men attending in the same period. All had been disqualified from driving after a conviction for driving under the influence of alcohol. OUTCOME MEASURES: Self-reported weekly alcohol consumption and expenditure on alcohol at apprehension and during the program; blood alcohol level (BAL) at apprehension; demographic characteristics; number of previous drink-drive and other traffic convictions; and score on the Michigan Alcoholism Screening Test (MAST). RESULTS: Women had a higher educational level than men, and were more likely to be managers or professionals and to live in areas of high socioeconomic status. Women reported lower levels of weekly alcohol consumption at both apprehension (women: 15.2 standard drinks; men: 31.6 standard drinks) and during the program (women: 7.1 standard drinks; men: 12.0 standard drinks) but had similar BALs to men at apprehension (mean, 0.12% [26 mmol/L]). Sixty percent of women drank wine, or wine, beer and spirits, while 75% of men drank beer. Women had lower MAST scores than men (mean [standard deviation]: women, 5.8 [5.2]; men, 8.9 [8.2]). Women were less likely than men to have prior convictions for drink-driving or other traffic offences. CONCLUSION: Although women presented with similar blood alcohol levels to men, their drinking patterns and sociodemographic characteristics differ greatly. Health education for women drink-drivers needs to have a different strategy to that for men.

Alcohol Drinking↗
PubMed2000

[Acute myocardial infarction in elderly patients: medical and social problems].

The number of elderly patients with acute myocardial infarction has been increasing. However, the choice of treatment remains controversial. Medical records of 310 consecutive patients with acute myocardial infarction were reviewed. Two retrospective analyses were performed. 1) Patients were divided into the elderly group(70 years or more) and the younger group(under 70 years). In-hospital course and outcome were compared. 2) Pre-hospital performance status and living status were reviewed in the elderly group. Acute phase reperfusion therapy was performed in fewer patients in the elderly group(60.8% vs 71.9%, p < 0.01). The difference was most pronounced in cases of direct coronary angioplasty(28.6% vs 54.7%, p < 0.05). As a result, the rate of reperfusion success(74.8% vs 86.8%, p < 0.01) was lower in the elderly group. Moreover, the rates of in-hospital death(23.6% vs 6.8%, p < 0.005), pulmonary edema(20.3% vs 10.8%, p < 0.05), cardiogenic shock(11.9% vs 6.0%, p < 0.005), pneumonia(17.3% vs 3.0%, p < 0.005), and delirium(29.4% vs 12.0%, p < 0.001) were higher in the elderly group. Five patients in the elderly group and 3 patients in the younger group required rehabilitation because of worsened performance status. Six of them were non-reperfused patients. Elderly patients considered likely to become bed-ridden because of pre-existing physical disability at admission accounted for 28.9% of the total. Moreover, many elderly patients had poor support systems (8.4% were living alone, 21.0% were living only with their spouse or a child, 30.1% were widows or widowers). These results show that a lower acute phase reperfusion rate(especially angioplasty) resulted in a poor prognosis and worse performance status in elderly patients. Also 30% of patients were not good candidates for conventional treatment because of delirium, and that self-help in daily life is a fundamental goal for most elderly patients. Rapid and simple acute phase reperfusion, subsequent immediate mobilization, and early discharge are recommended for elderly patients with acute myocardial infarction.

Activities of Daily Living↗