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PubMed1986

Characteristics of hazardous material spills from reporting systems in California.

Data on hazardous material releases that occurred between January 1, 1982 and September 30, 1983 in California were obtained from the California Highway Patrol (CHP) and the US Department of Transportation (DOT). The majority of incidents involved highway transport of hazardous materials, although some information was available on air, rail, and stationary facility releases. Vehicle accidents and failure of or damage to the container were the most frequent causes of releases. Proportionately more hazardous materials incidents occurred in early summer than at other times of the year, during weekdays, and daytime hours. The largest proportions of incidents involved the chemical categories of corrosives and fuels. Reported exposures and injuries to response personnel and other people at the scene were relatively few; no fatalities were reported. Few incidents were reported in both data sources, suggesting that the examination of only one data source would yield a gross underestimate of the total number of hazardous materials incidents in California. The lack of available denominator data limits the interpretation of the findings.

Accidents↗
PubMed1994

The validity of thoracolumbar paraspinal scanning EMG as a diagnostic test: an examination of the current literature.

OBJECTIVE: The purpose of this literature review was to assess the current validity of thoracolumbar paraspinal scanning EMG as practiced by the chiropractic profession within the context of adequate and acceptable epidemiological standards for validating a new diagnostic test. DATA SOURCES, STUDY SELECTION AND DATA EXTRACTION: Sources for the primary literature citations were obtained from several indexing services (MEDLINE--April 1993 to 1989; Index to Chiropractic Literature--1991 to 1980, Chiropractic Research Archives Collection--Vol. I-IV and Chiropractic Literature Analysis and Retrieval System) and hand searched under the subject heading of electromyography. For MEDLINE this was combined with electromyography as a title/abstract word and limited to "human." Primary literature citations were included in this review if the author, institution or journal was associated with the chiropractic profession and the paper dealt with thoracolumbar scanning EMG. Thirty-seven primary publications were identified and were systematically evaluated for contribution to any of the twelve key criteria used to validate a new diagnostic test. Secondary or tertiary citations from all sources were included if referenced in the primary literature as previous investigations supporting one of the key criteria. Additional secondary sources were included providing that the author was aware of them and the subject matter was germane to the EMG subtopic. DATA SYNTHESIS: Based upon this review, none of the 12 key criteria used to validate a new diagnostic test have been adequately satisfied. CONCLUSIONS: It is concluded that thoracolumbar paraspinal scanning EMG is premature for clinical application as a paraclinical diagnostic test. Recommendations for evaluation directions in the immediate future are provided.

Electromyography↗
PubMed1996

Management of sinusitis in the asthmatic patient.

OBJECTIVE: To describe pathophysiologic links between sinusitis and asthma; to identify means of diagnosing sinusitis in the asthmatic; to discuss the management of asthmatic patients with sinusitis, both medical and surgical; to examine the outcome of managing the asthmatic patient with sinusitis. DATA SOURCES: Prospective and retrospective data from the author's experience was evaluated. Medline database was searched from January 1, 1984, using the keywords "asthma" and "sinusitis" without restriction to species or language; 48 articles identified. Relevant articles referenced in retrieved sources, current texts in otorhinolaryngology and sinus disease were also utilized. STUDY SELECTION: From data source abstracts, pertinent articles (33) and book chapters meeting the objectives of our paper were intensively reviewed. RESULTS: Clinical and experimental studies indicate that sinonasal inflammation can result in worsening of lower airway disease, while the exact nature of this relationship remains debated. Regardless of mechanism, identification of the asthmatic patient with chronic sinusitis using the techniques of nasal endoscopy and CT scanning can lead to treatment of sinusitis with overall sinus and asthmatic disease improvement. Proper management is first medical, while surgical approaches are reserved for persistent cases. Traditional, more radical, surgical approaches have shown good results overall, while newer techniques of functional endoscopic sinus surgery which respect anatomy and mucosal function are less studied but expected to result in similar or better long-term outcome. CONCLUSIONS: Sinusitis and asthma coexist and impact on one another at many different levels. Proper identification of the asthmatic patient with chronic sinusitis can be readily discerned by an accurate and thorough history and physical examination including nasal endoscopy and CT scanning. Proper medical and surgical management of sinusitis in the asthmatic patient can result in both improved sinonasal and asthmatic symptoms with fewer physician visits and decreased need for medication.

Asthma↗
PubMed1997

Comparison of the Injury Severity Score and ICD-9 diagnosis codes as predictors of outcome in injury: analysis of 44,032 patients.

INTRODUCTION: Appropriate stratification of injury severity is a critical tool in the assessment of the treatment and the prevention of injury. Since its inception, the Injury Severity Score (ISS) has been the generally recognized "gold standard" for anatomic injury severity assessment. However, there is considerable time and expense involved in the collection of the information required to calculate an accurate ISS. In addition, the predictive power of the ISS has been shown to be limited. Previous work has demonstrated that the anatomic information about injury contained in the International Classification of Diseases Version 9 (ICD-9) can be a significant predictor of survival in trauma patients. The goal of this study was to utilize the San Diego County Trauma Registry (SDTR), one of the nation's leading trauma registries, to compare the predictive power of the ISS with the predictive power of the information contained in the injured patients' ICD-9 diagnoses codes. It was our primary hypothesis that survival risk ratios derived from patients' ICD-9 diagnoses codes would be equal or better predictors of survival than the Injury Severity Score. The implications of such a finding would have the potential for significant cost savings in the care of injured patients. METHODS: Data for the test population were obtained from the SDTR, which contains data from 1985 through 1993 from five participating hospitals. Four data sources were utilized to estimate the expected survival rate/mortality rate for each ICD-9 code in the SDTR. These were (1) the SDTR patients themselves, (2) the North Carolina State Hospital Discharge Database, (3) the North Carolina Trauma Registry Database, and (4) the Agency for Health Care Policy Research's Health Care Utilization Project Database. Each of these data sources was separately utilized to develop a survival risk ratio (SRR) for each ICD-9 diagnoses code. The SRR was calculated by dividing the number of survivors for patients with each ICD-9 code by the total number of all patients with the particular ICD-9 diagnoses code. The four groups of SRRs derived from our four data sources were used as predictors of survival and the ability of the SRRs to predict survival was compared with the predictive power of the ISS using measures of accuracy, sensitivity, specificity, and receiver operator characteristic curves. RESULTS: During the years 1985 through 1993, complete data were available for analysis on 44,032 patients. Of these, 2,848 patients died during their hospitalization (6%). Survival risk ratios were calculated for each of the diagnoses in the data base. Logistic regression, using the SAS System for statistical analysis, was used to assess the relative predictive power of the ISS and the survival risk ratios derived from the ICD-9 diagnoses codes from each of the four data bases. The analyses demonstrated that the regression models using the SRRs were generally as good or better than ISS as predictors of survival. The predictive power of the SRRs derived from the SDTR data, the North Carolina Trauma Registry data and the Health Care Utilization Report data were the best. In a subsequent analysis, the SRR values and the ISS were added to the patient's age and the revised Trauma Scores to create new predictive models in the mode of TRISS methodology. The analyses again indicated that the models using SRRs had as good or better predictive power than the model using the ISS. CONCLUSIONS: The present study confirms previous work showing that survival risk ratios derived from injured patients' ICD-9 diagnoses codes are as good as or better than ISS as predictors of survival.

Abbreviated Injury Scale↗
PubMed2005

Estimation of organic carbon blank values and error structures of the speciation trends network data for source apportionment.

Because the particulate organic carbon (OC) concentrations reported in U.S. Environment Protection Agency Speciation Trends Network (STN) data were not blank corrected, the OC blank concentrations were estimated using the intercept in particulate matter < or = 2.5 microm in aerodynamic diameter (PM2.5) regression against OC concentrations. The estimated OC blank concentrations ranged from 1 to 2.4 microg/m3 showing higher values in urban areas for the 13 monitoring sites in the northeastern United States. In the STN data, several different samplers and analyzers are used, and various instruments show different method detection limit (MDL) values, as well as errors. A comprehensive set of error structures that would be used for numerous source apportionment studies of STN data was estimated by comparing a limited set of measured concentrations and their associated uncertainties. To examine the estimated error structures and investigate the appropriate MDL values, PM2.5 samples collected at a STN site in Burlington, VT, were analyzed through the application of the positive matrix factorization. A total of 323 samples that were collected between December 2000 and December 2003 and 49 species based on several variable selection criteria were used, and eight sources were successfully identified in this study with the estimated error structures and min values among different MDL values from the five instruments: secondary sulfate aerosol (41%), secondary nitrate aerosol (20%), airborne soil (15%), gasoline vehicle emissions (7%), diesel emissions (7%), aged sea salt (4%), copper smelting (3%), and ferrous smelting (2%). Time series plots of contributions from airborne soil indicate that the highly elevated impacts from this source were likely caused primarily by dust storms.

Air Pollutants↗
PubMed2004

[Public health research with statutory health insurance drug data].

Major well-organized data sources about medical services are accumulated by statutory health insurance companies. These data are sufficiently representative of drug prescriptions and constitute a potential basis for pharmacoepidemiologic research. Especially for pharmacovigilance tasks or when political decisions have to be prepared, fast and reliable answers are often necessary. These can be generated utilizing health insurances' databases. Legal requirements for the analysis of data from medical services in the framework of research projects are described in Article 287 of the SGB V (Code of Social Law Book V). An increasing number of such projects were conducted during the last few years. The Gesetz zur Modernisierung der gesetzlichen Krankenversicherung (Law on Modernization of Statutory Health Insurance Companies of 14 November 2003) will induce important progress for the development and quality of pharmacoepidemiologic research using health insurance data. Probably in the future the analysis of such data will become-in addition to analyses of other data sources such as survey data-a substantial field of pharmacoepidemiology in Germany. This article describes the background and development of using routine data from health insurance companies for scientific purposes and discusses potentials and limitations of such data for public health research.

Adverse Drug Reaction Reporting Systems↗
PubMed1996

Placental abruption and its association with hypertension and prolonged rupture of membranes: a methodologic review and meta-analysis.

OBJECTIVE: To conduct a meta-analysis of published studies on placental abruption to examine its incidence, recurrence, and association with hypertensive disorders (chronic hypertension and preeclampsia) and prolonged rupture of membranes (PROM) in pregnancy. DATA SOURCES: We reviewed studies on placental abruption published since 1950, based on a comprehensive literature search using MEDLINE, and by identifying studies cited in the references of published reports. METHODS OF STUDY SELECTION: We identified 54 studies, excluding case reports on placental abruption and studies relating to placenta previa and vaginal bleeding of unknown origin. We also restricted the search to articles published in English. TABULATION, INTEGRATION, AND RESULTS: Studies chosen for the meta-analysis were categorized based on their study design (case-control or cohort), where they were conducted (United States or other countries), source of the data (vital records versus other sources), and magnitude of risk (risk of abruption greater or less than 1.0%). We used both fixed- and random-effects analysis to identify sources of heterogeneity in results among studies. There were striking differences in the incidence of placental abruption between cohort (0.69%) and case-control (0.35%) studies. United States-based studies found a somewhat higher incidence both for cohort (0.81%) and case-control (0.37%) studies compared with studies conducted outside the U.S. (0.60% and 0.26%, respectively). Abruption was more than ten times more common in pregnancies preceded by a pregnancy with abruption. Chronically hypertensive patients were more than three times as likely to develop placental abruption (odds ratio [OR] 3.13, 95% confidence interval [CI] 2.04-4.80) as normotensive patients. The OR for placental abruption was 1.73 (95% CI 1.47-2.04) for patients with preeclampsia. Similarly, women with pregnancies complicated by PROM were more than three times as likely to develop placental abruption (OR 3.05, 95% CI 2.16-4.32). United States-based studies, case-control studies, and studies with an incidence of abruption greater than 1% demonstrated stronger associations between abruption and hypertension and PROM. CONCLUSION: Risk of abruption is strongly associated with chronic hypertension, PROM, and especially abruption in a prior pregnancy, and somewhat more modestly with preeclampsia. The criteria for the diagnosis of placental abruption, hypertensive disorders, and PROM may have introduced variability among the results of these studies. More standardized definitions of these pregnancy complications would improve the comparability of the study results.

Abruptio Placentae↗
PubMed1999

A surveillance-oriented medical record as a source of data for both drug and quality of care surveillance.

The medical record for hospitalized patients has been modified in order to orient it towards two types of surveillance: adverse drug reactions (ADRs) and the quality of medical care. The modification consists of an adaptation of the progress notes; the transfer of the information to a special database is facilitated by the use of a simple system of codes that identify and correlate the items necessary for surveillance purposes. During the 6 months of observation of the 1103 pediatric patients included in the study, 35 clinically important suspected ADRs were noted by physicians. For the quality of medical care surveillance, all drug prescriptions were evaluated and areas in which to intervene in order to improve the appropriateness of prescriptions were identified. Quality surveillance was also extended to the monitoring of 'unexplained' adverse events for which no particular cause was attributable. We consider it advantageous to carry out these two types of surveillance simultaneously because they require many common items of information. The use of an oriented medical record as a source of data makes it possible to integrate surveillance with everyday ward activities.

Journal Article↗
PubMed2006

Diabetes information systems: a rapidly emerging support for diabetes surveillance and care.

BACKGROUND: With the rapid advances in information technology in the last decade, various diabetes information systems have evolved in different parts of the world. Availability of new technologies and information systems for monitoring and treating diabetes is critical to achieving recommended metabolic control, including glycosylated hemoglobin levels. The first step is to develop a registry, including a patient identifier that can link multiple data sources, which can then serve as a springboard to electronic mechanisms for practitioners to gain information on performance and results. OBJECTIVE: The aim is to review the provisions for diabetes surveillance in different parts of the world. This is a systematic review of national and regional information systems for diabetes surveillance. LITERATURE REVIEW: A comprehensive review was undertaken using Medline literature review, internet search using the Google search engine, and e-mail consultation with opinion leaders. TOPICS REVIEW: National/regional-level diabetes surveillance systems in Europe, the United States, Australia/New Zealand, and Asia have been reviewed. State-of-the-art diabetes information systems linking multiple data sources, with extensive audit and feedback capabilities, have also been looked at. RESULTS: National/regional-level audit databases have been tabulated. Diabetes information systems linking multiple data sources have been described. Most of the developed countries have now implemented systems such as diabetes registers and audits for diabetes surveillance in at least some regions, if not nationally. Developing nations are beginning to recognize the need for chronic disease management. CONCLUSIONS: With the advancements in information technology, the diabetes registers have the potential to rise beyond their traditional functions with dynamic data integration, decision support, and data access, as demonstrated by some diabetes information systems. With the rapid pace of development in electronic health records and health information systems, countries that are beginning to build their health information technology infrastructure could benefit from planning and funding along these lines.

Diabetes Mellitus↗
PubMed1997

The generalisability of pharmacoeconomic studies.

Authors of pharmacoeconomic analyses understandably want their findings to apply as broadly as possible. Also, decision-makers may have to interpret the results of analyses conducted in healthcare settings other than their own. The validity of transferring or generalising results from one setting to another raises important issues for health-economic evaluation. Pharmacoeconomic analyses attempt to model the costs and benefits of alternative treatments in normal clinical practice. Usually, no single clinical study directly provides all the required information, and a variety of data sources is generally included in each analysis. Different data sources present different problems in terms of their relevance to decision-makers. At one extreme, an analysis based purely on trial outcomes and resource use may be precise, but not reflect normal practice; at the other extreme, an analysis using practice data may appear relevant, but be exposed to biases and confounding. Reviews of published studies suggest that general standards have been inadequate in the past. Reapplying such analyses in different localities may simply replicate inadequate findings. The 'perfect' should not become the enemy of the merely 'good'. Models can be helpful in decision-making, provided that they accurately communicate uncertainties in modelling and data. Even so, there will be limits to the generalisability of pharmacoeconomic models, since the required analysis differs between jurisdictions, and because of variations in normal clinical practice. The transferability of research findings re-opens the issue of credibility in pharmacoeconomics. Methodological standardisation, reporting standards and researcher independence are recognised as important factors for enhancing credibility. Where possible, pharmacoeconomic analyses should reflect the findings of systematic reviews of health outcomes to avoid the risk of biased selection of the evidence. In addition, the application of findings to individual healthcare settings must be considered, since cost effectiveness may vary markedly by setting and perspective.

Decision Support Techniques↗
PubMed2004

A comparison of three different sources of data in assessing the frequencies of adverse reactions to amiodarone.

AIMS: To compare the frequencies of adverse drug reactions (ADRs) to amiodarone from three separate datasets: (i) a meta-analysis of clinical trials, (ii) spontaneous reports published in medical journals, and (iii) spontaneous reports sent to the World Health Organization (WHO). METHODS: We classified the ADRs into eight categories, based on the site involved, and built a rank order of the ADRs by category (from most to least commonly reported) for each dataset. We also calculated the relative proportions for all eight ADR categories within each dataset, in order to be able to compare the distributions of ADR frequencies: we assigned an index value of 1.0 to the frequency of respiratory toxicity in each set and calculated values for the other ADRs relative to respiratory toxicity. RESULTS: Thyroid disorders were the most commonly reported ADRs in the WHO dataset. In contrast, published case reports showed a preponderance of respiratory disorders, while in the meta-analysis cardiac conduction problems were the most frequent. The rank orders of ADRs differed among the three datasets, as did the index values of specific ADR categories with respect to the respiratory category. CONCLUSIONS: The distributions of ADR rank order and relative frequencies are dissimilar among the three datasets, as each dataset compiles information in a different way. Nevertheless, each dataset has its own specific strengths, and all three should be used together in obtaining a complete picture of a drug's safety profile. Important therapeutic and regulatory decisions should not simply be based on one source of data.

Adverse Drug Reaction Reporting Systems↗
PubMed2006

Problems in using birth certificate files in the capture-recapture model to estimate the completeness of case ascertainment in a population-based birth defects registry in New York State.

BACKGROUND: The limitations and underlying assumptions of the capture-recapture methods have hindered their application in epidemiological settings, especially in evaluating the completeness of birth defects registries. This study explored the possibility of using birth certificates as the secondary data source in a simple two-source capture-recapture model to estimate the completeness of case ascertainment of the Congenital Malformations Registry (CMR) for selected major birth defects. METHODS: The CMR and the birth certificates were used as the primary and secondary sources, respectively. Children who were born in 1996-2001 and had selected major birth defects were identified from the two sources. The accuracy of the diagnoses was examined by comparing the individual birth defect categories of the children from the two sources. RESULTS: Discrepancies in birth defect categories in the two data sources and false positives in the birth certificates were the major problems encountered in estimating the completeness of the CMR using the simple two-source capture-recapture method. The estimated completeness for selected major birth defects was only about 71%. Stratified analyses resulted in relatively high estimated completeness for oral clefts (90%) and Down syndrome (88%). CONCLUSIONS Although the birth certificate data was not a good source for estimating the completeness of case ascertainment of the CMR using capture-recapture methods, the analyses provided reasonable estimates for some conditions that were relatively easy to identify and diagnose at birth, such as oral clefts and Down syndrome.

Birth Certificates↗
PubMed2005

The eyes have it. How good is DIAGNOdent at detecting caries?

DATA SOURCES: Medline (1999-June 2004) provided the primary data source with references from one paper being reviewed for additional studies. The authors of one article were contacted for additional details. STUDY SELECTION: Articles, in English that assessed a commercially available caries detection device the DIAGNOdent (KaVo Dental GmbH Biberach), used human teeth with and without caries, and expressed diagnostic performance in terms of sensitivity and specificity of caries detection against a histological gold standard were included. DATA EXTRACTION AND SYNTHESIS: Data were extracted to determine whether articles included: an appropriate study population; an adequate description of the test; an appropriate reference standard; a blinded comparison of test and reference samples and avoidance of verification bias. No quality score was assigned. RESULTS: Of the 25 studies identified, 16 assessed the in vitro performance of DIAGNOdent (DD) on occlusal surfaces of primary and permanent posterior teeth, four reported similar in vivo assessments, two examined DD performance on smooth surfaces and the final three addressed detection of secondary caries and residual caries in simulated cavities. DD sensitivity scores for in vitro detection of occlusal dentinal caries ranged from 0.19 to 1.0 (n=16) with 14 of the 16 results being >/=0.73. Specificity values ranged from 0.52 to 1.00. DD tended to show higher sensitivity but lower specificity than visual assessment methods. Only four studies considered DD in vivo performance and demonstrated sensitivity from 0.73 to 0.96 and specificity from 0.63 to 0.95. CONCLUSIONS: In the limited studies available DD demonstrated greater sensitivity but poorer specificity than visual caries diagnosis. Combined with the fact that little in vivo evidence is available for DD performance, the greater number of false-positive diagnoses suggest it should not be relied on as a clinician's primary diagnostic method.

Comment↗
PubMed2005

90% of fixed partial dentures survive 5 years. How long do conventional fixed partial dentures (FPDs) survive and how frequently do complications occur?

DATA SOURCES: PubMed (1966-April 2004) provided the primary data source along with the bibliographies from identified articles and reviews. STUDY SELECTION: As there were no randomised controlled trials, English language prospective and retrospective cohort studies were selected if they had a mean follow-up of >/=5 years, included patients who were clinically examined at follow-up, reported details on suprastructures and described at least one-third of reconstructions as fixed partial dentures (FPDs). DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened articles for inclusion. Disagreements were resolved by discussion and agreement determined by kappa. Three reviewers extracted data on the survival and success of the reconstructions and on biological and technical complications. Studies deemed sufficiently similar by design were pooled using negative binomial regression with robust standard errors. Ten-year survival risks were calculated using exp(-10 x failure rate) and 10-year failure risks using 1-S(10). RESULTS: 17 retrospective and two prospective cohort studies including 1764 patients with 3548 FPDs analyzed in total. Meta-analysis was undertaken and after exclusion of one outlier a 10-year FPD survival of 92% was estimated. Only four studies provided information on FPD success - pooled complication rate was 34.1/1000 FPD years (95% CI 16-74). Exclusion of one outlier resulted in an estimated 10-year success of 81.1%. Considering biological complications, the estimated 10-years risk for caries at abutments was 9.5% (95% CI 4.6-89.9) while that for FPD loss due to caries and periodontal disease were 2.6% (95% CI 1.6-4.2) and 0.5% (95% CI 0.1-2.2), respectively. Estimated 10-year risks for technical complications were: 6.4% (95% CI 3.9-10.4) for loss of retention; 2.1% (95% CI 1.4-3.2) for loss of FPD due to abutment fracture and 3.2% (95% CI 1.5-6.5) for material fractures. CONCLUSIONS: Estimated success and survival rates for conventional FPDs largely confirm those of previous reviews. Technical complications such as loss of retention, which have not been reviewed before, resulted in a greater risk of FPD loss than did biological complications.

Comment↗
PubMed1992

Sogn and Fjordane county community-based injury prevention: evaluation design.

The Sogn and Fjordane Injury Prevention Programme is a community-based research and demonstration project located in the Sogn and Fjordane county (S&F county) in Western Norway. The aim of the project is: (i) to further effective intervention; (ii) to be cost-effective; (iii) to provide information about local community based injury intervention. Liaison groups on injury prevention will be organised in 24 communities participating in the project. Starting 1 April 1993 they will be supplied with local specific injury rates obtained from the all-injury registration of the National Injury Surveillance System. The intervention design includes feedback of three types of information: (1) home and traffic injury rates; (2) sports, occupational, school, and outdoor injury rates; (3) both (1) + (2). The liaison groups will be asked to concentrate their activities only on the information-related injury areas. The hypothesis is that the results will be information-related. The intervention protocol will last for two years, until 1 April 1995. Evaluation will be based on a hypothetical causal intervention model. The model includes three groups of independent influences, two groups of mediator attributes, and desired end-result. A variety of data sources will be used including national and local data sources, two cross-sectional surveys on awareness, knowledge, behaviour and attitudes, interviews, observations, and self-reports from individuals. A mixed-model ANOVA will be used to test the main information-related effects. A combination of multivariate analytical methods will be used to test the hypothesised causal intervention model.

Accident Prevention↗
PubMed2006

Measuring trends in prevalence and incidence of HIV infection in countries with generalised epidemics.

OBJECTIVE: Review of recent data and practice to derive guidance on questions relating to the measurement and analysis of trends in HIV prevalence and incidence. RESULTS: HIV prevalence among pregnant women attending antenatal clinics (ANCs) remains the principal data source to inform trends in the epidemic. Other data sources are: less available, representative of a small section of the population (sex workers, occupational groups), subject to additional bias (for example, voluntary counselling and testing service statistics), or are not yet available for multiple years (national surveys). Validity of HIV prevalence results may change over time due to improvements in HIV tests per se and implementation of laboratory quality assurance systems. The newer laboratory tests for recent infections require further validation and development of methodology to derive estimates of HIV incidence. CONCLUSIONS: Issues to consider during statistical analyses of trends among ANC attendees are: inclusion of consistent sites only, use of confidence intervals, stratification by site when performing a statistical test for trend, the need for at least three observations in a surveillance system with data collection every one to two years, and sound judgement. Trends in HIV prevalence among pregnant 15-24 year olds attending ANCs can be used to approximate trends in incidence. Indepth small area research studies are useful to inform the interpretation of surveillance data and provide directly measured trends in prevalence and incidence. Modelling can assess changes over time in prevalence, incidence, and mortality at the same time. Modelling tools need to be further developed to allow incorporation of estimates of HIV incidence and mortality, as these data are likely to become available in the future. To increase their explanatory power, models should also be extended to incorporate programmatic inputs.

Attitude to Health↗
PubMed2005

Symptom severity as a predictor of reported differences of prehospital delay between medical records and structured interviews among patients with AMI.

BACKGROUND: The time interval from symptom onset to hospital arrival can guide the decision to start reperfusion for patients with acute myocardial infarction (AMI). AIMS: The aims of the study were 1) to examine the consistency and agreement of prehospital delay time between medical record review and structured patient interview and 2) to identify whether symptom severity is an independent predictor of differences in reported prehospital delay between these two data sources. METHODS: In this cross-sectional study, a convenience sample of 155 patients with AMI in Japan was recruited. The time and date of symptom onset were obtained from medical record review and a structured patient interview. The interviewer asked about severity of symptoms, using a scale on 0 to 10 scale, with 0 being "no symptom" and 10 being "the most severe symptoms imaginable". RESULTS: The prehospital delay time from the medical record was significantly shorter than from the structured interview. Perfect agreement of reported prehospital delay time between two data sources was found in 46% of patients. Patients with symptom severity scores of greater than 8 on a 10-point scale were 2.2 times (95% CI: Odds Ratio 1.1 to 5.1) more likely to report different symptom onset time. CONCLUSIONS: Prehospital delay time documented in the medical record was shorter than that identified from a structured interview. In addition, the discrepancy between the two data sources may be larger in those patients with severe AMI symptoms.

Aged↗
PubMed2006

Gene and protein nomenclature in public databases.

BACKGROUND: Frequently, several alternative names are in use for biological objects such as genes and proteins. Applications like manual literature search, automated text-mining, named entity identification, gene/protein annotation, and linking of knowledge from different information sources require the knowledge of all used names referring to a given gene or protein. Various organism-specific or general public databases aim at organizing knowledge about genes and proteins. These databases can be used for deriving gene and protein name dictionaries. So far, little is known about the differences between databases in terms of size, ambiguities and overlap. RESULTS: We compiled five gene and protein name dictionaries for each of the five model organisms (yeast, fly, mouse, rat, and human) from different organism-specific and general public databases. We analyzed the degree of ambiguity of gene and protein names within and between dictionaries, to a lexicon of common English words and domain-related non-gene terms, and we compared different data sources in terms of size of extracted dictionaries and overlap of synonyms between those. The study shows that the number of genes/proteins and synonyms covered in individual databases varies significantly for a given organism, and that the degree of ambiguity of synonyms varies significantly between different organisms. Furthermore, it shows that, despite considerable efforts of co-curation, the overlap of synonyms in different data sources is rather moderate and that the degree of ambiguity of gene names with common English words and domain-related non-gene terms varies depending on the considered organism. CONCLUSION: In conclusion, these results indicate that the combination of data contained in different databases allows the generation of gene and protein name dictionaries that contain significantly more used names than dictionaries obtained from individual data sources. Furthermore, curation of combined dictionaries considerably increases size and decreases ambiguity. The entries of the curated synonym dictionary are available for manual querying, editing, and PubMed- or Google-search via the ProThesaurus-wiki. For automated querying via custom software, we offer a web service and an exemplary client application.

Abstracting and Indexing↗