Epidemiology Commons^™

Tropicalizando A Medicina [Portuguese], Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

A Case Study And National Database Report Of Progressive Systemic Sclerosis And Associated Conditions, David Phillips, Barbara Phillips, David M. Mannino

David M. Mannino

We report the case of a 34-year-old white woman with a history of progressive systemic scleroderma (PSS) and diffuse alveolar hemorrhage (DAH) that may be either a rare complication of PSS or induced by D-penicillamine. The DAH progressed to hemoptysis and led to intubation for airway protection. The patient progressed to acute renal failure. Her chest x-ray revealed diffuse bilateral infiltrates. She developed pulmonary fibrosis with secondary pulmonary hypertension. She experienced a brief period of improvement of her respiratory status after steroid treatment. We also report a database of 21,442 decedents with PSS over a 15-year period from 1979 to …

A Odisseia Do Paje, Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

Assessing The Accuracy Of A New Diagnostic Test When A Gold Standard Does Not Exist, Todd A. Alonzo, Margaret S. Pepe

UW Biostatistics Working Paper Series

Often the accuracy of a new diagnostic test must be assessed when a perfect gold standard does not exist. Use of an imperfect test biases the accuracy estimates of the new test. This paper reviews existing approaches to this problem including discrepant resolution and latent class analysis. Deficiencies with these approaches are identified. A new approach is proposed that combines the results of several imperfect reference tests to define a better reference standard. We call this the composite reference standard (CRS). Using the CRS, accuracy can be assessed using multistage sampling designs. Maximum likelihood estimates of accuracy and expressions for …

Variability Of Target Volume Delineation In Cervical Esophageal Cancer, Patricia Tai, Jake Van Dyk, Edward Yu, Jerry Battista, Larry Stitt, Terry Coad

Edward Yu

PURPOSE: Three-dimensional (3D) conformal radiation therapy (CRT) assumes and requires the precise delineation of the target volume. To assess the consistency of target volume delineation by radiation oncologists, who treat esophageal cancers, we have performed a transCanada survey. MATERIALS AND METHODS: One of three case presentations, including CT scan images, of different stages of cervical esophageal cancer was randomly chosen and sent by mail. Respondents were asked to fill in questionnaires regarding treatment techniques and to outline boost target volumes for the primary tumor on CT scans, using ICRU-50 definitions. RESULTS: Of 58 radiation oncologists who agreed to participate, 48 …

A Longitudinal Study Of Hospitalization Rates For Patients With Chronic Disease: Results From The Medical Outcomes Study., Eugene C. Nelson, Colleen A. Mchorney, Willard G. Manning, W H. Rogers

Dartmouth Scholarship

To prospectively compare inpatient and outpatient utilization rates between prepaid (PPD) and fee-for-service (FFS) insurance coverage for patients with chronic disease. Data from the Medical Outcomes Study, a longitudinal observational study of chronic disease patients conducted in Boston, Chicago, and Los Angeles.A four-year prospective study of resource utilization among 1,681 patients under treatment for hypertension, diabetes, myocardial infarction, or congestive heart failure in the practices of 367 clinicians.

Does Delay In Breast Irradiation Following Conservative Breast Surgery In Node-Negative Breast Cancer Patients Have An Impact On Risk Of Recurrence?, Olga Vujovic, Francisco Perera, A. Dar, Larry Stitt, Edward Yu, Sachi Voruganti, Pauline Truong

Edward Yu

PURPOSE: This retrospective review was conducted to determine if delay in the start of radiotherapy after definitive breast surgery had any detrimental effect on local recurrence or disease-free survival in node-negative breast cancer patients. METHODS AND MATERIALS: A total of 568 patients with T1-T2, N0 breast cancer were treated with breast-conserving surgery and breast irradiation, without adjuvant systemic therapy between January 1, 1985 and December 31, 1992, at the London Regional Cancer Centre. Adjuvant breast irradiation consisted either of 50 Gy in 25 fractions or 40 Gy in 15 or 16 fractions, followed by a boost of 10 Gy or …

Prevalent Low Income Status In Canadian And United States Metropolitan Areas, 1980 And 1990, Kevin M. Gorey

Social Work Publications

As compared to Toronto’s poor people, three to four-fold as many of upstate New York’s poor live in severely impoverished neighborhoods, areas where 40% or more of the residents have annual incomes below the federally established low income or poverty criterion. However, the prevalence of such extremely degraded living conditions increased similarly (two-fold) on both sides of the Canadian-US border during the 1980s. This urban problem, of the concentration of poor people, seems to predominantly be an inner-city problem in the US, whereas it was found to be nearly equivalently extant in the inner-city, mid-suburban and outlying suburban areas of …

Secular Trends In The Incidence Of Anorexia Nervosa: Integrative Review Of Population-Based Studies, Kevin M. Gorey

Social Work Publications

OBJECTIVE AND METHOD: Aggregating across retrospective cohort samples, this integrative review synthesizes the findings of 12 cumulative incidence studies (45 hypotheses) on anorexia nervosa secular trends.

RESULTS: (1) The female/male anorexia incidence rate ratio was estimated to be 8.20, 18.46 versus 2.25 cases per 100,000 per year, p < .05; (2) female teenagers experienced anorexia at a rate fivefold greater than other women, 50.82 versus 10.37 incident cases per 100,000 per year, p < .001; (3) no secular trend or change in the incidence of anorexia was observed among teenagers, while a near threefold increase was observed over the past 40 years among women in their 20s and 30s, 6.28 (1950-1964) versus 17.70 (1980-1992) cases per 100,000 per year, p < .05; and (4) the two cohort characteristics of age, and the age by year interaction accounted for nearly two thirds of the variability among anorexia incidence estimates, R2 = .614, F(2,27) = 21.49, p < .001. After the two factors of age and the Age x Year interaction were accounted for, none of the other study characteristics, including study year(s), were found to be significantly associated with anorexia incidence, that is, a main effect of time was not observed.

DISCUSSION: The integrative evidence across the population-based epidemiologic studies covering 40 years in this field suggests strongly that, overall, the incidence of anorexia nervosa, particularly among those very young women at greatest risk of experiencing it, has not increased significantly. However, the risk does seem to have increased significantly among women in …

Effectiveness Of Case Management With Severely And Persistently Mentally Ill People, Kevin M. Gorey

Social Work Publications

This meta-analytic review synthesizes the findings of 24 published studies dealing with the effectiveness of case management with the severely and persistently mentally ill. Summative findings were: (1) Overall, case management interventions are effective--75% of the clients who participate in them do better than the average client who does not; (2) The estimated preventive fraction (e.g., prevention of re-hospitalization) among clients who experience relatively intense case management service (case loads of 15 or less, 89%) is nearly 30% greater than that estimated among similar clients receiving less intensive service; and (3) Various case management practice models did not differ significantly …

Gorey, K. Association Between Socioeconomic Status And Cancer Incidence In Toronto, Ontario: Possible Confounding Of Cancer Mortality By Incidence And Survival, Kevin M. Gorey

Social Work Publications

OBJECTIVE: To observe the association between socioeconomic status (SES) and cancer incidence in a cohort of Canadians.

DESIGN: Cases of primary malignant cancer (83,666) that arose in metropolitan Toronto, Ont., from 1986 to 1993 were ascertained by the Ontario Cancer Registry and linked by residence at the time of diagnosis to a census-based measure of SES. Socioeconomic quintile areas were then compared by cancer incidence.

RESULTS: Significant associations between SES and cancer incidence in the hypothesized direction--greater incidence in low-income areas--were observed for 15 of 23 cancer sites.

CONCLUSIONS: These findings, together with the recently observed consistent pattern of significant …

Secular Trends In The United States Black/White Hypertension Prevalence Ratio: Potential Impact Of Diminishing Response Rates, Kevin M. Gorey

Social Work Publications

In this integrative review, the authors analyzed 25 studies on hypertension prevalence among black and white adults (1960-1991). The authors made the following inferences: 1) both female (2.59 vs. 1.77) and male (2.20 vs. 1.38) black/white hypertension prevalence ratios have diminished by approximately a third over the past three decades; 2) response rates were significantly lower among the more recent surveys (i.e., 1976 or later, mean 69.2 percent (standard deviation (SD) 6.9) vs. 1960 to 1975, mean 86.1 percent (SD 9.1)); and 3) these two trends are directly associated--response rates may account for a third (women, R2 = 0.362) to …

Premature Mortality From Heart Diseases In Brazil. A Comparison With Other Countries[Portuguese], Paulo A. Lotufo

Paulo A Lotufo

Chronic diseases have been the main cause of mortality in the Brazilian metropolitan areas since 1960. Circulatory diseases are the main causes of chronic diseases. The aim was to compare the heart disease related premature deaths in Brazil with other countries in 1984-87. Methods: We studied the deaths from the official mortality statistics from eight metropolitan areas with good assurance of information: Belém, Recife, Salvador, Belo Horizonte, Rio de Janeiro, São Paulo, Curitiba, Porto Alegre. Death causes analyzed were coronary heart disease (410-414); and heart diseases [ischemic heart disease (410-414) plus heart failure (428) plus, hypertension (401-404)]. The population was …

Tratamento Anti-Hipertensivo. Prescrição E Custo De Medicamentos. Pesquisa Em Hospital Terciário, Paulo A. Lotufo

Paulo A Lotufo

To study the most prescribed anti-hypertensive drugs, evaluating their agreement with established guidelines and drug cost. Methods - One hundred and forty one (101 women, mean age = 53.3 years) hypertensive patients who searched spontaneous attention were interviewed in a tertiary-care hospital. The inclusion criteria were previous diagnosis of hypertension and non cardiovascular complaints. Results - The majority of the 107 (75.9%) patients were on medical treatment. In those receiving monotherapy, thiazides were the most utilized drugs, followed by methyldopa, ACE inhibitors, calcium channel-blockers, a n d b e t a - b l o c k e r s …

Epidemiologia Das Doenças Isquemicas No Brasil [Portuguese], Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

The Beneficial Effects Of Volunteering For Older Volunteers And The People They Serve: A Meta-Analysis, Kevin M. Gorey

Social Work Publications

The current political-economic climate, which is generally supportive of both private and public sector down-sizing, increasingly demands that human service workers assess, engage, and creatively use consumer strengths and resources. This meta-analysis of thirty-seven independent studies provided the means of inferring not only that elder volunteers' sense of well-being seemed to be significantly bolstered through volunteering, but also that such relatively healthy older people represent a significant adjunct resource for meeting some of the service needs of more vulnerable elders, as well as those of other similarly vulnerable groups such as disabled children. Averaging across studies, 85 percent of the …

Surveillance For Waterborne-Disease Outbreaks -- United States, 1995-1996, Deborah A. Levy, Michelle S. Bens, Gunther F. Craun, Rebecca L. Calderon, Barbara L. Herwaldt

Journal Articles: Epidemiology

PROBLEM/CONDITION: Since 1971, CDC and the U.S. Environmental Protection Agency have maintained a collaborative surveillance system for collecting and periodically reporting data that relate to occurrences and causes of waterborne-disease outbreaks (WBDOs).

REPORTING PERIOD COVERED: This summary includes data for January 1995 through December 1996 and previously unreported outbreaks in 1994.

DESCRIPTION OF THE SYSTEM: The surveillance system includes data about outbreaks associated with drinking water and recreational water. State, territorial, and local public health departments are primarily responsible for detecting and investigating WBDOs and for voluntarily reporting them to CDC on a standard form.

RESULTS: For the period 1995-1996, …

O Estado Atual Do Controle Do Diabetes, Da Dislipidemia E Da Hipertensão [Portuguese], Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.