The open epidemiology journal最新文献

{"title":"Relationship Between Sources of Information and the Willingness of Healthcare Workers to Risk their Lives for a Patient During the Peak of A/H1N1 Pandemic in Israel §","authors":"Y. Bar-dayan, Sarit Natan Manor, Noga Boldor, Inbar Kremer, M. Barak, Y. Bar-Dayan","doi":"10.2174/1874297101003010053","DOIUrl":"https://doi.org/10.2174/1874297101003010053","url":null,"abstract":"Background: The willingness of healthcare workers to risk their lives for a patient if a fatal transformation of the virus would occur is a major concern, especially during a pandemic where the need for adequate staffing is crucial and where the public atmosphere might increase anxiety and fear of exposure. Objective: To examine the relationships between the source of information about the disease and the willingness of healthcare workers to risk their lives for a patient with a fatal A/H1N1 flu, during the winter A/H1N1 pandemic in Israel. Methods: A questionnaire was distributed to healthcare workers in 21 hospitals and 40 primary clinics in Israel between November 26, 2009 and December 10, 2009 (the peak of the winter A/H1N1 flu outbreak). Results: The questionnaire was completed by 1147 healthcare workers. The most common source of information reported was television (65%), followed by speaking with colleagues and reading the Ministry of Health regulations (63%) each, internet (61%), and newspapers (51%). The least common sources of information were reading a scientific article (35%) and attending a professional lecture (31%). Willingness to risk one's life was significantly higher in healthcare workers who reported that their source of information about the disease was reading a scientific article, Ministry of Health regulations, a professional lecture, or a colleague. Willingness was not significantly different among health care workers who reported that their source of information about the disease was television programs, a newspaper article, or general internet sites. Conclusions: Willingness to risk one's life for a patient is directly related to professional sources of information and is not related to nonprofessional information obtained from mass media.","PeriodicalId":87834,"journal":{"name":"The open epidemiology journal","volume":"1 1","pages":"53-57"},"PeriodicalIF":0.0,"publicationDate":"2010-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68062588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using Patient-Reported Outcome Measures (PROMs) Routinely: An Example in the Context of Elective Shoulder Surgery","authors":"J. Dawson, Katherine Rogers, H. Doll, R. Fitzpatrick, C. Cooper, A. Carr","doi":"10.2174/1874297101003010042","DOIUrl":"https://doi.org/10.2174/1874297101003010042","url":null,"abstract":"Objectives: This paper evaluates the usefulness of a set of PROMs data collected prospectively, in a relational database, over several years. The data were collected as part of routine practice, to audit patients undergoing shoulder surgery. Methods: Data, rendered anonymous, which included all upper limb surgical procedures and all outcome questionnaires (including Oxford Shoulder Score, OSS) data, were downloaded, prepared and analysed to produce the shoulder surgery study population. Details of procedures and questionnaires were merged by shoulder and analysed for completeness and accuracy. Pre- and post-operative OSS scores, with repeated observations from individual patients, were analysed using maximum likelihood mixed effects linear regression models. Results: Data preparation and cleaning was intensive. The final dataset contained 2110 questionnaires representing 815 surgical procedures and 755 patients. In relation to procedures, only 538 (66%) had a pre- and post-operative OSS score: 78 (9.5%) a pre-operative OSS only, 199 (24.4%) a post-operative OSS only, and 31 (3.8%) no OSS completed. OSS questionnaires had been completed in varying numbers and at varying times per procedure. There was a considerable amount of 'missing' data that was not missing completely at random. Missing data had a significant influence on OSS scores. Conclusions: In the absence of a research question (eg. exploratory research, descriptive audits, registers), a reason for collecting PROMs data should be stipulated and methods of data collection and storage standardised. Poor data cannot be 'fixed' in statistical analysis; statistical advice should be sought during the planning stages.","PeriodicalId":87834,"journal":{"name":"The open epidemiology journal","volume":"4 1","pages":"42-52"},"PeriodicalIF":0.0,"publicationDate":"2010-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68062489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Event Charts for the Analysis of Adverse Events in Longitudinal Studies: An Example from a Smoking Cessation Pharmacotherapy Trial","authors":"J. Dubin, S. O'Malley","doi":"10.2174/1874297101003010034","DOIUrl":"https://doi.org/10.2174/1874297101003010034","url":null,"abstract":"Purpose: To illustrate the use of one particular graphical method, the event chart (Lee et al., 2000), for the display of adverse events (AE's), along with other important considerations such as time on treatment/intervention, severity of AE's, treatment assignment, gender, etc., in longitudinal studies. These graphs can also include other key information such as efficacy measures and time-dependent covariates of interest. Methods: Emphasizing an application of a dose-ranging smoking cessation trial of naltrexone, we use event charts to convey a few potentially interesting findings from the complex data from this trial, with particular attention paid to the analysis of the safety (AE) data from the subset of individuals who dropped out before the end of the treatment phase of the study. Results: The event charts conveyed some interesting findings regarding relationships between gender, AE's and dropout time, as well as between treatment group, AE's and dropout time, and between AE burden and dropout time. Conclusion: Event charts can be one of the helpful exploratory tools in investigating the pattern of adverse events and their possible association with covariates and time on treatment/intervention in longitudinal studies. Findings from the event chart analysis of AE's could potentially lead to more formal statistical analysis and modeling. Software for generating these event charts is available in R and S-Plus.","PeriodicalId":87834,"journal":{"name":"The open epidemiology journal","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2010-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68062433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Disease Risk Factors and Attributable Risk Calculations: Are There Mathematical Limits?","authors":"David W. Brown, R. Anda","doi":"10.2174/1874297101003010001","DOIUrl":"https://doi.org/10.2174/1874297101003010001","url":null,"abstract":"The Adverse Childhood Experiences (ACE) Study, a collaborative effort between Kaiser Permanente (San Diego, CA) and the Centers for Disease Control and Prevention (Atlanta, GA), was designed to examine the long-term relationship between adverse childhood experiences (ACEs) and a variety of health behaviors and outcomes in adulthood [1]. ACEs include childhood emotional, physical, or sexual abuse and household dysfunction during childhood. The ACE Study, based on chronic disease prevention and control models, proposes that ACEs influence social, emotional, and cognitive impairments which in turn increase the probability of adopting health risk behaviors that have been documented to influence the subsequent development of disease, disability, social problems, and ultimately premature death. We use the ACE pyramid to depict this concept (see www.cdc.gov/nccdphp/ace/pyramid.htm).","PeriodicalId":87834,"journal":{"name":"The open epidemiology journal","volume":"3 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2010-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68062759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low Bone Mass and Osteoporosis in Women Referring themselves to DualX-Ray Absorptiometry - Experience with a Health Promotion Action","authors":"G. Goerres, J. Swanenburg, D. Uebelhart","doi":"10.2174/1874297101003010029","DOIUrl":"https://doi.org/10.2174/1874297101003010029","url":null,"abstract":"Aims: This retrospective analysis was done to describe the difference in the prevalence of osteoporosis/low bone mass between women referring themselves to bone mineral density (BMD) testing with dual X-ray absorptiometry (DXA) and women referred by their family practitioner. Methods: Women were recruited by a health promotion action in a Swiss weekly periodical and compared with female patients sent by their physician for DXA testing for various medical indications during the same period. Patients under steroid treatment, known previous fracture and undergoing follow-up for low bone mass were excluded. Self referred women were compared to female patients aged 40 years and older and the same evaluation was repeated for women aged 65 and older. Results: No differences were found in the prevalence of osteoporosis /low bone mass in women referred by their physician vs those who were self referred. However, a significant difference was found with age: the self referred women were 63.1 ± 8.6 years of age whereas the patient group's mean age was 59.7 ± 9.4 (p=0.0001, 95% CI of the difference: 21 - 61 years). Conclusion: We suggest that health promotion actions might be able to recruit the correct candidates for BMD testing, since we found no significant difference in the prevalence of osteoporosis/ low bone mass between self referred and physician referred women. Our data further suggest that physicians may react earlier on their patient's risk profiles than the time frame of action by the self-referred women.","PeriodicalId":87834,"journal":{"name":"The open epidemiology journal","volume":"3 1","pages":"29-33"},"PeriodicalIF":0.0,"publicationDate":"2010-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68062414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Clinical Predictive Model for Catheter Related Bloodstream Infections from the Electronic Medical Record","authors":"G. Bearman, Michael I. Oppenheim, Eneida A. Mendonça, N. Hupert, Maryam Behta, P. Christos, L. Drusin","doi":"10.2174/1874297101003010024","DOIUrl":"https://doi.org/10.2174/1874297101003010024","url":null,"abstract":"Background and Methods: Previous studies identifying risk factors for catheter related blood stream infections (BSI) have relied on labor-intensive paper chart review. The electronic medical record (EMR) can provide real-time data for profiling patients at risk for BSI. Our study's aim was to use our hospital EMR to identify risk factors and develop a clinical predictive model for catheter related BSI from June 2001-June 2002. Using a modified CDC definition for BSI, we retrospectively extracted a number of variables from the EMR data repository including demographics, medications, nutritional status, presence of diabetes (DM), skin/wound status, use of a mechanical ventilator, and presence of a urinary catheter or central/arterial/PICC catheter. We developed a Cox Proportional Hazards model using half the cohort (14,977 controls and 123 BSI cases), and validated the model using the other half. Final variables in the multivariate model were chosen by clinical relevance, significance on univariate analysis and by step-wise automated selection. Results: The final model contained: use of antibiotics (HR 4.6), central venous catheter for 0-6 days (HR 1.8), central venous catheter for greater or equal to 7 days (HR 1.3), tunneled central venous port (HR 9.3) and DM (HR 2.1). Variables from multivariate analysis were used for the predictive index; points were derived from the respective HR of the Cox model. A cutoff value that maximized sensitivity (75%) and specificity (89%) had a positive predictive value (PPV) of .05. This model was validated on the second half of the cohort (122 BSI, 14,977 'non-cases') with resultant sensitivity of 69%, specificity of 88% and PPV of 0.05. Comparison of the two models revealed no significant differences in the sensitivity, specificity and PPV. Conclusion: We successfully used a hospital-based EMR in developing a Cox Proportional Hazards model for catheter related BSI. This model was used to derive a predictive index. At a cutoff point providing a sensitivity of 75% and specificity of 89% for finding patients who develop catheter related BSI, the index had a PPV 0.05. When applied to a predictive index, real time data gathered from the EMR may assist in identifying patients at risk for a catheter related BSI and may be further utilized as part of a protocol driven, preventive strategy for catheter related BSI risk reduction.","PeriodicalId":87834,"journal":{"name":"The open epidemiology journal","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2010-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68062376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathways to Smoking and Snus Use Cessation - Is Spontaneous Quitting Underrated?","authors":"Mats Toftgård, H. Gilljam, T. Tomson","doi":"10.2174/1874297101003010020","DOIUrl":"https://doi.org/10.2174/1874297101003010020","url":null,"abstract":"Aim: To investigate to what extent smokers and snus users in Sweden consider and plan their quit attempts in advance, and to assess if spontaneity is associated with success. Methods: A sample of 5999 Swedish men and women between 16 and 80 years were interviewed via telephone about current and former smoking and snus use and their latest quit attempts. Results: Among 2272 ex-smokers and current smokers who had ever made a serious quit attempt 48% reported to not having planned their latest attempt in advance. Furthermore, 40% reported to not even having considered giving up smoking before they actually made the attempt. Of 809 former and current snus users 48% did not plan, and 44% did not consider quitting in advance. Smokers and ex-smokers were more likely to remain smoke-free for at least six months if the attempt was unplanned (sex and age adjusted OR=2.6; 95% CI=1.7-3.8). When dividing the smoking quit attempts into considered versus not considered the advantage of the spontaneous attempts remained (adjusted OR=1.9; CI=1.3-2.9). The corresponding analyses of snus use quitting showed similar advantages for the unplanned and the not considered quit attempts. Conclusions: In Sweden, a considerable proportion of the attempts to quit smoking, as well as to quit using snus, are made without prior consideration or planning. Spontaneous quit attempts appear to have a greater chance of long-term success than those preceded by consideration or planning.","PeriodicalId":87834,"journal":{"name":"The open epidemiology journal","volume":"3 1","pages":"20-23"},"PeriodicalIF":0.0,"publicationDate":"2010-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68062354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Power and Error: Increased Risk of False Positive Results in Underpowered Studies","authors":"R. Christley","doi":"10.2174/1874297101003010016","DOIUrl":"https://doi.org/10.2174/1874297101003010016","url":null,"abstract":"It is well recognised that low statistical power increases the probability of type II error, that is it reduces the probability of detecting a difference between groups, where a difference exists. Paradoxically, low statistical power also increases the likelihood that a statistically significant finding is actually falsely positive (for a given p-value). Hence, ethical concerns regarding studies with low statistical power should include the increased risk of type I error in such studies reporting statistically significant effects. This paper illustrates the effect of low statistical power by comparing hypothesis testing with diagnostic test evaluation using concepts familiar to clinicians, such as positive and negative predicative values. We also note that, where there is a high probability that the null hypothesis is true, statistically significant findings are even more likely to be falsely positive.","PeriodicalId":87834,"journal":{"name":"The open epidemiology journal","volume":"3 1","pages":"16-19"},"PeriodicalIF":0.0,"publicationDate":"2010-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68062309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alcohol-Related Deaths and Hospitalizations by Race, Gender, and Age in California","authors":"Mandy A Stahre, Michele R. Simon","doi":"10.2174/1874297101003010003","DOIUrl":"https://doi.org/10.2174/1874297101003010003","url":null,"abstract":"Introduction: Excessive alcohol use is the third leading preventable cause of death in the United States each year and responsible for about 10,000 deaths in California alone. In addition, excessive alcohol use is responsible for many hospitalizations due to injuries and illnesses. Alcohol consumption is known to differ by age, sex, and race/ethnicity and these consumption patterns can lead to differences in alcohol-related outcomes. Methods: Using data from a variety of sources, alcohol-attributable deaths and nonfatal hospitalizations for illnesses and injuries were calculated for California for the year 2006. Results: Excessive alcohol use resulted in over 10,000 deaths and 72,000 nonfatal hospitalizations in California. The majority of consequences (51%) were due to chronic illnesses associated with long-term excessive use of alcohol. Overall, males reported more deaths and nonfatal hospitalizations due to excessive alcohol use than women. Alcohol-attributable deaths and hospitalizations are more likely to occur among individuals aged 50-64 years for illnesses and individuals aged 20-34 years for injuries. Older individuals suffered from more chronic conditions such as alcoholic liver disease, while younger individuals were more likely to suffer from injuries, the most common being motor-vehicle traffic crashes. Significant differences in the rate of deaths and nonfatal hospitalizations by race/ethnicity were more common due to injuries and violence than chronic diseases. Conclusions: This study highlighted key findings of demographic differences in consequences suffered by excessive alcohol use in California. Continued efforts to better evaluate the contribution of alcohol to morbidity and mortality by demographic factors, especially by race and ethnicity, is warranted to prevent and reduce the harm associated with this behavior.","PeriodicalId":87834,"journal":{"name":"The open epidemiology journal","volume":"3 1","pages":"3-15"},"PeriodicalIF":0.0,"publicationDate":"2010-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68062296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular Epidemiology and Virulence Characteristics of Klebsiella pneumoniae Strains Isolated from Hospital-Associated Infections","authors":"M. Damian, C. Usein, A. Palade, S. Ceciu, M. Coşman","doi":"10.2174/1874297100902010069","DOIUrl":"https://doi.org/10.2174/1874297100902010069","url":null,"abstract":"Purpose: The present study aimed to confirm by classical and molecular laboratory methods hospital- associated outbreaks due to virulent Klebsiella pneumoniae strains. Methods: Eighty three Klebsiella pneumoniae strains isolated from new-born patients, adults and hospital environment and devices in five hospital units, were analyzed for resistance to antibiotics, including last generation cephalosporins, sensitivity to bacteriophages and pulsed-field gel electrophoresis profiles in order to evaluate the epidemiological relatedness and their clonal spreading. Polymerase chain reaction targeting fur genes and several subtractive sequences (SL 002, SL 003, SL 019, SL 020, SL 021 and SL 025) was used for virulence assessment. Results: More than 50% of strains were resistant to third generation cephalosporins and among them 69% were extended spectrum beta-lactamase producers. Phage typing associated with pulse field gel electrophoresis documented the clonal dispersion of strains. Studying the distribution of virulence sequence, our results reveal that fur gene is present in all strains and among the subtractive sequences the most frequent is SL 020 followed by SL 019. None of the analyzed sequences are present in all clinical isolates and none of the bacterial strains carry all these sequences pointing out the heterogeneity of Klebsiella pneumoniae population. Conclusions: Phage typing method associated with pulse field gel electrophoresis typing and genetic profile for virulence indicated the occurrence of hospital associated-infections produced by Klebsiella pneumoniae strains. Moreover, the results reveal that virulence pattern could be used as a molecular marker in order to define strains which are involved in the process of the development of infectious diseases.","PeriodicalId":87834,"journal":{"name":"The open epidemiology journal","volume":"2 1","pages":"69-78"},"PeriodicalIF":0.0,"publicationDate":"2009-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68062743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}