Biomedical subjects

E Kupek

Publications and source records attributed to E Kupek.

At least 19 recordsLinked to original sources

PubMed2003

Effectiveness of a mass immunization campaign against serogroup C meningococci in children in the federal state of Santa Catarina, Brazil.

In addition to vaccine efficacy studies, there is a pressing need to evaluate vaccine effectiveness in a way that takes into account the limitations of health care systems in certain settings. An attempt to reach this objective was exemplified by a vaccination campaign against serogroup C meningococci in the federal state of Santa Catarina, in Brazil. A polysaccharide vaccine against serogroup C meningococci was administered to all individuals between 6 months and 14 years of age in March, 1996, in the municipalities that had the highest incidence of meningococcal disease in the previous year. All cases of the disease due to this serogroup observed in Santa Catarina during a 1-year period before and after the vaccination were included in the analysis. The cumulative incidence rate ratio was calculated for the unvaccinated compared to the vaccinated area. As a second step, the ratio of this quantity for the period before and after the vaccination, i.e. the ratio of the rate ratios (RRR), was calculated. One minus RRR was used to estimate the vaccine effectiveness. In the general population, the vaccine effectiveness was 74.3% (95% confidence intervals 52.7% to 99.6%). In children 6 months to 14 years, vaccine effectiveness was 93.1% (85.2% to 100%). Vaccine effectiveness could not be confirmed within more specific age bands, probably due to the lack of statistical power. It is concluded that group C meningococcal vaccine is effective in reducing the occurrence of meningococcal disease in children 6 months to 14 years of age, and that the ratio of rate ratios (RRR) in a useful method to evaluate vaccine effectiveness.

Adolescent↗

PubMed2003

Meals, snacks and food choices in Brazilian shift workers with high energy expenditure.

OBJECTIVE: To describe the food intake of garbage collectors, who works in three shifts, in terms of meal and snack frequency, content, time distribution and the contribution of various popular foods to the total diet. METHODS: Sixty-six Brazilian garbage collectors, who work in morning, afternoon, and night shift, participated in the present study. The quantitative methods used were a combination of one 24-h recall and two 24-h records during three nonconsecutive work days. The qualitative method used was the food-based classification of eating episodes model modified in order to define meals or snacks in three categories of events: meals with three food groups of high nutrient density (three HND meals), meals with two food groups of high nutrient density (two HND meals) and snacks, composed of only one food category of high nutrient density. RESULTS: The total number of eating events per day was significantly higher for night shift workers. Over 24-h, 'two HND meals' were the most common events and contributed the most energy, in all three shifts. Night shift workers ate more at dawn and less in the morning than other shifts. In all three shifts, meat was the most important food contributing to energy intake. CONCLUSION: Different work schedules did not affect the relative frequency of meal types and snacks or their contribution to daily energy intake, but affected the daily distribution of eating events, with a redistribution of intake from day to night in night shift workers.

Adult↗

PubMed2001

Clinical, provider and sociodemographic determinants of the number of antenatal visits in England and Wales.

The objective of this study was to measure the independent effects of clinical factors and non-clinical factors, such as provider and sociodemographic characteristics, on the number of antenatal visits made by women in England and Wales. The study was based on a survey of the secondary case records of 20,771 women with singleton pregnancies who were delivered between 1 August 1994 and 31 July 1995. The women in the survey attended one of nine maternity units in Northern England and North Wales selected within those areas to reflect geographical variations, as well as variations in the size and teaching status of the institution. A multivariate Poisson regression model was developed to examine differences in the number of antenatal visits made by women with different clinical and non-clinical characteristics. After controlling for non-clinical factors, primiparous women identified as high risk at booking made 1.0% more visits than primiparous women identified as low risk at booking (p = 0.196). Multiparous women identified as high risk at booking made 3.5% more visits than their low risk counterparts (p<0.001). High risk-defining criteria during antenatal care led to a 0.3% weekly increase in the number of antenatal visits amongst primiparous women (p <0.001) and a 0.4% weekly increase in the number of antenatal visits amongst multiparous women (p < 0.001). Several notable results, not reported elsewhere in the literature, were revealed by the regression analyses. After all independent variables were controlled for, women who were booked into urban teaching hospitals made 10% fewer antenatal visits than the women who were booked into the urban non-teaching hospitals. Women of Pakistani origin made 9.1% fewer antenatal visits than women of white British origin. Similar results were revealed for women of Indian origin and women from other ethnic groups. Non-smokers made 6.0% more antenatal visits than smokers. The planned pattern of antenatal care, number of carers seen, gestation at first presentation and maternal age also had significant independent impacts on the number of antenatal visits. The study highlights the sizeable impact of non-clinical factors on the antenatal care delivery process and indicates ways in which variations in antenatal care might be reduced.

Adult↗

PubMed2001

Sexual attitudes and number of partners in young British men.

The relationship between sexual attitudes and number of heterosexual partners in a survey-based and nationally representative random sample of 551 British men aged 16-25 years was examined. The main predictor of the number of partners in the last 5 years was the time since the first sexual intercourse, whereas age, marital status, education, social class, smoking, and alcohol consumption contributed on a smaller but significant level. Sexual attitudes were summarized in terms of three underlying dimensions which could be described as permissiveness, attitudes toward sexual relations of same-sex partners, and importance of orgasm for sex. None of these was a significant predictor of the number of partners in the last 5 years. Both permissiveness and number of partners were associated with the age of first sexual intercourse and other background variables indicating opportunities for social contact. In conclusion, common factors of sexual attitudes and the number of sexual partners are not directly related but rather jointly predicted by a very similar set of background variables such as age, time since first sexual intercourse, social class, smoking, and alcohol consumption. Given the absence of a significant relationship between sexual attitudes and number of young men's partners, promoting safer sex may be a more sensible strategy than trying to change these attitudes.

Adolescent↗

PubMed2001

[Allocation of health care resources in the state of Santa Catarina, Brazil: a contribution to a discussion on health financing].

OBJECTIVE: To describe the health situation in municipalities in the state of Santa Catarina, Brazil, in 1996, and to investigate how that correlated with federal health spending in 1997. METHODS: Multiple regression analysis was used to investigate the association between federal health care funding and proportional mortality, supply of health services (hospitals and outpatient clinics), and the municipality's population (number of inhabitants). Also investigated was the association between mortality from broad groups of causes and socioeconomic structure, supply of health services, and the municipality's population. RESULTS: The multiple regression analysis showed an association between proportional mortality due to: 1) infectious diseases and: infant mortality, number of non-doctor medical professionals per 10,000 inhabitants, and number of physicians per 10,000 inhabitants (negative association); 2) chronic degenerative diseases and: percentage of individuals 60 years and older, infant mortality (negative association), and number of non-doctor medical professionals per 10,000 inhabitants (negative association); and 3) external causes of death and: the municipality's population, number of hospitals per 10,000 inhabitants (negative association), and percentage of children younger than 1 year. Health spending per inhabitant in 1997 was mainly associated with the municipality's population, number of outpatient clinics per 10,000 inhabitants, Swaroop and Uemura mortality rate, and deaths due to chronic degenerative diseases in 1996. CONCLUSIONS: Municipalities with a better morbidity and mortality profile and a better health services structure received more federal health care resources. To improve this situation, special strategies should be considered in order to ensure additional resources for municipalities that have poorer health indicators.

Brazil↗

PubMed2000

HIV associated culture proved tuberculosis has increased in north central London from 1990 to 1996.

OBJECTIVES: To examine rates of culture proved tuberculosis in HIV infected patients in three specialist centres in north central London. METHODS: Cases of tuberculosis in patients with previously documented HIV infection from 1990 to 1996 were identified retrospectively from microbiological/clinical records at Chelsea and Westminster, St Mary's, and University College London Hospitals. RESULTS: Between 1990 and 1996 202 cases of culture proved tuberculosis were identified at the three centres. Of these, 132/202 (65.3%) occurred in homosexual/bisexual men, 41/202 (20.3%) were in patients with heterosexual contact in sub-Saharan Africa, and 29/202 (14.4%) were in "others." Overall 148/202 (73.3%) had pulmonary tuberculosis. The total number of HIV infected individuals seen at the three centres increased from 4298 in 1990 to 5048 in 1996. Rates of tuberculosis in the three centres increased from 0.46% in 1990 to 0.83% in 1996. Part of this increase was due to an increase in tuberculosis among Africans from 1993 to 1996. CONCLUSIONS: Rates of HIV associated tuberculosis increased in these three centres in north central London between 1990 and 1996. In part this was due to an increase in the number of African patients with HIV infection attending the three centres. In addition, there was circumstantial evidence of recent transmission among homosexual men with HIV infection. Prospective "real time" surveillance of tuberculosis in HIV infected patients is needed in order to detect case clustering and to improve tuberculosis control.

Africa↗

PubMed2000

The relationship between rainfall and human leptospirosis in Florianópolis, Brazil, 1991-1996.

The relationship between serologically confirmed cases of leptospirosis and the amount of rainfall in greater Florianôpolis, in southern Brazil, was studied retrospectively for the period 1991 to 1996. Maximum daily and total monthly rainfall for present and previous months were statistically significant predictors of the number of cases of leptospirosis in Poisson regression models. However, daily maximum rainfall data showed a much better model fit than total monthly rainfall. For each millimeter increase in maximum daily rainfall for the month above the average for the period studied, there was an increase of 0.55% in the number of leptospirosis cases relative to the period average. For the past month's daily maximum, this increase was 0.21%. Maximum daily rainfall during the month is a sensitive indicator of large amounts of rain falling in a brief period of time. This may cause flash floods and, thus, disseminate pathogenic Leptospira among the human population, particularly in densely populated areas with large rodent populations and without adequate drainage. This situation is typical for the association of tropical rainstorms and the spread of leptospirosis among slum dwellers.

Antibodies, Bacterial↗

PubMed2000

Serial outbreaks of food-borne disease in Blumenau, Brazil, caused by Salmonella enteritidis.

This work describes the epidemic profile of outbreaks of food infection caused by Salmonella enteritidis, serogroup D, in the city of Blumenau, Federal State of Santa Catarina, Brazil, during the period between February, 1994, and June, 1997. Ninety-six outbreaks were observed, and 79 (82%) were investigated, involving 7,802 people with signs and symptoms consistent with the infection. Most frequent symptoms were diarrhea (92%), abdominal pain (73%), fever (70%), vomiting (49%) and nausea (45%). Mayonnaise was the food most frequently associated with the outbreaks, being the responsible vehicle in almost two thirds of the cases investigated. The outbreaks most frequently occurred at home (60%), but the largest number of infections resulted from industrial kitchens (78%). The age group between 20 and 30 years was most affected. No relationships between the number of outbreaks and outside temperature or humidity were found. The attack rate showed no significant difference between men and women. Better attention to storage of food products at home and in industrial kitchens is needed to control this common gastrointestinal illness.

Adult↗

PubMed1999

Demograghic and socio-economic determinants of community and hospital services costs for people with HIV/AIDS in London.

We examined the influence of demographic, social and economic background of people with HIV/AIDS in London on total community and hospital services costs. This was a retrospective study of community and hospital service use, needs and costs based on structured questionnaires administered by trained interviewers and costing information obtained from the service purchasers and providers, based on two Genito-urinary Medicine clinics in London: the Jefferiss Wing at St. Mary's Hospital and Patric Clements at the Central Middlesex Hospital, London, England. The subjects were 225 HIV infected patients (105 asymptomatic, 59 symptomatic non-AIDS and 61 AIDS). We found that over and above well established determinants of health care costs for HIV infected people such as disease stage and transmission category, social and economic factors such as employment and support of a living-in partner significantly reduced community services costs. Private health insurance had a similar effect, though only a small proportion of HIV people had such cover. The cost of community services for HIV infected non-European Union nationals, mainly of African origin, was one quarter that for the European Union nationals. Community services costs were highest for heterosexually infected women and lowest for heterosexually infected men after adjusting for other factors. Hospital services costs were significantly higher for HIV infected people lacking educational qualifications and employment. We conclude that access to community care for HIV infected non-EU nationals appears to be very poor as the cost of their community services was one quarter that for the EU nationals after adjusting for the effects of transmission category, disease stage, living with a partner, employment and having a private health insurance. Additional incentives for informal care for HIV infected people could be a cost-effective way to improve their community health service provisions.

Acquired Immunodeficiency Syndrome↗

PubMed1999

Estimation of the number of sexual partners for the nonrespondents to a large national survey.

For a random sample of 4548 respondents to the British National Survey of Sexual Attitudes and Lifestyles, item nonresponses were assessed by utilizing alternating least squares and optimal scaling. Of men who did not answer the question on number of lifetime partners, 61% were estimated to have had 10 or more partners, whereas 48% of female nonrespondents were estimated to have had no partners. Among the latter, the percentage of those with 10 or more partners was also elevated to the level almost twice that of respondents. However, the overall impact of the estimates on the distribution of lifetime partners was hardly noticeable due to the relatively small proportion of incomplete answers to this question. Those who did not respond to the question of number of lifetime partners were likely to be over 45 years, of lower social class, and poorer education in comparison with those who answered the question fully. A larger proportion of the former were of Asian extraction and non-Christian in comparison to the latter, particularly among women. Not providing a complete answer to the question on the number of lifetime partners was associated with the nonresponse rate in the range of 90% on the questions of STD clinic attendance and drug abuse. Heavy smoking was more prevalent among male nonrespondents in comparison to those who provided a full answer to the question on the number of lifetime partners.

Adolescent↗

PubMed1999

Some psychometric properties of the Texas Grief Inventory adjusted for miscarriage.

The psychometric properties of an adjusted version of the Texas Grief Inventory (Zisook, Devaul & Click, 1982) were evaluated in a sample of 207 women following an early pregnancy loss. Factor structure of the Inventory was examined, and the validity was assessed by comparing the level of grief in women who became pregnant following a miscarriage and those who did not. Factor analysis resulted in a three-factor solution that was theoretically interpretable. The identified subscales were: pure grief, grief-related emotions and perceived adjustment and functioning since miscarriage. Significantly lower levels of grief-related behaviours and feelings were reported in women who became pregnant, which was suggestive of the construct validity of the Inventory. The high reliability coefficient (Cronbach's alpha = .90) obtained with this 17-item version of the Grief Inventory suggests it to be a reliable instrument for the assessment of grief after early miscarriage.

Abortion, Spontaneous↗

PubMed1998

Determinants of item nonresponse in a large national sex survey.

The study aim was to describe patterns of item nonresponse in a sex survey and identify factors associated with high nonresponse. A random sample of 4548 respondents to the National Survey of Sexual Attitudes and Lifestyles in Britain, 1990-1991 was assessed. Both respondent-wise and variable-wise patterns of incomplete response are described in terms of distinctive characteristics of nonrespondents and questions with a high nonresponse rate. Logistic regression was used to model the determinants of extreme nonresponse. For at least 90% of respondents, the item nonresponse was ignorable for most practical purposes and recall difficulties were indicated as its main cause, while the sensitivity of the questions had a large effect mainly among those in the top 5% of the overall nonresponse distribution. The latter were also distinguishable in terms of refusals to answer some face-to-face questions. Several overlapping indicators of poor educational and social background were associated with elevated overall nonresponse, particularly among the top 5% of the distribution. Thus recall accuracy rather than sensitivity of some sex survey questions was the key difficulty for a majority of the respondents whose overall nonresponse was satisfactorily low. The sensitivity of the topic had a large effect on item nonresponse only for a small group of participants.

Demography↗

PubMed1997

Asthma and thunderstorms: description of an epidemic in general practice in Britain using data from a doctors' deputising service in the UK.

OBJECTIVE: To describe the areas affected and the scale of an epidemic of thunderstorm associated asthma on the night of 24/25 June 1994 and to explore the spatial and temporal relationship between the thunderstorm and the associated epidemic. SETTING: The 29 offices of a deputising service for general practitioners' (GP) out of hours calls (Healthcall). At the time of the storm the deputising service provided out of hours cover for about 8500 out of about 30000 GPs in England, Scotland, and Wales. METHODS: Patients who phoned the Healthcall offices to request a home visit were categorised as "asthma" or "other causes" based on their presenting complaint. The number of calls on the night of 24/25 June 1994 was compared in areas affected by thunderstorms and areas not affected by thunderstorms and with the night of 17/18 June 1994, when there were no thunderstorms. RESULTS: A large area of the south and east of England was affected by an epidemic of asthma closely related both temporally and spatially with the thunderstorms on 24/25 June 1994. The pooled Mantel-Haenszel estimate for the risk of asthma in thunderstorm affected areas compared with the control night was 6.36 (95% confidence interval 4.97, 8.32) compared with a value of 1.01 (0.80, 1.27) for those not exposed. Extrapolation suggests about 1500 extra patients were likely to have requested a visit from a GP that night because of epidemic asthma. CONCLUSIONS: Under certain circumstances thunderstorms are associated with asthma and can affect many patients. Deputising services are a useful source of data for the investigation of epidemics in primary care.

Adolescent↗

PubMed1996

Thunderstorm associated asthma: a detailed analysis of environmental factors.

OBJECTIVES: To seek associations between meteorological factors, concentrations of air pollutants or pollen, and an asthma epidemic which occurred in London on 24 and 25 June 1994 after a thunderstorm. DESIGN: Retrospective study of patients' accident and emergency department records, with bivariate and multivariate analysis of environmental factors and data collection for the two months surrounding the epidemic. SETTING: The accident and emergency department of St Mary's Hospital in west central London. SUBJECTS: 148 patients presenting with asthma between 1 June and 31 July 1994, of whom 40 presented in the 24 hours after the storm. RESULTS: The asthma epidemic was significantly associated with a drop in air temperature six hours previously and a high grass pollen concentration nine hours previously. Non-epidemic asthma was significantly associated with lightning strikes, increase in humidity or sulphur dioxide concentration, a drop in temperature or high rainfall the previous day, and a decrease in maximum air pressure or changes in grass pollen counts over the previous two days. CONCLUSIONS: New episodes of asthma during the epidemic on 24 and 25 June 1994 were associated with a fall in air temperature and a rise in grass pollen concentration. Non-epidemic asthma was significantly associated with a greater number of environmental changes. This may indicate that the patients with thunderstorm associated asthma were a separate population, sensitive to different environmental stimuli.

Air Pollutants↗

PubMed1996

Community service needs of people with HIV infection in London.

The objectives of this study were to describe the expressed needs for community services of HIV-infected individuals by disease stage, gender and transmission category and the barriers which prevent the receipt of such services. Structured interviewer-administered questionnaires concerning a 6-month retrospective period were used to obtain information on need for community services and problems which prevented the receipt of services. The study sample included 70 homosexual men with asymptomatic HIV disease, 42 homosexual men with symptomatic non-AIDS, 53 homosexual men with AIDS, 23 heterosexual men, 29 heterosexual women, 9 male and 9 female injecting drug users. The main outcome measures were the extent to which needs for community services were met and person/service combinations for which problems or barriers prevented the receipt of community services. On average, subjects expressed a need for 10 categories of community services over the 6-month period: homosexuals expressed a mean of 10, heterosexuals 10, injecting drug users 11, subjects with asymptomatic HIV infection 9, subjects with symptomatic non-AIDS 11, subjects with AIDS 13, men 9 and women 14. A total of 58% of community service needs were always met, 6% were rarely not met, 16% were sometimes not met, 6% were often not met and 14% were not met at all. The extent to which subjects felt that their needs were met was similar for the different study groups, but the needs of women were met somewhat less frequently than those of men. Similarly, people with AIDS felt that their needs were met slightly less often. Reported levels of unmet need were high for a wide range of services. The most common reason subjects gave for not having received a community service for which they expressed a need was ignorance of where or how to obtain the service. This was mentioned in one-third of all such cases. Anxieties over the competence with which a service would be rendered was mentioned in 13% of cases and long waiting times in 11%. The frequencies of unmet need for many community services were high and often seemed to arise either from a lack of awareness on the part of subjects on how and where services could be obtained or from doubts about the relevance of services offered. Both of these barriers should be surmountable through the provision of better information to patients, extending user involvement in service development and the better co-ordination of service delivery through care management approaches.

Adult↗

PubMed1996

The economic costs of caring for people with HIV infection and AIDS in England and Wales.

The objectives of this study were firstly to estimate total lifetime care costs for an individual with HIV/AIDS, and secondly to estimate the total costs of caring people with HIV infection and AIDS in England and Wales between 1992 and 1997 inclusive. Questionnaires and monthly diaries were used to collate data on healthcare utilisation from patients with HIV infection over a 6-month period. These data were then used to estimate the annual total direct costs of care (stratified by disease stage), total lifetime costs of care, and present and future total national care costs for England and Wales. Costing data were obtained from providers of services throughout Greater London. In total, 235 patients with HIV infection were recruited from 2 clinics in Greater London. All costs were calculated in 1992-93 pounds sterling (pound; 1 pound = $US1.58, December 1995). Annual care costs were estimated at 4515 pounds ($US7134) for a person with asymptomatic HIV disease, 8836 pounds ($US13,961) for a person with symptomatic non-AIDS and 15 268 pounds ($US24,123) for a person with AIDS. Lifetime care costs were estimated at 84,522 pounds ($US133,545) per patient. The total costs of care for England and Wales were forecast to increase from 116,627,400 pounds ($US184,271,300) in 1992 to 162,638,100 pounds ($US256,968,200) in 1997. In conclusion, our study further emphasises the continued shift in hospital services from the inpatient sector to the outpatient sector. The importance of community care and informal care, in terms of the associated direct economic costs, is also highlighted. This emphasises the need for close collaboration between different agencies and strategic coordination of services. Finally, the study forecasts an increase in care costs in England and Wales during the 1990s.

Acquired Immunodeficiency Syndrome↗

PubMed1995

Pathologist variation in reporting cervical borderline epithelial abnormalities and cervical intraepithelial neoplasia.

AIMS: To evaluate the interobserver variation in the diagnosis of cervical intraepithelial lesions, including the new category "borderline abnormalities of uncertain significance" (BAUS) which has not been tested before. METHODS: Biopsy specimens of 122 patients were reviewed by five histopathologists and the diagnoses subjected to kappa statistical analysis. RESULTS: There was poor interobserver agreement in all categories, particularly between BAUS and normal tissue. CONCLUSIONS: The current guidelines for the histological diagnosis of cervical intraepithelial neoplasia and BAUS are poorly reproducible.

Biopsy↗

PubMed1995

Cost and utilisation of community services for people with HIV infection in London.

This study aimed to describe the use and costs of community services for HIV-infected people by disease stage, sex and transmission category (homosexual, heterosexual, injecting drug use) by use of a prospective cohort study in which people were followed up for six months. There were two major components; gathering quantitative information on service utilisation from people with HIV infection using two interviewer-administered questionnaires and six self-completed monthly diaries; and estimating the costs of the services provided. People were recruited from two London clinics: the Jefferiss Wing Genito-urinary Medicine (GUM) clinic at St. Mary's Hospital, Paddington, and the Patrick Clements GUM clinic at the Central Middlesex Hospital, Harlesden. Costing data was obtained from providers of community services throughout Greater London. The main outcome measures were contacts per person-year, and costs per person-year, for all community services stratified by service sector. The people studied each made, on average, 139 community service contacts per year at a cost of 2,806 pounds; there was little difference in average utilisation between the three transmission categories. There were differences in both the utilisation of services and costs within the formal and informal sectors for subjects from different disease stages. Although the average number of contacts per person-year were similar for women and men, the total cost of community services was higher for women than for men, reflecting the differences in types of services used. The results indicated a high proportion of total care costs for people with HIV and AIDS is incurred through community-based social care.(ABSTRACT TRUNCATED AT 250 WORDS)

Community Health Services↗