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Biomedical subjects

H Rolka

Publications and source records attributed to H Rolka.

At least 19 recordsLinked to original sources
PubMed2005

BioSense: implementation of a National Early Event Detection and Situational Awareness System.

BioSense is a CDC initiative to support enhanced early detection, quantification, and localization of possible biologic terrorism attacks and other events of public health concern on a national level. The goals of the BioSense initiative are to advance early detection by providing the standards, infrastructure, and data acquisition for near real-time reporting, analytic evaluation and implementation, and early event detection support for state and local public health officials. BioSense collects and analyzes Department of Defense and Department of Veterans Affairs ambulatory clinical diagnoses and procedures and Laboratory Corporation of America laboratory-test orders. The application summarizes and presents analytical results and data visualizations by source, day, and syndrome for each ZIP code, state, and metropolitan area through maps, graphs, and tables. An initial proof of a concept evaluation project was conducted before the system was made available to state and local users in April 2004. User recruitment involved identifying and training BioSense administrators and users from state and local health departments. User support has been an essential component of the implementation and enhancement process. CDC initiated the BioIntelligence Center (BIC) in June 2004 to conduct internal monitoring of BioSense national data daily. BIC staff have supported state and local system monitoring, conducted data anomaly inquiries, and communicated with state and local public health officials. Substantial investments will be made in providing regional, state, and local data for early event detection and situational awareness, test beds for data and algorithm evaluation, detection algorithm development, and data management technologies, while maintaining the focus on state and local public health needs.

Bioterrorism↗
PubMed2005

Implementation of laboratory order data in BioSense Early Event Detection and Situation Awareness System.

INTRODUCTION: Laboratory test orders constitute an early outbreak data source. CDC receives laboratory order data in HL7 format from the Laboratory Corporation of America (LabCorp) and plans to use the data in the BioSense Early Event Detection and Situation Awareness System. METHODS: These LabCorp data contain information on tests ordered and include the type of test ordered and the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)-coded reasons for the order. A consensus panel was formed to group test orders on the basis of expert opinion into eight standard syndrome categories to provide an additional data source for early outbreak detection. A laboratory order taxonomy was developed and used in the mapping consolidation phase. The five main classes of this taxonomy are miscellaneous functional tests, fluid screening tests, system-specific tests, tests for specific infections (by primary manifestation), and tests for specific noninfectious diseases. RESULTS: Summary of numbers of laboratory order codes in each syndrome category are fever (53), respiratory (53), gastrointestinal (27), neurological (35), rash (37), lymphadenitis (20), localized cutaneous lesion (11), and specific infection (63). CONCLUSION: With the daily use of laboratory order data in BioSense, the actual distribution of laboratory order codes in syndrome groups can be evaluated, allowing modification of the mapping.

Clinical Laboratory Information Systems↗
PubMed2005

Deciphering data anomalies in BioSense.

INTRODUCTION: Since June 2004, CDC's BioIntelligence Center has monitored daily nationwide syndromic data by using the BioSense surveillance application. OBJECTIVES: The BioSense application has been monitored by a team of full-time CDC analysts. This report examines their role in identifying and deciphering data anomalies. It also discusses the limitations of the current surveillance application, lessons learned, and potential next steps to improve national syndromic surveillance methodology. METHODS: Data on clinical diagnoses (International Classification of Diseases, Ninth Revision, Clinical Modifications [ICD-9-CM]) and medical procedures (CPT codes) are provided by Department of Veterans Affairs and Department of Defense ambulatory-care clinics; data on select sales of over-the-counter health-care products are provided by participating retail pharmacies; and data on laboratory tests ordered are provided by Laboratory Corporation of America, Inc. All data are filtered to exclude information irrelevant to syndromic surveillance. RESULTS: During June-November 2004, of the approximately 160 data anomalies examined, no events involving disease outbreaks or deliberate exposure to a pathogen were detected. Data anomalies were detected by using a combination of statistical algorithms and analytical visualization features. The anomalies primarily reflected unusual changes in either daily data volume or in types of clinical diagnoses and procedures. This report describes steps taken in routine monitoring, including 1) detecting data anomalies, 2) estimating geographic and temporal scope of the anomalies, 3) gathering supplemental facts, 4) comparing data from multiple data sources, 5) developing hypotheses, and 6) ruling out or validating the existence of an actual event. To be useful for early detection, these steps must be completed quickly (i.e., in hours or days). Anomalies described are attributable to multiple causes, including miscoded data, effects of retail sales promotions, and smaller but explainable signals. CONCLUSION: BioSense requires an empirical learning curve to make the best use of the public health data it contains. This process can be made more effective by continued improvements to the user interface and collective input from local public health partners.

Bioterrorism↗
PubMed2005

Indoor air studies of fungi contamination of social welfare home in Czerewki in north-east part of Poland.

PURPOSE: The contamination of the indoor environment with yeast-like fungi and moulds in social welfare home in Czerewki was evaluated. MATERIAL AND METHODS: The concentration of airborne fungi (in front of the building and in the corridors, patient rooms, study rooms, recreation rooms, kitchens, bathrooms, toilets) was determined using SAS-Super 100 (Pbi International). The fungal concentration on walls was assessed using the Count-Tact applicator and the plate Count-Tact irradiated (BioMerieux). Swabs were taken from the skin of the interdigital spaces of feet and hands, nails and the oral cavity of the residents. The fungi from the swabs were cultured on Sabouraud medium. Fungi were identified using standard microbial procedures. RESULTS: Tests of air and walls revealed significant differences in mycological flora in depending on the place isolation (e.g. corridor, rooms, reading room, nurse, room, kitchen, dining room, bathroom) and season (summer, autumn, winter, spring). A significant increase in the fungi isolated from the air and walls in the social welfare home was found, depending on the season. CONCLUSION: An increase in the fungi isolated from residents was found in relation to the season.

Air Pollution, Indoor↗
PubMed2005

The education of patients with rheumatoid arthritis--the knowledge and expectation of patients-the opinions of rheumatology nurses.

Rheumatoid arthritis (RA) is a chronic, progressive, immunologically dependent, systemic diseases of connective tissue, leading to disability, cripplehood or even premature death. Helping to improve the quality of life of RA patients involves teaching them how to cope with disease-related problems of everyday life, with stress and with suffering. The aim of the presented work is to determine the following: the patients' level of knowledge about rheumatoid arthritis; their educational needs; the impact of the level of knowledge on the patients' pro-health behaviours; the knowledge of nurses and their ability to recognize patients' problems; the nurse's tasks in preparing an RA patient for self-care. The subject group consisted of patients with RA diagnosed according to The American Rheumatism Association criteria and nurses from rheumatology clinics and wards. The research method used was a survey questionnaire, which had been constructed for the purpose of the research. The research results indicate a great need of patients, especially those with early rheumatoid arthritis, for education, support and help in adaptation. At the same time, the nurses, even though they do not fully fulfil their educational role, declare a willingness to participate in organized forms of health education.

Arthritis, Rheumatoid↗
PubMed2005

The importance of the health education in life quality improvement in patients with psoriasis.

PURPOSE: The aim of the study was to determine the influence of the psoriatic patient knowledge of the disease on the quality of life. MATERIAL AND METHODS: The study was carried out in 149 patients with psoriasis. All patients answered on anonymous questionnaire, in according to Psoriasis Disability Index (PDI). RESULTS: Almost 43% patients could not show any factor which provoked their disease, 31.5% could not tell any recommendations for cure and care of the psoriatic lesions and 32.2% patients could not point out any methods to avoid psoriatic lesions spread. Almost 60% of the group admitted that their quality of life fell because of the disease. At the same time, patients who did not have enough information concerning the disease had lower quality of life index. CONCLUSIONS: The level of the disease knowledge in the patients with psoriasis influences their quality of live. Therefore it is indicated for the patiens and their families to be involved in the proper educational program.

Adult↗
PubMed2000

Antimicrobial resistance of nasopharyngeal isolates of Streptococcus pneumoniae and Haemophilus influenzae from children in the Central African Republic.

BACKGROUND: To assist the Central African Republic (CAR) develop national guidelines for treating children with pneumonia, a survey was conducted to determine antimicrobial resistance rates of nasopharyngeal isolates of Streptococcus pneumoniae (SP) and Haemophilus influenzae (HI). Secondary purposes of the survey were to identify risk factors associated with carriage of a resistant isolate and to compare the survey methods of including only children with pneumonia vs. including all ill children. METHODS: A cross-sectional survey of 371 ill children was conducted at 2 outpatient clinics in Bangui, CAR. RESULTS: In all 272 SP isolates and 73 HI isolates were cultured. SP resistance rates to penicillin, trimethoprim-sulfamethoxazole (TMP-SMX), tetracycline and chloramphenicol were 8.8, 6.3, 42.3 and 9.2%, respectively. All penicillin-resistant SP isolates were intermediately resistant. HI resistance rates to ampicillin, TMP-SMX and chloramphenicol were 1.4, 12.3 and 0%, respectively. The most common SP serotypes/groups were 19, 14, 6 and 1; 49% of HI isolates were type b. History of antimicrobial use in the previous 7 days was the only factor associated with carriage of a resistant isolate. Resistance rates were similar among ill children regardless of whether they had pneumonia. CONCLUSIONS: Resistance rates were low for antimicrobials recommended by the World Health Organization for children with pneumonia. We recommended TMP-SMX as the first line treatment for pneumonia in CAR because of its low cost, ease of dosing and activity against malaria.

Carrier State↗
PubMed1999

Cluster of postinjection abscesses related to corticosteroid injections and use of benzalkonium chloride.

Benzalkonium chloride (BC) is an unreliable disinfectant. A matched case-control study and environmental investigation were conducted to determine the cause of and risk factors for a cluster of postinjection abscesses at a private medical clinic where BC was used as a disinfectant. Twenty-eight case-patients who had an abscess at the injection site were matched with 126 control patients who had received an intramuscular injection at the clinic on the same day. Risk factors for abscess development in a multivariable logistic model were corticosteroid injection and being female. All case-patients had received a corticosteroid injection from a multidose vial. Cultures of abscesses from 20 of 23 case-patients grew Pseudomonas aeruginosa. Cultures of BC prepared at the clinic also grew P aeruginosa, suggesting that BC was the source of infection. Injection site cleaning with BC did not appear to be the route of infection since use of BC at the time of injection was not associated with abscess development. A more likely route of infection was injection of contaminated corticosteroid from multidose vials that could have been inoculated with pseudomonads via needle puncture after vial septa were wiped with contaminated BC. Benzalkonium chloride should not be used to clean injection vial septa or injection sites.

Abscess↗
PubMed1997

Reliability of reported age at menopause.

Age at menopause is an important epidemiologic characteristic whose reliability of reporting in the US population is not known. The authors examined four hypotheses about the reliability of reported age at menopause in the United States: 1) women with hysterectomy-induced menopause more reliably report their age at menopause than women who have undergone natural menopause; 2) reliability declines with time since menopause; 3) reliability declines with age; and 4) women with higher educational levels report their age at menopause more reliably than women with less education. The authors used linear regression models among 2,545 women in the First National Health and Nutrition Examination Survey and Followup Study (1971-1984) and compared responses at first and follow-up interviews. Among women who had undergone a natural menopause, 44% reported their age at menopause within one year from the first to second interviews; among women who had undergone a hysterectomy-induced menopause, 59% reported their age at menopause within one year from first to follow-up interviews. Only hysterectomy status and years from menopause to follow-up interview were significantly associated with the absolute difference between age at menopause reported at first and follow-up interviews. The authors conclude that caution in studies involving age at menopause may enhance our understanding of this critical event in the lives of women.

Adult↗
PubMed1996

Episodic versus prophylactic infusions for hemophilia A: a cost-effectiveness analysis.

OBJECTIVE: To assess the incremental cost-effectiveness of prophylactic compared with episodic care in boys with severe hemophilia A. SETTING: Eleven U.S. hemophilia treatment centers. METHODS: Charge data from a randomly selected cohort of 70 boys receiving episodic infusions for bleeding events and from all 27 boys receiving infusions prophylactically were collected from documents obtained from the hemophilia treatment centers during a period of approximately 2 years. Published and public sources were used for conversion to cost, lifetime earnings, and earnings losses from disability. A model was constructed for a hypothetical patient from ages 3 to 50 years by means of three infusion scenarios. RESULTS: The cohort receiving prophylactic treatment had fewer bleeding events each year (median, 3 vs 31) but used more concentrate (3323 vs 1015 units/kg per year). Factor VIII concentrate accounted for more than 93% of the cost of both episodic and prophylactic care. Compared with episodic infusion, prophylaxis from ages 3 to 20 years costs $1100 per bleeding event prevented, in comparison with $1380 for prophylaxis from ages 3 to 50 years. The total cost of prophylactic care from ages 3 to 50 years would equal the current total cost of episodic care if the price of the concentrate were decreased by 50%. CONCLUSION: Prophylactic care markedly reduces the number of bleeding events and should prevent joint function impairment, but at substantial cost.

Adolescent↗
PubMed1996

An outbreak of viral gastroenteritis in a nursing home: importance of excluding ill employees.

BACKGROUND: In May 1994, 43 persons in a nursing home were reported with gastroenteritis. An outbreak investigation was conducted to determine risk factors for gastroenteritis among residents and staff. METHODS: Data were analyzed using contingency tables; relative risks (RR) and statistical significance were determined with Fisher's Exact Test. The chi-squared statistic to perform a goodness of fit test for the binomial distribution was used to determine whether cases occurred randomly and independently of each other. Stools were tested for bacterial enteric pathogens, ova, and parasites and were examined by electron microscopy, Southern hybridization, and reverse transcription-polymerase chain reaction. Paired sera were collected to detect fourfold rises in antibody titer by enzyme immunoassay against Norwalk viruses. RESULTS: Of 121 residents, 62 (51%) had gastroenteritis, as did 64 (47%) of the 136 staff. The index case was a nurse who became ill at work and continued to work, while symptomatic, for another 2 days. Only residents who had received medications from this nurse between May 17 and May 20 became ill on the first day of the outbreak (13 of 35 versus 0 of 5). Nurses and nurse aides were more likely than employees without direct resident contact to be cases (46 of 68 versus 18 of 58; RR, 2.18; P < .001). Bacterial stool cultures and parasite examinations were negative. Results of electron microscopy, polymerase chain reaction with Southern hybridization, and enzyme immunoassay indicated the causative agent was a small, round, structured virus similar to the Snow Mountain Agent. CONCLUSION: To minimize outbreaks in nursing homes, we recommend that ill staff be excluded from work until symptoms resolve.

Adult↗
PubMed1996

Epidemic Salmonella enteritidis infection in Los Angeles County, California. The predominance of phage type 4.

Between April and July 1994, 501 cases of Salmonella enteritidis infection were reported in Los Angeles County, California, nearly 5 times the number reported between April and July 1993; of these, 422 (84%) were sporadic (not related to known outbreaks). A case-control study was done to determine risk factors for sporadic illness; the distribution of S enteritidis phage types was evaluated. Case-patients (n = 58) were county residents older than 1 year with culture-confirmed S enteritidis infection in August 1994. One to two acquaintance controls (n = 98) were matched to each case by age, sex, and race. Two risk factors-eating raw or undercooked eggs (matched odds ratio [MOR] = 6.6; 95% confidence interval [CI] = 1.9, 23.0) and eating in restaurants (MOR = 4.9; 95% CI = 1.2, 19.4) in the 3 days before the onset of illness-remained significant in the conditional logistic regression model. Of 16 randomly selected S enteritidis case-isolates, 15 (94%) were phage type 4. The reasons for the regional predominance of phage type 4, an S enteritidis subtype recently associated with large and destructive increases in salmonellosis among poultry and humans in Britain and much of Europe, are unclear. To minimize human S enteritidis infection, food service workers need frequent training in the proper handling of raw foods, eggs should be kept refrigerated during distribution and storage, and eggs should be cooked until the yolk is firm, particularly for persons at the greatest risk for serious illness: pregnant women, elderly persons, and those with compromised immune systems. Clinicians should obtain stool specimens for culture from patients who present with diarrhea and fever or bloody diarrhea or who are possibly part of an outbreak.

Adolescent↗
PubMed1987

[Computer analysis of peripheral pulse curves].

The methodical fundaments as well as the technical solutions for a technique of the computerized analysis of non-invasively registered peripheral arterial pulse curves are demonstrated. Hereby a quantitative analysis of the pulse curves using new and significant evaluation parameters is performed as well as a reference to the probability diagnosis for the total estimation of the pulse curve is given. The technique is realised in form of a mobile microcomputer measuring place and allows an automatic registration, evaluation documentation and recording of rheograms and pulse oscillograms, respectively immediately at the patient's bed and is suited for a broad application in the angiological preliminary and special diagnostics.

Computers↗
PubMed1983

Immune response to hepatitis B vaccine in newborns.

Three injections of 10 microgram/ml hepatitis B vaccine (Merck) given in the first week after birth, a month later and again at the age of six months to 63 neonates in a rural African population, elicited an antibody response in 93 per cent. The initial hepatitis B marker status of the babies and mothers did not influence the results at nine months. Side-effects were minor and we conclude that the vaccine can effectively and safely be used from birth in endemic situations.

Female↗
PubMed1983

[Results of a computer-based analysis of peripheral pulse waves in arterial occlusive diseases of the lower extremity].

A system of data acquisition and computer analysis for pulse wave measurements, realized by means of electronic oscillography (Boucke-Brecht system) or impedance rheography, is described. The system includes: 1. Computer-compatible data acquisition and registration 2. Conversion of data into digital form 3. Data processing and evaluation of parameters 4. Classification. Records are taken from equivalent points of left and right lower extremities. Computer analysis is performed off-line using a small computer (TPA-i). The computer program evaluates the following parameters: 1. Time intervals and amplitudes of pulse propagation time, inclinations, crest time, peak width, maximum and minimum of dicrotic wave 2. Areas between pulse curve and baseline 3. Extremes of 1st and 2nd derivates for the dynamic characterization of signal 4. Fourier coefficients All parameters are computed for 12 single pulse cycles and finally averaged, printed out, and stored in a data bank. The diagnostic significance of all these parameters was examined and evaluated for separation of normal and pathological curves. With linear discriminance analysis a correct classification of about 90% was obtained. Advantages of computer analysis are: 1. Time-consuming visual evaluation is avoided. 2. Accuracy and reliability of diagnosis are improved. 3. Additional parameters offer more diagnostic information. Further investigations are directed toward reducing the number of parameters and developing an efficient screening method for early diagnosis of peripheral arterial obstructions.

Arterial Occlusive Diseases↗
PubMed1977

[Universal measurement site for the processing-oriented recording of cardiovascular data].

A measuring place is described for the registration of standardized, evaluable by means of the computer deviations of bioelectric signals (parameters of heart and circulation, peripheral pulse curves and rheogramms). The high demands which concern the adequate establishment measuring places with regard to quality and comfort of attendance and condition corresponding technical solutions are explained. At the instance of the rheogram the mode of function is described. A short prognosis on the trend of development in the recognition of biological measuring values is given.

Cardiovascular Diseases↗
PubMed1977

[Experience in the use of Smith's ECG evaluation program].

After the experiences with the use of the programme of Pipberger concerning the automatised ECG-analysis in clinic, outpatient department and factory public health, which were made at the Medical Academy Erfurt during the last years, at this time comparative examinations with the ECG-analysis programme of Smith were performed. The intake of data (3 orthogonal leads) is done by means of a data establishing unit developed by us. For the analog-digital-changing, the pretreatment of data and the transmission of the ECG-data on the digital magnet tape a process-calculator TPA-i is used. The analysis is performed by the computer Robotron 21. The evaluation of the results shows that, when a great number of patients is examined, normal curves are correctly estimated at 100%. The recognition rate of pathological curves has with 79.5% about the same size as the visual judgment. The deficiencies of the diagnostic programme of Smith must be essentially found in the relatively high proportion of falsely negative findings, the insufficient differentiation of the changes of the chamber variation, in the sometimes incorrect formation, why the classification of the curves in individual groups was performed. On account of the certain centage of falsely negative ones the programme is well recognition of normal findings and the tolerable pernotion of the diagnosis and the sometimes lacking insuited for screening examinations.

Diagnosis, Computer-Assisted↗