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S B Thacker

Publications and source records attributed to S B Thacker.

At least 19 recordsLinked to original sources
PubMed1996

Surveillance in environmental public health: issues, systems, and sources.

This article describes environmental public health surveillance and proposes a framework to enhance its practice in the United States. Special issues for surveillance in environmental public health are examined, and examples of existing systems useful for environmental public health practice are provided. Current and projected surveillance needs, as well as potential sources of data, are examined. The proposed framework for conducting environmental public health surveillance involves data from three points in the process by which an agent in the environment produces an adverse outcome in a host: hazards, exposures, and outcomes. Environmental health practitioners should build on efforts in other fields (e.g., infectious diseases and occupational health) to establish priorities in the surveillance of health conditions associated with exposure to environmental toxicants. For specific surveillance programs, existing data systems, as well as data gaps, should be identified. Coordinated surveillance systems can facilitate public health efforts to prevent and control disease, injury, and disability related to the interaction between people and their environment.

Environmental Exposure↗
PubMed1995

Efficacy and safety of intrapartum electronic fetal monitoring: an update.

OBJECTIVE: To compare the efficacy and safety of routine electronic fetal monitoring (EFM) of labor with intermittent auscultation, using the results of published randomized controlled trials (RCTs). DATA SOURCES: We identified RCTs by searching the MED-LINE data base for the period 1966-1994, contacting experts, and reviewing published references. METHODS OF STUDY SELECTION: Our search identified 12 published RCTs addressing the efficacy and safety of EFM; no unpublished studies were found. The studies included 58,855 pregnant women and their 59,324 infants in both high- and low-risk pregnancies from ten clinical centers in the United States, Europe, Australia, and Africa. DATA EXTRACTION AND SYNTHESIS: Data were abstracted, and their accuracy was confirmed independently. A single reviewer assessed study quality based on criteria developed by others for RCTs. Data reported from similar studies were used to calculate a combined risk estimate for each of nine outcomes. Overall, a statistically significant decrease was associated with routine EFM for a 1-minute Apgar score less than 4 (relative risk [RR] 0.82, 95% confidence interval [CI] 0.65-0.98) and neonatal seizures (RR 0.5, 95% CI 0.30-0.82). The protective effect of EFM for a 1-minute Apgar score less than 4 was apparent only in the non-United States studies, and the protective effect for neonatal seizures was evident only in studies with high-quality scores. No significant differences were observed in 1-minute Apgar scores less than 7, rate of admissions to neonatal intensive care units, and perinatal death. An increase associated with the use of EFM was observed in the rate of cesarean delivery (RR 1.33, 95% CI 1.08-1.59) and total operative delivery (RR 1.23, 95% CI 1.15-1.31). Risk of cesarean delivery was greatest in low-risk pregnancies. CONCLUSION: The only clinically significant benefit from the use of routine EFM was in the reduction of neonatal seizures. Because of the increase in cesarean and operative vaginal deliveries, the long-term benefit of this reduction must be evaluated in the decision reached jointly by the pregnant woman and her clinician to use EFM or intermittent auscultation during labor.

Female↗
PubMed1994

Future directions for comprehensive public health surveillance and health information systems in the United States.

The authors describe a comprehensive system for public health surveillance for the United States based on a network of data systems ranging from population surveys and physician-based records to electronically linked laboratory and administrative data. They also discuss traditional uses of surveillance data, legal and ethical issues associated with using data from any surveillance system (particularly the tension between individual privacy and the public right to a healthful environment), and factors impeding the development of a comprehensive system. Just as provisional data on notifiable diseases are critical in protecting communities from disease, data from other information systems should be applied to prevention practice with the same urgency. The major barriers to a successful comprehensive, nationwide, integrated public health surveillance and information system are a lack of appreciation for the value of high-quality provisional surveillance data and a weak societal commitment to public health.

Confidentiality↗
PubMed1994

Infectious diseases in competitive sports.

OBJECTIVE: Participation in competitive sports is popular and widely encouraged throughout the United States. Reports of infectious disease outbreaks among competitive athletes and recent publicity regarding infectious disease concerns in sports underscore the need to better characterize the occurrence of these problems. DATA SOURCES: To identify reports of infectious diseases in sports, we performed a comprehensive search of the medical literature (MEDLINE) and newspaper databases in two on-line services (NEXIS and DIALOG PAPERS). STUDY SELECTION: Articles selected from the literature review included those describing cases or outbreaks of disease in which exposure to an infectious agent was likely to have occurred during training for competitive sports or during actual competition. Articles from the newspaper review included reports of outbreaks, exposures, or preventive measures that directly or indirectly involved teams or spectators. DATA SYNTHESIS: The literature review identified 38 reports of infectious disease outbreaks or other instances of transmission through person-to-person (24 reports), common-source (nine reports), or airborne (five reports) routes; the newspaper search identified 28 reports. Infectious agents included predominantly viruses but also a variety of fungi and gram-positive and gram-negative bacteria. CONCLUSIONS: Our findings indicate that strategies to prevent transmission of infectious diseases in sports must recognize risks at three levels: the individual athlete, the team, and spectators or others who may become exposed to infectious diseases as a result of sports-related activities. Team physicians and others who are responsible for the health of athletes should be especially familiar with the features of infectious diseases that occur in sports and measures for the prevention of these problems.

Communicable Disease Control↗
PubMed1994

Breast cancer risk and duration of estrogen use: the role of study design in meta-analysis.

Recent meta-analyses of studies of the risk of breast cancer associated with hormone replacement therapy agree that little risk is associated with ever-use or short-term use of estrogen replacement. These analyses disagree, however, about the effect of long-duration estrogen use. To understand differences in the findings among the meta-analyses of the effect of long-term use, we investigated the source of heterogeneity among the included studies. We analyzed subgroups by source of controls (community vs hospital), study design (case-control vs follow-up), and types of estrogen. We also examined the effect of modeling assumptions: that before women began estrogen use, those who chose to use estrogen replacement (1) were, or (2) were not, at substantially different risk from those who chose not to use estrogen. We found a small increase in risk in all subgroups of studies except those that used hospital controls. From a homogeneous group of case-control studies using community controls that analyzed the effect of conjugated equine estrogens, we estimated that the risk of breast cancer after 10 years of estrogen use increased by at least 15% and up to 29%.

Breast Neoplasms↗
PubMed1994

Relative risks and benefits of long-term estrogen replacement therapy: a decision analysis.

OBJECTIVE: To evaluate the relative risks and benefits of exogenous estrogen use among women entering the climacteric and to consider estrogen use for relief of symptoms or prevention of disease. METHODS: Decision analysis was used to assess the value of estrogen replacement therapy in a hypothetical cohort of 10,000 women assumed to be age 50 years; health outcomes were extrapolated to age 75. Risk ratios for mortality and morbidity of health outcomes associated with the use of estrogen replacement therapy were based on longitudinal studies reported in the literature. RESULTS: Estrogen use for 25 years would decrease fatal coronary heart disease events by 48% (567 cases), decrease deaths from hip fracture by 49% (75), increase deaths from breast cancer by 21% (39), and increase deaths from endometrial cancer by 207% (29 excess deaths). On balance, 25 years of estrogen replacement therapy in a cohort of 10,000 women would prevent 574 deaths. Further, women using estrogens for 25 years would gain 3951 quality-adjusted life years compared with women not using estrogens. Sensitivity analysis suggests that the benefits of estrogen replacement therapy outweight the risks under most assumptions. CONCLUSION: In a hypothetical, population-based analysis, the health benefits of postmenopausal estrogen replacement exceed the health risks incurred. Nevertheless, clinicians must still evaluate each individual's risks and needs.

Aged↗
PubMed1993

A Bayesian approach to the detection of aberrations in public health surveillance data.

The accurate and timely detection of unusual patterns in data from public health surveillance systems presents an important challenge to health workers interested in early identification of epidemics or clues to important risk factors. We apply the Kalman filter, a Bayesian method, to public health surveillance data collected in the United States to illustrate a methodology used to detect sudden, sustained changes in reported disease occurrence, changes in the rate of change of health event occurrence, as well as unusual reports or outliers. The method allows use of information external to reported data in forecasting expected numbers, information such as expert judgment, changes in case definition or reporting practices, or changes in the health event process. Results show good agreement with epidemiologically established patterns beginning early in the data series and demonstrated usefulness on a relatively short series. Because the method is unfamiliar to most practicing epidemiologists in public health, it should be compared with other techniques and made more "user-friendly" before general application.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Infectious diseases and injuries in child day care. Opportunities for healthier children.

OBJECTIVE: To provide pertinent background information on infectious diseases and injury in child day care and outline measures to address these health care needs. DESIGN: We reviewed published English-language literature identified through a MEDLINE bibliographic search, major literature summaries, and bibliographies from identified articles. SETTING: Child day-care settings reviewed included family child care homes, centers, special facilities for ill children, and facilities for children with special needs. PATIENTS OR OTHER PARTICIPANTS: Primarily children in a variety of day-care settings, often compared with children cared for at home. MAIN OUTCOMES: The occurrence of outbreaks and illness related to infectious disease and injury. RESULTS: Compared with preschool-aged children reared at home, among children in day care the risk of some infectious diseases was two to four times greater. Rates of both intentional and unintentional injuries in day-care settings were somewhat lower than those for children cared for at home. CONCLUSIONS: Because preschool-aged children spend increasing time in structured day-care settings, the risk for some infectious diseases has increased. At the same time, child day-care settings present opportunities for ensuring healthier children through enhanced development, safer environments, better nutrition, increased vaccination coverage, and health promotion.

Child Abuse↗
PubMed1992

The role of public health surveillance: information for effective action in public health.

Public health surveillance can provide the quantitative information needed for setting priorities and establishing rational health policy. Although there are many examples of the effective use of such information, the full potential for surveillance has not yet been realized. To a large degree, failure to achieve this potential has resulted from limited perspectives regarding the role and conduct of surveillance. Both practitioners (those who conduct surveillance) and users (those who apply surveillance data in a real-world setting) have fallen victim to such myopia. Public health surveillance must be advocated as an essential part of the global health agenda if we are to achieve international goals for improving health status. As we improve our appreciation of the variety of uses for public health surveillance data, we need to understand more fully the determinants of the decision-making process. Effective dissemination of information and effective communication are as important as data collection and analysis. No longer do we have--or should we have--the luxury of collecting information for its own sake. The information collected must have a demonstrated utility. Developing and training personnel to have expertise in public health surveillance will necessarily incur opportunity costs. Bridging gaps in data methodology and coverage will force us to weigh alternatives and to compromise. We hope that the International Symposium on Public Health Surveillance will accomplish several goals. First, we wish to foster international understanding of the definition, role, and importance of surveillance in reducing morbidity and mortality, in improving quality of life, and in setting effective health priorities. Second, we hope that this symposium will serve as a springboard for identifying issues and topics that can be addressed in greater depth at future international meetings. Finally, we see the symposium as an essential step in developing a firm commitment on the part of countries, donor agencies, and multilateral organizations to develop the essential capacity for public health surveillance throughout the world. Each country should have the capacity to measure and monitor changes in health status, risk factors, and health-service access and utilization among its people. All countries should have the means to detect emerging health problems and implement measures for their control, to evaluate the impact of health policies and programs, and to communicate health information in a meaningful fashion to policymakers and the public. If we are successful in these endeavors, the long-term effects on the public's health will be well worth the struggle required to achieve them.(ABSTRACT TRUNCATED AT 400 WORDS)

Global Health↗
PubMed1991

The role of home environment in infant diarrhea in rural Egypt.

In 1982 and 1983, a descriptive environmental survey was conducted in 317 households with newborn infants in rural Bilbeis, Egypt. The incidence of infant diarrhea in these households was ascertained by twice-weekly home visits for a 1-year period (1981-1982). Using univariate and multivariate analyses, the authors identified household factors that were statistically associated with infant diarrhea incidence, including number of children in the house under 4 years of age; number of persons per household; incidence of diarrhea in other family members; having a dirt (vs. concrete) dining room floor; having multiple living areas in the house; having a house or roof in need of repair; using well water rather than tap water for cooking or bathin; the absence of a sewer for waste bathwater; food being left out at room temperature between meals; and having many rodents in the house. Two practices involving interaction with the environment appeared to be protective: butchering of cattle by the family for home consumption, and protection of the infant from flies by a veil during napping. The combined household variables explained 25% of the variance in the total incidence of diarrhea. Categories of variables that accounted for most of the total variance explained by environmental factors are, in decreasing order: house structure (28%); water usage (24%); toilet and bathing area (12%); animal management (11%); food preparation area (10%); hygiene (8%); and wastewater management (6%). This approach may be useful in identifying environmental characteristics whose change would reduce diarrheal illness among infants.

Abattoirs↗
PubMed1991

A meta-analysis of the effect of estrogen replacement therapy on the risk of breast cancer.

To quantify the effect of estrogen replacement therapy on breast cancer risk, we combined dose-response slopes of the relative risk of breast cancer against the duration of estrogen use across 16 studies. Using this summary dose-response slope, we calculated the proportional increase in risk of breast cancer for each year of estrogen use. For women who experienced any type of menopause, risk did not appear to increase until after at least 5 years of estrogen use. After 15 years of estrogen use, we found a 30% increase in the risk of breast cancer (relative risk, 1.3; 95% confidence interval [CI], 1.2 to 1.6). The increase in risk was largely due to results of studies that included premenopausal women or women using estradiol (with or without progestin), studies for which the estimated relative risk was 2.2 (CI, 1.4 to 3.4) after 15 years. Among women with a family history of breast cancer, those who had ever used estrogen replacement had a significantly higher risk (3.4; CI, 2.0 to 6.0) than those who had not (1.5; CI, 1.2 to 1.7).

Adult↗