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PubMed1987

A method for estimating lifetime cancer risks from limited epidemiologic data.

Partly because of the poor quality of exposure information on humans, most lifetime carcinogenic risk assessments have been based on animal data. There are, however, surrogate measures for exposure that have not been fully utilized. One of these is duration of exposure where data on mean exposure levels are available. A method is presented for the use of such data, and the method is illustrated by developing a risk assessment from the available epidemiologic literature on gasoline and kidney cancer. This risk assessment is fairly consistent across studies and close to a risk assessment based upon an experiment with rats. While there needs to be much improvement in the quality of environmental data available to epidemiologists, it is possible that a number of risk assessments can be made from existing epidemiologic data and efforts directed away from extrapolation from animal data.

Adult↗
PubMed1987

Epidemiological data on cervical carcinoma relevant to cytopathology.

Epidemiological studies based on cervical cytopathology have aroused widespread interest since it was realized that they could be a useful tool for measuring the effectiveness of screening programs and defining practical measures for the prevention of invasive neoplasms and deaths. In the present article, published evidence from screening programs, cohort investigations and case-control studies is reviewed, and possibilities for further analyses and applications are discussed. In particular, when estimates of the relative protections conveyed by Pap smear from various case-control studies conducted on different populations and using different criteria of selection were pooled, a surprisingly close concordance emerged, with overall risk estimates of invasive cervical cancer of 0.42 for women reporting one smear, and of 0.20 for two or more smears in the past. This protection appeared to be long-lasting in a considerable proportion of cases, since the major determinant of invasive cancer risk was the number of previous smears rather than the interval since last smear, and a noticeable residual effect was evident even more than 10 years after the last smear. Besides providing a measure of the effectiveness of cytological screening and helping define the optimal frequency of screening using the limited resources available, case-control studies should permit accurate estimates of the sensitivity of the test and quantify the probability of transition and the duration of various stages of the neoplastic process, i.e., permit a better understanding of the natural history of the disease.

Carcinoma↗
PubMed1997

[Air pollution in Switzerland--quantification of health effects using epidemiologic data].

Public health costs ascribable to air pollution are socialized in our society. To quantify the damage to public health, epidemiologic studies are needed. We present the methods and epidemiologic background data which form the basis for estimating the public health effect ascribable to air pollution. The figures are presented per 1 million "average" Swiss population and per 10 micrograms/m3 increase in long-term annual mean particulate pollution (PM10). Quantification was restricted to the health effects given below (due to lack of complete data for other effects or to avoid duplicating health effects which may be described by overlapping measurements). In parenthesis we present (1) the mean effect estimates (+/-1 SE) (% increase per 10 micrograms/m3 increment in PM10) derived from national and international epidemiologic studies, and (2) the expected absolute additional health effects (+/-1 SE) per 1 million Swiss population and per 10 micrograms/m3 increment in PM10, based on Swiss population statistics: total mortality (long-term estimates from the 2 US cohort studies) (+4.4% [+/-1.1]/349 [+/-91] premature deaths per year); prevalence of chronic bronchitis in adults (+25% [+8.4]/increase in long-term prevalence by 3,513 [+/-1.475]); bronchitis among children (35% [+/-13]/5,180 [+/-2,590] additional children sufferers in a year); repeated cough among children (+54% [+/-8.8]/23,490 [+/-5,873] additional children per year); cough/phlegm in adults (+12.8% [+/-7.8]/1.56 [+/-1.08] million person-days per year); hospital admissions for respiratory diseases (+1.47% [+/-0.5]/71 [+/-24] additional admissions or 1,104 (+/-390) hospital days); admissions for cardiovascular diseases (+0.9% [+/-0.25]/70 [+19] admissions; 970 (+/-270) hospital days); restricted activity days (+10.5% [+/-0.77]/0.42 [+/-0.03] million person-days); days with asthma attacks among the 6.7% asthmatics (Swiss prevalence) (+5.3% [+/-2.1]/ 240,000 [+/-102,000] additional person-days). Conservative assumptions were used throughout the study and thus the true effects are likely to be larger. Estimates of Swiss population exposure distribution would be needed to apply these results to the entire population. This step, and monetary quantification of these total effects, were the second and third elements (not shown in this report) of this Swiss government funded project. Although individual relative risks of air pollution are rather slight, the public health burden of even moderate pollution may be substantial.

Adult↗
PubMed1998

Analysis of epidemiological data on oral diseases in Nepal and the need for a national oral health survey.

This paper reviews and analyses the results of epidemiological studies on periodontal diseases and dental caries in Nepal and considers the need for additional data on oral diseases for the planning of a national oral health strategy. Almost all subjects aged 12 to 19 years (68-97 per cent) and 35 to 44 years (93-100 per cent) had calculus. The various studies showed that a median 29 per cent of subjects aged 35-44 years had deep periodontal pockets. According to this estimate it can tentatively be concluded that Nepal belongs to the 15 per cent of countries in the world where periodontal conditions of the population are among the worst. An accurate DMFT-value for different age groups at present cannot be estimated due to period and sampling effects. The observed cohort effect over time suggests that caries has increased in the 12-19 years age group in Nepal in the period 1980-1996. The estimated range of DMFT-values for 12 years old children is between 0.6-1.9 and for 35 to 44 years old persons between 2.5-4.0. With these DMFT-values Nepal belongs to the countries with a 'low to very low' caries experience according to the WHO decay rating. The present epidemiological data do not justify a claim for a national oral health survey as a starting point for a national plan of oral health since more accurate data do not add additional value to that planning, particularly not in poor countries as Nepal where the oral health service is still in its infancy.

Adolescent↗
PubMed2001

[Men and health--new epidemiological data from Germany in a summary].

OBJECTIVES: In epidemiological investigations men are often considered and used as the healthy control group. This article aims to provide a detailed overview about health in men. METHODS: Analyses of the indices of health (life expectancy; mortality; state of health) and health-related behaviour (drinking, smoking, and eating behaviour; use of the health system' services) were performed, using data of the German Health Board (1999) and of an health survey in commission of the state (1998) plus data from our own representative investigations of 1994 and 1996. RESULTS: Men, in comparison to women, have a shorter life expectancy as well as a higher mortality rate when suffering from cardiac infarction, lung cancer, traffic accidents, or suicide. In consideration of health-related behaviour, men do smoke and drink more and more frequently than females. In addition, men call on the services of the health system to a lesser extent and deny psychological influences to their health. Effects of age and differences between East and West Germany were obtained. CONCLUSIONS: The presented data can only be explained by a combination of biological, psychological, and sociological perspectives. According to these results, investigations of health-related data should focus more on the difference between men, on the gender-related role of men in different contexts and on the investigation of the sub-group of healthy men.

Adolescent↗
PubMed1991

Ethical issues in sharing epidemiologic data.

Concurrent with the explosion in large data files and computers capable of handling both linkage of large data sets and analyzing multiple studies for meta-analysis, this decade has seen a rise in professional concern about the need for researchers to share their data. As scientific groups began to address this question, its importance and complexity became quickly apparent. In this paper recent developments on the ethics of data sharing in statistics, sociology, psychology, and other fields related to epidemiology are summarized, followed by a discussion on why data should be shared, what kinds of data should be shared, who among epidemiologists should be sharing data, when it is appropriate to share data, and how data sharing should be conducted.

Access to Information↗
PubMed2003

[Unilateral laryngeal paralyses: epidemiological data and therapeutic progress].

OBJECTIVES: Analysis of the epidemiology and progress in treatment of unilateral laryngeal nerve paralysis. METHOD: A retrospective study in a cohort of 325 patients (1989-2001) with unilateral laryngeal nerve paralysis. RESULTS: The sex ratio was 1:2. Age varied from 16 to 98 years (mean age: 55 years). Symptoms included dysphonia in 321 patients, swallowing impairment in 126 patients and dyspnea on exertion in 3 patients. Etiologies were post-surgical (243 patients) predominantly thyroid and thoraco-mediastinal surgery, idiopathic (39 patients), tumoral (28 patients), non-surgical traumatism (8 patients) and medical causes (7 patients). The paralysis was globally related to a neoplastic disease in 50% of cases. Analysis of the evolution of the etiologies over time revealed an increase in the post surgical causes and paralysis related to a neoplastic diseases. Spontaneous recovery of unilateral laryngeal nerve paralysis occurred in 23% of patients. Surgical rehabilitation was performed in 44% of patients (thyroplasty under local anesthesia in 55 patients and intracardal injection under general anesthesia in 88 patients). The analysis of the evolution of treatment modalities showed: an increasing number of patients undergoing surgical rehabilitation, an increasing number of patients undergoing surgery under local anesthesia (thyroplasty) and an increasing number of patients refusing any surgical rehabilitation. CONCLUSION: Analysis of the data underlined the changes in the distribution of the etiologies and treatments of unilateral laryngeal nerve paralysis.

Academic Medical Centers↗
PubMed1991

[Clinical epidemiologic data of malignant melanoma based on 1,368 patients of the Graz University Dermatology Clinic (1970-1989)].

Epidemiological and histological data of 1368 patients with invasive malignant melanoma treated at the Department of Dermatology between 1970 and 1989 were analysed retrospectively. Frequency of melanoma increased from 103 cases between 1970 and 1974 to 593 between 1985 and 1989. The male/female ratio was 1/1.5 and did not change during the study period. Mean age of patients at the time of primary operation was 56.1 years and was approximately the same for males and females (males 55.8, females 56.3 years). The predominant site was the trunk in males (58.7 per cent) and the lower leg in females (41.6 per cent). There was a relative increase of melanomas of the back in males and the lower leg in females at the expense of melanomas of the face. The Breslow index was significantly higher in males than in females. In patients older than 69 years, the proportion of thick melanomas was above average. During the study period, the frequency of thick melanomas (greater than 1.5 mm) showed an encouraging decrease in both sexes. In 1989, 50 per cent of all melanomas were thinner than 1.01 mm. This can be interpreted as a successful outcome of efforts in preventive medicine.

Adult↗
PubMed2003

Use of psychometric techniques in the analysis of epidemiologic data.

PURPOSE: This article demonstrates techniques for developing reliable multi-item scales for analysis of complex public health data. METHODS: Information from a questionnaire designed to evaluate the acceptability and efficacy of the female condom as a method for STD/HIV prevention was summarized using psychometric analysis. 1159 high-risk women attending STD clinics participated in this study. Questionnaire items were designed to measure nine domains of predictors of condom use. RESULTS: Principal components analysis was employed to reduce the number of potential predictors. Reliability of the multiple-item scales was assessed using Cronbach's alpha. Pearson's correlation coefficients were calculated to evaluate collinearity among multi-item scales. Approximately half (51%) of the questionnaire items that were analyzed were retained in the final scales. Data reduction procedures identified several multi-item scales with acceptable reliability (Cronbach's alpha >0.70). The correlation coefficients between scales was never >.5, suggesting that there was little collinearity among the scales. CONCLUSIONS: When focused on multiple partially interdependent determinants of an outcome, data reduction decreases the number of independent variables to be evaluated, ensures they have adequate reliability, maximizes strength of their association with outcomes, and reduces collinearity among predictors.

Adolescent↗