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PubMed1989

[Sudden cerebrovascular accidents in the District of Martin. The clinical picture and epidemiologic data].

The authors investigated stroke morbidity (incidence, prevalence) and mortality, established register, and analyzed the epidemiological situation of this disease in the Martin district. Precondition for this study has been in 35 years neurological following the stroke patients at four neurological out-patients departments of the district and their hospitalization at the Neurological Clinic in Martin. During the period from 1983-1986 559 patients with an average age of 64.1 +/- 12.8 years (the range being 4-97 years) were treated at the above institutions. During four years of the study the average incidence of the stroke was 108/100.000/year. The mortality of the group 45/100.000/year is, as compared with world-wide statistics, low and is due to the care devoted to stroke patients for many years. The calculated, so-called expected prevalence, is 920 +/- 147/100.000 and can be explained by the relatively low mortality. In the Turiec region there are some 1012 +/- 162 stroke patients. This number was obtained by calculation for the number of inhabitants of the Martin District.

Adult↗
PubMed1996

[Epidemiologic data, clinical and prognostic features of autosomal dominant polycystic kidney disease in a French region].

Epidemiological study on autosomal dominant polycystic kidney disease (ADPKD) was undertaken in a French region from 1988 to 1993. This survey was led in a population of 410,000 inhabitants and 84 kindreds with ADPKD and 296 affected members were studied. Prevalence of ADPKD in the studied region was calculated to 1/1111 inh. Renal prognosis was evaluated according to the Kaplan-Meier method in 296 affected subjects of whom 212 were members of propositus kindreds. In our region 17% of patients had ESRD by the age of 50 years, 47% by the age of 60 years and 70% by the age of 70. No significance difference was found between males and females. The influence of the sex of the parent from whom ADPKD was received on the renal prognosis of the disease in affected descendants was evaluated. Anticipation of ESRD for at least one offspring inheriting ADPKD from parent was found in 15 (38%) out of 39 families, without genetic imprinting linked to gender. Mean survival to ESRD for fathers transmitting ADPKD to offspring (52 +/- 10 years) was significantly earlier compared to that for mothers transmitting ADPKD (61 +/- 10 years, p < 0.001), therefore that for siblings inheriting the disease from their fathers (sons: 49 +/- 7 years, daughters: 51 +/- 9 years) and for those inheriting ADPKD from their mothers (sons: 57 +/- 10 yrs, p < 0.01, daughters: 55 +/- 6 yrs, p < 0.02). Prevalence of de novo mutations was evaluated to 1/135,000 inh. Adult polycystic disease of the liver (APLD) was studied in 82 kindreds with 158 ADPKD affected members by ultrasonography and/or CT. In patients with APLD, 49/84 (58.3%) were females compared to 46/74 (62.2%) in those without APLD. Familial APLD (at least 2 affected members and all with APLD) was demonstrated in 22/27 APLD kindreds (81.5%). Familial ADPKD without APLD (at least 2 affected members and all without APLD) was demonstrated in 12/12 kindreds (100%). Renal prognosis of ADPKD in 84 APLD pts was compared to that in 71 non-APLD pts, in whom mean age was not different at the time of the study. In APLD pts 28/84 (33.3%) had reached ESRD compared to 23/71 (32.3%) non-APLD pts (ns). The occurrence of stroke in ADPKD patients was documented in 24/231 pts (10.4%) from 11/82 kindreds (13.4%). Family history of cerebro-vascular event was found in 4/11 kindreds (36%).

Adult↗
PubMed1997

Clinical and epidemiological data on lung cancer at a chromate plant.

The workforce of the only chromite ore processing plant in the United Kingdom at Eaglescliffe has been the subject of several epidemiological studies. There are also medical data available through a health surveillance program conducted by the plant's medical center. The clinical information has in part been collected to fulfill the requirements of health and safety legislation. Through this system, 18 cases of lung cancer among the workforce have been identified. The mean age at diagnosis was 57 years, with all but two cases occurring in smokers. There were no obvious histological or clinical features that could allow differentiation between the occupational and nonoccupational cancers. The epidemiological studies indicated an excess lung cancer risk among the workers beginning employment on the site before 1960. The risk appeared to have diminished after a major process change in 1960 which removed the addition of calcium carbonate to the process. Further studies including case-control analyses and construction of a job exposure matrix through use of recall by long-term workers and pensioners are in progress. The feasibility of an updated cohort mortality study at Eaglescliffe and possibly using the same protocol for other similar cohorts in U.S. and European plants should be considered.

Case-Control Studies↗
PubMed1992

[Pathogenic role of hyperinsulinism in macroangiopathy. Epidemiological data].

The hypothesis of the atherogenic role of endogenous insulin was based on a series of epidemiological studies. Several large-scale prospective studies have demonstrated that diabetes constitutes an independent risk factor for cardiovascular disease. However, neither the duration of diabetes nor the blood glucose level appear to be predictive of the incidence of a cardiovascular accident. More recent prospective studies (Finland, Australia, Paris) in non-diabetic men have shown that hyperinsulinemia, while fasting or after glucose stimulation, constitutes a risk factor for fatal myocardial infarction, but they failed to show whether diabetes or the blood glucose level constituted a risk factor for the disease. Cross-sectional studies have provided similar results. Insulin resistance affects the majority of non-insulin-dependent diabetics and glucose-intolerant patients. It has also been observed in 25 percent of non-obese subjects with a normal glucose tolerance test. Associated hyperinsulinemia prevents the development of diabetes, but diabetes appears when the beta-cell function is altered and can no longer maintain this hyperinsulinemia. However, hyperinsulinemia is not devoid of cardiovascular consequences. Insulin resistance and hyperinsulinemia are also observed in patients with essential hypertension: a correlation between plasma insulin and blood pressure has been reported. These data, together with other experimental arguments, suggest that excessive endogenous insulin may participate in the rise in blood pressure. Furthermore, hypertensive patients have a high risk of coronary heart disease and this risk is not significantly decreased by anti-hypertensive treatments. This is probably related to the presence of other metabolic risk factors associated with insulin resistance: hyperinsulinemia, glucose intolerance, hypertriglyceridemia, decreased HDL cholesterol. These metabolic disorders have been grouped together under the term "syndrome X". All of these risk factors are probably also involved in the development of coronary heart disease in general population. In conclusion, epidemiological studies now suggest that insulin resistance and hyperinsulinemia increase the risk of hypertension and coronary heart disease. A great many experimental studies support this hypothesis. Lastly, it can be proposed that the increased cardiovascular risk in non-insulin-dependent diabetics is related to the fact that they belong to a larger group of insulin-resistant subjects. The management of diabetes, hypertension, and all of the metabolic abnormalities would appear to be the only way of reducing the incidence of cardiovascular disease.

Coronary Disease↗
PubMed1976

[Results of the systematic control of tuberculosis in the People's Republic of Poland according to the development of the epidemiological data till 1975 (author's transl)].

After the second World War a marked improvement of the epidemiological situation in the field of tuberculosis has been achieved in Poland. In 1952 the incidence of tuberculosis amounted to 490 per 1000 000 of the population; the prevalence to 1400. The mortality rate was 105.8 in 1950. In 1974 the incidence rate has been reduced to 81.4 (among them 49.4 excretors of tubercle bacilli), the prevalence rate was only 248.9 (among them 78.3 with excretion of tubercle bacilli and 11.7 with chronic tuberculosis--persons excreting tubercle bacilli for more than 2 years). The mortality rate from tuberculosis amounted to 13.8 at this time. The most sensible reduction of all indices was found among children 0-14 years old. Tuberculosis in Poland is still a problem of medico-social importance in adults and before all in old people, being that part of the population in past times only in a low degree vaccinated or revaccinated and in a higher degree exposed to severe infections with tubercle bacilli. The comprehensive complex programme of tuberculosis control passed by the Sejm of the Polish People's Republic, includes three approaches since 1960: the epidemiological, the integrating and the phthisiopneumological direction. Prerequisites for the scheduled realisation of the programme are the case-finding as early as possible, the quick and correct diagnosis and the immediate onset of a specific treatment, further on the dispensary care of all contacts of the patient (his surroundings) and optimal prophylactic measures against tuberculosis.

Adolescent↗
PubMed1995

Gastrointestinal cancer: epidemiological data and premalignant lesions.

A variety of cancers develop in the gastrointestinal tract. Knowledge of the epidemiological risk factors and the premalignant changes associated with these cancers may help prevent or decrease the incidence of these malignancies. We enumerate the risk factors and discuss the premalignant lesions associated with each cancer in light of the many epidemiological and clinical studies important to practicing gastroenterologists.

Gastrointestinal Neoplasms↗
PubMedDate not supplied

[The plague in Madagascar: epidemiologic data from 1989 to 1995 and the national control program].

After briefly reviewing the history and epidemiological cycle of the plague in Madagascar, we report a detailed analysis of 5,927 suspected cases of plague observed from 1989 to 1995 (average of 846 cases per year). Of those, 1,337 individuals (average of 191 cases per year) were confirmed (by isolation of Yersinia pestis) or indicated to be probable for plague (by positive smears). Since 1994, we observed an increasing number of confirmed and probable cases (252 cases in 1995). Most of the cases occurred between October and April in the central highlands, inside a geographical triangle limited by Alaotra lake, Itasy lake and the city of Fianarantsoa. Two exceptional epidemics occurred in the harbor of Majunga in 1991 and 1995. The bubonic plague was the most frequent clinical from (91.3%), with primarily an inguinal localization (67.8%). The mean case fatality rate was 19% of the confirmed or probable cases (14.8% for the bubonic form and 57.1% for the pneumonic form). The bubonic plague was significantly more frequent between the ages of 5 and 14 years, as compared to the general population, while the pneumonic plague was more frequent over 15 years of age. Males were more effected by the bubonic form, as the sex ratio (m:f) was 1.3. The national control program for plague is being strengthened to improve 1) the patient's early diagnosis and care system; 2) the measures for the prevention of epidemics; 3) the epidemiological surveillance; and 4) the studies on the biology of the plague vectors, rodents and fleas, and the agent, bacilli, in Madagascar.

Adolescent↗
PubMed1980

A test for the radomness of the occurrence of a disease trait in familial or other similar ordered sequences of epidemiological data.

Through the construction of a probability distribution, a test is proposed for the randomness of the occurrence of an epidemiological event in a series of structured ordered sequences. Such sequences may be of persons admitted to hospital in some specified order, individuals seen in a large set of extended screening program, or individuals in a large set of extended genealogies. Modifications to account for the limited length of ascertained sequences are also given. The method will be particularly important in the first-stage evaluation of genealogical data to indicate the existence and degree of familial aggregation of diseases such as cancer and to justify more complex methods of analysis designed to evaluate the specific elements of causation that may be operating. The statistical power of this approach is also derived, considering the anticipated sample sizes in its application, to detect some forms of familial aggregation in a large genealogical data base from Laredo, Texas.

Age Factors↗
PubMed2000

Using epidemiological data to model efficiency in reducing the burden of depression*

BACKGROUND: The Global Burden of Disease study has suggested that mental disorders are the leading cause of disability burden in the world. This study takes the leading cause of mental disorder burden, depression, and trials an approach for defining the present and optimal efficiency of treatment in an Australian setting. AIMS OF THE STUDY: To examine epidemiological and service use data for depression to trial an approach for modelling (i) the burden that is currently averted from current care, (ii) the burden that is potentially avertable from a hypothetical regime of optimal care, (iii) the efficiency or cost-effectiveness of both current and optimal services for depression and (iv) the potential of current knowledge for reducing burden due to depression, by applying the WHO five-step method for priorities for investment in health research and development. METHODS: Effectiveness and efficiency were calculated in disability adjusted life years (DALYs) averted by adjusting the disability weight for people who received efficacious treatment. Data on service use and treatment outcome were obtained from a variety of secondary sources, including the Australian National Survey of Mental Health and Wellbeing, and efficacy of individual treatments from published meta-analyses expressed in effect sizes. Direct costs were estimated from published sources. RESULTS: Fifty-five percent of people with depression had had some contact with either primary care or specialist services. Effective coverage of depression was low, with only 32% of cases receiving efficacious treatment that could have lessened their severity (averted disability). In contrast, a proposed model of optimal care for the population management of depression provided increased treatment contacts and a better outcome. In terms of efficiency, optimal care dominated current care, with more health gain for less expenditure (28 632 DALYs were averted at a cost of AUD295 million with optimal care, versus 19 297 DALYs averted at a cost of AUD720 million with current care). However, despite the existence of efficacious technologies for treating depression, only 13% of the burden was averted from present active treatment, primarily because of the low effective coverage. Potentially avertable burden is nearly three times this, if effective treatments can be delivered in appropriate amounts to all those who need it. DISCUSSION: This paper reports a method to calculate the burden currently averted from cross-sectional survey data, and to calculate the burden likely to be averted from an optimal programme estimated from randomized controlled trial data. The approach taken here makes a number of assumptions: that people are accurate in reporting their service use, that effect sizes are a suitable basis for modelling improvements in disability and that the method used to translate effect sizes to disability weight change is valid. The robustness of these assumptions is discussed. Nonetheless it would appear that while optimal care could do more than present services to reduce the burden of depression, current technologies for treating depression are insufficient. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: There is an urgent need to educate both clinicians (primary and specialist) and the general public in the effective treatments that are available for depression. IMPLICATIONS FOR HEALTH POLICIES: Over and above implementing treatments of known efficacy, more powerful technologies are needed for the prevention and treatment of depression. IMPLICATIONS FOR FURTHER RESEARCH: Modelling burden averted from a variety of secondary sources can introduce bias at many levels. Future research should examine the validity of approaches that model reductions in disability burden. A powerful treatment to relieve depression and prevent relapse is needed.

Journal Article↗
PubMed1986

Use and misuse of epidemiologic data in the courtroom: defining the limits of inferential and particularistic evidence in mass tort litigation.

Medical epidemiology is the cornerstone for understanding the safety and efficacy of drugs and medical devices. Epidemiologic principles provide a statistical basis for determining correlations, and ultimately mathematical causation, between two series of events. Medical epidemiologic evidence and statistical inferences are useful and are now routinely accepted in the courtroom. The complex distribution systems that provide fungible goods throughout the country often preclude the identification of the specific source of an allegedly defective product. An expansion of the principles established in Summers v. Tice and Ybarra v. Spangard provide a logical and rational means for the courts to address products liability issues in cases involving multiple and unnamed defendants. This Article discusses the impact of epidemiology on the judicial process, both in the nature of judicial decision-making and in the nature of the law itself. Part III B discusses the "weak" and "strong" versions of the traditional preponderance of the evidence rule, as recast by recent products liability litigation. The remainder of the Article defines the useful and appropriate scope of epidemiologic evidence, concluding that "intentless" epidemiologic evidence alone cannot support an award of punitive damages.

2,4,5-Trichlorophenoxyacetic Acid↗