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PubMed2006

Varicella surveillance practices--United States, 2004.

Varicella became a reportable disease in the United States in 1972, with states reporting weekly aggregate data to the National Notifiable Disease Surveillance System (NNDSS). In 1981, varicella reporting was removed from the national notifiable diseases list because reporting of this common disease was becoming a burden in the absence of a vaccine. This action was followed by additional changes in varicella surveillance practices. In 1995, varicella vaccine was licensed and added to the routine childhood vaccination schedule. In 2002, the Council of State and Territorial Epidemiologists (CSTE) recommended that varicella casebased surveillance be implemented in all states by 2005; in 2003, varicella again was added to the national notifiable diseases list to allow for monitoring of the effect of varicella vaccine on varicella incidence. In 2004, to assess the progress in varicella surveillance in the United States, CDC surveyed immunization program managers in selected public health jurisdictions. This report describes the results of that survey, which indicated that substantial progress has been made toward the implementation of case-based surveillance as recommended by CSTE in 2002. As of 2004, however, 28 jurisdictions still had not implemented case-based surveillance. To monitor the effect of the vaccination program on the changing epidemiology of varicella disease, every state should now be conducting case-based surveillance for varicella. This is particularly important in light of the 2006 recommendation by the Advisory Committee on Immunization Practices for a routine second dose of varicella vaccine for children aged 4-6 years because enhanced surveillance is needed to further monitor varicella epidemiology.

Chickenpox↗
PubMed2006

Update on the disposition of military insanity acquittees.

There has been little study of the use of the insanity defense within the military judicial system, and aggregated data concerning such cases are not readily available when needed. Useful information is not consolidated in a central location, hindering potential research and the development of systemic improvements. One key area that would benefit from closer analysis is the process of the disposition of insanity acquittees. The Manual for Courts-Martial (2000 ed. Washington, DC: U.S. Government Printing Office) provides limited guidance in procedures to disposition, outlining the process in rather broad terms. The result is often a time-consuming and resource-draining process that can create significant burdens for both the military legal and health care systems. The need to address challenges within the system is discussed, and the creation of a centralized databank as a step toward improving this system is recommended.

Adult↗
PubMedDate not supplied

[Evaluation of a questionnaire for measuring individual environmental exposure to disinfection byproducts found in drinking water].

Epidemiological studies to evaluate the association between environmental exposure to risk factors and negative health effects often use population level aggregated data to measure exposure, but do not consider personal characteristics that may affect the degree of exposure at the individual level. The aim of this study was to evaluate the validity and reproducibility of a questionnaire specifically designed to measure individual oral, inhalation and transdermal exposure to disinfection byproducts in drinking water. Reproducibility of the questionnaire was evaluated by administering the questionnaire twice, in different time periods, to the same subjects. On the other hand, validity was tested by comparing responses to the questions with information contained in diaries filled out by the subjects daily over a period of one week (gold standard). Questionnaire reproducibilty and validity were both found to be very good, as shown by high Spearman's correlaton coefficients, Intraclass correlation coefficients (ICC), kappa concordance coefficient, sensibility and specificity. The use of a questionnaire such as the one evaluated in this study may be a valuable aid when conductin epidemiological studies to assess individual environmental exposure to risk factors found in drinking water and to explain the effect of such factors on human health.

Adolescent↗
PubMed1991

Oral contraceptives and breast cancer. A meta-analysis.

Since the relationship between oral contraceptive use and breast cancer has not been consistent we undertook a meta-analysis of studies published to date. Papers were located by searching the MEDLINE data base, supplemented by a hand search of all the references in the articles recovered. Studies were graded as to quality. Those judged as probably unbiased were included in the analysis. The method of Woolf was used to combine relative risks. Forty-seven studies were collected: 40 case-control and 7 cohort studies. Thirty-nine of these were considered unbiased. The main results observed were: RR was 1.06 (1.02-1.10) for all studies and 1.14 for premenopausal cancer. For premenopausal cancer, higher RRs were observed in women who early used oral contraceptives with a significant linear dose-response effect: 1.25 (1.10-1.44) in OC users before age 25, and 1.17 (1.06-1.30) in users before the first full-term pregnancy. We conclude oral contraceptive use may be a risk factor for premenopausal breast cancer. Limitations to our research are discussed.

Adult↗
PubMed1990

Relationship between diabetes mellitus mortality rates and drinking water magnesium levels in Iowa.

A recent ecologic study has suggested a relationship between mortality from diabetes mellitus and levels of magnesium in drinking water. However, diabetes mortality rates were from aggregate data for the entire geographic area under study. The state of Iowa has data resources available to determine diabetes mortality rates for individuals on known water supplies in Iowa and magnesium levels for raw drinking water supplies. To determine the presence of this relationship in the state of Iowa, mortality rates from 1976 through 1985 for diabetes as an underlying cause of death and for major cardiovascular disease with diabetes as an ancillary cause of death were compared for individuals from towns in Iowa with populations of 1,000 to 10,000. At the stratification levels of magnesium in municipal drinking water used in this study, no significant differences were found in diabetes mortality rates.

Cardiovascular Diseases↗
PubMed1990

Observations on the influenza epidemic of November/December 1989.

This paper reports on the surveillance of influenza by the weekly returns service of the Royal College of General Practitioners during the epidemic of November/December 1989. An epidemic of influenza became evident in mid-November and incidence peaked in the week beginning 6 December. The increase in incidence of influenza-like illness and of aggregated data for all respiratory disease to above the levels for non-epidemic years occurred one week before that attributed to influenza. The pattern of incidence was similar in the three geographic regions of England and Wales. The peak was first achieved in the age group 5-14 years and last in age 65+ years. The pattern of deaths from all causes closely followed the pattern of respiratory disease with an interval of between one and two weeks. During the period 15 November to the end of the year there were approximately twice as many people reporting respiratory disease than was usual for this time of year. The peak weekly incidence was the highest recorded for 12 years but it was substantially less than the peaks for the winters of 1969/70, 1972/73 and 1975/76. Further research is in progress to establish the most effective means of monitoring influenza epidemics.

Adolescent↗
PubMed1989

The International Classification of Impairments, Disabilities, and Handicaps (ICIDH): its use in rehabilitation.

This article intends to show possibilities and examples of actual use of ICIDH in rehabilitation. Most of the examples concern the use of the classification at the individual level (patient profile, assessment of patient needs, evaluation of treatment, discharge status). Some can serve at meso level: aggregated data (statistics) for evaluation of treatment at institutional level, determination of numbers of staff required. A few other examples concern the use of the ICIDH at macro level in rehabilitation: national policy, education and training of professionals, community-based rehabilitation programmes. Special attention is given to examples of ICIDH use in rehabilitation of special groups such as children, the mentally retarded, cancer patients, elderly people, geriatric patients.

Adolescent↗
PubMed1989

Black/white differences in health status and mortality among the elderly.

Grade of membership (GOM) representations are used to characterize and compare the health status of a very heterogeneous sample of blacks and whites in an elderly cohort of 2,806 noninstitutionalized men and women living in New Haven, Connecticut. They were interviewed in 1982 as part of the Established Populations for the Epidemiologic Study of the Elderly (EPESE). Ideal profiles based on functional disabilities, chronic diseases, and selected biomedical and behavioral risk factors are constructed empirically. Each individual in the sample is represented by a set of GOM scores, interpreted as degrees of similarity of his or her health record to each of the profiles. Four profiles emerge from GOM analyses: healthy elderly, elderly with cognitive impairment, elderly with impairment in mobility function and physical performance and with selected chronic conditions, and elderly with major limitations in activities of daily living and multiple chronic conditions. Although elderly blacks and whites generally have similar configurations of profiles, there are important differences, especially when chronic conditions are related to specific types of functional impairments. Questions about and claims for black/white mortality crossovers at older ages, usually addressed with aggregate data, are examined conditional on GOM scores that correspond to diverse combinations of disabilities (or lack thereof) together with housing characteristics of cohort members (e.g., whether they live in public housing for the elderly or in owned or rented housing in the community).

Activities of Daily Living↗
PubMedDate not supplied

Pack size, reported cigarette smoking rates, and the heaviness of smoking.

Three distinct samples show that pack size is highly associated with individual reports of daily cigarette intake, confirming an earlier report based on aggregate data. Those who report smoking 25 cigarettes per day (or who buy packs of 25) are heavier smokers than those who report smoking 20 cigarettes per day (or who buy packs of 20), as evidenced by greater likelihood of starting smoking earlier in the morning and by higher average levels of alveolar carbon monoxide. Categorizations based on number of cigarettes smoked per day should not assume that "one pack of twenties" is roughly the same as "one pack of twenty-fives." No conclusions can be drawn about whether the availability of larger packs promotes heavier smoking.

Adolescent↗
PubMedDate not supplied

[Is the medical research carried out in Croatia an integral part of science worldwide?].

Presented are the results of a scientometric study carried out on a sample containing 5339 journal articles published by the Croatian authors over the period of 11 years. The analysis is performed on a macro-level, i.e. it is based on journal-aggregates data. To evaluate whether Croatian output in medicine is incorporated into the mainstream of the world science or suffers from the intellectual island effect, the extent of the journals' coverage by high quality international secondary literature, is examined. The extent of coverage is found to be 80%, making only that part of the Croatian output accessible to the world scientific community.

Bibliometrics↗
PubMed1986

Restriction fragment length polymorphism of the human insulin gene region among type II diabetic Mexican-Americans and Tunisians.

The human insulin gene is flanked by a polymorphic locus that is located approximately 500 base pairs (bp) from the 5' end of the point where transcription begins (Bell et al. 1981; Bell et al, 1982). Its occurrence is due to an insertion-deletion region which gives rise to two major classes of alleles: those containing small insertions of 0-600 bp and those containing larger insertions of 1,600-2,200 bp (Owerbach and Nerup, 1982). Insertions of 600-1,600 bp are rare (Rotwein et al., 1983). The larger insertions have previously been reported to be associated with type 2 diabetes (Owerbach and Nerup, 1982). We have conducted studies on a Mexican-American population in Starr County, Texas (98% Mexican-American) and a Tunisian population in Tunis, Tunisia, to determine if the frequency distribution of these classes of insulin gene alleles are similar to the previously reported frequency distributions and if any of the classes of alleles are associated with type 2 diabetes in these populations. We conclude that none of the classes of insulin gene alleles are associated with type II diabetes among Mexican-Americans or Tunisians, and that the frequency distributions of the insulin gene alleles do not vary significantly between the Tunisians, Mexican-Americans, or the aggregate data resulting from combining the insulin gene frequencies of several of the populations described thus far (Bell et al., 1984).

Adult↗
PubMed1986

Expenditures for the medical care of elderly people living in the community in 1980.

Policy debates about financing medical care for the elderly are often clouded by evidence drawn from averages based on aggregate data. The National Medical Care Utilization and Expenditure Survey enables examination of the circumstances of the 95 percent of the elderly who are not institutionalized. A significant portion of out-of-pocket charges falls on the poor; public expenditures are highly concentrated for the relatively few elderly in their last year of life. Medicare and Medicaid have successfully lessened the burden on families.

Aged↗
PubMed1987

Pyruvate dehydrogenase complex deficiency as a cause of subacute necrotizing encephalopathy (Leigh disease).

Leigh disease is a disorder with great clinical variability and for which diverse biochemical causes have been proposed. Clarification requires rigorous correlation of biochemical abnormalities with strict morphologic diagnosis; such an unambiguous association is the subject of this report. A patient with well-documented clinical and biochemical pyruvate dehydrogenase complex deficiency is shown on postmortem examination to have the specific CNS pathology of Leigh disease. These findings, considered together with the aggregate data in the literature, suggest strongly that pyruvate dehydrogenase complex deficiency is the basic defect in a subgroup of patients with Leigh disease.

Acidosis, Lactic↗
PubMedDate not supplied

Experiences with linked birth and infant death certificates from the NIMS project.

The National Infant Mortality Surveillance (NIMS) project aggregated data provided by 53 vital statistics reporting areas--50 States, New York City, the District of Columbia, and Puerto Rico (subsequently called States)--from their files of linked birth and death certificates and compared individual States' total infant mortality experiences for the 1980 birth cohort by age at death, race, birth weight, and plurality. Therefore, it was essential to achieve maximum uniformity among the separate data sets and to specify when this uniformity could not be obtained. In working with these multiple sources, we identified five key issues that relate to data from linked birth and death certificates: Variations in definitions of variables are often embedded in data that have been gathered from several independent sources. (For NIMS, the sources were 53 reporting areas and the National Center for Health Statistics.) Variations in States' linking procedures--these are based on an individual State's primary purpose for linking the data--affect the completeness and comparability of the 1980 resident birth cohorts used for NIMS. Variations in the recording of some pregnancy outcomes as fetal deaths or live births are known to be a problem in vital statistics data that particularly affects data for events among infants weighing less than 500 g at birth. Ambiguities occur frequently in unknowns or zero values. For NIMS this effect was most pronounced for the pregnancy history variables. Examination of the values reported for unknown or zero categories helps in uncovering problems with and improving quality of data. (e) Analysis from a new perspective may reveal unexpected data problems. These problems tend to surface only during a reexamination of underlying data that is prompted by unusual findings.Continued alertness to these issues may improve further the quality of data in files of linked birth and death certificates and assure the integrity of analysis based on these data.

Birth Certificates↗
PubMed1987

Traditional approaches to functional assessment in arthritis.

Both clinical rheumatology and medical rehabilitation have traditional functional assessment approaches to patients with arthritis. Drawing from both, a suggested "universe of function" for rheumatic disease patients is presented. The variables included begin with components of the physical examination and continue to maneuvers performed by the patient, mobility, activities of daily living (ADL), upper extremity function, extended living functions, and global assessment instruments. The development of standardized methodologic techniques is greater for some variables, especially ADL. In all, there is a need for a consensus approach so that aggregate data generated in different studies and programs will be more comparable.

Arthritis, Rheumatoid↗
PubMed1987

Regulation of copper metabolism in the mottled mouse.

Menkes' kinky-hair syndrome is an X-linked recessive neurodegenerative and connective-tissue disorder, with decreased serum copper and ceruloplasmin-copper oxidase concentrations and tissue-specific increases in copper content. Clinical manifestations can be related to relative copper deficiency and reduced activity of cuproenzymes in multiple organs. An animal model is provided by mice hemizygous for mutant alleles, such as the blotchy allele, at the X-linked mottled locus. This locus may be homologous in mouse and man. The basic defect is unknown but has been thought to reside in the regulation of the function or synthesis of metallothioneins. In the blotchy mouse and in cultured skin fibroblasts derived therefrom, we showed that the mutation specifically affects the metabolism of copper and not other trace metals. Excessive accumulation and abnormal (reduced) exit kinetics were demonstrated for copper but not for the related trace metals cadmium and zinc. While metallothionein-I messenger RNA (mRNA) concentrations were elevated in blotchy fibroblasts, the elevations in metallothionein-I mRNA in response to metallothionein inducers (cadmium, copper) were similar in blotchy and control cells. Further, metallothionein-I mRNA levels were indistinguishable in mutant and control fibroblasts containing equivalent intracellular copper concentrations. Finally, metallothionein-I mRNA content was not elevated in blotchy kidneys at early developmental stages, before storage of excessive copper. The aggregate data suggest that the basic defect in the blotchy mouse--and, by analogy, in Menkes' syndrome--does not reside in defective modulation of metallothionein function and does not cause abnormal regulation of metallothionein synthesis.

Animals↗
PubMed1987

Are physicians advising smokers to quit? The patient's perspective.

Physicians can play an important role in smoking cessation because they have frequent contact with smokers and because most smokers believe that a physician's advice is important in the decision to quit. Therefore, to determine smokers' perceptions of physician involvement in smoking cessation, we analyzed aggregate data from two random statewide surveys of 5875 Michigan adults. Of smokers who had seen a physician in the previous year, only 44% reported that they had ever been told to quit smoking by a physician. Young male smokers were the least likely (30%) to have been told to quit. Smokers who were hypertensive, obese, diabetic, sedentary, or users of oral contraceptives were no more likely to have been told to quit than smokers without these additional cardiovascular risks. Conversely, smokers who had survived a myocardial infarction or stroke were more likely to have been told to quit than smokers who had not suffered these events (73% vs 43%). Most smokers do not perceive physicians to be even minimally involved in their efforts to quit. Physicians need to increase their efforts in counseling smokers to quit before smoking-related diseases result, especially for smokers with additional risk factors for cardiovascular disease.

Adolescent↗