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PubMedDate not supplied

Pessimism and optimism as early warning signs for compromised health for caregivers of patients with Parkinson's disease.

BACKGROUND: Although pessimism and optimism are associated with health-related outcomes, the long-term effects of pessimism and optimism in the caregiving process are understudied, and little is known about their role in health changes over time. OBJECTIVE: To determine whether pessimism and optimism can be used as early warning signs for negative changes in caregiver depressive symptoms and physical health over a 10-year period. METHODS: Multilevel modeling was used to examine longitudinal data from 311 spouse caregivers of individuals with Parkinson's disease, with data points at baseline, Year 2, and Year 10. Measures included the Life Orientation Test, the Center for Epidemiological Studies-Depression Scale, and the SF-36 Health Survey physical functioning scale. RESULTS: Caregiver pessimism early in the caregiver role was found to be a warning sign for poor current and future caregiver health. High baseline pessimism signaled high levels of baseline depressive symptoms and poor physical health, as well as a faster decline in health over the 10-year study. Optimism played a role in predicting baseline depressive symptoms, although the magnitude of its beneficial contribution was not as great as the deleterious effects of pessimism. CONCLUSIONS: Nurses and clinicians have a unique opportunity to detect and intervene with caregivers who show high levels of pessimism early in the caregiving trajectory.

Adult↗

PubMed2005

Setting up an early warning system for epidemic-prone diseases in Darfur: a participative approach.

In April-May 2004, the World Health Organization (WHO) implemented, with local authorities, United Nations (UN) agencies and non-governmental organisations (NGOs), an early warning system (EWS) in Darfur, West Sudan, for internally displaced persons (IDPs). The number of consultations and deaths per week for 12 health events is recorded for two age groups (less than five years and five years and above). Thresholds are used to detect potential outbreaks. Ten weeks after the introduction of the system, NGOs were covering 54 camps, and 924,281 people (IDPs and the host population). Of these 54 camps, 41 (76%) were reporting regularly under the EWS. Between 22 May and 30 July, 179,795 consultations were reported: 18.7% for acute respiratory infections; 15% for malaria; 8.4% for bloody diarrhoea; and 1% for severe acute malnutrition. The EWS is useful for detecting outbreaks and monitoring the number of consultations required to trigger actions, but not for estimating mortality.

Altruism↗

PubMed2006

Evaluation of ProMED-mail as an electronic early warning system for emerging animal diseases: 1996 to 2004.

OBJECTIVE: To identify emerging animal and zoonotic diseases and associated geographic distribution, disease agents, animal hosts, and seasonality of reporting in the Program for Monitoring Emerging Diseases (ProMED)-mail electronic early warning system. DESIGN: Retrospective study. SAMPLE POPULATION: 10,490 disease reports. PROCEDURES: Descriptive statistics were collated for all animal disease reports appearing on the ProMED-mail system from January 1, 1996, to December 31, 2004. RESULTS: Approximately 30% of reports concerned events in the United States; reports were next most common in the United Kingdom, Canada, Australia, Russia, and China. Rabies, bovine spongiform encephalopathy, and anthrax were reported consistently over the study period, whereas avian influenza, Ebola virus, and Hantavirus infection were reported frequently in approximately half of the study years. Reports concerning viral agents composed more than half of the postings. Humans affected by zoonotic disease accounted for a third of the subjects. Cattle were affected in 1,080 reports, and wildlife species were affected in 825 reports. For the 10,490 postings studied, there was a retraction rate of 0.01 and a correction rate of 0.02. CONCLUSIONS AND CLINICAL RELEVANCE: ProMED-mail provided global coverage, but gaps in coverage for individual countries were detected. The value of a global electronic reporting system for monitoring emerging diseases over a 9-year period illustrated how new technologies can augment disease surveillance strategies. The number of animal and zoonotic diseases highlights the importance of animals in the study of emerging diseases.

Animals↗

PubMed2001

Malaria early warning in Kenya.

Kenya displays large spatiotemporal diversity in its climate and ecology. It follows that malaria transmission will reflect this environmental heterogeneity in both space and time. In this article, we discuss how such heterogeneity, and its epidemiological consequences, should be considered in the development of early warning systems for malaria epidemics.

Disease Outbreaks↗

PubMed2006

Rapid screening of topoisomerase gene mutations by a novel melting curve analysis method for early warning of fluoroquinolone-resistant Streptococcus pneumoniae emergence.

We developed a real-time PCR assay combined with melting curve analysis for rapidly genotyping quinolone resistance-determining regions (QRDR) of topoisomerase genes in Streptococcus pneumoniae. This assay was not only accurate for the screening of fluoroquinolone (FQ) resistance but also relevant as an early warning system for detecting preexisting single QRDR mutations.

Anti-Bacterial Agents↗

PubMed2006

The Pediatric Early Warning System score: a severity of illness score to predict urgent medical need in hospitalized children.

PURPOSE: We developed and performed the initial retrospective validation of a pediatric severity of illness score. The score is to preemptively identify hospitalized children who are likely to require resuscitation to treat cardiopulmonary arrest. MATERIALS AND METHODS: The Pediatric Early Warning System (PEWS) score was developed using expert opinion. The score generated contained 20 items, 16 of which were able to be retrospectively abstracted. Validation used a case-control study design in a Canadian university-affiliated pediatric hospital. Eligible patients were younger than 18 years, were admitted to a hospital ward, and had no level-of-care restrictions. Case patients had a code blue called to obtain immediate assistance for treatment of impending or actual cardiopulmonary arrest. Control patients had no code blue event and were not urgently admitted to the intensive care unit within 48 hours of study. A total of 128 controls and 87 cases were compared. RESULTS: The PEWS score area under the receiver operating characteristic curve was 0.90. The sensitivity was 78% and the specificity was 95% at a score of 5. CONCLUSIONS: Application of the score may have identified more than 3 quarters of code blue calls in our hospital with at least an hour's warning. After further refinement and validation, the PEWS score has great potential to increase the efficiency of care delivery and to improve the outcomes of care provided to hospitalized children.

Cardiopulmonary Resuscitation↗

PubMed2001

The development of Malaria Early Warning Systems for Africa.

Current efforts to predict malaria epidemics focus on the role weather anomalies can play in epidemic prediction. Alongside weather monitoring and seasonal climate forecasts, epidemiological, social and environmental factors can also play a role in predicting the timing and severity of malaria epidemics. Such factors can be incorporated into a framework for malaria early warning.

Africa↗

PubMed2005

Use of rainfall and sea surface temperature monitoring for malaria early warning in Botswana.

Improved prediction, prevention, and control of epidemics is a key technical element of the Roll Back Malaria partnership. We report a methodology for assessing the importance of climate as a driver of inter-annual variability in malaria in Botswana, and provide the evidence base for inclusion of climate information in a national malaria early warning system. The relationships of variability in rainfall and sea surface temperatures (SSTs) to malaria incidence are assessed at the national level after removing the impact of non-climatic trends and a major policy intervention. Variability in rainfall totals for the period December-February accounts for more than two-thirds of the inter-annual variability in standardized malaria incidence in Botswana (January-May). Both rainfall and annual malaria anomalies in December-February are significantly related to SSTs in the eastern Pacific, suggesting they may be predictable months in advance using seasonal climate forecasting methodologies.

Botswana↗

PubMed2004

ProMED-mail: an early warning system for emerging diseases.

The Program for Monitoring Emerging Diseases (ProMED-mail) reports on outbreaks of diseases of infectious or toxic etiology, whether natural or intentionally released, that affect humans. Open to all sources, free of political constraints, and available to users free of charge, ProMED-mail exploits the speed and ubiquity of the Internet to serve as an early warning system for the detection of emerging disease outbreaks. ProMED-mail monitors diseases of plants and animals of agricultural importance in addition to zoonoses because of their key role in disease emergence. Reports are carefully screened for validity and are placed in an appropriate context by commentary and references from a panel of expert moderators. Reports are then posted to the Web and sent by e-mail to >32,000 subscribers in >150 countries.

Animals↗

PubMed1996

Early warning and response: why the international community failed to prevent the genocide.

The enormity of the genocide in Rwanda demands that it be subjected to searching enquiry and that members of the international community, collectively and individually, examine their own roles in the event. This paper draws extensively on Study II of the Joint Evaluation, and examines the effectiveness of international monitoring (early warning) and management of the Rwanda conflict. It is not intended to explore all the factors which together contributed to the genocide that were or might have been amenable to modification by the international community. The focus is on warning and response beginning with the start of the civil war in 1990, and culminating in an analysis of the international response to the genocide in April-June 1994.

Crisis Intervention↗

PubMed2000

Early warning of malaria epidemics in African highlands using Anopheles (Diptera: Culicidae) indoor resting density.

Several highland regions of Africa recently have suffered malaria epidemics. Because malaria transmission is unstable and the population has little or no immunity, these highlands are prone to explosive outbreaks when densities of Anopheles exceed critical levels and conditions favor transmission. If an incipient epidemic can be detected early enough, control efforts may reduce morbidity, mortality, and transmission. Here we present three methods (direct, minimum sample size, and sequential sampling approaches) that could be used to determine whether the household indoor resting density of Anopheles gambiae s.I. has exceeded critical levels associated with epidemic transmission. Data on Anopheles density before, during, and after a malaria epidemic (December 1997-July 1998) in the highlands of southwestern Uganda were evaluated to demonstrate the application of these three approaches. During this epidemic, a density of 0.25 Anopheles mosquitoes per house was associated with epidemic transmission, whereas 0.05 mosquitoes per house was chosen as a normal level expected during nonepidemic months. The direct approach to calculating mean Anopheles density with an allowable error of 20-50% of the mean would require the sampling of 102-16 houses, respectively. In contrast, with only seven houses, the minimum sample size approach could be used to determine whether Anopheles density had exceeded the critical level. This method, however, would result in an overestimation of the risk of an epidemic at low Anopheles density. Finally, a sequential sampling plan could require as many as 50 houses to conclude that risk of an epidemic existed, but this disadvantage is offset by the ability to preset the probabilities of concluding that risk of an epidemic exists at both the critical and normal Anopheles densities. Our study illustrated that it is feasible, and probably expedient, to include monitoring of Anopheles density in highland malaria epidemic early warning systems.

Altitude↗

PubMedDate not supplied

Ecological Monitoring and Assessment Network's proposed core monitoring variables: an early warning of environmental change.

This article reports on the evaluation of existing ecological monitoring variables from a variety of sources to select a suite of core variables suitable for monitoring at the Ecological Monitoring and Assessment Network (EMAN) sites located across Canada. The purpose of EMAN is to promote the acquisition of relevant and consistent data that can be used to report on national trends and provide an early warning of ecosystem change. Existing monitoring variables were evaluated in two steps. In the first step, three primary criteria were used to pre-screen preliminary variables. In the second step, a more detailed evaluation considered twenty criteria based on data quality, applicability, data collection methods, data analysis and interpretation, existing data and programs, and cost effectiveness to select a draft set of core monitoring variables (CMV). An ecological framework was developed to organize the CMV in a manner that permitted a gap analysis to confirm the CMV assessed a wide range of relevant environment components. The suite of CMV were then tested to determine their effectiveness in detecting ecosystem change caused by stressors with ecosystem responses that have been well documented in the literature. This project is part of a process lead by Environment Canada to select CMV to detect and track ecosystem change at EMAN sites. It is anticipated that the proposed CMV will undergo future discussion and development leading to the final selection of a suite of CMV for use at EMAN sites.

Biomarkers↗

PubMed2004

GenSo-EWS: a novel neural-fuzzy based early warning system for predicting bank failures.

Bank failure prediction is an important issue for the regulators of the banking industries. The collapse and failure of a bank could trigger an adverse financial repercussion and generate negative impacts such as a massive bail out cost for the failing bank and loss of confidence from the investors and depositors. Very often, bank failures are due to financial distress. Hence, it is desirable to have an early warning system (EWS) that identifies potential bank failure or high-risk banks through the traits of financial distress. Various traditional statistical models have been employed to study bank failures [J Finance 1 (1975) 21; J Banking Finance 1 (1977) 249; J Banking Finance 10 (1986) 511; J Banking Finance 19 (1995) 1073]. However, these models do not have the capability to identify the characteristics of financial distress and thus function as black boxes. This paper proposes the use of a new neural fuzzy system [Foundations of neuro-fuzzy systems, 1997], namely the Generic Self-organising Fuzzy Neural Network (GenSoFNN) [IEEE Trans Neural Networks 13 (2002c) 1075] based on the compositional rule of inference (CRI) [Commun ACM 37 (1975) 77], as an alternative to predict banking failure. The CRI based GenSoFNN neural fuzzy network, henceforth denoted as GenSoFNN-CRI(S), functions as an EWS and is able to identify the inherent traits of financial distress based on financial covariates (features) derived from publicly available financial statements. The interaction between the selected features is captured in the form of highly intuitive IF-THEN fuzzy rules. Such easily comprehensible rules provide insights into the possible characteristics of financial distress and form the knowledge base for a highly desired EWS that aids bank regulation. The performance of the GenSoFNN-CRI(S) network is subsequently benchmarked against that of the Cox's proportional hazards model [J Banking Finance 10 (1986) 511; J Banking Finance 19 (1995) 1073], the multi-layered perceptron (MLP) and the modified cerebellar model articulation controller (MCMAC) [IEEE Trans Syst Man Cybern: Part B 30 (2000) 491] in predicting bank failures based on a population of 3635 US banks observed over a 21 years period. Three sets of experiments are performed-bank failure classification based on the last available financial record and prediction using financial records one and two years prior to the last available financial statements. The performance of the GenSoFNN-CRI(S) network as a bank failure classification and EWS is encouraging.

Accidents↗

PubMed2003

Lessons learnt from an international intercomparison of national network systems used to provide early warning of a nuclear accident.

As part of the European Research Council's Fourth Framework Programme, the EURADOS Action Group on Monitoring of External Exposures held an intercomparison of national network systems. This took place during May/June 1999 at the Risø Natural Enviromental Radiation Measurement Station in Denmark and at the Underground Laboratory for Dosimetry and Spectrometry (UDO) of the Physikalisch-Technische Bundesanstalt (PTB) in Germany. The network systems are used continuously to monitor radiation levels throughout a country in order to give early warning of nuclear accidents having transboundary implications. The radiation levels measured are used to estimate the radiation risks to people arising from the accident. Seven European countries participated in the intercomparison with detector systems used in their national network systems as well as with detectors being developed for future use. Since different radiation quantities were measured by the systems (namely exposure, air kerma and ambient dose equivalent), the initial analysis of the intercomparison results was made in terms of the quantity air kerma rate. This report completes the analysis of the results and these are given in terms of air kerma rate in order to be consistent with the preliminary report. In addition, in some cases the results are also given in terms of the quantity measured by each national network system. The experience gained from this intercomparison is used to help organise a follow-up intercomparison to be held at the PTB Braunschweig in September 2002 and in which a further seven or eight countries from Europe will participate.

Air Pollution, Radioactive↗

PubMedDate not supplied

The Global Public Health Intelligence Network and early warning outbreak detection: a Canadian contribution to global public health.

The recent SARS epidemic has renewed widespread concerns about the global transmission of infectious diseases. In this commentary, we explore novel approaches to global infectious disease surveillance through a focus on an important Canadian contribution to the area--the Global Public Health Intelligence Network (GPHIN). GPHIN is a cutting-edge initiative that draws on the capacity of the Internet and newly available 24/7 global news coverage of health events to create a unique form of early warning outbreak detection. This commentary outlines the operation and development of GPHIN and compares it to ProMED-mail, another Internet-based approach to global health surveillance. We argue that GPHIN has created an important shift in the relationship of public health and news information. By exiting the pyramid of official reporting, GPHIN has created a new monitoring technique that has disrupted national boundaries of outbreak notification, while creating new possibilities for global outbreak response. By incorporating news within the emerging apparatus of global infectious disease surveillance, GPHIN has effectively responded to the global media's challenge to official country reporting of outbreak and enhanced the effectiveness and credibility of international public health.

Canada↗

PubMed1998

Early warning signs of impending hypoglycaemia masked by post-extraction labial paraesthesia.

Temporary lingual and labial paraesthesia are not uncommon following the removal of mandibular third molar teeth. In patients with insulin-treated diabetes circum-oral paraesthesia is a common and important sign of impending hypoglycaemia. This report highlights the case of a 17-year-old girl with Type 1 (insulin-dependent) diabetes who, following the extraction of her four wisdom teeth, experienced minor circum-oral sensory disturbances. These effectively masked her early warning signs of impending hypoglycaemia which had hitherto allowed her to have very good glycaemic control. Trembling, sweating and loss of concentration became the new presenting symptom complex, which she found both disabling and worrying. Fortunately, within six months the paraesthesia had subsided and the patient was once again able to appreciate her usual warning symptom of impending hypoglycaemia.

Adolescent↗

PubMed1990

The Exploitation Index: an early warning indicator of boundary violations in psychotherapy.

Exploitive behavior by therapists is highly disruptive in psychotherapy because it violates the sense of trust derived from a coherent treatment boundary. Such behavior may be difficult to detect because it is often associated with self-deception. The compensatory need to feel "special," a state of mind often associated with exploitiveness, suggests that narcissistic mechanisms play a significant role. The authors present an "Exploitation Index" (EI), a self-assessment questionnaire for therapists that is designed to serve as an early warning indicator of boundary violations.

Ethics, Medical↗

PubMed2005

Development of communication networks and water quality early warning detection systems at drinking water utilities in the Ohio River Valley Basin.

Source water quality is of major concern to all drinking water utilities. The accidental introduction of contaminants to their source water is a constant threat to utilities withdrawing water from navigable or industrialized rivers. The events of 11 September, 2001 in the United States have heightened concern for drinking water utility security as their source water and finished water may be targets for terrorist acts. Efforts are underway in several parts of the United States to strengthen early warning capabilities. This paper will focus on those efforts in the Ohio River Valley Basin.

Accidents↗